Chapter 03: Working for Sidney Farber

Chapter 03: Working for Sidney Farber

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In this chapter, Dr. Jaffe discusses his move to the U.S. and his roles at the Stanley Farber Cancer Institute (Fellow in Tumor Therapy) and the Children’s Cancer Research Foundation (Fellow in Pediatrics). Dr. Jaffe was disappointed to discover no real fellowship program under Stanley Farber. He was also distressed by the state of treatment for cancer and had not desire to treat dying children. He tells an anecdote about Farber blocking him from resigning his fellowship. He describes Stanley Farber’s character and his strategy of moving Dr. Jaffe into administration. Dr.Jaffe very candidly says that Farber “took advantage” of him and he felt locked in the “vice” of the job, though he and Farber became close over the years. This section closes with his recollections of testifying in the House and Senate on behalf of funding for the Children’s Cancer Research Foundation on Farber’s death.

Identifier

JaffeN_01_20120420_C03

Publication Date

4-20-2012

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Path; Professional Path; Funny Stories; Evolution of Career; Understanding Cancer, the History of Science, Cancer Research; Portraits; Influences from People and Life Experiences; The Administrator

Transcript

Tacey Ann Rosolowski, PhD:

That’s great. Would you tell me about going to Boston and Sidney Farber?

Norman Jaffe, MD :

Well, I accepted my post in Baragwanath Hospital as a chief, and I enjoyed it. I was chief mainly of Neonatology, and then Sidney Farber wrote to me approximately three and a half months after I’d accepted the post that he was somewhat desperate, and he wished me to come as a Fellow, initially because he wanted to make sure that I was appropriate for this particular position. He said he will in fact support my application for an immigrant’s visa, which gave me carte blanche to do what I wanted really in the United States. He indicated that the Fellowship would be available in June of ’66. I felt a little uncomfortable and embarrassed after I had in fact signed a contract at Baragwanath Hospital to be a chief, one of the chiefs that were available there, to do work in pediatrics. After being there for three and a half months I [reneged on] my contract. I’m not sure how happy they were with me, but that doesn’t matter. And I then left the South African shores by air on BOAC. I remember the actual airline. And I came to the United States with a wife, a child, and two suitcases. One of the suitcases was half packed with cloth diapers.

Tacey Ann Rosolowski, PhD:

How old was your child?

Norman Jaffe, MD :

He was three years old, and those cloth diapers were examined meticulously by the customs [officials] in case I was bringing drugs in. I had to unpack each diaper to show them that there were no drugs concealed in the diapers. In this country, you [didn’t] have diapers. You have regular diapers that [are made] with paper and things of that nature. But that’s the way it was in my time. Incidentally, there is a little story attached to this pediatrics. When I was trying to make up my mind what I wanted to do, I approached our practitioner, our family doctor, and I asked him what he [thought] I should do at that particular time, because I was interested in all parts of medicine, but I was gravitating to pediatrics, and he said, “Listen, my friend, sit down,” so I sat down. He said, “Go into pediatrics as you wish to do.” I said, “Thank you. Why?” He said, “The secret of pediatrics is to keep the mother occupied.” I said, “What do you mean?” He said, “Most children happily get cured, get well on their own. Just don’t be overzealous.” And he said, “And when you’re called to a child who is ill, tell the mother to take a huge pot”—he spoke to me in Yiddish, Nem a teppel. “Take a huge pot, and tell her to put in three-fourths of a pot filled with water and a pinch of salt and to put it on the stove and run it at a particular temperature and to stir it every fifteen minutes. Tell her to do it three times a day, because that’s what she will be feeding the child, and [] to add [a certain] amount of milk. But keep her occupied.” And he said, “And that is the secret of pediatrics.” I was thinking, “Oh, that’s not a bad idea,” so I entered pediatrics in the hope that I would keep the mothers occupied. And what happened? Immediately thereafter, the cloth diapers disappeared, Similac was introduced, there was no stove, there was no hot water, there was no added pinch of salt, there was no milk, there was no stirring of the pot, and the parents could go and purchase Similac and so on. I could no longer keep them occupied. That’s what happened in pediatrics.

Tacey Ann Rosolowski, PhD:

So you never found another way to keep the mother occupied.

Norman Jaffe, MD :

No, but that was originally the secret of pediatrics.

Tacey Ann Rosolowski, PhD:

That’s funny. Did you ever make that prescription for the [mixture]?

Norman Jaffe, MD :

0 Oh, no.

Tacey Ann Rosolowski, PhD:

It’s a good story, though. It really is.

Norman Jaffe, MD :

But it’s true, and I remember the name of the doctor [Dr. Witkin]. I have it written down somewhere, but he was a congenial, nice old man, and the way he said to me, “Sit down,” and he spoke to me half in Yiddish, as if I was his son. He said, “I’ve known you since you were a very small boy, and I kept your mother occupied.”

Tacey Ann Rosolowski, PhD:

What did you discover after the customs officers went through all the diapers and when you got to see Stanley Farber?

Norman Jaffe, MD :

Sidney Farber. I was disappointed. I was devastated. I came there— Well, I knew that the oncology was not the best [choice], but I didn’t expect so many children to be dying. But strangely, there were a few who were living, and I got interested in that. And Sidney Farber had a very, very well-established organization called the Children’s Cancer Research Foundation in Boston. Are you familiar with Boston?

Tacey Ann Rosolowski, PhD:

Not terribly, no.

Norman Jaffe, MD :

There is a book written by a man called [Siddhartha] Mukherjee, The Emperor of All Maladies. I think you should read it. It’s not accurate in certain aspects because I was Sidney Farber’s administrator for about seven years, and I ran the clinic for him, and I know what [happened]. But in general, it’s a reasonably good read, and it does give you some insight into the problems that existed. Well, Sidney Farber invited me to come there, and I expected to learn about pediatric oncology. I did. I learned entirely on my own. There was no real Fellowship program, but I began to absorb things and notice how one treated them. I read many publications and books and so on. I was entirely self-taught at that particular time. At the end of one year, I said, “That is enough. All the children are dying. This is not a position for me. I did not enter pediatrics to treat dying children.” I wrote a memo to Sidney Farber. You never spoke to him directly. You always communicated by memo, and I sent a memo to him saying, “I thank you for sponsoring me into this country. It’s been an interesting experience, but I feel that I am not cut out for this particular type of pediatrics. I really want to do neonatology, as you will see from my curriculum vitae, and as you will see, I was a Chief of Neonatology in Baragwanath Hospital, and as such, am making arrangements with Clement Smith, who is a neonatologist at the Beth Israel Hospital across the road, to enter into neonatology with Clement Smith for one year.” In fact, I’d already seen Clement Smith, and it was almost a sealed deal. [However,] he made a statement to me which I now understand in retrospect. He said, “Look, Dr. Jaffe, I’m impressed with your curriculum vitae. I’m impressed with what you’ve done. You want a job with me, I will give you the job, but you go to Sidney Farber and tell him that you are taking this job. I am not going to communicate with Sidney Farber.” I said, “Sure,” and then I communicated with him by memo. The day before I was due to start, I received a telephone call from Sidney Farber’s secretary—her name was Mrs. McGeichie—who, incidentally, had her own secretary to do some of the work. That was how busy they were. Her name was Dorothy Witkin, the same name as the doctor who told me to keep the mothers occupied. Witkin was her name. Mrs. McGeichie said, “Dr. Farber would like to talk to you,” and I said, “Fine, I have no problem with that,” and he was a very charismatic, avuncular man. You have no idea how you fell into his grasp, but you felt so good about things. He knew how to talk. He was a master of the English language and with such confidence. You really had to have a great deal of respect for him. The telephone conversation went more or less like this: “Dr. Jaffe.” And I said, “Yes, sir.” “What is this piece of paper I have in front of me?” I said, “Sir, I have no idea what piece of paper you are referring to.” He said, “Apparently”—and I remember this very well—“apparently it is a memo from you to me advising me that you’re leaving my service,” and I said, “Yes, sir. I am making arrangements with Clement Smith to take a job in Pediatric Neonatology.” There was a significant pause. It was deafening, that pause, and then he said, “Do you know who I am?” and I said, “Yes, sir.” And he said, “Do you know how powerful I am?” and I said, “Yes, sir.” And he said, “You will never receive a job anywhere in this country unless I sanction it, and I do not sanction this job. I did not bring you over from South Africa for you to desert me at the last minute and work for Clement Smith.” It may be that he had some problems with Clement Smith and was going to spite him or something of that nature, but I don’t know. He said, “You are hereby appointed the administrator of my clinic. I will escalate your salary from $2,000 to $16,000, and I will discuss your Harvard appointment next week,” and he put the phone down, and that was it. I walked home—please note that I walked home. I could not afford an automobile. When I left South Africa, I could not take much money out, so I walked home, and I said to my bride, “Do you know where I’m working tomorrow?” and she said, “Yes, Clement Smith.” I said, “Listen, this is what happened.” The next day I duly reported. I was ecstatic. I had the same office, the same place and so on, but a new sign went up, and it said Administrator. I was doing the same work I was doing before, but I was now administrator. And I said, “Well, if I’m going to do this, I’ve got to get things straightened out over here. I may as well do something.” If I’m locked in for a while, I’ll do that, and so I became the administrator of the clinic, which I did for seven years. There was an interesting point about that as well. I came in as a [South African] citizen. Not [as]—an American []. I could therefore get a job anywhere because I had this immigrant’s visa, and as such, I was also liable for the draft in Vietnam. And approximately two or three months after becoming the administrator, I got a letter from the draft offices saying that “you are here on an immigrant’s visa. Please report for possible recruitment to Vietnam.” I said, “Is this part of the system as well? I’m an American? I’m not even an American! I’m a South African, and I haven’t even sworn allegiance to this country.” And they wrote back to me and said, “All immigrants are liable to the draft, and therefore, you will report.” I discussed this with my wife. I discussed it [also] with Sidney Farber, and his response to me was very clear. “Let us hope wisdom will prevail.” That’s all he said to me, and I duly reported to the draft office. They said, “Appear for a [medical] examination,” [for] which I had to come back a week later. They did it very, very efficiently. I do congratulate them on that. They had stations. You went from one station to the other, and this station did the rectal examination, this station did that and so on and so forth. You went right through, and I was impressed with that more than anything else. This one listened to the heart, this one listened to the chest, this one did that, and so on and so forth. It was efficient right through, and at the end of that I said, “Listen, I had rheumatic fever as a youngster, and perhaps there’s something wrong with my heart,” and they listened again. They said, “No, there’s nothing wrong with your heart.” [] “You are now classified as A1. Be prepared to be called up and [keep] this [draft card]”—they gave me a “ticket” to hold in my wallet for the future, in case I’m asked about the draft. I [decided], “There’s no option now. I’m not going back to South Africa, and if I have to go to Vietnam, we’ll discuss the situation at that [stage].” I remained in anxiety and almost in fear until the age of thirty-five, and after the age of thirty-five. After the age of thirty-five, they would not call you up. At the age of thirty-six, I became an official American citizen, [and there was no possibility] of conscripting me to the draft because of my age, although I was [possibly] eligible from other aspects. That was an interesting experience as well.

Tacey Ann Rosolowski, PhD:

It must have been really stressful.

Norman Jaffe, MD :

Oh, yes, because I didn’t want to leave my wife, and we had another child at that stage and things of that nature.

Tacey Ann Rosolowski, PhD:

And just putting yourself in serious harm’s way.

Norman Jaffe, MD :

That’s right, but it was interesting that I could be called up [into] the draft even though I was not an American citizen.

Tacey Ann Rosolowski, PhD:

I had no idea.

Norman Jaffe, MD :

[ ] One of my colleagues, Jeffrey Maisels—you may know him—who incidentally became a good neonatologist, he was with me at Baragwanath Hospital, was in fact drafted and fortunately didn’t have to go to Vietnam. He was in the Army for a period of two years. There were several South Africans who were drafted in that particular situation even though they were not American citizens, but that was the law, the system, and we came here. We enjoyed the fruits of the United States. I can understand it from that point of view, but it becomes very difficult [to understand]. Even though one may not agree with some of the things and even particularly because one is not an American citizen yet [they could] still ask me to fight for the United States. But that’s the way it was. I then continued [my employment] under Sidney Farber. I began to organize the conferences [and] take a more active role. I said, “I cannot move now. I know where I stand.” He really exploited me. He took great advantage of me. He insisted that I run the clinic efficiently and I report to him daily. The reporting daily to him— I think I should send you a copy of the letter that I sent to Dr. Mukherjee indicating some of [these] aspects that he omitted to put in his book, The Emperor of All Maladies. If you give me your email, I could send it to you. [Note: The relevant correspondence is included beginning on page 107 of this transcript.]

Tacey Ann Rosolowski, PhD:

I would like to have that. Yes, I will.

Norman Jaffe, MD :

And the point is this: [ ] I revamped the entire system over there. I became the real administrator now because I was given the power to do that. He relied heavily on me. I almost became his confidant; in fact, so much so that he would take me to Washington. Sidney Farber would take me to Washington with him where he would go and talk to the Senate and [other committees]. I remember one occasion. He called me up to his office, and he said, “Norman”—sometimes he’d call me Norman. Sometimes he would call me Dr. Jaffe. This time he was very, very approachable, and he said, “Norman, I’ve just spoken to Dick.” I said, “Yes, sir.” I didn’t know who Dick was. And he said, “You have a great future in pediatric oncology. We will move forward. We will advance.” He had great vision, and he said, “I want to go to Washington next week, and you will come with me, and we will discuss this further. But meanwhile, prepare a report on how far we have advanced in pediatric oncology at the present time and what your actions [and activities] are in my clinic.” I said, “Yes, sir,” and there were discussions about a few other things [ ]. I went out from his office on the eighth floor, and I said to Mrs. McGehre his secretary, “Who is Dick?” And she said, “Dick is the president. Didn’t you know that?” I said, “No.” She said, “It’s Richard Nixon.” I didn’t know. I [assessed the situation and thought], “What a great man. He’s just spoken to the president, and now he’s speaking to me.” This [was] Sidney Farber! We went there, but he wouldn’t let me see Dick, or perhaps Dick didn’t want to see me. He kept me in the hotel, and anytime he had a problem he would phone me, and then he would ask me about things and [ ] go and speak to Dick [ ]. I’d go to Washington on occasion [ ]. Sidney Farber, incidentally, was also a Jew, but he didn’t have much understanding [and] experience in Jewish affairs. I think he felt a little bit disturbed about that, so much so that he was invited to [ ] the Board of Governors of Brandeis University. He accepted with great pleasure to show his Judaism [ ]. He would discuss some aspects of it with me as well. When we used to travel to Washington in the car, he would ask me about [ ] Judaism, [ ] the Talmud and things of that nature. I [spent] a great deal of time with Sidney, and I enjoyed my association with him, even though he kept a vise on me. I couldn’t move. I knew that he had great power, and the only time the power was dissipated or even eradicated completely and the shackles were severed was when he died. When he died, I was in Mexico, and I received an urgent call to return [ ] to Boston because they wanted to reassure the staff that I looked after that there would be no change in the situation, their jobs were guaranteed [ ]….[ ] He had me well trained. I had to report to [ ] Farber every evening. I never knew when I would return home. At 5 o’clock, after all the doctors had left [ ] and [I’d report] [ ]. I would sit in my office and wait for a telephone call from Mrs. McGehre to come up to Sidney Farber. The call would be received sometimes at 5:30, sometimes at 6:00, sometimes at 8:00, and so on [ ]. My bride knew that she would have to come [to] fetch me at different times [ ]. That was the way it worked, and I accepted it. I’d go up there at 8 o’clock at night and he’d say, “Give me the report on the clinic. Give me the report on this, give me the report on that.” The report would take about twenty minutes. It wasn’t long. “And how is the staff reacting, and what are they doing?” He had his finger on the pulse of [things]. He knew exactly what was happening, so I do give him credit for that, that he took a great deal of interest [in the clinic operations], but he never did ward rounds. I would do the ward rounds. He may have done them before my arrival, but he never did it while I was there. For seven years that I was the administrator and for many years prior to that, apparently, he never did any ward rounds, although in [Mukherjee’s] book it says he did ward rounds. I don’t think that’s correct. [ ]I really got a good grounding on my own, and because I was given the liberty to do things and he trusted me, I think I was able to advance the situation at the Children’s Cancer Research Foundation [in] Boston. [ ] [W]hen Sidney Farber died, they wanted to start a new building, but they didn’t have the money, and the new chief, Tom Frei, who came originally here from MD Anderson, was my new chief. I had a great relationship with him, and he sent me down to Washington, where I testified and asked for funds for [the building. The testimony] is available in the Congressional Records. I testified before the House, and I testified before the Senate. I think the reason why he really did that was I treated Ted Kennedy for osteosarcoma. After I had testified [(]Kennedy had recused himself from the meeting because, he said, “You have treated my son” [)], [Emil] Tom Frei [ ] told me, “You went down and you asked for $10 million to start the building, and we’re getting that $10 million!” Whenever I go past [the building] in Boston, I say, “That building belongs to me,” for what it’s worth. I put the foundations in.

Tacey Ann Rosolowski, PhD:

I’m wondering about something else too, because when you went to Washington with Sidney Farber and he was talking to President Nixon, do you know the substance of that? Because that was just prior to the cancer plan.

Norman Jaffe, MD :

He was responsible for initiating that cancer plan. Nixon relied heavily on Farber to do that. I think they called it The Conquest of Cancer or something of that nature. I can’t remember, but it’s in that book The Emperor of All Maladies. It’s worthwhile reading.

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Chapter 03: Working for Sidney Farber

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