Chapter 06: An International Pathway back to MD Anderson

Chapter 06: An International Pathway back to MD Anderson

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Description

Dr. Goepfert begins this chapter by describing his activities on returning to Chile in 1968, after finishing his research project in the Section of Head and Neck Surgery at MD Anderson. He practiced general surgical oncology at the Instituto Radium in Santiago and also created a multidisciplinary pediatric tumor clinic at the Hospital Roberto del Rio. He explains that Chile was in political turmoil with coming elections and anticipated the election of a Socialist government that would not put a high priority on cancer treatment. He took his family to Stuttgart, Germany and went to work at the Katherinenhospital (’70-’71). He did not flourish in the rigid work environment in Germany, and he returned to Houston for a residency in Otorhinolaryngology at Baylor College of Medicine and was a research project investigator in the Section of Head and Neck Surgery6 at MD Anderson. In 1974, as he says, he walked out of his residency and became Chief of Surgery in the Otolaryngology under Dr. Stanley Dudrick at the University of Texas Health Science Center Medical School. He describes how he met his main goal: finding a way for a range of specialties (general surgeons, plastic surgeons, dentists, etc.) to collaborate in handling trauma of head and neck surgery. He also talks about the first resident in the Head and Neck section, Pedro Jimenez. He did not “give up” MD Anderson, but was appointed Associate Surgeon and Associate Professor in the Section of Head and Neck Surgery. He then describes the process of becoming Chair of the Head and Neck Section of MD Anderson, the first board-certified otorhinolaryngological surgeon to take on the role.

Identifier

GeopfertH_01_20120827_C06

Publication Date

8-27-2012

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Path; Professional Path; The Researcher; The Clinician; Building/Transforming the Institution; Multi-disciplinary Approaches; Joining MD Anderson

Transcript

Tacey Ann Rosolowski, PhD:

Now, after you did your research project in regional chemo here and your senior fellow in surgery, you mentioned that you went back to Chile, and you were developing, as I understand from doing my background research, a multidisciplinary pediatric tumor clinic at the Hospital Roberto del Rio. Can you tell me about that, and why did you choose to leave that?

Helmuth Goepfert, MD:

I left Chile for another reason, but I was at the Instituto Nacional Radium, which I told you was basically a barn; it was very primitive. Radiation therapy—they had a covered unit that was underserved in the sense that God knows when was the last they what the output was. It was very primitive. Pediatrics was done in a separate hospital—Hospital Roberto del Rio, which was across the street. To some fortuitous meeting, I had talked to the then chief of maxillofacial surgery, which was a general surgeon that made his reputation in Latin America for the management of cleft lip and palettes. He invited me to help him in this, which was, again, a way to enhance my income because the income from the Instituto Nacional Radium was miniscule and I had to feed a family of three plus myself. So, I helped him, and he said, “Listen, our tumor system at Roberto del Rio is very disorganized. Would you mind looking at it?” I said, “I’d be happy to. Whom do I talk to?” He gave me the contact. I immediately saw that the basic thing was a limited knowledge, a willingness to do something provided that you sort of made clear what the boundaries were. So, I figured out, I said, “Okay, I myself, I love surgery, but here I have to tackle this a little bit differently.” So, I created a tumor board, but I did not intend to do the surgery because I knew there were surgeons that wanted to do it. I offered myself to assist them in the surgery but not to take over the surgery. So, I organized this clinic, and we had routine meetings every week in which we discussed cases, and we decided on cases, and some of these cases are used for case reports that are in the initial literature of what I published in Chile. So, as I say, this is the way I worked it. Now, at the Instituto Nacional Radium people really didn’t work very hard. They had a salary there because it was an assigned salary, and they worked from 9:30 until 12:30 and then did their private practice in the afternoon, so that’s all they did. I could not get enough steam among these older folks to really create anything different, so I went out of the system and looked at the university and helped them develop some modem of interdisciplinary care, but it was incomplete. Now, this is 1968-’69, and the country was in some turmoil. It was clear that the next president very likely was going to be a socialist/communist, which was Dr. Salvador Allende. Now, Salvador Allende had been a classmate of my dad, but that certainly wouldn’t help me. But what I sort of figured immediately was if a socialist takes over, it would be the first government in the world where a communist had been elected in a democratic fashion. I thought cancer, the way I see it, is at the bottom of the list of what they would like to improve. You cannot gain much in a system that is basically a country in development by improving cancer care. You gain much by improving infant mortality, infectious diseases, transmittable diseases, and all of that has to do with vaccination. That gives you much more product for the buck. So it was that that I saw. Then I saw, too, if they take over, they may close the borders just like Cuba or like China. This was a little difficult. So, the family council decided we were going to leave, so I applied for a visa to the United States, but the quota was such that it would take at least 6 months to a year. Now, the election was going to take place in November, or somewhere there, so when I saw that this was coming, I basically said, “What do I do next?” Now, the history has to be taken back for my initial years in Bolivia, where as a German-speaking physician I was invited to Santiago to host one of the visitors that came from Germany for the Latin American Cancer Conference. I was the host for the director of radiation therapy at the Katherinenhospital in Stuttgart. I showed him around Chile in 1963. Now, in 1970—yeah, the beginning of ’70—he said, “Listen, if you are having trouble in Chile, I can give you a job.” So of course we took it. We took a boat from Buenos Aires to Genoa. I took all of my family with me, and we left Chile. I was in Katherinenhospital, hired as a physician in charge of organizing the chemotherapy for solid tumors at this hospital. Now, the system in Germany, of course, is a very silo-oriented system. It still is to an extent. The only one that really has to say what is to be done is the professor. The democratic organization that exists within medicine within the United States— Although, yes, there are some silos here but not as visible as there. I couldn’t live with that. So, I had been in touch with Rick Jesse. I came for the cancer conference that was here in 1970. I visited with him. I visited Germany. I stayed in Germany for as long as I needed, but the minute I transferred all my papers to the embassy in Frankfurt, and as soon as they said, “You have a visa,” we were on a plane and back to Houston. So that’s how I arrived here in May 1971.

Tacey Ann Rosolowski, PhD:

In ’74.

Helmuth Goepfert, MD:

In ’71. Now, I had no training, and by just a stroke of luck Dr. Alford, who ran the department over there, had four residents and one of them unfortunately got a back problem. In those days back problems basically limited your existence, not like today. He was out of the residency, so he had a vacancy, and he offered me the vacancy, but going in there as one that had already been trained in head and neck cancer, I became a threat to his junior faculty. The initial discussion we had he said, “Listen, I’d love to have you work as a resident, but—” I said, “No. I can handle that.” So I had to be very careful how I dealt with anything that had to do with tumor management or anything like that because I obviously, based on the two years I had been at MD Anderson, was more capable than the fellows they had there. They were good guys, but obviously they didn’t have the ability to deal with it technically as somebody who had been trained at MD Anderson.

Tacey Ann Rosolowski, PhD:

Can I ask you just a quick question about your experience at the Katherinenhospital? Was there anything—I mean—despite the limitation of what you were able to do there because of the way it was structured—?

Helmuth Goepfert, MD:

I was basically in charge of the inpatient unit. Patients there, in those days, were admitted for the length of their treatment. So, as I say, I treated advanced patients. We were doing some limited neoadjuvant treatment in the sense of giving chemotherapy before treatment even though there was no evidence for that. But in those days evidence didn’t matter much. And I worked very closely in certain areas of gallium scintigraphy with the radiologists and even wrote a paper in German. So, as I say, these are the things that I did then, and I had to dictate letters in German and correspond with these referring physicians and so forth, so it was an interesting time.

Tacey Ann Rosolowski, PhD:

Was there something that you gleaned from that experience that helped you develop as a surgeon or as an administrator? Because that became important later.

Helmuth Goepfert, MD:

Basically I learned how things were not to be done. I learned from the failures of somebody else. As I say, no, I didn’t get any training in administration ever except by following the example of somebody else. Formal training in administration only came later in the late ‘80s when we had the Rice course.

Tacey Ann Rosolowski, PhD:

Right. In ’92 you went through that executive development course.

Helmuth Goepfert, MD:

Executive development course, but before that it was trial and error—it was trial and error. And why they made me chairman then when there were other candidates, I don’t know, but it was a difficult time for me. So, I came here and I did my three years of residency. Interestingly enough, they waived the requirement for me to do general surgery. The board waived it; otherwise, it would have been five years.

Tacey Ann Rosolowski, PhD:

Why did they waive it?

Helmuth Goepfert, MD:

Because of the training I had in the past. They accepted that.

Tacey Ann Rosolowski, PhD:

That’s great.

Helmuth Goepfert, MD:

And in those days the University of Texas Health Science Center Medical School here in Houston had just hired a chief of surgery, Dr. Stan Dudrick, and Stan Dudrick was developing his sections. One of the sections was otolaryngology, because that was under surgery. The ex-chairman there, Dr. [Herbert] Harris, suggested my name to Stan Dudrick, and I walked out of residency and became chief somewhere. You see? As I say, those were interesting times because Stan Dudrick loved to hear himself. He’s a marvelous guy otherwise. He loved to hear himself, and some of our monthly staff meetings started at 6:30 in the afternoon and didn’t end until midnight. I mean, I was there together with Red Duke. You know who Red Duke is. (laughs)

Tacey Ann Rosolowski, PhD:

That’s pretty astonishing to walk out of being a resident and then to be Chief of Section. So, what did you see as your goals when you took on that role?

Helmuth Goepfert, MD:

Number one, my heart was in head and neck cancer. Number two, I had the necessary training to do all the subspecialties of otolaryngology—stapes surgery, laryngology, all of what was available in those days.

Tacey Ann Rosolowski, PhD:

I missed that first phrase.

Helmuth Goepfert, MD:

Stapes—otosclerosis surgery. I did only one stapedectomy once I finished the residency. I said, “No. I’ll leave this for somebody else,” because I immediately recognized that there are certain things that, unless you have the proficiency of repetitive action, you shouldn’t be doing it. That was one of the first things that I learned. The second was I wanted to create the section because this was the job I had—to create a section. But this was in the presence of General Surgery that did not want to give up thyroid surgery, Plastic Surgery that did not want to give up the trauma at Hermann Hospital, and dentists who wanted to participate in the trauma of head and neck surgery. So, one of the first, not battles to fight but issues to agree upon, was these three separate sections—how were we going to handle the trauma? We know that the oral surgeons have a mastery of dentition, of occlusion. The plastic surgeons are basically predominantly for the beauty, and the otolaryngology, okay, because it’s part of where we work daily—day in and day out. So, we came to an agreement—and there was no resident available yet at that time—6 months later we had the first resident—that we would alternate every 3 nights in the emergency room on call. So, when trauma came in on the night of Ear, Nose, and Throat, we would take care of it, and the day it came in for Plastic Surgery, they would take care of it. The day it came in for Dental, they would take care of it. We tried to be available for the need between us.

Tacey Ann Rosolowski, PhD:

Now, that seems like a kind of arbitrary way to—

Helmuth Goepfert, MD:

Yeah, but it is the way that it had to be solved in order to satisfy the need of three specialties. Now, shortly after I started the job, a gentleman that had been trained in Cuba and practiced in Cuba came to me. He came over to Miami. His wife already was in the States. She was a pathologist in Miami. He wasn’t going to start a practice here without having done a residency. Mind you, he was 57 years old, and he offered himself to be a resident, so I basically had the first pillar to form a residency. I approached the residency review committee and the board and everybody else, and I got a temporary permit to run a residency with one resident. That was Pedro Jimenez. Now, Pedro Jimenez finished the three years of residency with me. The first time, at age sixty, that he sat for the boards in otolaryngology he passed it, which was unusual. Nobody had done it, and nobody had done it at that age. He started practice here in Houston. Pedro Jimenez eventually died a couple of months ago of old ago, but he was the first resident in otolaryngology at UT Medical School. Now, I wasn’t going to totally give up MD Anderson, and during my residency I kept work in chart review with Richard Jesse. It was a grand supplemented part of my income. I wasn’t going to give up what I had learned at MD Anderson nor give up my participation there. When I got my initial appointment, it paid sixty percent by medical school and forty percent by MD Anderson.

Tacey Ann Rosolowski, PhD:

Because you were a part-time faculty member at that point—associate professor in 1974?

Helmuth Goepfert, MD:

Yeah. I became associate professor. Why so quick? I don’t know. (laughs) I became associate professor here and over there. As I say, in those days there was basically hot, black asphalt between here and Hermann Hospital. You got out of the back of MD Anderson, and you walked across the hot pavement all the way over to the other side a couple times a day. It was quite a bit of sweating. As I say, this was in 1974. Then we had the big flood in 1972, where six feet of water was here on Holcombe. Everything flooded. Then in 1979, when Dick Jesse was already with advanced cirrhosis from hepatitis, he had acquired from a patient back in ’73, I gave up the Hermann Hospital because it was a little too much. It was getting crazy. Somebody else was selected. Then I came full-time to MD Anderson. Shortly thereafter, Dick Jesse was asked to put me in as a deputy chair—this was sometime around there—Deputy Chair of Head and Neck Surgery, and Dr. Jesse then died in August of 1981. So that is how I got into the role of being a chairman here. Now, I basically was the first otolaryngology board-certified member of this department. All the other people had been general surgeons or were general surgeons, which caused a little bit of friction. Most of the time it went without a hitch, and certainly it was not a big deal outside the institution. The institution itself was not bad, but outside of the institution it was said, oh, finally MD Anderson has become an otolaryngology department. But I didn’t see it that way. Life has to go on regardless of what it is, but the otolaryngology out in the community, they made it a big deal.

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Chapter 06: An International Pathway back to MD Anderson

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