It is with sadness that we note that Dr. Sidney Starkman passed away on September 26, 2023 after a long fight with cancer.
Dr. Starkman, Sid, was a generous man, unique in his clinical training and interests, who defined the field of vascular neurology at its inception. Sid was jointly boarded in Emergency Medicine and Neurology, and jointly appointed in both Departments. He started on faculty at UCLA in 1987, and was vigorously active in both fields. He worked on emergency department protocols and technology for neurological problems, such as simplified EEG biomarkers of migraine and standardized care for seizures. In 1992, Sid recognized the need for better awareness and treatment of stroke, and formed a volunteer organization to monitor for all stroke when it came into the UCLA ED—and call Sid! This was a group of UCLA undergraduates, who came to be known as Sid’s Kids. Then, the NINDS tPA trial transformed stroke and the entire specialty of neurology. Sid was uniquely positioned for this transformation, and pioneered stroke care, stroke clinical trials and the application of tPA and other stroke therapies into the larger medical community. Because of the hemorrhage rate with tPA, recognition of stroke as a treatable disease and tPA as a therapeutic, had critics and slow acceptance in some circles. Sid battled the forces against this revolutionary new therapy for stroke at local and national levels. To turbocharge the pipeline of stroke recognition to treatment, Sid’s Kids became a UCLA-wide early warning network for stroke, and Sid was the conductor of the orchestrated clinical response.
There were long periods—possibly decades--where Sid seemed to be involved in almost every stroke in the Los Angeles metropolitan area. He was helping with stroke care at UCLA Westwood, Olive View, the VA and in phone consultations with physicians across Los Angeles. Many wondered how he could do it. At the Friday morning UCLA neurovascular conferences, Sid would invariably personally know most of the cases—like an intrepid war reporter present at the scene—but Sid was also fighting the war. Past stroke fellows and current faculty recall how Sid helped straighten out one difficult case after another, seemingly all over Los Angeles hospital sites, diplomatically aligning an attending physician at one institution or another with the proper and timely care necessary for stroke. In these instances, Sid might sweep into an MRI scanner with the patient in tow, eddies of energy spinning off in his wake, surprising residents, fellows and scanner staff with positive energy and patient care command.
Sid led important clinical trials, notably in conjunction with Jeff Saver, such as the FAST-MAG trial. This comprehensive stroke trial involved a total of 315 paramedic-staffed ambulances and 60 receiving hospital sites in Los Angeles and Orange Counties, developed its own stroke screening protocol and led the way for the future as a paradigm for acute stroke and particularly pre-hospital stroke care.
Sid was also passionate about societal issues of human welfare, local and global politics. He was a national leader in Physicians for Social Responsibility and an advocate for public health funding. These were charged and difficult roles, fights for which he pursued a commitment to social issues that set him apart from strong elements in our society. Passion, commitment, presence and perseverance define Sid Starkman, and call to mind a poem by William Stafford, The Way It Is:
There’s a thread you follow. It goes among
things that change. But it doesn’t change.
People wonder about what you are pursuing.
You have to explain about the thread.
But it is hard for others to see.
While you hold it you can’t get lost.
Tragedies happen; people get hurt
or die; and you suffer and get old.
Nothing you do can stop time’s unfolding.
You don’t ever let go of the thread.
Sid followed his thread. He never let go through so many patient care situations and locations, though tragedies happened and people got hurt and died. He fought suffering in his patients and in society. Nothing that we can do will stop time’s unfolding, but Sid Starkman provided care of his fellow human being that made that time unfold in as best way as possible.
Written By Dr. S. Thomas Carmichael
Professor and Chair, UCLA Department of Neurology