Chapter 5: Bringing Clinical and Laboratory Experience Together and Identifying a Research Focus
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Description
Dr. Kleinerman notes that her fellowship in clinical research had enabled her to secure national recognition. She then spent three years focusing on clinical practice at Children’s Hospital National Medical Center in Washington, DC. She explains how this helped her later research career when it came to identifying treatment for patients. She also describes going to see the film, “Promises in the Dark,” an experience that influenced her decision to focus on oncology.
Dr. Kleinerman then explains how she took a position as a Clinical Associate in the Metabolism Branch of the NCI Bethesda (1978−1981), where she met Isaiah Fidler, DVM, PhD [Oral History Interview], who was working on immune therapy for lung metastasis, research she felt could work for osteosarcoma. Dr. Fidler would become her mentor.
Identifier
KleinermanES_01_20140521_C05
Publication Date
5-21-2014
City
Houston, Texas
Interview Session
Eugenie Kleinerman, MD, Oral History Interview, May 21, 2014
Topics Covered
The Interview Subject's Story - The ResearcherThe Researcher Inspirations to Practice Science/Medicine Influences from People and Life Experiences Professional Practice Evolution of Career Discovery and Success Human Stories
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
Tacey Ann Rosolowski, PhD:
Sure. I’ll pause the recorder. Okay. We didn’t need to pause the recorder. So your next move—and I wasn’t sure what your position was—was this another fellowship from 1975 to ’76 at Children’s Hospital National Medical Center?
Eugenie Kleinerman, MD:
No, I was a pediatric intern resident.
Tacey Ann Rosolowski, PhD:
Oh, okay, a pediatric, a resident at that point.
Eugenie Kleinerman, MD:
Right.
Tacey Ann Rosolowski, PhD:
So you were there for between 1975 and 1978.
Eugenie Kleinerman, MD:
Correct.
Tacey Ann Rosolowski, PhD:
So tell me about that experience. What was happening there with your research and your—
Eugenie Kleinerman, MD:
Okay. Well, so my husband finished his residency and he was accepted at NIH for a clinical fellowship in oncology, so I really had to limit—I had wanted to do my residency with Children’s Hospital, Philadelphia, because that was the premier pediatric program, and I had already published, and I had received an award at medical school graduation for my research. Ralph was instrumental and Dr. Charlie Daniels [phonetic], who’s the pathologist that I did the collaboration with, they were instrumental in getting me that award. So I really probably could have gotten into CHOP or into Boston Children’s, but I sort of—you know, my marriage was important, so I had to either go to Hopkins or to one of the two programs in Washington, which were weak compared to Children’s Hospital, Philadelphia or Boston Children’s. But Hopkins was not. Hopkins was the Harriet Lane Service, and that was a very preeminent service, but it was in Baltimore. But I went there to interview, and they offered me a position out of the match. You know, on the match, you have to write down what your four choices or ten choices are, and then the hospital writes and they sort of match you. And what they said, “If you want to come here, we’ll take you, and we’ll give you time during your first year to do research, we’ll give you time—,” you know. “We want you to continue your research.” But the call is every other night and Saturday rounds, so that meant I would be commuting from Washington, and most of the residents lived in the compound across the street.
Tacey Ann Rosolowski, PhD:
Oh, wow.
Eugenie Kleinerman, MD:
So I thought long and hard and I said, “You know, my marriage’ll never sustain this, just won’t. I’m going to be tired. I’m going to be cranky. He’s going to be tired. I’m going to be commuting an hour each way. Not going to work.” So I looked at Children’s Hospital National Medical Center and I looked at Georgetown. Georgetown was a very small program; it was D.C. Children’s at that point, before they renamed it. It was a big inner-city children’s hospital. They could have cared less whether I did research. They could have cared less whether I came from Duke. So they didn’t offer me a position outside the match. They said, “You know, rank us. We’ll rank you, and we’ll see what happens.” So I did rank them first, and I did get matched there. And actually, in retrospect, it was the right decision to do, because it was a very intense clinical three years. Nobody did laboratory research there, really. They had this what they called the interstitial space. It was between two floors with no windows. That’s where the labs were. I mean—
Tacey Ann Rosolowski, PhD:
Yeah. (laughs)
Eugenie Kleinerman, MD:
But, boy, did I learn how to take care of patients. Could do it in my sleep. My clinical skills were really sharpened. And because it was in D.C. and there were many women who were married to attorneys, so they were locked into the D.C. area as well, my colleagues were exceptional people. So it really was a lot of fun, a different, totally different atmosphere, all only focused on clinical—
Tacey Ann Rosolowski, PhD:
Interesting.
Eugenie Kleinerman, MD:
—taking care of the patient, no clinical research, no basic science, you know, “How does this work? What’s the mechanism?” Just taking care of the patient.
Tacey Ann Rosolowski, PhD:
How did that clinical immersion have an impact later on your research career?
Eugenie Kleinerman, MD:
Excellent question. It gave me the confidence to come here and take this position, because after my clinical residency—I was there for three years—I realized I don’t want to go into private practice. After five years, I’m going to be bored. Nothing against it. It’s just after—you know, I want to be with the discovery. I want to be the one not just following the recipe. I want to be cooking, making the recipe. I want to change practice. But I was going to be an immunologist, in keeping with the research that I did in undergraduate school. So I got a fellowship at the National Cancer Institute in the metabolism branch, which did immunology, after my residency. So I went out to NCI from ’78 to ’81. My husband was an oncologist, and he kept saying, you know, just like [unclear], “Oncology, oncology, oncology. It’s interesting. It’s—,” whatever. He was a movie buff, so he’d drag me to all these movies. So he took me to see—it’s called Promises in the Dark, starred Marsha Mason, and it was the story about a woman general practitioner who got divorced and is moving to a small town in probably eastern Massachusetts, I guess, and she’s covering the practice for her partner, and she gets called because a high school student kicks a soccer ball and she breaks her leg. So she’s called to the emergency room, and she looks at the x-ray. She doesn’t like something on the x-ray. “You know—.” “No, I want another x-ray taken.” So they take another x-ray, and it turns out she has osteosarcoma, and she develops pulmonary metastases, and she goes through the chemotherapy and she relapses. And Marsha Mason’s on the phone calling the NCI and saying, “You must have something. This is a young girl. You must. Don’t tell me you don’t have anything for her. She’s going to die.” And I walked out of that movie and I was in tears, and I was like, “I don’t know what I’m supposed to do with this. I just don’t know.” So then I started becoming more interested in oncology and I—
Tacey Ann Rosolowski, PhD:
(laughs) I’m sorry. You’re the first person who’s ever told me that they had a movie that was a catalyzing event, but you never know where the inspiration’s going to come. And I have to say when you were telling the story, I was kind of tearing up. I probably shouldn’t go to that movie. It would be Kleenex central. (laughs)
Eugenie Kleinerman, MD:
I have it here in my desk. I have it here in my desk. I’ve made my children watch the movie.
Tacey Ann Rosolowski, PhD:
Really? That’s amazing. Yeah.
Eugenie Kleinerman, MD:
It was very realistic. In retrospect, they did a great job, very realistic. So I really didn’t know what to do with it. So I was going to finish my fellowship, and then we had the decision what’s the next thing to do. And during that time I started to investigate what effect chemotherapy had on the immune system. Remember I told you I had done viruses, so this is sort of like it was a natural. Okay, cancer, a little cancer chemotherapy. People said it’s immunosuppressive. Is it really immunosuppressive? Nobody proved it. In fact, it isn’t necessarily. So, you know, I was doing this research. Okay, where am I going to go? Bottom line, my husband got offered a position, a permanent position at NCI, and there was a new facility opening up in Frederick, which was thirty miles north, but it was an NCI facility, and I was offered a position. And I was offered a position down at Walter Reed. And I just didn’t know what to do, so I called Ralph. I said, “Ralph, you know, Len wants to stay here, and I just don’t know what to do.” He says, “Well, you know, there’s this guy Josh Fidler, who’s out at Frederick, and he has a really great reputation. I think you need to go talk to him.” I said, “Okay.” He said, “Tell me about Walter Reed.” I said, “Well, you know, it’s in the city and, you know, the pay is good, the benefits are good, and I knew the people. They’re very nice.” And he said, “No, no, no, no. What about the work?” “Well—.” He says, “I don’t like what I’m hearing. If you don’t like the work, if you’re not excited about the work, you’re going to be miserable. I don’t care how much money you’re making and I don’t care that it’s convenient. You’re not going to like it.” So the American Association for Cancer Research happened to be meeting in Washington, D.C., and I opened up the program and there Josh Fidler is giving a lecture. Ralph says I should go talk to him. Okay. Well, let me go hear what he’s doing before I go talk to him. So I go, and what does he present? He presents his work using this immune modulator in this mouse model that has a tumor in the leg. He amputates the tumor, it has lung metastases, he gives this immune-therapy, the lung metastases go away. I said to myself, “This is osteosarcoma. This therapy could work in kids with osteosarcoma.”
Tacey Ann Rosolowski, PhD:
Wow.
Eugenie Kleinerman, MD:
So, took me about two months to make an appointment with him, because this was in April, so I wasn’t going to start till July. So I took the position at Frederick, and I went to make the appointment, and I told him my idea. And you can imagine, “Okay, this is what we’re going to do.” He takes out paper. “Okay. This is what we’re going to do. You’re going to come. You’re going to get [unclear]. We’re going to have to show the—,” da, da, da, da, da, da. That was the beginning.
Tacey Ann Rosolowski, PhD:
Yeah. So he just completely—wow. You walk in the door, you’re in.
Eugenie Kleinerman, MD:
Right.
Tacey Ann Rosolowski, PhD:
What did he see? What did he see in you?
Eugenie Kleinerman, MD:
I guess somebody who was eager. I don’t know.
Tacey Ann Rosolowski, PhD:
And you presented him with this idea, and it’s like, “Wow [unclear].”
Eugenie Kleinerman, MD:
Yeah, and I think he was looking for—you know, he’s a vet and he’s a Ph.D., and osteosarcoma does affect dogs. So I think he saw this as a real opportunity for him, too, to get into the clinic, because I had clinical legitimacy. So this is a long way to get to your question of how did that immersion, clinical immersion—so when he came here and wanted me to come here, I had not seen a patient for three years because I was in the lab.
Tacey Ann Rosolowski, PhD:
So the whole time at the NCI, you were just in the lab.
Eugenie Kleinerman, MD:
It was actually more than three years. No, it was three years. It was three years when I went out to Frederick. I didn’t see patients anymore. I was there for three years. And I walked into the clinic, it was like riding a bike.
Tacey Ann Rosolowski, PhD:
Wow.
Eugenie Kleinerman, MD:
And I think it’s because I was just so comfortable with taking care of patients and drawing blood and feeling bellies and looking in eyes. You know, after you do it a million times, it just comes back. And so I exuded the confidence when I walked into the clinic, people saying, “You know, she’s a basic scientist. She’s coming into clinic for one day a week. Who does she think—?” But they became comfortable and they saw that I knew what I was doing.
Recommended Citation
Kleinerman, Eugenie S. MD and Rosolowski, Tacey A. PhD, "Chapter 5: Bringing Clinical and Laboratory Experience Together and Identifying a Research Focus" (2014). Interview Chapters. 1401.
https://openworks.mdanderson.org/mchv_interviewchapters/1401
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