Chapter 19: Thoughts on MD Anderson in a Period of Change
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Description
In this chapter, Dr. Komaki talks about third President John Mendelsohn [oral history interview] and his successor Ronald DePinho [oral history interview] and discusses changes at the institution during the transition between them and since Dr. DePinho’s resignation on 8 March 2018. She begins with a very positive portrait of Dr. Mendelsohn and the feeling of teamwork he was able to create among employees to take the institution to its number one position.
Next, she reflects on Dr. DePinho, noting that she respected him, but that his focus on basic since didn’t ripple through the institution to generate a common feeling. She also explains that the focus on generating funds for the Moon Shots program created a mechanical, inhuman feel to the institution that had an impact on patient care. Next, Dr. Komaki explains that the transition team that assumed leadership after Dr. DePinho’s resignation began to fire and “target” anyone who had been supported by Dr. DePinho. She says she counts herself in this category. After a few comments about Dr. Peter Pisters, MD, fifth president of MD Anderson, a close friend of hers and Dr. James Cox’s [oral history interview], she explains that people were afraid during to speak up in support of people being fired during the interim period. She touches on her own experience, which she attributes to being targeted for removal. She laments the lack of respect for the faculty and leaders who were able to take the institution to its number one position and the fact that the incoming faculty do not know and respect the institution-builders who have come before. She cites some evidence that the Department of Radiation Oncology is losing ground.
Dr. Komaki then speaks about how “blessed” she has been by seeing patients and her commitment to teaching residents the patient care mission. She talks about the lectureship she and Dr. Cox established in November 2017 and the individual who will be giving the lecture this year.
Identifier
KomakiR_05_20190221_C19
Publication Date
2-21-2019
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Institutional Change; Leadership; On Leadership; Mentoring; On Mentoring; Portraits; MD Anderson Culture; MD Anderson Culture; Working Environment; Critical Perspectives; Critical Perspectives; Critical Perspectives on MD Anderson; MD Anderson History; MD Anderson Snapshot
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
T.A. Rosolowski, PhD:
I wanted to shift gears a little bit, because we’ve talked a lot about your research, we’ve talked about your impact on the field. I wanted to get your perspective on some changes that MD Anderson was going through, you know the movement from John Mendelsohn [oral history interview] to Dr. DePinho [oral history interview] and all of the turbulence. Then after Dr. DePinho resigned, and kind of the changes to the institution. So you know, kind of looking at the big picture, what were some of your observations about that shift, from Dr. Mendelsohn to Dr. DePinho, for example.
R. Komaki, MD:
I’m still in grief, losing Dr. John Mendelsohn, who was our mentor. He worked so closely with almost everybody, including myself and my husband, and he really made MD Anderson Cancer Center the number one cancer center in the world.
T.A. Rosolowski, PhD:
And I just want to say for the record that we’re speaking just a couple of weeks after Dr. Mendelsohn passed away.
R. Komaki, MD:
You know he had knowledge of the basics of cancer, and not only scientific knowledge of cancer, how cancer behaves and the molecular pathology and genetic mutation. He was so positive to treat people, employees, and so was his wife, and we were a part of a team. John Mendelsohn and Anne Mendelsohn, they treated MD Anderson employees as a whole family, “We can make MD Anderson Cancer Center number one cancer center if we are a team .” They invited us, all the faculty members, to his home, which is not far away from here, [South Boulevard]. And you know, the way we were treated by them, we had a kind of passion: “we’ll make it and we’ll make it best for MD Anderson and the patients,” and we had a kind of spirit to do it. I respected Dr. Ron DePinho. He really liked me, and I received an employee award in regard to patient care, 2017, from Ron DePinho. He wanted to do more in just a scientific way, rather than treating everybody like a whole family. I think maybe because of his interests and also his wife’s interest were more basic research rather than clinically oriented. Their spirit didn’t go through the entire whole institution as family members. Some people, they felt like they were just treated like a technologist or just an employee. Also, MD Anderson became so big, or more mechanical, and all the technology we got into. Somebody who cannot handle it, because of the number of patients they have to take care of and all the things, it became a more computerized system: they were kind a target to be kicked out if they did not use computerized system. We used to spend more time with patients, explaining, and we had more sensitivity to the patients, and that got lost. I think when Ron was the president, it was more money, money, money, we are losing money. We had to limit the time talking to the patients, in 15 minutes our time was out with one patient. We were watched: how many minutes we were with patient in the room. I said, this is just not acceptable, I’m not talking about more than ten minutes, and they were checking the time, how long I was in the room to see patient and explain treatment and side effects as well as teaching our residents and visitors. Then, they decided to check all the documents for what was reimbursed. Every tiny thing, we were watched, and it became so inhuman. We were like a machine and more mechanistic, and if we were targeted, we were kicked out. There are ways to get rid of like my assistant, physician’s assistant. She was with me so many years and she was targeted. She was under probation like two years, without telling her what she did wrong, she was kicked out. All those things never openly described what she did wrong, and once she was kicked out . Also I was not given any residents under my service although I had so many follow up patients since I have been at MDACC for 29 years. Then the next one, the new division head came and he said, “well, I don’t want to renew your tenure.” So I said that’s fine, next five years, I’ll be 80 years, so I don’t want next tenure position.
T.A. Rosolowski, PhD:
Yeah, you—
R. Komaki, MD:
And all those things, it became so impersonal, we were not treated—when Ron was president, we are not treated as human beings. They lost respect for physicians, or anybody who contributed so much and so many years to our patient care.
T.A. Rosolowski, PhD:
What do you think the impact on the patients was?
R. Komaki, MD:
Patients were devastated. They cried and cried, and they said what happened with Dr. Komaki? I just resigned because I could not tolerate the way I was treated, and around that time, my husband was ill and I said I’m going to just stop.
T.A. Rosolowski, PhD:
Yeah, you’ve talked about that. I mean it seems like there are a number of people who have mentioned the dramatic effect of some of these financially based decisions, on patient care and on personal, people’s professional experience at the institution. What did you feel—and I didn’t want to cut you off, but we have talked about that in other sessions, so I wanted to kind of move forward with your narrative.
R. Komaki, MD:
The people who tried to get on cutting off the salaries for employees, those people who are leaders, they were kind of chopped off to get the junior attendings or junior employees to work cheap. Also, the senior --I mean the crossing those, I know more about computers than anybody around here-- came in and tried to control the people who have been at MD Anderson. There is only one way to do that: they just cut off the top and get the new people, who do not know the history of MD Anderson and patient care, and they just followed whatever the leader said, do this and do that. They just totally lost the way MD Anderson became number a one cancer center. No idea what we had to do. In the past 30 years, we spent every second, every minute, for patient care, and the best for them. They never, ever cared what we have done.
T.A. Rosolowski, PhD:
What do you think is the effect now? I mean Dr. DePinho resigned and then this transition team came in. What was your view of what the transition, with Marshall Hicks [oral history interview] and Steve Hahn? How did you feel they were—what did you feel about their efforts to counteract it?
R. Komaki, MD:
It was awful, it was a disaster.
T.A. Rosolowski, PhD:
Oh really? Why so?
R. Komaki, MD:
Because they did not have any idea what MD Anderson is and how they should treat every employee with respect, and how MD Anderson became so much oriented to the patient, not just getting money, or even the research we have done. It’s all based on the patient care, the best we can do for the patient, that’s why we were driven to do research.
T.A. Rosolowski, PhD:
What were some of—because I’m trying to get a sense of --we have this transition team that’s come in after Dr. DePinho resigns. What were the things they were not doing? What were they not looking at, that would have supported what you’re discussing here?
R. Komaki, MD:
Those people who were kind of favorites of Ron DePinho, or even in our department, by Jim Cox, they were targeted. They were out. They were basically fired. They did not want to see the people who had been working and are very popular. So Ron DePinho disappeared. All the vice presidents were fired. That was the biggest mistake they made. I was a distinguished [endowed professor in Lung Cancer Research and tenured professor], and I was targeted because I worked for MD Anderson [Cancer Center, Ron DePinho, and Jim Cox. Dr. Whelera (spelling?), Dr. Dan Gomez and Dr. Mary McCalester (spelling?) sat down in the conference room in front of me, and they said, “well, from now on, we are going to check every patient plan made by you .”] I asked them “Why?” They never explained why. They said they could not tell why. I really truly thought I might sue them over these sessions torturing me and bulling me. You know, she said --she’s QA person—“I’m going to check you every month, how you are doing your patient plans.” And no resident, and I said I just cannot believe what I hear, based on what?
T.A. Rosolowski, PhD:
And you felt that this was primarily because you had had a good working relationship with Dr. DePinho?
R. Komaki, MD:
Yes. I had outstanding employee award from Ron DePinho. [Or maybe I am Jim Cox’s wife and him Cox has retired from MD Anderson Cancer Center?]
T.A. Rosolowski, PhD:
And you were a co-investigator with him, co-PI on various research studies.
R. Komaki, MD:
Co-PI of the CCSG, yes that’s correct, and they wanted me to get out.
T.A. Rosolowski, PhD:
What do you think the impact has been on the institution of the transition team? I mean you had your personal experience, which was very damaging. In terms of the direction that the institution is going as a whole, what do you think the impact of the transition team, and now Dr. Pisters, what do you think that has done?
R. Komaki, MD:
Dr. Pisters, Peter Pisters, is a close friend of ours, Jim Cox and myself, and when he and his wife Dr. Katherine Pisters --Katherine Pisters, she worked with me and Jim Cox for the lung cancer patients for so many years. I know her and Peter, and Jim Cox put Dr. Peter Pisters as a subcommittee chair of general surgery for the RTOG when Jim Cox was RTOG chair, between 1985 and 2000. Yeah he resigned. But anyhow, he is a very good person and the new president, he has more personal feeling. He and his wife, they would like to treat the people, employees at MD Anderson, with more warm feeling, with some respect. They do have more personal feeling, rather than we are machines. I have more hope for MD Anderson, the people who are working. The transition between Dr. Ron DePinho and Dr. Peter Pisters, nobody wanted to speak up about anything because they were so afraid that they will be fired by Steve Hahn, and I don’t know whoever was interim, Marshall Hicks, or whoever. It was so bad, nobody wanted to speak up or support somebody who was under target. A very, very close friend of mine, Tom Buchholz [oral history interview], why did he have to leave? He was vice president and you know, all the people who contributed so much to MD Anderson, they had to leave, and that was just totally a disaster. That was not good for MD Anderson. MD Anderson, 75 years, this was one of the worst times we faced.
T.A. Rosolowski, PhD:
Yeah, it was a very difficult time.
R. Komaki, MD:
It was a disaster and hopefully, that damage will be repaired, but it sure takes a long time. I’m telling you, I had my training at the Medical College of Wisconsin and I was a faculty member at Columbia University, Columbia Presbyterian Medical Center, and the associate professor of Columbia University, and all the people wherever I was, at the ASTRO meeting, NRG meeting, they kept saying, “What is going on at MD Anderson?” They were so negative about the way MD Anderson is going, because the people who left MD Anderson didn’t say much good things about MD Anderson.
T.A. Rosolowski, PhD:
What were you hearing, I mean what were people seeing from the outside. What were their attitudes when you would go to these meetings?
R. Komaki, MD:
They don’t want to talk to MD Anderson people because the people who worked at MD Anderson, they were shut down and they just zipped their mouths. They did not want to say anything, because it goes around and it will come back to them, to haunt them. So they were not open to what was going on, they just wanted to protect themselves. That’s what happened, our dosimetrist and I did all the plans and everything, and that had to be checked by Dan Gomez, who took the section chief, and now he’s out. They did not say anything, what he has changed, and I kept asking why every—my plan has to be checked by him? He never saw my patients and he does not have any right to change my patient plan. He never saw the patients, and that’s illegal and unethical, but they never ever said anything to anybody, what was going on, because they did not want to lose their job.
T.A. Rosolowski, PhD:
Yeah, they were—a lot of people have talked about the lack of transparency [phone rings] and fear about speaking up about things. It was really a problem. Did you need to get the phone?
R. Komaki, MD:
No.
T.A. Rosolowski, PhD:
So you said that you have—I mean what do you hope for the future, I mean what do you think would be some positive avenues for the institution to pursue, to recapture the patient care piece?
R. Komaki, MD:
Okay. All the employees, they have to speak openly, transparently, speak to the leaders straight. Forget about chairman and section chief or whoever. They have to speak directly to the president. The president has to listen to every employee, whichever their level is, otherwise, our institution does not advance, they cannot go back the way it was. Jim Cox, when he was divisional head and chairman, he listened to everybody; administrative person, technologist, dosimetrist, it didn’t matter, he listened, resident, medical student, visitors, he listened. It’s not happening now. They don’t want to speak up, and the leaders, they don’t want to hear from the bottom. That’s the biggest mistake in our institution. We became so big. When we arrived in 1988, we are a much, much smaller group, one third of what we have, and it became so big, and it became out of control, maybe during the time of Ron DePinho. He was not a very good listener. He had to get a grant and he had to establish his research position and support the research group. He was more interested in his own financial aspect and being connected with drug companies and so on, but not a very good leader for the entire institution. But he was very friendly for Radiation Oncology and he was very good to me and Jim. I don’t have any objection about the way he went, I think it really started his wife. She wanted to get everything for her sake and that became obvious, and she was kicked out around that time. It became so critical about MD Anderson leaders, you know they were always interested in themselves, not anybody else, and that became really bad publicity about MD Anderson.
T.A. Rosolowski, PhD:
It was very bad publicity, I mean there were constantly things in the paper.
R. Komaki, MD:
And it started kind of deteriorating around that time. The people, they lost “we’re among the family, we’re among the group, we are among the team,” they lost that and they were so afraid to speak up just because anything they tried to speak up, they were fired and they needed the job. It’s very sad.
T.A. Rosolowski, PhD:
As you look back, I mean and these were difficult years, you know the past years, for you, for the institution at all kinds of levels, but as you look back, what can you pinpoint as the things that have really given you the most satisfaction in the time you spent at MD Anderson? What are you pleased with? [0047:34]
R. Komaki, MD:
I was blessed by seeing so many patients, the best institution, multidisciplinary oriented institution. I went through Columbia University and the surgeons, they said, “why are you called a radiation oncologist, you used to be a radiation therapist?” So I said, “well, our therapist took name of radiation therapist, so we had to be radiation oncologist.” Oh, those --Dr. Haegenson’s students, the breast surgeon, they treated radiation oncologists like technologist. That was totally different when I came to MD Anderson. I was respected. I had to work so hard, since I’m the only one attending to treat patients with thoracic malignancy. The patients who had the lung cancer, malignant mesothelioma (inaudible), thymoma, anything related to the thoracic malignancy were treated by me since I was the only one attending. I was so fortunate to work with Dr. Cliff Mountain and Dr.Jack Roth [Division of Surgery Interview Collection] and Dr.Waun Ki Hong [oral history interview] and [I got all the respects from surgeons, medical oncologists, pulmonary medicine physicians, pathologists, diagnostic radiologists ,our residents, Visitors, nurses, therapists, dosimetrists, physicists and best of all our patients when I was there]. I wanted to be a part of the multidisciplinary team and I was. I was blessed by all those really established people, who took me as a part of the team. Yeah, I miss them so much. They don’t want to talk with those people who used to work at MD Anderson, unfortunately. [ ] I tried to teach residents, I said you have to do everything for our patients, you have to speak up, you have to do everything, you have to use the sixth sense to make diagnosis. You have to go in and see the patients, that’s the only one way to learn about patient care. I just hope that they remember what I taught them.
T.A. Rosolowski, PhD:
What is this sixth sense that you’re talking about?
R. Komaki, MD:
The sixth sense is beyond the five senses which are smell, see, taste, hear and touch we have. When you walk in and the patient will say “Oh doc, I don’t smoke.” I said “No? But I can smell you’re smoking.” I have to use all the senses. Then I can use my sixth when I sit and talk to the patient. They quit smoking or not, I can tell, and if they are suffering or not, I can tell by talking. Some of the trainees, they are losing that. They just go to our computers and they look up the image, and they present, and they minimize talking to the patients because of the time demand. They used to publish a lot of papers with us and the last issue of International Journal of Radiation Oncology, Biology, Physics, which my husband used to be editor in chief, I read the last volume coming out. None of the papers came from MD Anderson. It was so disappointing. When Jim and myself, we are attending, every month we had an article published in the journal, but no more. Publication of patient care, the scientific research and clinical trials [was not found in the February 2019 issue of IJROPB. Maybe they have decided to publish their paper in different journals.]
T.A. Rosolowski, PhD:
Well I’m sorry you’ve had such a disappointing kind of final period of your time with MD Anderson.
R. Komaki, MD:
Yeah. I hope it will come back some time, I don’t know when, but it will take time.
T.A. Rosolowski, PhD:
It does.
R. Komaki, MD:
You know, I think Peter Pisters is a very nice person and he listens, but then after that, how he can bring change, to get MD Anderson keeping up number one cancer center, because if he does not think ahead, it will not be number one. It might take five years or ten years, MD Anderson will go away, because so many years, when I came here in 1988, Memorial Sloan Kettering was the number one cancer center, and I immediately talked with Jim, why not? I can tell MD Anderson can be number one cancer center, but we did not have very good leader at that time. LeMaistre [oral history interview] was president, my husband was vice president, and Jim, be honest, he did not like that job, vice president for five years.
T.A. Rosolowski, PhD:
He told me in his interview, it was a difficult one.
R. Komaki, MD:
He disliked his job because the president, he was not cancer specialist first of all and asked Jim to quit the Chair of the RTOG, which Jim refused. He was a good pulmonologist, and he was a good politician, connected in Austin, and that was a good thing. But to put MD Anderson as the number one cancer center, you really have to do a lot; scientific, patient care, and caring employees, all those elements, somebody who can put it together and put MD Anderson number one, it sure took a long time and John Mendelsohn [oral history interview] and Jim Cox, and maybe Wuan Ki Hong [oral history interview], the people who were there and they had some experience from other institutions, they pushed it to number one. They pushed the whole group, basic researchers, clinical researchers, translational researchers, and the patient care group, made it number one, and I hope it doesn’t slip down.
T.A. Rosolowski, PhD:
Is there anything else you would like to add before we close off?
R. Komaki, MD:
Things go around and come around, that’s my last word.
T.A. Rosolowski, PhD:
Well I want to thank you for your time and candor during these interview sessions. I know it’s been a challenge at times, but I want to thank you.
R. Komaki, MD:
I miss my husband so much.
T.A. Rosolowski, PhD:
Yeah, I can’t imagine. The institution misses him too, I know, many people speak about him.
R. Komaki, MD:
Yeah. The second Ritsuko and Jim Cox Lectureship is coming up July eighth, and our friend, Dr. Sarah Donaldson accepted to be a second speaker. She’s coming from Stanford University. [At noon on July 8, 2019, I hope I can meet with her, my old residents and attending at the Planning Clinic Room B 1. 056 MDACC where Dr. Gilbert H Fletcher was sitting in front of all residents, follows, visitors and attending to decide treatment plans.]
T.A. Rosolowski, PhD:
Now this is a lectureship that you and Dr. Cox established?
R. Komaki, MD:
Established.
T.A. Rosolowski, PhD:
And when did you establish this?
R. Komaki, MD:
That was established November, 2017, so the first one was Dr. Ralph—I have to show you.
T.A. Rosolowski, PhD:
Okay, let me pause the recorder. [Pause in Recording]
R. Komaki, MD:
His name is Ralph, R-a-l-p-h, Weichselbaum. Weichselbaum. He gave first lecture, that was July 16, 2018, that was Jim’s birthday, and all the family members, they were here.
T.A. Rosolowski, PhD:
Oh that’s wonderful.
R. Komaki, MD:
They went to listen to this talk.
T.A. Rosolowski, PhD:
That’s wonderful.
R. Komaki, MD:
Yeah. So this is the one we have established.
T.A. Rosolowski, PhD:
Wonderful, yeah.
R. Komaki, MD:
So, second speaker will be Sarah Donaldson, who is a pediatric radiation oncologist, but Jim Cox influenced her to become radiation oncologist. She used to be a nurse in the operating room. The surgeon in the operating room, I think his name was Dr. William Fletcher, told her, “Sarah, you should go to medical school,” and she decided to go to medical school and she did a residency program at, I think Stanford. Jim talked to her, to become radiation oncologist, rather than going to other modality, because she visited Colorado Springs when she was a medical student and that’s the place Jim was a resident, and he and his friend, Larry Kun, and Frank Wilson, they talked Sarah into becoming radiation oncology resident, and she did the residency program at Stanford. She’s a very close friend of ours, and so she asked me oh, those slides of Jim Cox yesterday, and so I was kind of overwhelmed, to do so many things for Jim. Yeah, but I’m glad she accepted to give a talk in July.
T.A. Rosolowski, PhD:
Well, I want to thank you for your time.
R. Komaki, MD:
You’re welcome.
T.A. Rosolowski, PhD:
It’s been a real pleasure talking to you. All right, and I just want to say I’m turning off the recorder at twenty-five minutes after eleven.
R. Komaki, MD:
Thank you so much for interviewing me.
T.A. Rosolowski, PhD:
Oh, it’s been a real pleasure.
Recommended Citation
Komaki, Ritsuko MD and Rosolowski, Tacey A. PhD, "Chapter 19: Thoughts on MD Anderson in a Period of Change" (2019). Interview Chapters. 1300.
https://openworks.mdanderson.org/mchv_interviewchapters/1300
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