Chapter 05: Issues with Multi-Disciplinary Care and Taking a Position at the Cleveland Clinic
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Description
Dr. Schover begins this chapter by explaining why she chose to leave MD Anderson in 1986 for a position as staff psychologist at the Cleveland Clinic. She sketches the political environment in the Department of Urology that motivated her decision.
Next, Dr. Schover describes her work at the Cleveland Clinic, where she began to focus on fertility issues and conducted a first, pioneering study of fertility in young cancer patients. She also co-authored a textbook on sexuality and chronic illness with Tony Thomas: this book is still in print.
Dr. Schover then explains why she left the Cleveland Clinic. Ellen Gritz, PhD, the head of Behavioral Science at MD Anderson offered her a job. Dr. Schover talks about the decision she had to make between her marriage and her career and other work/life issues.
Identifier
SchoverL_01_20180918_C05
Publication Date
9-18-2018
City
Houston, Texas
Interview Session
T.A. Rosolowski, PhD, Oral History Interview, September 18, 2018
Topics Covered
The Interview Subject's Story - Professional Path; Multi-disciplinary Approaches; Joining MD Anderson; Growth and/or Change; Institutional Politics; Controversy; Professional Path; Evolution of Career; The Researcher; Personal Background; Discovery and Success; Experiences Related to Gender, Race, Ethnicity
Transcript
T.A. Rosolowski, PhD:
So, tell me about that period, because it was five years before you left to go the Cleveland Clinic. Tell me about what was going on during those five years.
Leslie Schover, PhD:
Well, it was a nasty time in Urology, because the former chair of Urology was a very well respected surgeon and clinician, and he decided that he wasn’t really the right person, in the era of multidisciplinary care, to lead the department forward. So he decided to stay on the faculty but to resign as chair, and that led to a search for a new chair.
T.A. Rosolowski, PhD:
Who was this individual who resigned?
Leslie Schover, PhD:
I’m having another senior moment [Douglas Johnson].
T.A. Rosolowski, PhD:
Okay, we can put it in later. I wasn’t sure if you were not mentioning out of discretion or if it was…
Leslie Schover, PhD:
No.
T.A. Rosolowski, PhD:
Okay. We’ll just find it later, or you’ll think of it.
Leslie Schover, PhD:
I’ve always been really bad with names. I’m getting slightly worse with age. It’s like if I saw the name of him….
T.A. Rosolowski, PhD:
So you said he resigned and then a search was initiated.
Leslie Schover, PhD:
They did a national search and they brought in about five different people, but they ended up picking Andy von Eschenbach as the next chair.
T.A. Rosolowski, PhD:
And he was obviously an internal hire.
Leslie Schover, PhD:
Yeah. He had been originally, the protégé of the old chair, but they had very different patient philosophies, and so over the years they’d gotten estranged. So what happened—
T.A. Rosolowski, PhD:
What was the difference in their philosophies?
Leslie Schover, PhD:
Well, I think Andy, he was more into multidisciplinary care. He was less the traditional bite-the-bullet Texas surgeon kind of person. They were also just very different personally. The former chair was on his third marriage and was kind of a very embittered person, and Andy had a very big Catholic family and was very close to his wife. He was just much more, he was, I think Andy was more political, so they were just very different, but what it devolved into was a war. So when there would be a patient and there would be a case conference, they would take, you know, often different sides in terms of what the treatment plan would be, and the residents and fellows kind of chose up sides too, and it was just very ugly. And because I was more Andy’s kind of hire and protégé, I felt like I got caught in the middle without wanting to be and I by that time had an American Cancer Society grant. I needed patients to be referred into the study, and I wasn’t getting very many referrals, partly because --I don’t think that the former chair was blocking it deliberately, but they just weren’t all that interested in referring patients into the study. Finally, towards the end of the time I was there, I went to Andy and said, “I’m really concerned, I don’t know how I’m going to fulfill this grant if I don’t get more referrals,” and he said, “You know, I’ve got enough problems in this department right now. I don’t have the political currency to put into helping you get more referrals.” And anyway, and I’ve always remembered this, he said, “I think you think this issue is more important than the patients think it is,” which was very you know, different from anything he ever said before when he hired me. So I thought the writing is on the wall, I’ve got to get out of here and around that time, I got an offer out of the blue from the Cleveland Clinic, to go to Cleveland and be part of a multidisciplinary sexuality clinic with GYN and Urology and myself.
T.A. Rosolowski, PhD:
Before we focus on that, and I do want to hear about that time, I wanted to just go back to that conflict over multidisciplinary care within the Department of Urology, because obviously, multidisciplinary care was coming in as sort of the MD Anderson hallmark. So what was the source of the difference there?
Leslie Schover, PhD:
You know, I’m not even sure and I don’t know that the issue was always multidisciplinary care in these fights. I think it was more like there was so much interpersonal bitterness that you know, if they had a difference of opinion about what a treatment plan should be, it split the department into these sides. I don’t remember the details any more. I don’t think there was an issue like multidisciplinary versus straight surgery, that was more of an issue. It might have been a little bit more innovative treatments versus traditional, radical surgery, but I’m not so sure about that.
T.A. Rosolowski, PhD:
Okay. I mean that’s a common thing, when atmospheres go poisonous, that there’s the issue that’s the explicit issue and then there’s the real issue that’s in the background.
Leslie Schover, PhD:
Yeah, yeah.
T.A. Rosolowski, PhD:
Okay. Well if you have other thoughts on that, that’s an interesting topic to pursue just for clarity, as a history of the department.
Leslie Schover, PhD:
Yeah. I think people characterized Andy as someone who was too political, who wanted to get along with everybody and get [ahead] at the institution, which I think was somewhat unfair, but he certainly, throughout his career, certainly followed that model of wanting to be a leader, et cetera.
T.A. Rosolowski, PhD:
Well, would you like to talk about the experience at the Cleveland Clinic? What was that about?
Leslie Schover, PhD:
Well, I was kind of scared about going there, because I enjoyed doing research, as well as clinical work, and I perceived, at least the Psychiatry Department, I thought, at the Cleveland Clinic, was really kind of mediocre and non-research oriented, and I was worried that if I went there, I wouldn’t be able to do much research. I was offered a joint appointment with psychiatry and urology, and the Urology Department, in contrast, was very research oriented and it was one of the top and --I think it’s maybe rated as the top Urology Department in the country. Also, there had been a long conflict at times, between psychologists and psychiatrists at the Cleveland Clinic. The psychologists had had a lot of leadership roles in the 1970s and early ‘80s, and then they brought in some new psychiatrists who resented the authority and the kind of status in the institution that psychologists had and did their best to kind of undercut that, and I didn’t want to be caught up in that either. There was still a lot of bitterness and [ ] having just come out of this bitter war, I really didn’t want to get caught up in that. So I ended up, fairly quickly, just really trying to spend as much of my time as I could in urology and avoiding a lot of the psychiatry stuff as much as I could, because I just felt like I fit better there. Also, that was where my patients were coming from. Also, soon after I got there, they hired a gynecologist who was double boarded in gynecology and psychiatry and was kind of interested in problems like genital pain and vulvar pain, which was a fairly newly recognized syndrome at that time. I worked with him a lot and then I got involved with the infertility program, and they were a great bunch. They were doing things like starting one of the very first donor programs that used volunteer [egg] sudonors, who got paid a small amount at that time. We had to put together a program with Bioethics and Psychology and Gynecology, to try to evaluate them and make sure we weren’t exploiting them. And then I got interested in things like how parents made decisions about using sperm or egg donation and what sperm donors were like, you know some of those third-party parenting issues. In the end, just before I left, I did a survey study about young cancer patients and their attitudes about having children, which was kind of a pioneering survey, because very little had been done in that area, and we didn’t even know, did most people want to have children or did the experience of cancer make them too scared and not want to have children. So, that paper was very interesting and we found that you know, the great majority of people who were childless when they were diagnosed with cancer did want to have children. It was kind of an influential start of a whole new area of research.
T.A. Rosolowski, PhD:
Now, did you—the study that you had had trouble enrolling patients in at MD Anderson, did you transfer that study to the Cleveland Clinic?
Leslie Schover, PhD:
I’m trying to remember. I think it was basically ending around that time, so I think I did the best with it that I could and got a publication out of it.
T.A. Rosolowski, PhD:
So it sounds like that time at the Cleveland Clinic really kind of consolidated things and expanded some things.
Leslie Schover, PhD:
Yeah, and I worked with a lot of different chronic illnesses. I kept on working some with cancer patients, and I worked with multiple sclerosis and diabetes patients. Actually during those years, I coauthored a textbook on sexuality and chronic illness, where we had chapters on different illnesses and their effects on sexuality. I think it was published in 1988. It may still be a little bit in print, you know how they can just run off a copy of something. I’ve never updated it because in recent years, I’ve not been that interested in doing books. I also did a couple of self-help books. I did a book on sexuality for men over 50, which was a little early for its time and I did a self-help book for couples with male factor infertility, and I worked with Tony Thomas, who was the Cleveland Clinic’s expert on male infertility, and one of maybe five nationally known experts in that area. We wrote a book together and that one is still in print. No one else has done another book like it, where we looked at the medical and emotional aspects. Basically, half of infertility is male factor, which a lot of people don’t realize. So I had a lot of good learning experiences, but I was frustrated, and in the end, I ended up essentially being fired at the Cleveland Clinic. What happened was that my interests and my wish to be more involved in research didn’t dovetail very well. They were going through cycles of kind of boom and bust. They would hire a whole bunch of staff and then, if revenues didn’t look as good as they were supposed to, they’d fire a bunch of people. It was a very lousy management strategy. I think it’s improved over the years. So, I wasn’t bringing in enough revenue, but part of the problem was that it wasn’t under my control, because in urology, there was an internal medicine doctor who was seeing most of the men with problems. He liked to do everything himself. So I kept trying to float a model where I would do the psychological evaluation, he’d do the medical stuff, and we could see a lot more patients and do things more effectively, and he wasn’t having any. He was just kind of a very methodical, kind of obsessive kind of guy and he wanted to do things his way, so I wasn’t seeing a lot of the patients that he was seeing. Then, Maury Markman, who was at that time, the head of the Cancer Center at Cleveland Clinic and later came here for a while and now is at Cancer Treatment Centers of America, asked me to take a leadership role in developing the first familial inherited cancer clinic at the Cleveland Clinic. So I did a lot of training myself up to understand that whole area and develop an assessment, you know questionnaires and interviews and stuff, but then they hired a geneticist who was not a cancer geneticist and who didn’t believe that psychologists should have any role in a clinic like that, and he cut me out of the process. So there was a big part of what I was supposed to be doing that I couldn’t do either. So they told me I had six months to find another job, over the objections of the Urology chair, who wanted me to stay. Maury Markman offered me a soft money job, to stay on in the Cancer Center, and at the same time, Ellen Gritz [oral history interview] had already come here and even two years before that, had offered me a job here. My ex-husband, who is a biochemist, couldn’t find a job at Houston, and so I had regretfully turned down that job. At this point I said, if that job is still open, I really want to look at it seriously. So it was a very difficult time, because I had been married for about eight or nine years. I had a seven-year-old son and I knew that my ex-husband, who was about nine years older, had been having a terrible time getting tenure or finding another job, and he had finally just gotten tenure, kind of by the skin of his teeth, at Case Western [Reserve University] and I knew it was unlikely he was going to find a job in Houston. So I had to essentially make a choice between my marriage and my career, and I felt especially terrible for our son, because he didn’t think anything was wrong and our marriage was really not in great shape. So I decided that the best thing, I have to support myself, I have to support my son and send him to college, and this is a great job. My ex-husband kept saying oh, it’s the job of a lifetime, you should go and you should take it and I’ll try to follow you, even though I didn’t believe him. So I decided to come back to MD Anderson, and I did end up getting divorced very shortly after.
T.A. Rosolowski, PhD:
And your former husband’s name?
Leslie Schover, PhD:
His first name is Menachem, so M-e-n-a-c-h-e-m, and his last name is Shoham, S-h-o-h-a-m. We have actually, a very friendly divorce. I speak with him regularly and my son spent summers with him. I was petrified that he was going to not want me to take my son out of state, but he had three older children from his first marriage and I think he was a little bit more interested in having his midlife fun than he was in having a full-time child around. I mean, he loves our son very much, but it was fine with him to just have him for a few weeks in the summer and holidays, and thank goodness that worked out. I just, I didn’t take any child support essentially, because I knew that was going to be a big bone of contention, and I was, at that point, making more money than my ex-husband and I decided I’d be better off just keeping our relationship as excellent as possible, so that our son doesn’t suffer and I don’t care about the money. So that’s what we did.
T.A. Rosolowski, PhD:
Those life issues do affect, I mean there’s a connection between profession and life.
Leslie Schover, PhD:
I think I was one of the few women I know who actually was financially better off after a divorce, because during our marriage, he was still supporting his kids in Israel and even though they were almost adults, and so I didn’t have that burden of worrying about their financial support any more and I could just worry about us. I paid for my son’s entire private school tuition at Oberlin [College], which was probably with all his expenses, about a quarter of a million dollars. Now he’s in grad school at NYU [New York University] and actually, my ex-husband is paying the part of his tuition that’s not under scholarship. I almost fainted, so.
T.A. Rosolowski, PhD:
And your son’s name?
Leslie Schover, PhD:
My son’s name is Oren, O-r-e-n. He has his father’s last name.
T.A. Rosolowski, PhD:
Difficult time.
Recommended Citation
Schover, Leslie PhD and Rosolowski, Tacey A. PhD, "Chapter 05: Issues with Multi-Disciplinary Care and Taking a Position at the Cleveland Clinic" (2018). Interview Chapters. 1496.
https://openworks.mdanderson.org/mchv_interviewchapters/1496
Conditions Governing Access
Open
