Meir Kryger, MD, FRCP(C), professor of medicine (pulmonary) and clinical professor of nursing, has retired from clinical care, effective June 30, 2022.
“I have been taking care of patients now for 51 years, and this was a time for other people to carry the torch in my field,” explained Kryger.
Kryger was born in 1947, two years after the end of World War II. His family was originally from Poland, and after Germany invaded Poland in 1939, his parents, Rose and Sam, ultimately ended up in a slave labor camp. When the war ended in 1945, they were refugees and settled first in Israel, and then in Montreal, Canada.
Kryger chose to pursue medicine after his father fell ill. Sam Kryger was admitted to the Montreal Neurological Institute in about 1960 for treatment of a subdural hematoma. “Dr. Wilder Penfield evacuated the subdural hematoma, and my father woke up,” recalled Kryger. “I was hooked to be a doctor. I decided that I wanted to be a neurosurgeon.”
He entered McGill University School of Medicine to pursue his medical degree, and his path crossed again with Penfield. Penfield would tell students, “If you can’t build a house, don’t go into neurosurgery.” Upon hearing those words, Kryger decided to change course.
In 1973, Kryger had a patient while rotating on an internal medicine/endocrine ward that would alter his career trajectory. Kryger noticed when he would make his nighttime rounds around the unit, the 42-year-old obese male patient was struggling to breathe. The patient did not fit the medical literature, so Kryger published a paper on his care. “The sleep deprivation syndrome of the obese patient. A problem of periodic nocturnal upper airway obstruction.”
“This was the very first article that I ever wrote by myself, and that article turned out to be, in terms of my life, a game changer. That article was really the first description in detail in North America of sleep apnea and was written before the term obstructive sleep apnea existed,” said Kryger.
Kryger did multiple fellowships in internal medicine, then pulmonary medicine and respiratory physiology before becoming assistant professor at the University of Manitoba, Winnipeg, Canada. In Winnipeg, he was told to put together a sleep program, and was put in charge of second year medical student teaching.
While “waiting for funding,” Kryger wrote his first of many books, Pathophysiology of Respiration.
Long-time friend Thomas Roth, PhD, director, Sleep Disorders and Research Center at Henry Ford Hospital, recalls meeting Kryger in 1984 at an American Thoracic Society symposium on sleep. The duo had similar backgrounds. Both came from post-World War II Eastern Europe and immigrated to North America. They had an immediate kinship.
“We talked and had all of our meals together. I became incredibly impressed with Meir. There were a lot of pulmonary people who go into the sleep field, but they're really not sleep people, they're sleep apnea people. Meir was the first guy I met who was a pulmonologist by training, but who had an appreciation for the breadth of sleep and sleep disorders and was very eager to learn,” said Roth.
Roth thinks the first discussion of creating a sleep textbook occurred while in an elevator with Kryger and William “Bill” C. Dement, MD, PhD.
“Bill used to point out that the one thing that's missing in our field, which makes it a field, is an official textbook. And Meir went to Palo Alto and spent some time with Bill, and Bill certainly encouraged him. So, we got together and did an outline. We had very similar ideas of what we wanted to cover,” said Roth.
In 1989, Kryger, Roth, and Dement published the first edition of Principles and Practice of Sleep Medicine, one of Kryger’s major career accomplishments. Kryger says it was the beginning of a beautiful friendship. The trio partnered on six editions of the text, but unfortunately, before they could finish the next edition, Dement passed away suddenly. Kryger was shocked by the death of his friend.
“He was really the inspiration for me to start on the books in the first place. There were five authors who died during the creation of this edition, who would have contributed to the book, [Dr.] Christian Guilleminault also died. And so, it [the seventh edition] was a very tough thing to actually get done, but we had to get it done and we did get it done,” said Kryger.
The most recent version of the field’s quintessential text, its seventh edition, was released in 2022. Kryger was looking for people to assist with the textbook and began asking around. One name kept coming up, Cathy Goldstein, MD, a brilliant neurologist, said Kryger.
Goldstein, associate professor of neurology at University of Michigan, remembers the email from Kryger asking her to participate in the seventh edition. He didn’t have to sell her on the job.
“To me, this is like being asked by Anna Wintour to sit on the editorial board of Vogue. The book is our sentinel text. I knew Meir’s amazing work well and truly loved Principles and Practice of Sleep Medicine, so there was no question I was going to do it. I just was so grateful to have been given an opportunity,” said Goldstein. “What I continue to be in awe of is Meir's seemingly inexhaustible academic curiosity. He is someone considered as a bastion of wisdom in our field yet is so inquisitive and open when it comes to the emerging work of others. This was the case when it came to the bidirectional relationships between COVID-19 and sleep.”
Roth said that if you need something done, Kryger is the one to ask. That trait was also something that impressed Goldstein too, along with his humble nature.
“One of the amazing things about him is, despite his extensive career, there is zero ego. When there was work to be done, he said ‘How do we split this?’, not, ‘I'm going to delegate to you and to this person.’ He understands that in a project like this, forward motion is always required. He was really good at moving people forward. He was both responsible and willing to do the work, the hard work, not just overseeing it from a content standpoint, but leading and doing, and that really inspires others,” said Goldstein.
“That's why he has written a gazillion books,” joked Roth.
Kryger arrived at Yale School of Medicine 11 years ago. “Yale hired me at a time when most people would not hire someone my age. This could have been seen as a liability, and I have to give them a lot of credit because it was a gutsy thing to do,” said Kryger.
In November 2011, Kryger became a staff physician at the VA Connecticut Healthcare System and initiated a few projects that are still being used today. He created a process to monitor and manage his patients remotely. In addition, he launched the use of dental appliances to treat some people with sleep apnea instead of using a CPAP device. And he formalized and grew the Sleep Medicine Fellowship Program, which now has four fellows annually.
Christine Won, MD, MSc, BA, associate professor of medicine (Pulmonary); and medical director, Yale Centers for Sleep Medicine, knows the first time she met Kryger. Won interviewed him with colleague Klar Yaggi, MD, MPH, professor of medicine (pulmonary, critical care & sleep medicine); and director, Yale Centers for Sleep Medicine.
“I remember him walking into the conference room for the interview and he had his book, his textbook in his arm,” said Won. “He did a phenomenal job explaining how he would contribute to our sleep medicine program, the things he would offer as a master educator, as a renowned specialist in sleep medicine, and so that's when we decided to hire him.”
Won was immediately impressed by Kryger’s work ethic. He knew how to get things done, she learned. Won credits him with getting the resources to expand the program from one fellow to four, now one of the largest programs in the country. Having Kryger on faculty also attracted fellows and sleep center employees to flock to learn from him.
“It was always a topic brought up by the interviewing fellows. They knew of his presence at Yale and wanted to study under him. He also attracted a lot of the Sleep Center employees, many of our respiratory technicians, sonographers, and sleep technicians. I remember interviewing for a manager for our Sleep Center on Zoom. We asked him, ‘Why do you want to work for Yale?’ He was sitting in his office and then he turns around and showed us Meir's books lined up on his bookshelf. He wanted to come work with the best,” said Won.
When Yale-PCCSM Section Chief, Naftali Kaminski, MD, Boehringer Ingelheim Pharmaceuticals, Inc. Professor of Medicine (Pulmonary), arrived at Yale in 2013, he was excited that the sleep legend was on his faculty. “There's depth in him. It's not only experience, perspective, understanding how things go. Like many other of our faculty, I seek advice from Meir. He has what I would call humble wisdom, which is not derived from his rank or stature. He’s one of the people that makes my job easier,” said Kaminski.
Kaminski calls Kryger a giant and says that he is irreplaceable. “The beauty of academic medicine is that it is built both on unique individuals and on teamwork. For many of our leaders, there's never a replacement, but then there's somebody else who's equally talented and outstanding that takes their role, but it's not a substitute. It is a different person with different skills and contributions, that are equally important and contribute to the team and our mission. I don't think you can really replace giants, and Meir is a real giant.”
Lauren Tobias, MD, assistant professor of medicine (pulmonary) and program director, Sleep Medicine Fellowship, had worked with Kryger as a pulmonary fellow for several months before realizing he had edited the definitive sleep textbook in the world. She was struck by his humility and learned many lessons working alongside him.
"Meir has a core belief that our imperative as educators is to foster trainees' professional development by helping them to discover their own passions. Once our fellows identify the career path that is right for them, our role is to support them along that journey -- whether clinical or academic,” said Tobias. "Another one of his strengths is focusing on what really matters. Meir doesn't get distracted by the little stuff. Whether during patient encounters or discussions about our fellows' educational experience, he always sees the big picture. He approaches situations with a mentality of 'I'm here to do good' and his behavior follows that value."
During a sabbatical in 2017, Kryger and his wife Barbara, traveled to London, so Kryger could spend time at the clinic of Adrian Williams, FRCP, FAASM, professor of Sleep Medicine at King's College, London. Williams met Kryger at an early sleep conference 30 years ago, but their time in London ‘gelled’ the friendship.
“I think he thoroughly enjoyed it [his sabbatical], everyone loved having him around borrowing his expertise in the way of sleep medicine. He was able to sit in clinics with our British patients and experience how we do sleep medicine,” said Williams. “Meir is a luminary. He is collegiate, generous, and my wife says that he is one of the funniest people she knows. I agree with her.”
During his last talk at Yale, “Serendipity” on Wednesday, May 25, Kryger reflected on his career and his family. He credits his parents for shaping his vast interests in medicine, art, and writing.
“My father, his career was that of a butcher, but he was a painter. He painted works of art. My mother taught poetry in a slave labor camp during the war and wrote a book about her experiences. So, my interest in writing and art, it's probably partly genetic, partly just observing my own parents. But I was really lucky in a lot of ways, it wasn't just that I was born right after the war, but in my life, I've been lucky in that I have been exposed and been mentored by incredibly terrific people.”
Kryger talked about how his family will be his legacy, and the support of Barbara, his wife of 48 years, and his children Shelley, Michael, and Steven.
“If you can name anybody in medicine who won a Nobel Prize five years ago, I'll give you $100,” Kryger joked. “In other words, you fade, and so the most important thing in your life is your own family. They are going to be your legacy, and I am intensely proud of my family.”
Kryger also discussed the “giants in science” teachers at McGill University, recalling that, at the time, he had no idea that they were famous.
Melissa Knauert, MD, PhD, associate professor of medicine (pulmonary) understands. “He came to Yale before I was a sleep fellow, and I had no idea who he was. He started showing up at our grand rounds. Since he was at the VA, I never ran into him clinically. Then I realized that he is one of the fathers of sleep medicine. The thing about Meir is that he has accomplished a lot, and the more you get to know him, the more you're struck by what he’s done. He's done such amazing things,” said Knauert.
Knauert shared her experiences being at a sleep conference with Kryger.
“You'll get stopped every 10 feet by someone who just really wants to meet him. One night, we were leaving dinner, and someone came up to Meir, like a teenager at a rock concert, and is like, ‘Oh my gosh, Dr. Kryger, could I take a picture with you?’ When I think about him retiring, I know he will still come to our national conferences and hang out with us; so, we still get to go on these wild rides with Meir,” said Knauert.
In addition to the clinical care he provided to patients and serving as the program director for the Yale-PCCSM sleep fellowship program, Kryger teaches an undergraduate class called “Mystery of Sleep,” which he will continue upon his retirement.
On June 6, 2022, Kryger was presented the Nathaniel Kleitman Distinguished Service Award for dedication to the sleep field and significant contributions in the areas of administration, public relations, and government affairs from the American Academy of Sleep Medicine.
Roth nominated Kryger for the honor. In his nomination letter, Roth wrote, “I have known Kryger for well over thirty years. During that time, I have collaborated on research projects with him, served on societal and journal editorial boards with him, sat on NIH study section, and took part in symposia at national and international meetings with him. Over this period of time, I became convinced of his profound commitment and singularly outstanding contributions to societal service, scholarship broadly, and to academic sleep medicine specifically.”
“Meir has made enormous contributions to the field of sleep medicine in general and to our Yale Centers of Sleep Medicine in particular. Here at Yale, he has helped to build one of the largest sleep fellowships in the country and started a weekly sleep seminar that has grown to include sleep medicine sites around the country. He is an outstanding clinician and educator. We will miss him greatly,” said Yaggi.
Everyone agrees on the impact of Kryger but Won disagrees with his sentiment that Yale took a chance on him. “I never saw it that way. I always thought he was the one offering us an advantage for our sleep program. I remember I told [Dr.] Lynn Tanoue, ‘Wow, this is Meir Kryger. He's been practicing in Connecticut for years now. Why isn't he at Yale?’"
The legacy he cemented will be felt for generations to come. Kryger was honored with emeritus status as of July 1, 2022 and will return to give honorary Yale-PCCSM Grand Rounds in the fall.
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