
Chapter 04: Choosing to Focus on Cancer
Files
Loading...
Description
Dr. Hortobagyi explains that once he felt the limitations of small-town medical practice, he applied for residencies in the U.S., first going to Case Western Reserve University to serve at Saint Luke’s Hospital Cleveland, Ohio (1971-’74). (He chose Cleveland because of the large Hungarian community, where Hungarian was even spoken at the MacDonald’s.) At this time he left surgery for a more intellectually stimulating, and began thinking about oncology. He also notes that on recognizing the more generous resources and education available in the U.S., he had a crisis about whether or not to return to Colombia.
Dr. Hortobagyi describes how oncology was the “wild west of medicine” and offered a field where he could bring together his thinking on hematology and immunology. He recalls that, during rounds in the early seventies at Saint Luke’s Hospital, physicians would by-pass rooms of patients with solid tumors. He tells an anecdote about two women with advanced breast cancer who were treated only with morphine. He found an article on chemotherapy and once he began treating women with chemotherapy, they lived.
Identifier
HortobagyiGN_01_20121130_C04
Publication Date
11-30-2012
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Gabriel Hortobagyi, MD, Oral History Interview, November 30, 2012
Topics Covered
The Interview Subject's Story - Joining MD Anderson/Coming to TexasCharacter, Values, Beliefs, Talents Personal Background Professional Path Inspirations to Practice Science/Medicine Influences from People and Life Experiences Discovery and Success Human Stories Offering Care, Compassion, Help Patients Cancer and Disease Professional Practice The Professional at Work Evolution of Career Formative Experiences Understanding Cancer, the History of Science, Cancer Research The History of Health Care, Patient Care
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
Gabriel Hortobagyi, MD:
So at that time I took my tests to come to the US. I applied to a number of hospitals and centers, and I was accepted in several, and then I had to make a decision. And then I came to Cleveland. I came to Cleveland—the two finalists were Toronto and Cleveland, and Toronto—I applied in Toronto because one of my sisters lives there. I said, “Well, at least I would have someone.” And then I applied to Cleveland because Cleveland is probably the second largest Hungarian city in the world outside of Budapest.
Tacey Ann Rosolowski, PhD:
And this is—so and this was when you went to the clinical residency in internal medicine at St. Luke’s Hospital at Case Western Reserve.
Gabriel Hortobagyi, MD:
Right. Right.
Tacey Ann Rosolowski, PhD:
And that was 1971 to ’74—I’m just saying for the record.
Gabriel Hortobagyi, MD:
Tacey Ann Rosolowski, PhD:
Yeah.
Tacey Ann Rosolowski, PhD:
Tacey Ann Rosolowski, PhD:
So I didn’t realize it had such a huge Hungarian community.
Gabriel Hortobagyi, MD:
Oh, yes. It’s a huge community. You know like the Italians and the Ukrainians and the Pols around the turn of the century and the early part of the twentieth century, many came to the rust belt—
Tacey Ann Rosolowski, PhD:
Yeah.
Gabriel Hortobagyi, MD:
—because that is where the jobs were.
Tacey Ann Rosolowski, PhD:
Cleveland—or Chicago was a huge Polish community.
Gabriel Hortobagyi, MD:
Chicago, Toledo, Detroit, Cleveland, Buffalo—all of these areas are full of European immigrants, and the Hungarian community in Cleveland happens to be huge. So, there were—between the first, second, and third generation—probably close to a third of a million. So, in the area where St. Luke’s was, there were a number of stores that—like in Miami today—they had signs that said, “English is spoken here,” because otherwise you could conduct your entire life in Hungarian. There were multiple Hungarian churches, multiple Hungarian newspapers, schools, community halls, et cetera, et cetera, et cetera. In fact, in retrospect it was funny that you would walk into a McDonald’s and people would greet you in Hungarian, and you would have to ask for your stuff in Hungarian in order to be served. And it turns out that I didn’t really do much with the Hungarian community because I was too busy training and whatnot but that’s when—so when I took the decision that I didn’t want to stay in this little town very long, then it also dawned on me that I had been doing surgery feverishly for a number of months or years and that the excitement was sort of vanishing because I needed something that was more intellectually stimulating. So then I went to Cleveland, and in Cleveland I had a wonderful team of mentors and teachers. And that’s when I started to think of oncology.
Tacey Ann Rosolowski, PhD:
Really?
Gabriel Hortobagyi, MD:
Not from the very beginning but towards the beginning of my second year. I spent three years there.
Tacey Ann Rosolowski, PhD:
What got you started thinking about oncology?
Gabriel Hortobagyi, MD:
Well, when I came to Cleveland, I came with the intention of staying maybe a couple of years and then going back to Colombia because by then I had spent the most important formative years of my life there and had friends and acquaintances. My family was there. We were in a comfortable situation. And in fact, I had several offers for positions—both at the university and in practice—so I went with that idea. And then as you start your training in the US, you realize how huge the difference is in terms of the way medicine is practiced, the resources that are involved, the opportunities that are involved in further training and doing research, and a number of things that you couldn’t do in South America at that time. So, then I started to change. It was sort of an internal crisis of I can’t go back; and yet how can I not go back? How can I abandon everything I have and start anew? But then you sort of solve your internal struggle. And what got me started on oncology was the fact that as you settle the issue of do I stay or do I go, you start thinking, “Well, if I stay what am I going to do?” And then you start thinking, well, general internal medicine is interesting but maybe not that interesting. Now what are the specialties that would be interesting? And then at that time I perhaps mistakenly had thought cardiology being a very old specialty—a lot had been discovered. There were fewer opportunities perhaps. Perhaps it was less interesting because there was more known—the same for pulmonary diseases, same for a number of other specialties. And I started to get interested in hematology and the infectious diseases and endocrinology, and I said, “Gee, what could bring all of these things together?” And then oncology came increasingly to the surface.
Tacey Ann Rosolowski, PhD:
So you were really looking for kind of the uncharted territory in a sense.
Gabriel Hortobagyi, MD:
Yeah. Yeah. The Wild West of medicine. And then it dawned on me that as we were making rounds in the mornings—and this was a much nicer hospital than San Juan de Dios, so these were either individual or semi-private rooms, and you would walk in with the professor and the residents and whatnot—and I would notice that increasingly we would bypass the rooms of patients with cancer. Patients with leukemia and lymphoma were treated, but there was virtually nothing to be done for patients with advanced solid tumors like breast cancer, lung cancer, colon cancer, et cetera. So, the teacher sort of shortcut the process in saying, “Oh, that’s—they are getting their pain medication.” And I remember that sort of irritated me, and I said, “You know, there must be something we can do about these folks.” And then a couple of things happened. One was that there happened to be two young women in their mid-thirties or so who were admitted—not at the same time but over a relatively short period of time—with advanced breast cancer—widespread advanced breast cancer. They were bedridden and in really terrible shape and suffering and whatnot. And the initial approach was, well, let’s give them enough morphine so that they die in peace and whatnot. And I said, “No, that can’t be the end.” Then I started to do reading, and there was not much to be read at that time. There were no textbooks in oncology. There were one or two journals—cancer was one of them. Most of our leading journals from today didn’t exist at that time. So, I did a little reading and found this abstract that had been presented at the American Society of Medical Oncology a couple of years earlier about chemotherapy. So, I harassed my professor until he authorized me to give chemotherapy to these women—much against his best judgment—and both of them walked out of the hospital. I said, “You know, there is a new world here, so we need to do something about this.”
Recommended Citation
Hortobagyi, Gabriel N. MD and Rosolowski, Tacey A. PhD, "Chapter 04: Choosing to Focus on Cancer" (2012). Interview Chapters. 1109.
https://openworks.mdanderson.org/mchv_interviewchapters/1109
Conditions Governing Access
Open
