Doctor Keeps His Promise

Ophthalmologist ensures that a Madera man’s eyes are used to research his disease.
By Barbara Anderson
The Fresno Bee
(Published Sunday, April 27, 2003, 4:56 AM)

David Kaye took a deep breath. The atmosphere of the funeral home unnerved him.

He looked at Donald Kautz’s body, which was prepared for burial. How many times had Kautz come into Kaye’s Fresno ophthalmology office wearing a tie that matched his suit, just as he was dressed now?

How often had Kaye teased Kautz about sharing game strategies and secret plays when the Madera High School football coach came to his office straight from practice?

Kaye took a step back. These vivid memories of the straight-talking man he respected and admired shook him.

He wanted to leave.

But here, on this cold evening in December 2001, he had an obligation to still be Kautz’s doctor — and to honor a promise. Five years earlier, he had sworn he would help researchers seek better treatments or a cure for the disease that blurred Kautz’s vision.

He just didn’t expect that his friend would die of a massive heart attack at 54.Kaye took another deep breath, then began to remove Kautz’s eyes.

From the moment in 1996 when Kaye looked inside Kautz’s eyes and saw the tiny dots, scattered like pebbles on a beach, he knew they explained the man’s fading nighttime vision and complaints about fuzzy scoreboards.

Kautz had an inflammatory disease called birdshot retinochoroidopathy. It gets its name from white lesions in the back of the eye that resemble the scatter of shotgun pellets.

In addition to his shaky vision at night, Kautz had a hard time focusing in the first hours after awakening. When his family gathered for breakfast, daughter Melissa Kautz would read him box scores on the sports pages.

Kaye had personally seen two cases of birdshot retinochoroidopathy, so he and his patient both had a lot to learn. Kautz peppered Kaye with questions: Could he go blind? Was the eye disease contagious?

Yes, Kaye said, there was a chance he could lose his sight. No, his family couldn’t catch the disease.

This left Kautz with one main question: Was there a cure?

Kaye scoured textbooks, read medical journals and contacted colleagues in his native South Africa, where he had trained as an ophthalmologist. There was no way to eliminate the disease, but there were drugs that might stabilize it.

That wasn’t good enough for Kautz. He challenged his doctor to find a cure.

Kaye, who taught 2 1/2 years at Yale University before moving west in 1980 to open a private practice, remembers his own response: “I’d have to give up a year of my life and go research this for you.”

Nevertheless, he admired Kautz’s can-do attitude: “Don was an American. The American spirit is a spirit that doesn’t dwell on the negative. The American spirit dwells on the possibilities and knows how to get there. That was Don.”

The best Kaye could do was refer his patient to eye specialists at Proctor Medical Group at the University of California at San Francisco.

Doctors there confirmed Kaye’s diagnosis and ordered Kautz to get a complete physical. They looked for other problems, such as arthritis, that can cause inflammation.

But they didn’t find anything, says Kautz’s wife, Jane: “The cause remained a mystery for us.”

In the five years following Kaye’s diagnosis, the Kautzes tried to live with his fluctuating vision as they prayed for a medical breakthrough.

Dec. 15, 2001, began as a routine Saturday morning. Jane sipped coffee and read the paper while waiting for Don to return from his morning run.

He typically ran for 45 minutes. She glanced at the clock. He had been gone for an hour.

Jane brushed aside a shiver of concern and continued to drink her coffee. He could be talking to someone he’d seen during the run. That happened often.

Thirty more minutes passed. She tossed the paper aside. He never took this long. She got in her car and drove around the neighborhood. No sign of her husband.

She returned to the house, and she and daughter Melissa, 25, wondered what to do. Whom should they call? The police? Perhaps because Melissa worked in the human resources department at Madera Community Hospital, they phoned its emergency room.

A nurse said they should come. After they arrived, as the nurse escorted her into a tiny room, Jane knew: Don was dead.

A passer-by in a pickup truck had seen Kautz stagger on a street near his home. Kautz then slumped to the ground. Paramedics came but couldn’t revive him.

He would have been 55 in 13 days.

An autopsy showed arteries to his heart were heavily blocked.

He had watched his diet, had exercised faithfully. “It was a complete shock to everybody,” his wife says.

The autopsy was required because of Kautz’s unexpected death. The coroner’s office called Kaye to ask about medical history. When the chief deputy coroner gave Kaye the news, he knew he had to get permission to retrieve Kautz’s eyes.

Kaye had met Jane Kautz only once or twice. He didn’t know how she’d react to his request. But she gave her consent. She says her husband liked Kaye and trusted him.

“The doctor appears to be such a gentle, quiet-spoken person. But he strikes me as the kind who’s not going to just do the everyday practice,” she says.

Besides, Don had an organ-donor designation on his state driver’s license.

“I knew that it would be something he would have agreed to,” Jane says.

Coaching was Kautz’s passion. If he wasn’t working with his own team, he was watching other coaches on the field.

“He’d go to girls tennis. He’d go to everything — absolutely everything,” Jane says. “He felt every sport, even if it was one of the lesser-known, was as important as another.”

Coaching brought the Kautzes to Madera in 1979 from Wasco. He became the defensive coordinator for Madera High’s varsity football team. She got a job in town as an elementary school teacher. The couple bought a house in northwest Madera. It’s the same home Jane Kautz, 55, lives in today with their son and daughter.

The Kautzes grew up together in Colorado. They became a couple while in college and were married for almost 32 years.

Soon after they arrived in Madera, the school district gave teachers personality tests. The Kautzes ended up “about as far apart on the spectrum on this test as you possibly could,” Jane says with a laugh. She was messy and disorganized. Her husband was neat and detail-oriented.

“I guess we helped each other — kind of pulled each other toward the middle,” she says.

Diane Franklin, administrative assistant to the Madera High athletic coordinator, says Kautz never came to work in the office without a tie: “He was a very dapper dresser.”

Even on the athletic fields, he carried his 5-foot-9, ramrod-straight frame in perfectly matched school colors. “We loved to tease him about that,” Franklin says. “He was an easy mark.”

Franklin knew Kautz for almost 20 years, including his eight years as athletic director, from 1992 to 2000. After he died, she found a picture of the two of them at the office. She had it framed and keeps it on her desk.

“The most important thing I remember about Don was how much he loved kids,” Franklin says. “He was here for the kids.”

Melissa Kautz says her father’s coaching schedule meant he wasn’t around a lot at night. “But we went to all the games. I can remember running on the field when we were little.”

On a recent afternoon, as she and her mom talk, 20-year-old Jeff Kautz stays in his room but keeps an ear to the conversation. When his mother says she can’t remember all of the championship teams his father coached in football and track, Jeff runs into the living room holding a faded T-shirt that commemorates a 1986 league title in track. Jeff played on his dad’s last football team in 2001.

Kautz didn’t talk much about his disease at the high school but didn’t try to hide it. “He suffered greatly with his eyes,” Franklin says. “But he was always very staunch.”

He didn’t let his vision problems interfere with coaching or athletic department duties, Franklin says, “other than to miss work because of his doctor’s appointments. Dr. Kaye became as popular a man on his appointment book as coaches and administrators.”

Kautz approached his disease in the same methodical way he managed his job. Pills were taken on time, medical appointments kept. Part of the therapy involved injections into the eye. “I had to leave when they did that,” Jane Kautz says.

Emotions were always kept in check with Don Kautz. He had to warm up to you first, says Bruce Davi, who spoke for the football team at a memorial for the coach that filled the south campus cafeteria.

Davi, now 19, says Kautz once pulled the team’s seniors aside for a pep talk during one of their last practices.

The coach told them: “What you learn on the football field, you have to take it to other places, because teamwork is involved. You have to take that into real life, because teamwork is involved just about anywhere — at college or at work.”

At the funeral home, Kaye still felt Kautz’s presence hovering over him. He had been there an hour, but it seemed longer.

Kaye put Kautz’s eyes in a special tray and packed them inside dry ice in a Styrofoam container for shipment to the eye pathology laboratory at UC San Francisco.

Says Kaye: “He didn’t leave me until I took his eyes, and I felt like he vanished — whoosh — and he was gone.”

Kaye needed to talk to someone. He called his wife, fellow ophthalmologist Loan Nguyen, on his cell phone. That night, Kaye skipped dinner and retreated quietly to his study.

“I think he and Don had that special relationship that they developed over the years,” Nguyen says, “and that was why it was more difficult to go through all the process.”

Kautz’s eyes piqued the curiosity of J. Brooks Crawford, director of UC San Francisco’s eye pathology laboratory.

“You never know what you’re going to find,” he remembers thinking as he began to examine the eyes under a microscope.

They gave Crawford the first magnified view of birdshot retinochoroidopathy in the early stages of the disease. “Nobody had ever seen this before,” he says.

Crawford now had evidence of how the disease progresses in a human. Up to that point, genetically engineered mice provided the best look at the chain of events in the disease’s development.

Researchers have a better shot at stopping the disease if they know how it starts.

Kautz’s eyes added to evidence of a genetic connection. The eyes tested positive for a protein known as HLA-29. “As far as we can tell, only people who carry the gene [for the protein] get the disease,” Crawford says.

The lesions in the eyes also closely matched patterns in the lab mice. Researchers now can use the animals to study the disease more confidently, Crawford says.

Researchers owe a debt to Kautz and to his doctor, Crawford says. The results were published in the December 2002 issue of the British Journal of Ophthalmology.

Jane Kautz feels some hope these days, because discoveries made thanks to her husband’s eyes could help people with the disease. When somebody walks into an eye clinic, she says, “maybe this doctor can say, ‘Well, we think this is what causes it now. And we can do this for you because of that.’ “

Her husband would be pleased, too, she says. “I kind of think of him as a guardian angel for somebody that needed a guardian angel. He would be very pleased to know that they did find something that could be useful to others.”

For Kaye, there was a “great sense of defeat” in removing Kautz’s eyes; it was a reminder that a cure hadn’t been found in his patient’s lifetime.

At the same time, he says, “it was a moment of great opportunity to find out what was going on.”

And he kept a promise.

The reporter can be reached at

banderson@fresnobee.com or 441-6310.

This year, 80,000 people in the United States are on waiting lists for organ and tissue transplants. About 15,000 needing transplants live in California, and 7,500 are residents of Northern and Central California. Each day, 17 people in the United States die waiting for a transplant, says Esther Padilla, community outreach coordinator in Fresno for the California Transplant Donor Network. Last year, 227 people became organ donors in Northern and Central California; 126 people were tissue donors, and 77 were cornea donors.

The California Transplant Donor Network offers the option of organ donation to families whose loved ones have died.

Community Tissue Services coordinates donations of tissues, such as skin, tendons and heart valves.

The Lions Eye Bank of the Central Valley gives families the choice of donating corneas for transplant.

For details about organ and tissue donation: in English, (888) 570-9400; in Spanish, (800) 588-0024.

Doctor Keeps His Promise

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Written by Laura Nguyen