Warren D. Grover’s career in child neurology was ground breaking. As a master of the academic triple threat, he tirelessly provided exceptional care to children whose clinical conditions ranged from simple neurological diagnoses to those that were life-threatening or exceedingly rare. His dedication to the everyday work of taking care of patients was the foundation for his success as a clinician, educator and researcher.
Warren Deacon Grover, known as “the Deacon,” and then as “D” by his family, was born on November 2, 1928, in Mount Holly, New Jersey. He obtained a BS in Biology from Bucknell University and his MD from Temple University in Philadelphia. Following internship at Philadelphia General Hospital, he served in the US Navy for two years, then returned to Philadelphia for pediatrics training at St. Christopher’s Hospital for Children. After a short time practicing general pediatrics, an experience that no doubt contributed to his excellent general pediatric knowledge and his superb clinical abilities and acumen, he trained in neurology at Temple University Hospital and child neurology at the Children’s Hospital of Philadelphia; under Charles Kennedy.
Dr. Grover returned to St. Christopher’s Hospital and Temple University School of Medicine in 1967. He was the first formally trained, board-sanctioned child neurologist in the Neurology program. He had a very rapid rise through the academic ranks, first as Assistant Professor in 1967, next to Associate Professor in 1969, and finally, to Professor of Pediatrics and Neurology in 1976. He remained at St. Christopher’s Hospital for his entire career.
Dr. Grover became the Director of the Division of Child Neurology and the Handicapped Children’s Unit (“the HCU”) at St. Christopher’s Hospital in 1978. The HCU had a long history of utilizing the team approach to deliver services to children with cerebral palsy. Under his guidance, and working collaboratively with Dr. Anthony Pilleggi, an esteemed neurodevelopmental pediatrician, the training programs in both child neurology and developmental pediatrics flourished. At its height, there were two child neurology fellows and two developmental pediatrics fellows per year. During his tenure as Director, Child Neurology increased to five neurologists, three developmental pediatricians, and several nurse practitioners and research assistants.
Dr. Grover loved making patient rounds. Rounds were twice a day, in the morning and the late afternoon. He made rounds so much that when asked where he had been during several historic events, the answer was always the same; “I was making rounds.” Every case, both the simple and complex, was for teaching. The residents learned that no properly analyzed neurologic problem was simple. Every admission was presented and then dissected, starting with the history, then the neurologic examination, lesion localization, differential diagnosis, evaluation, and finally, the treatment. The proper equipment was always in his black bag: the stethoscope to listen for cranial bruits, the large flashlight for transillumination in the pre-CAT scan or MRI days, and the Wood’s lamp. Legend has it that during one outpatient visit, after placing his stethoscope on the child’s head to listen for a cranial bruit, she turned to her mother, a nurse at the hospital, and with a quizzical look on her face uttered “but I thought you said he was a good doctor!” Fellows typically spent 6 hours a day rounding, but never complained, realizing they were being taught by a master. Stacks of articles for the weekly journal clubs were distributed, with his famous hand-written “20 copies” at the top, the original faded by repeated photocopying. Dr. Grover was the first recipient of the Victor C. Vaughan, M.D. Award for Teaching Excellence at St. Christopher’s Hospital, an accomplishment of which he was very proud. He was esteemed throughout the tri-state Philadelphia area for his clinical care, receiving innumerable awards and recognition and, because of the demand for his services, he saw outpatients every day in-between inpatient rounds.
His use of language was erudite and precise, reflecting his approach to the description of the neurologic examination. This requirement for language precision caused consternation for many a fellow when writing manuscripts, with these manuscripts re-written many times in order to achieve precise wording and clarity. However, the fellow was rewarded when the manuscript was accepted without a single requested revision!
Although Dr. Grover was a master of every subspecialty in child neurology, his work in metabolic diseases and neurocritical care led him to describe new treatments and identify new clinical syndromes. Dr. Grover was not afraid of the ICU. While most neurologists of his era shunned the ICU like a plague, the Neurology service cared for many children in the PICU before the days of pediatric critical care medicine.
He was especially facile in the care of Reye’s Syndrome and near-drowning, devising treatment protocols for increased intracranial pressure using barbiturates and monitoring intracranial pressure. In order to make management decisions to save the brain, Dr. Grover mandated that Neurology be involved at the onset, saying, “We must be involved at the beginning,” rather than merely a late involvement to only define neurologic deficits. It is a little known fact that his astute clinical observations led to the first description of infant botulism, along with Henry Baird, in a letter to the Lancet, “Pseudo-myasthenia gravis of infancy,” followed by a more complete description in “Recovery following cranial nerve dysfunction and muscle weakness in infancy.” Neurocritical care research done by his fellows resulted in the following: “The Fallacy of Varicella Hepatitis: Evidence for Reye Syndrome”; “Evidence that Rheumatic Encephalopathy may Represent Reye Syndrome”; “The Value of Plasmapheresis in Hepatic Encephalopathy”; “Outcome of Status Epilepticus Treated with Phenobarbital in a Pediatric Population”; “Hypoxemia and Hemodynamic Changes during the Hypercarbia Stimulation Test”; “Efficacy of Primidone for Seizure Control in Neonates and Young Infants”; and “Timing of Maintenance Phenytoin Therapy after an Intravenous Loading Dose.” He was also one of the first to research the encephalopathy of chronic renal failure.
He was fascinated by all neurometabolic disorders and approached these disorders in a manner similar to his approach to neurocritical care, not only to make a diagnosis but to search for ways to treat and protect the brain. He has made seminal contributions in two of these, the copper and mitochondrial disorders. He studied all aspects of Menkes Disease, (or more properly, trichopoliodystrophy), describing the associated vascular and bladder abnormalities, researching copper infusion therapy, and finally identifying the neurotransmitter defects, published as “A defect in catecholamine metabolism in kinky hair disease,” in Annals of Neurology. Children with Menkes Disease came to St. Christopher’s Hospital from all over the US for his care. Dr. Grover studied disorders of lactic acid metabolism before there were mitochondrial disorders. Fellows learned that the CSF examination was a requirement when no specific diagnosis had been made. A family grateful for his care to their two children established the Barnett Center for Investigation of Mitochondrial Disorders, with Dr. Grover serving as the Medical Director. His legacy continues in the Child Neurology division at St. Christopher’s Hospital, where there is ongoing research in mitochondrial disorders, and in the many fellows that he trained around the US and the world.
Dr. Grover was one of the first child neurologists to understand the importance of the pediatric neurology nurse practitioner in the care of the child and in the changing health care environment. The Association of Child Neurology Nurses now has the Elizabeth F. Hobdell Nursing Research Grant, named after his devoted research clinical specialist and nurse practitioner.
His fortitude, strength, and love of neurology were evident in his approach to his personal experience with histiocytic lymphoma of the thyroid. The only work missed during his entire treatment was at the beginning, following the initial surgery. Dr. Grover made sure that his chemotherapy was scheduled for Friday afternoons, so that he could recover over the weekend and return to work, which he did, every Monday morning.
Dr. Grover greatly enjoyed sports, linguistics, and semantics. Dr. Grover played football: he was an end at the Rancocas Valley High School, in Mt. Holly, NJ, and is enshrined in the Rancocas Valley Regional High School Football Hall of Fame. He was also an avid golfer and runner. Given his propensity for the proper use of language, he enjoyed the “Word of the Day Calendar”; concerned for our overall education, he always managed to somehow introduce this word into morning rounds. He became flustered only once during rounds, when a clever resident detected the origin of this additional daily vocabulary instruction and began using the word on rounds before he could use it!
Dr. Grover was supported throughout his career by his wonderful wife, Connie, and their four children: Christopher, a company vice-president; Joel, a psychologist for the deaf; Allyson, a geriatrician; and Timothy, a geology professor. Connie and he are now retired in South Carolina, where he had been able to play his beloved golf and they can enjoy sitting outside year-round in the sun, looking at the marsh.