When Henry Paulson was four years old, he knew that his father wore a white coat to work. Young Henry and his siblings – he's one of five – would often play in the gardens at Duke University, where their father George was on the neurology faculty. “He'd take breaks during his free time and come out to see us for a few minutes,” Henry recalled in a phone interview with Neurology Today.
By the time he was eight, he knew that dad worked on the brain. “In about the third or fourth grade, I became a control for some of his experiments,” he recalled. “Having electrodes put on my head sounded like a neat thing to do, but once you realize that you have to sit still for an hour, it's not quite so much fun.”
Although he knew his father worked on the brain, young Henry and his siblings had little idea of the important role their father played in the world of neurology and movement disorders.
“He's this amazing guy, a powerful Chair who turned the Division of Neurology at Ohio into a department, making major discoveries about Parkinson disease and Huntington disease – and we never really knew much about that,” he said. “We knew him as a doctor who made house calls, took phone calls any hour of the night, and tirelessly drove to make presentations to patient support groups hours away. Only now do I realize just how unusual that is.”
Whatever George Paulson's neurological career entailed, young Henry initially had little interest in sharing it. “I was never one of those kids who said, ‘I want to do what my father does.’ It's always been a little hard to admit that I'm in exactly the same profession my father is in,” he said.
In fact, he remembers riding along to a few of those patient support group meetings and “sitting in the back of the room and not knowing at all what they were talking about, finding it very boring.”
INTEREST IN HOW THE BRAIN WORKS
It was only after graduating from Yale, where he'd particularly enjoyed his studies in evolutionary biology, and finding a position as a biomedical research technician that Henry realized that medicine might be for him.
“I think there must have been sort of a steady influence of interest in how the brain works, as a kid – unrelated to disease, but just how the brain works – that made me most interested in neuroscience, and pursuing an MD-PhD,” he said, attributing that scientific focus not only to his father, but to his mother, who was the only woman in her dental class at the University of North Carolina and an avid researcher. “I started to do molecular neuroscience and wanted to apply it to a specialty in the brain, and in the end, neurology seemed to be the best fit.”
But he still didn't imagine that he'd end up pursuing not only the same specialty as his father, but the same diseases as well. “I was convinced that I would work on epilepsy, particularly the role of ion channels,” Henry said. “But during my residency, neurodegenerative disease really interested me most. The fascinating discoveries about these repeat expansion diseases first came into play during that time, and I really enjoyed working with these patients and their families.”
CONNECTION TO HUNTINGTON DISEASE
Years later, Henry attended his first AAN meeting and met the renowned Huntington disease pioneer Nancy Wexler. “She gave me a big hug and said, ‘Do you know that your father really got us going in Huntington disease?’ She explained how he had organized the first international Huntington disease conference on Ohio, which I remembered from when I was a kid.”
It was at that conference that Dr. Wexler saw films of a Venezuelan village filled with an unprecedented number of Huntington patients, the village that became critical to Dr. Wexler's research and discovery of the disease gene. “And here I was working on the very same disease,” Henry said. “I've never tried to consciously model myself after my dad, but when you look at it, it's pretty amazing – we're both neurologists, both in movement disorders, and both in Huntington disease.”
Going into medicine despite, not because of, a parent's interest seems to run in the family. George remembers that as a young man, he got a Pepsi-Cola scholarship – “they don't even exist anymore” – to attend undergraduate school.
“I was always very interested in nature versus nurture, and what makes people the way they are,” he recalled. “My father was a teacher at North Carolina State and was always trying to learn something, so he had a very big impact on my education. But going into medicine – surely that goes back to my mother, a sweet, religious, Baptist woman. During my senior year, I was sitting with my zoology professor, agonizing over whether to pursue an MD or a PhD. After an hour of discussion, he looked at me coolly and said, ‘Just because your mother wants you to be a doctor doesn't mean you should not be a doctor.’ I ended up going to medical school then.”
At that time, George said, “Neurologists were ‘nihilologists.’ You'd define a stroke, for example – although you'd often be wrong, because there were no CAT scans or MRIs – but there wasn't anything considered a good therapy for most diseases. Now there's almost no disease for which we don't have some therapy. As a neurogeneticist, I think Henry is now on the cusp of where many of the new advances in neurology will come along, and I think that's marvelous,” he said.
Discussing difficult cases with each other is one of the greatest pleasures for both father and son. “At Yale, during his MD-PhD studies, Henry would call me up and ask me questions about Bell's palsy and what I thought about it,” George said.
“He'd say, ‘The staff say to treat this case with steroids, and some say it doesn't do any good – what do you think?’ When he was at the University of Pennsylvania as a resident, he called me one night and asked, ‘Is everybody who does epilepsy a little bit crazy?’ I told him yes, and not to worry about it.”
“I always call my father when I have a puzzling case, because he's seen more than anybody I know in neurology,” said Henry. “He's an old-school doc who saw dozens of patients a day. A lot of movement disorders and a lot of neurology is pattern recognition, and he's seen more than anybody else. Whenever I have a tough case, which is often, I'll call him – and he's even called me a couple of times.”
“He knows far more than I do about trinucleotide repeats!” the senior Paulson declared. “Last week, he called and told me that the genetics course he taught at the Academy meeting had gotten very nice grades and that several people had praised him for it. I get more pleasure when he does things like that, and when he gets articles published, than when I do. It's a lot of fun to realize that my son is more scholarly than I am.”
MASTER TEACHERS, CLINICIANS
George also claims that his son has the edge in teaching as well. “I know that I'm good by the bedside, but I'm not as good in front of an audience as he is,” he said. “I've had the pleasure of seeing him give lectures, which is a rare treat for a father, and he's always optimistic and upbeat. Those are good qualities in a teacher. He also prepares better – while I believe in just getting up and talking!”
Henry counterered: “He will often say he's ‘just a clinician.’ A couple of years ago, I had the chance to write a short piece about him and looked over his CV: there are over 200 papers, back from when he was a resident and a medical student, in the top-tier science journals. He's the scientist that I would like to be.”
But George's greatest influence on his son, said Henry, has indeed been as a clinician. “His compassion as a doctor has had a great effect on me,” he said. “He takes calls any time. He recognizes that patients or families can be frightened or angry, but they're not taking it out on you, it's because of the disease. I've tried to learn a lot from that, both from seeing him with patients as a colleague, but also from watching him as a kid, talking on the phone to them. I know I picked it up a long time ago, even if not in a conscious way. You listen.”