Robert S. Rust, Jr. (1948–2024)

Robert S. Rust, born August 11, 1948 in Van Nuys, California, was a true polymath—physician extraordinaire, investigator, teacher, scholar, historian, and musician. He exemplified and imparted the importance of Osler's Aequanimitas as well as the value of a firm handshake. A bibliophile and prolific reviewer for the Virginia Quarterly, his interests, expertise, and impact leave an extraordinary legacy (Figures 1-3).

Dr. Rust received a Bachelor of Arts in History and English magna cum laude from Kent State University in 1970, followed by a Master of Arts in History from his beloved University of Virginia (UVA) and certificate in Greek language, history, and culture at the University of Thessaloniki/Institute for Balkan Studies. His education career began as a biology teacher at Albemarle High School (Albemarle County, VA), then as Associate Director of Studies at the International College Salzburg, Austria, where he lectured on the history of philosophy and science.

Rob then spent several years as a research associate in the UVA Department of Surgery, studying wound infections and the lymphatic aspects of immune function—an area that proved to be especially relevant in hindsight. During this time, he also developed a deep interest in the writings of Osler and Penfield. He would matriculate into the medical school with the plan of entering surgery until he encountered luminaries such as the renowned neuroanatomist Lennart Heimer, epileptologist Fritz Dreifuss, and neurologist/neuropathologist James Q. Miller, leading to a historic change of direction. He completed pediatric residency at Yale followed by pediatric neurology at Washington University, influenced particularly by Laura Ment, George Lister, Philip Dodge, Arthur Prensky, Ed Dodson, and Joseph Volpe. The early interest in immunology was especially fostered by Dodson and adult neurologist John Trotter, with Dr. Rust's first publication establishing reference values for cerebrospinal fluid immunoglobulins in children published in the Annals of Neurology [1]. Rob then worked in Dr. Volpe's laboratory, studying the regulation of the dolichol synthase pathway and protein glycosylation [2]. He also worked in the famed metabolism laboratory of Oliver Lowry, meticulously quantifying enzymatic activity from cell culture analysis in cerebral cortex and superior cervical ganglia [3].

Dr. Rust then moved to the University of Wisconsin, succeeding Ray Chun as Director of Child Neurology and Medical Director, Cerebral Palsy Clinic, and established a National Institutes of Health (NIH)–funded Developmental Brain Chemistry Laboratory. Dr. Chun became a lifelong mentor and friend; Rob kept a photograph of Dr. Chun, grinning widely in the presence of a child, on his desk throughout his career. Dr. Rust was especially touched to deliver the Raymond Chun Memorial Address in Madison in 2014.

In 1997, Rob joined Boston Children's Hospital as Associate Professor and Clinical Scholar at Harvard Medical School and Director of Neurology Clinics and Education. He quickly won the Harvard Longwood Area Distinguished Teaching Award and a special neurology residents teaching award. He returned to the Shenandoah Valley and Virginia Piedmont in 1999 and became the Thomas E. Worrell Professor of Epileptology and Neurology, notably being the endowed chair previously held by Fritz Dreifuss. He quickly restarted the UVA child neurology training program, became the Division Director in 2007, and remained on UVA faculty until his retirement in 2015. The UVA Department of Neurology acknowledges his many contributions to the department through its sponsorship of the annual Robert S. Rust Endowed Lecture and the annual Robert S. Rust Faculty Teaching Award. When asked about plans, he would remark that his next stop was the UVA faculty cemetery, where he could often be found tending to the graves of Dr. Dreifuss, the historian Bernard Mayo, and other distinguished faculty.

His prodigious fund of knowledge, clinical teaching, and research were nothing less than breathtaking. When asking Dr. Rust a “yes-or-no” question, one always needed to be prepared for a thorough essay on the topic. As his senior pediatrics resident, one of us (DEM) recalls that all there was to do was observe and admire Rob's excellence as a clinician and educator even at this early stage of his career.

His scientific contributions to the literature include careful and authoritative descriptions of acute cerebellar ataxia [4], l-carnitine supplementation for valproate-associated hyperammonemia [5], and paroxysmal autonomic instability with dystonia after brain injury [6]. There was a massively broad and deep scope of manuscripts, reviews, and chapters on infectious and para-infectious neurological disease, epilepsy and headaches, stroke and related syndromes, movement disorders, head trauma, autism, developmental language disorders, neurological manifestations of systemic disease, and the history of neuroscience and pediatrics. It would be an oversight not to mention his brilliant, accessible, daily, and evidently effortless contributions to the Child-Neuro List Serve, in an era when instant communication became possible to share cases and overall career reflections and advice. No one did this more generously and comprehensively than Rob Rust. A favorite anecdote from cofounder of the List Serve Steve Leber, faculty member at the University of Michigan, was an unknown case posted by a resident and Dr. Leber a week or so before the annual meeting of the Child Neurology Society (CNS). Upon seeing Steve at the meeting, Rob said, “It was so nice of you to let the resident try to work through the case himself by posting it on the list serve when I'm sure it was obvious to you that the patient had Niemann-Pick type C.”

Dr. Rust's imprint on the discipline of pediatric neurology is most manifest in education and his trainees, colleagues, and patients that he touched. He edited and contributed heavily to a 2011 issue of Seminars in Pediatric Neurology entitled “Training of the Child Neurologist in the 21st Century” [7] that serves as a blueprint for residency training and provides a guidepost from which to measure evolution in the field. His bedside teaching style, at least partially modeled from Philip Dodge and Ray Chun, was enchanting and always emphasized humanistic aspects of the profession.

Dr. Rust served on multiple editorial boards, including the New England Journal of Medicine Journal Watch, and was an active oral ABPN examiner, an ad hoc advisor to the NIH/National Institute of Neurological Disorders and Stroke–sponsored Disability in Speech/Language Disorders consortium, and chair of the American Academy of Neurology (AAN) Child Neurology Education Committee and Child Neurology Section. He was the lead writer for the AAN Residency-in-Service Training Exam for pediatric neurology, served as Councilor from the South for the CNS, and served on the President's Advisory Council and Executive Board of the International Child Neurology Association. He is perhaps best known for his unmatchable written portraits of the CNS awardees year after year, serving as the chief archivist of the society with magnificent write-ups of those being honored for their own contributions. His awards included teaching awards from Albemarle High School (1971) and the International College in Salzburg (1974), the Irwin P. Levy Teaching Award for Neurology at Washington University (1984), eight university or national teaching awards and innumerable visiting professorships, the CNS Hower Award (2006), and the CNS Blue Bird Circle Training Director Award (2015).

Time spent with Rob was always joyful. A car ride to the UVA Southwest Virginia Field Clinics to care for underserved populations would be replete with Rob teaching about life and neurology through story. Anyone who had the pleasure of touring the UVA Academical Village or Monticello with Rob was in for a treat as he made the history truly come alive. A favorite memory of one of us (PLP) is from a conference held at the Dead Sea in honor of the renowned pediatric neurosurgeon Fred Epstein. During a bus tour of Masada, Rob amazed everyone by knowing more about its history than the tour guide.

Rob will undoubtedly be remembered for his brilliance and contributions to the field of pediatric neurology. It is, however, his principal achievement to have been a loving husband and father. In an address to graduating residents at the University of Virginia, Rob cautioned, “Gravestones say beloved husband and father and not author of 186 papers.”

Howard P. Goodkin: conceptualization, writing – review and editing. David E. Mandelbaum: conceptualization, writing – review and editing. John R. Mytinger: conceptualization, writing – review and editing. Phillip L. Pearl: conceptualization, writing – original draft, writing – review and editing.