Chapter 06: Accepting Epidemiology as Part of Oncology

Chapter 06: Accepting Epidemiology as Part of Oncology

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Description

Mrs. Hermes begins the chapter with some memories of R. Lee Clark and the focuses on Dr. MacDonald’s relationships with faculty at MD Anderson and the process of building acceptance for epidemiology. She confirms that there were “not a lot of famous women” at MD Anderson at the time and also that clinicians were not particularly data driven. She notes that Dr. MacDonald has a poor working relationship with Dr. William Russell, the head of Pathology, but otherwise was well respected. Mrs. Hermes said that she worked closely with Dr. Clark, who took advantage of her strong science writing skills. She also notes that it took a while for epidemiology to take hold as an academic study. She recalls how much she loved working for Dr. MacDonald and what a “marvelous” data analyst she was.

Identifier

HermesKL_01_20180122_C06

Publication Date

1-22-2018

City

Houston, Texas

Topics Covered

Overview; Portrait; Overview; Working Environment; MD Anderson History; MD Anderson Snapshot; Research; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Women and Diverse Populations; Critical Perspectives; Women and Minorities at Work; Critical Perspectives on MD Anderson

Transcript

T.A. Rosolowski, PhD:

All right, we are back after a brief break, and you were just about to share a memory of Dr. Clark, and just for the record, it’s just noon. So, what was it that you were remembering about Dr. Clark?

Kay Hermes, BS:

Well, one of the things I remember about Dr. Clark is, several years, it must have been in, I suppose the 1960s or so on. There was a big display honoring him in the lobby of MD Anderson, but there was a picture of him, in the whole display, focused on R. Lee Clark, the great communicator. Now, I don’t think Dr. Clark would have ever been wanted to be remembered as a great communicator. I think he wanted to be remembered as an excellent, innovative, marvelous surgeon, which he was. In the early days, when people had head and neck cancer, the operation for it involved removing all this tissue.

T.A. Rosolowski, PhD:

Under the chin.

Kay Hermes, BS:

Yeah, everything. He devised the operation, I saw the film of it, where I remember thinking I was going to faint when they made the incision, but I didn’t, I was so interested in it. But anyway, he devised this operation where he dissected out all the lymph nodes in the neck, in that area of the body, and that was very innovative at the time and of course, it completely altered the treatment of head and neck cancer. I’m sure there were other things that he did too, but I think it’s important to remember what a very fine clinician and surgeon he was, as well as a man of great [vision for making the cancer hospital a reality]. The biographies show what a man of great vision he was, to have established that wonderful institution from the little MD Anderson estate, is a marvelous accomplishment.

T.A. Rosolowski, PhD:

But you know, I think you’re right, to bring attention back to his clinical skills. I really wonder if he could have been as successful convincing other physicians and researchers to join him, if he himself didn’t have the medical credibility.

Kay Hermes, BS:

I think that’s very true. I think that’s a very real possibility. I think his initial contacts and bringing people to Anderson, did relate to his clinical ability.

T.A. Rosolowski, PhD:

Yeah, because I mean he was very charismatic. I’m thinking of Charles LeMaistre [oral history interview], who was not a surgeon, wasn’t even an oncologist. He was very much an administrator, you know a person who was going to reorganize MD Anderson as an institution, but not inspiring in the same way as Dr. Clark was. So I really wonder, I do wonder about that, if Clark could have made the mark that he was able to, if he had not also been a really, really great doctor.

Kay Hermes, BS:

He was. Yeah, I think it was necessary, it was absolutely necessary. I don’t think the—probably his time had come. The hospital, the Cancer Institute in Rochester, New York, and other places, in California, Boston of course, [Dana] Farber, and the memorial in New York. I think probably, its time was coming, but he was way ahead.

T.A. Rosolowski, PhD:

Absolutely, absolutely.

Kay Hermes, BS:

He was very definitely way ahead. Anyway, that’s one of the things I remember about him. I remember looking at that exhibit and thinking you know; he really wouldn’t want to be remembered as a great communicator. I think he would want to be remembered as a great surgeon, which he was.

T.A. Rosolowski, PhD:

I wanted to ask you a few more questions about your work with the coding, with Eleanor MacDonald, because we talked about how you were working with records that were out in the different counties in Texas, but what relationship did epidemiology have to the patients who were being treated at MD Anderson? Were you also coding all of their records?

Kay Hermes, BS:

Yes.

T.A. Rosolowski, PhD:

Okay. So how did that work?

Kay Hermes, BS:

Well, we had the listing of patients as they—not when they came in, but I think mostly when they had completed their diagnosis and treatment. And then we requested the records and went to the record room and got them ten or twelve at a time and coded them by the same code that we coded all the other abstracts. That data though, was separate from the registry. I don’t think that data was ever included in the Cancer Registry, because there was no population base to relate it to.

T.A. Rosolowski, PhD:

Oh, okay, all right. Now, what kind of working relationship did Eleanor MacDonald have, and epidemiology have, to the rest of MD Anderson? Was she well thought of? Did people say, Yes, I’ll share my records with you? How did that all work?

Kay Hermes, BS:

Well, I think in the beginning, I think it might have been difficult, because there were very few famous women at that time. She was of course, one of the more famous people in the hospital actually, in terms of international and recognition beyond the borders of Texas. I think people in the hospital, clinicians were not necessarily data oriented. I do remember, the way the clinician got data, he had a big yellow pad with lines drawn across here, the names of his patients down the side, and then probably male or female and age, and diagnosis or something, across the page, so this was his data. That is the way I think initially, that clinicians thought about data. I think Eleanor was very well respected and certainly well-liked by almost everyone. [Redacted] I think she was much better friends with [all] the other clinicians. [Redacted]

Kay Hermes, BS:

I think Eleanor was well respected. She did a lot of work with Dr. Clark. If he was ever making talks or trying to raise money or anything like that, he always came to Eleanor. She did a lot of the writing. Yeah. She was a really wonderful writer, science writer especially. She had, I think a very good working relationship with Dr. Clark and all the medical people. Dr. White was a very good friend of hers, the Surgeon-in-Chief.

T.A. Rosolowski, PhD:

I’m sorry, his last name?

Kay Hermes, BS:

White, Dr. White. He was Surgeon-in-Chief for quite a long time, and I think she got along well. I’m not sure and I wasn’t sensitive to it, I guess. I wasn’t really sensitive to prejudice against women. I didn’t get it. I think there was a lot of prejudice, I mean I think everybody thought it was just fine for me to sit in the office and code records, but they wouldn’t have thought it was so fine for me to manage the department.

T.A. Rosolowski, PhD:

Yeah, yeah, the whole taking orders from a woman thing.

Kay Hermes, BS:

That’s right. I didn’t get it actually, I never felt that. I never felt any discrimination and I don’t know if Eleanor did. I think she was not, say in the years 1950 to maybe 1953 or ’54, I don’t think she was probably—she was accepted as a person because everybody liked her, she was very charismatic. I think all the people in the staff liked her personally, but I’m not sure that they—for one thing, I know several people did ask. They did not understand the term, epidemiology, as applied to cancer, and people did ask that question. When you said you worked in epidemiology, they would say well, what is that? Because they’re thinking of the mass aspects of the disease, like in the World Health Organization or something, so they didn’t—I think it took a while for the epidemiology of cancer to really take hold as an academic study. The Federal Government had a good deal to do with that, because they did eventually compile a very large database. I think as time went on, I think Eleanor was always accepted, and of course she was always well known because that paper, her first paper that she published, was a landmark paper. No data like that had ever been seen before. She was producing data like that in Texas.

T.A. Rosolowski, PhD:

Did you like working for her?

Kay Hermes, BS:

I just loved working for her. She taught me everything I knew how to do. She was an absolutely marvelous analyst. You could sit with her when she was taking a paper. She reviewed—there was no Editorial Department, so she reviewed a lot of the papers that came out of Anderson. I can remember sitting with her and looking. She would look at a paper and she’d just look at it and she’d go down the paper, and then she’d point to a certain number, and she’d say, well now there’s something wrong with that, and she could see it. She was very analytical and really, I think her genius lay in her critical ability. She was excellent at a vision of collecting data and a vision that always started with an idea. It always started and the end result was never just to collect a bunch of information. It’s always going to be to study. The first study I did when I was there, in the Record Registry, there were, I believe, about 298 cases of primary melanoma, and it was 100 percent fatal. Then, you see, I quit working in 1956 and I went back to work for Dr. Mountain, I think in 1973. He had called Eleanor. He was involved in a project with the North American Lung Cancer Study Group, and he had called Eleanor and asked her if she knew anybody that could help manage that project, and she said well, I’m not sure, you might call Kay Hermes and see. She’s the only one I know that’s really capable of doing it and that might do it. She knew other people that were certainly more capable than me. So anyway, the point I’m making is when I went back to work, after being gone eighteen years, only one thing had changed. The cure rates of everything else were still the same. One thing had changed and that was melanoma, and that was because it was common clinical practice in the 1950s and before, to cauterize moles, which meant there would be no pathology of course. Some of them probably lived just fine, but anybody who had the diagnosis of melanoma died in that population base, and that changed. By the time I was—by 1973 that had changed. I think a Dr. Stehlin at St. Joseph’s Hospital had devised a very innovative program for treatment of melanoma.

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Redacted

Chapter 06: Accepting Epidemiology as Part of Oncology

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