Chapter 13: Building Collaborations and Treating Patients from Around the Globe

Chapter 13: Building Collaborations and Treating Patients from Around the Globe

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Dr. Jaffe quips that when he realized he wasn’t going to win the Nobel Prize he began to turn his mind to how to ensure that what he had learned about treating pediatric sarcoma and survivorship would be passed on. In this chapter he speaks about the many collaborations he has sustained with physicians internationally over the last fifteen or twenty years. For the past ten years, for example, he has helped physicians in many cities in Mexico establish programs for solid tumors and survivors. Many hospital programs in different nations in South America have requested his expertise. He has many contacts across Europe, has been involved in EURAMOS, the European and American Osteosarcoma Study group, and for the past fifteen years has sustained contacts in Germany, Norway and Sweden. He tells an interesting anecdote about hosting several doctors from Slovenia who contacted him about coming to observe practices at MD Anderson. Dr. Jaffe hosted them at his home during their visit of 6-8 weeks. One physician noticed how many surgical instruments MD Anderson discarded, and it was arranged that she could take home a crate of instruments for use in their hospital. In another anecdote, Dr. Jaffe describes he was invited to Egypt several times and then asked by an ambassador to write a report about the poor treatment for cancer in that country. That document resulted in the creation of the Friends of Egyptian Children with Cancer group, which hosts various fundraisers to provide children with improved care. [redacted] In another anecdote, Dr. Jaffe talks about his hesitancy to accept an invitation to Saudi Arabia because of his (Jewish) faith. He was very impressed at his treatment, however, and surprised that they offered him a position.

Identifier

JaffeN_03_20120831_C13

Publication Date

8-31-2012

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Beyond the Institution; Beyond the Institution; The Clinician; The Administrator; Professional Practice; The Professional at Work; Collaborations; Leadership; Patients, Treatment, Survivors

Transcript

Tacey Ann Rosolowski, PhD:

I was wondering if you could tell me about some of the important collaborations that you set up at MD Anderson.

Norman Jaffe, MD :

Sure, I’ll be happy to do that.

Tacey Ann Rosolowski, PhD:

And I’m thinking here pretty broadly, too, because you’ve worked administratively as well as in education and then on the research side, clinical, so whatever you feel is really significant.

Norman Jaffe, MD :

I reached a stage in my life where I felt it was important to bring the younger people into the program and to teach and train them in order to ensure that whatever I had learned in the past would be maintained and developed and in fact be transmitted to others. And as a consequence, because I was receiving a fair number of inquiries and discussions, consultations and what have you from different parts of the globe, I thought it would be important to establish collaboration with these individuals. Let’s start with the different parts of the globe. Let’s take first the Americas. I developed a very, very strong collaborative effort with doctors in Mexico. I invited doctors, whoever was interested, to come to the MD Anderson Cancer Center and to take them on rounds to show them what I was doing and to establish with them programs in their own hospitals and institutions for the treatment of children with solid tumors and for that matter long-term survivors, and that collaboration has existed. I was invited to go there. It happened almost every year for a period of about ten to fifteen years that they would come here once a year, and I would go to Mexico once a year. And as I say, it still exists. We have a very close friendship, and we’ve developed close associations to the extent that some of them even consider me as part of their family. They are very competent and very well-trained doctors. I think one must recognize that things can be done in Mexico.

Tacey Ann Rosolowski, PhD:

What are the institutions that they represent?

Norman Jaffe, MD :

The National Institutes of Health or Child in Mexico. There are several. I can’t remember their names offhand, but I have contacts in Guadalajara, contacts in Mazatlan, contacts in several other places in Mexico, particularly Mexico City, where I have three or four hospitals where the contacts are very viable. From Mexico, let’s go down a little bit to Costa Rica. I had patients from Costa Rica, and I developed a close association with one doctor, who unfortunately is now deceased, in Costa Rica, but he was responsible for promoting the welfare and the modern treatment of children with cancer. And I have several patients who are alive and well still in Costa Rica today who keep in touch with me. One I know is married and has a child already. That’s Costa Rica. Then let’s go to Brazil. Sorry, let’s go to Panama. I have several patients from Panama and several doctors who have kept in touch with me. Then there’s Brazil. I invited two doctors from Brazil to come over here as a result of their interest. One doctor is Dr. Sergio Petrilli, P-E-T-R-I-L-L-I, and another is Dr. Sidnei, spelled S-I-D-N-E-I, Epelman, E-P-E-L-M-A-N, who are in charge of very large hospitals for the treatment of childhood cancer, and we still have a very close collaboration. In fact, only two weeks ago I received a paper from Dr. Petrilli indicating that I was part of the program that we had set up for the treatment of cancer, and he was now describing it and the results and so on and asked me if I would join him as a co-author, correct whatever misinformation, if there was any, that I could detect and add to it anything else. I did that and sent it back to him. The contact is still viable even though I have been retired for almost six years now. With Sidnei Epelman it is the same. I heard from him last week, in fact. Unfortunately, his wife had developed a serious problem, but we hope things will improve. He asked me advice of it, and I said, “You must talk to your doctors now.” Whatever the circumstances, that contact remained in very, very close existence for the past—I would say—twenty-five years. We still have very good collaboration. From Brazil we go to Argentina. There were several doctors over there, and although the contacts are not as strong and as viable as they were in Brazil, we still have some collaboration with them, and one or two of them are still my personal friends. Next to Argentina is Uruguay. There is a doctor in Uruguay who is very, very close to me, and we keep in touch, and he consults with me every now and again, even though I’m supposed to be retired, about problems. From Uruguay we can go to Chile, and we have a very good doctor in Santiago who I think is supreme in his approach to the problem. They have very good medicine over there, but he still keeps in touch with me as well and uses some of the programs that I advocated with him. There is also a surgeon, Dr. Blanco, I think is his name, who incidentally has thirteen children, and he is very, very good. I think the standard of medicine is excellent. We should not detract from their achievements. Let’s go to Europe now. I had a very close contact at one stage with doctors from the Insitut Gustave Roussy in Paris. That has not been viable for the past few years now. I think there’s been a change in leadership and so on and so forth, and the French have their own way of doing things. That’s fine, but we are still good friends. In England I had several trainees. Unfortunately, one died of a cerebral tumor three years ago, but we had a close collaboration in the United Kingdom as well. That has not been as close now during the past few years, but I think they are very good in any case. They don’t need us, and we do not need them, for that matter, but we have an association through what is called the EURAMOS study, a study that is investigating—it’s spelled E-U-R-A-M-O-S, EURAMOS—which is the investigation for osteosarcoma in the United States, Europe, and the United Kingdom. Let’s go from there to Germany. We have a very good relationship with some doctors in Germany, and they are part of the EURAMOS study as well. Norway, a good relationship, and the relationship between Germany and Norway is such that I invited a doctor from Germany and a doctor from Norway to assist me as co-editors of a book I published recently on osteosarcoma in the adolescent and child.

Tacey Ann Rosolowski, PhD:

I’m really impressed with the international breadth of these connections, and I’m wondering, I imagine it took many years to set this up, and do some of these individuals have contact with one another as well?

Norman Jaffe, MD :

Yes, it’s all through the Internet.

Tacey Ann Rosolowski, PhD:

And how has that facilitated further advances, do you think, in care?

Norman Jaffe, MD :

0:28.30.3 I think it’s done a tremendous amount for them and for us. It’s a two-way stream, and the one hand washes the other. It’s been very, very good.

Tacey Ann Rosolowski, PhD:

I’m really struck.

Norman Jaffe, MD :

That’s Germany and Norway. I had a close contact with a Hans Strander in Sweden, but that has not been viable for the past fifteen years now. I think he’s still alive, but he is part of his own institution.

Tacey Ann Rosolowski, PhD:

You mentioned that when you were setting up these connections you did so because you got to a point in your career where you wanted to make sure that there were certain things that were passed on. When was that that you decided?

Norman Jaffe, MD :

I would say that was about fifteen years ago when I realized that I would not be a nominee for the Nobel Prize, so I said, “I may as well do something else,” and that was fine with me.

Tacey Ann Rosolowski, PhD:

And another question I wanted to ask you is you obviously came to MD Anderson because your career had already developed very strongly in these two areas with osteosarcoma and then with survivorship, but I’m wondering how do you feel your perspective and approach evolved during the time that you were here, or did it?

Norman Jaffe, MD :

MD Anderson has been very good to me. I was permitted to do mostly whatever I liked. I have no complaints about it. Look, there is no utopia anywhere, but I think that I have had a great opportunity in working here to do what I wanted, to develop, and to be recognized worldwide. I can only give them praise. I know that it’s not 100 percent. There are certain things that I may have wanted, but with age and perspective and a year older and a year wiser, I hope I have a better opportunity to reevaluate the situation, and I believe that I have made a contribution in this world, and I hope that contribution has been for the better.

Tacey Ann Rosolowski, PhD:

How did you feel that you grew as a clinician?

Norman Jaffe, MD :

Very well. I felt that I was given a lot of opportunity to do what I did. They did not interfere with me in many aspects, and I can only sing their praises.

Tacey Ann Rosolowski, PhD:

Is that a function of the way the administration is set up? To what do you attribute that?

Norman Jaffe, MD :

No, I think they didn’t want to interfere with me. They recognized that I had a very good name worldwide, and I think that if they started doing anything to me or against me it would be counterproductive, so they left me alone.

Tacey Ann Rosolowski, PhD:

Who were some individuals here that you felt you had really good working relationships with in forwarding your projects?

Norman Jaffe, MD :

They were mainly individuals in the bone tumor service. It was the late Dr. John Murray, Dr. Alberto Ayala, who was the pathologist. Who else could I say? Of course, the latest, Dr. Valerie Lewis and so on, but it was mainly in the beginning Alberto Ayala and John Murray.

Tacey Ann Rosolowski, PhD:

And what sort of work did you do with them?

Norman Jaffe, MD :

Well, we discussed the problems relating to the treatment of a patient with a particular bone tumor. It was mainly in the bone tumor and musculoskeletal area. They became very close friends, in fact. It was inevitable that that would occur.

Tacey Ann Rosolowski, PhD:

What do you feel you learned from them?

Norman Jaffe, MD :

A great deal and I’m still learning. In fact, I do not want to say that I know enough. I think the longer I continue to learn the more humility I can inspire in myself and the more I can appreciate the wonders of mankind.

Tacey Ann Rosolowski, PhD:

I notice that though you have mentioned that you retired in ’06, it’s sort of a theoretical retirement.

Norman Jaffe, MD :

Oh, yes. I’m still learning.

Tacey Ann Rosolowski, PhD:

What have you been doing since your so-called retirement?

Norman Jaffe, MD :

Let’s continue this before we get off the theme, but I want to give you a few more aspects. In Italy I developed a tremendous relationship with doctors. I was invited to be a visiting professor at the oncology institute. I can’t remember the exact title that it has. It’s the Rizzoli Institute, R-I-Z-Z-O-L-I, Rizzoli Institute, and I was a visiting professor there for six weeks. There I developed a very good relationship with three prominent doctors. In fact, you can sing their names. They rattle off my tongue almost. It’s Picci, Bacci, and Campanacci. [Piero] Picci was the pathologist. [G.] Bocci was the chemotherapist, and [Mario] Campanacci, who died of pancreatic cancer, an excellent surgeon. We’re close friends. I still have the relationships with Picci and Bacci, and I spent six weeks over there. They provided an apartment for me. I took two of my kids with me. We had a wonderful time in Italy, and I also was able to follow one of my patients there. I’ll give you her name, Giulia Ottaviani, who became a doctor and a pathologist, and now she’s interested in pediatric oncology and is making arrangements to come to this country to serve as a pediatric oncologist. In fact, I think I may have mentioned, but I have ten patients who became doctors.

Tacey Ann Rosolowski, PhD:

Yeah, you mentioned that when we were talking about the ski program.

Norman Jaffe, MD :

[redacted]

Tacey Ann Rosolowski, PhD:

Why, when you decided to reach out to other physicians fifteen years ago, did you decide to do it globally?

Norman Jaffe, MD :

It was not my real intent, but they began to approach me, and I certainly did not reject them. I think fifteen years is probably a little inaccurate. It should be about twenty years ago, twenty to twenty-five. Whatever the circumstances, from Italy let’s drop down now a little bit further to Slovenia. Slovenia is one of the three countries that constitute the original Yugoslavia. Tito brought them all together and established the country of Yugoslavia, which broke up several years ago. In Slovenia there were a number of doctors who decided they wanted to contact me and to get me to help them in developing a pediatric oncology service. They made great efforts to nominate me for a Fulbright scholarship. I was granted the scholarship, and as a result, I spent six weeks as a Fulbright scholar in Slovenia and organized their pediatric oncology program. While I was here at MD Anderson I was given permission to go as a Fulbright scholar. They really appreciated it, and I think they were impressed, because when I left two years later I was again re-nominated by them for a Fulbright scholarship, again accepted, and went there and developed the program further. And I did something in addition to that. I organized for three of their doctors to spend two months at the MD Anderson Cancer Center. They had no money, but I housed them in my own home. Professor [Marija] Auersperg, head and neck surgeon, came, Dr. Derganc, D-E-R-G-A-N-C. Her name is Meta, M-E-T-K-A, Metka Derganc [pediatric intensivist], and a third doctor, Dr. Gabriela [Gabriela Petric-Grabner] —I can’t remember her surname—as a radiation therapist. [Added: the group also included Professor Marija Us Krasovec, cytologist, and Marjanca Cucek Plenicar, orthopedic surgeon.] They stayed at my home, came to MD Anderson every day with me. My wife prepared sandwiches because they didn’t want me to take them to lunch. They said it was too expensive. It wasn’t for me, but for them it was, and I was prepared to even pay for it, but they said, “No, we’ll take the sandwiches.” They spent six weeks to two months with us at my home, training at MD Anderson. When they left, there was something interesting. Professor Auersperg, Dr. Auersperg, incidentally, stems from royalty and has many castles named after her family in Slovenia. They were all taken by the government. She owns nothing, but she went to the operating room every day and followed patients and what happened to them, and she came back one evening and said, “You know, you have discarded”—not me but MD Anderson—“had discarded very, very good operating instruments saying they are no longer operable, they are not useful.” She says, “I would like to take those instruments back to Yugoslavia. We can fix them and do things with them.” When she left, she left with a crate of instruments, taking them back to Yugoslavia, where they have people who are able to repair and reuse them and so on and so forth, and she said that is one of the major dividends that she accumulated through this particular visit to MD Anderson. She was with us for two months, as I say.

Tacey Ann Rosolowski, PhD:

I imagine you observed some pretty amazing situations in visiting these other nations.

Norman Jaffe, MD :

Absolutely, absolutely.

Tacey Ann Rosolowski, PhD:

The facilities and equipment are not up to what we expect here.

Norman Jaffe, MD :

Absolutely. You reminded me of a story of when I first came to this country. My father-in-law came to visit us, and we had a toaster, the usual toaster, given to us by a bank. The toaster was useful. It broke down, and I said, “Well, I’ll buy a new one.” And my father-in-law was shocked, and he said, “I will repair it,” and he repaired it. He came from South Africa. He repaired it. The neighbors heard about this, and the next thing is we were inundated with toasters which he was prepared to repair at no cost. They had an extra life off their toasters for several years, but that’s the sort of thing. In the United States we don’t repair. We discard.

Tacey Ann Rosolowski, PhD:

It’s a throw-away culture now.

Norman Jaffe, MD :

That’s right, but he repaired toasters.

Tacey Ann Rosolowski, PhD:

I’m curious, was there anything that came of that experience of collecting these broken bits of equipment from surgery and sending them?

Norman Jaffe, MD :

They used them.

Tacey Ann Rosolowski, PhD:

Right, but did that continue?

Norman Jaffe, MD :

No, that was it. She could take them with her in the plane or at the same time, but nothing further developed after that. Anyway, let’s go a little further. I think we’re getting nearer. Then from Yugoslavia we can go down to Turkey. I was invited to go to Turkey, and in Turkey I had a very—and still have—a very good relationship with several doctors, Dr. Inci Ayan, I-N-C-I, Ayan, A-Y-A-N, and Dr. Rejin Kabudi, R-E-J-I-N, Kabudi, K-A-B-U-D-I, and I’m often consulted about problems and difficulties that they have. Incidentally, it was a two-way stream. I invited them over here, and they also invited me, and I’ve been to Turkey and Slovenia and so on several times as a consequence of that.

Tacey Ann Rosolowski, PhD:

What have you noticed about the facilities and treatment there?

Norman Jaffe, MD :

They are not optimum, but they are definitely improving. They improve more and more with each subsequent visit that they come over here and when I go there. And let me tell you something, some of them are equivalent to the United States. They are not fools. They’re innovative, they understand things, and their standard of medicine is very good.

Tacey Ann Rosolowski, PhD:

Are there different rates of childhood cancer in those countries—in other countries—than in the US?

Norman Jaffe, MD :

Some cancers may be a little more prevalent than others, but in general, they are more or less the same. Now, this doesn’t apply to the underdeveloped countries like those in Africa and so on and so forth, but in these countries in Europe, in the Americas and so on, they’re more or less the same. Mexico has a tremendous amount of retinoblastoma, more than the United States. I don’t know why. But the principles, the tactics, and the strategies are identical that they use that we use. Just in passing, that’s the end of Turkey. Let’s go to Egypt. I’ve been invited several times to Egypt, and there is a man called Dr. [Sherrif] Abouelnagu. I came to my office one morning at the MD Anderson Cancer Center, and there was a doctor sitting in the office, Dr. Abouelnagu, and he said to me, “I have come to learn how to treat osteosarcoma.” I said, “Who arranged this?” He said, “I’ve come.” Well, he came.

Tacey Ann Rosolowski, PhD:

And you welcomed him.

Norman Jaffe, MD :

Absolutely, and he was with me for three months and then invited me to go to Egypt, where I established a program. We published a paper about the program. They treat them very, very well.

Tacey Ann Rosolowski, PhD:

What did you do with him when he was here?

Norman Jaffe, MD :

I took him around the wards with me. Wherever I went, he went, and so on and so forth. I mean, he became my close, personal aide, so to speak, and I told him what I was doing and why I was doing it. I questioned him. I didn’t let him get away with things, and he really appreciated it, so much so that, as I say, he invited me two or three times to come to Egypt at different times to inspect what he was doing, to advise and guide him and so on.

Tacey Ann Rosolowski, PhD:

And he set up a solid tumor service?

Norman Jaffe, MD :

Well, it was in existence before, but he developed it. As a consequence of this, incidentally, when I returned from Egypt the first time—it was in 1960—I got a call from the—I wouldn’t call him ambassador, but he was really someone under the ambassador of Egypt, and he said, “Listen, I need to talk to you.” I said, “Sure,” and he said, “You’ve just come from Egypt. I want you to write a report about your findings in Egypt.” I said, “Mr. Ambassador, if I write a report of Egypt, they will never let me get into Egypt again. There’s so much conniving. There’s so much graft, so much difficulty, that you are not giving the patients the proper attention.” He said, “Do me a favor. Write that report.” And I wrote the report, and three or four weeks later I got a call from a woman, Susan Worth, W-O-R-T-H, and she said, “I’m establishing an organization called the Friends of Egyptian Children with Cancer. I want you to be a founding member of this, and we want to send information, drugs, whatever they need in Egypt in order to improve the treatment of childhood cancer.” I became a founding member. I, at one stage, was a president of this organization, and I’m still a member. We meet every three or four months and discuss things. We hold an annual gala, and next year the gala will be held at the Junior Club. We have sufficient funds that we can send about twenty dollars’ to thirty dollars’ worth of drugs and money and so on to Egypt every year to special hospitals where we believe this is a vital need for them to treat childhood cancer.

Tacey Ann Rosolowski, PhD:

What is the amount that you spend for the drugs each year?

Norman Jaffe, MD :

It varies. About $20,000 to $30,000 a year.

Tacey Ann Rosolowski, PhD:

Wow, that’s amazing. Have there been other initiatives like that either local or in the states that have come out of some of these connections?

Norman Jaffe, MD :

Not to my knowledge.

Tacey Ann Rosolowski, PhD:

That’s really striking and great that there was someone as farseeing as this individual to say, “Go ahead and write that report.”

Norman Jaffe, MD :

[redacted] Then you have another place where the American fleet is. I don’t remember the name of that country, but they invited me in the Middle East to give some talks over there, and finally, I think, what I call the piece de resistance. When I was in Egypt and I was giving a talk in Egypt, I got a call from a doctor in Saudi Arabia, and he said, “We have just heard your talk through the mechanism of Internet, and we want you to come to Saudi Arabia.” I said, “Listen, my friend, you will never let me go into your country. I am a Jew. I have been in Israel. I have a stamp on my passport, and you do not let me come into the country.” He said, “Hold on a moment.” There was a discussion, and they said, “We will let you come in. Just send us your consent.” I did that, and after a lot of sending information to the Saudi embassy in Washington and so on I was given two visas to go to Saudi Arabia. One was a visa for myself, which was given to me gratis. A second was a visa for my wife, for which I paid $150. Mine was gratis, and they admitted me to Saudi Arabia. I want to tell you they treated me with the utmost respect. It was a pleasure to go there, and recognizing my religion and so on was of no barrier, no consequence, so much so that at the end of my visit I was approached by the chief of the hospital. He said to me, “Listen, we are impressed with what you have done for us. We are impressed with how you’ve handled things, and I’m authorized to offer you a senior position in this hospital.” I didn’t want to insult them, and I said, “Listen, I have grandchildren. I need to go and see the grandchildren.” He said—he was very clever—he said, “Listen, with the amount of money that we will pay you, you can fly and see your grandchildren every month.” But it was nice of him to offer that, and I would have a divorce at that stage. My wife had to wear an abaya. We were advised by the United States government, the consulate and so on, travel almost incognito. Blend in with the country, so my dear wife had on an abaya. She looked like an Arab, and I hope I looked like an Arab, but they treated me with the utmost respect. It was an interesting experience, and I was there for ten days as a visiting professor. I was invited to go back, but I said, “Listen, I think that I have other things that I have to attend to.”

Tacey Ann Rosolowski, PhD:

Was it medically interesting as well as culturally?

Norman Jaffe, MD :

Yes, whatever you want medically they have the money to buy it. The trouble is, you see, they have the money to buy it. They have instruments and so on, but there’s no one to use it, no one to do it properly. They give contracts to people, and listen, the individual, his wife cannot stay there. A woman is not allowed to drive. She has to put on an abaya. There are no theaters. There are no museums. There’s no entertainment for them. They’re isolated and things like that. The only place where you can get some taste of American culture is the Aramco compound, but it is very small, and after a while you can only say hello to about ten, fifteen, twenty people, and what happens after that? You can’t move. It’s not a life for the European as we know, but I do want to say I give them credit, they treated me with respect. I had no problems.

Tacey Ann Rosolowski, PhD:

It’s 11:30, Dr. Jaffe, and I want to make sure you’re not late for your rounds.

Norman Jaffe, MD :

No, because they’ve canceled the rounds, so I can stay another fifteen, twenty minutes, and then we can tie it all up.

Tacey Ann Rosolowski, PhD:

That would be great. Is there anything else you would like to say about your international collaborations?

Norman Jaffe, MD :

Let me see. Of course, in Israel I’ve had a tremendous amount of collaboration, and I try to go there more or less once a year. Let me see, from Saudi Arabia and that area, Bahrain is the other area that I was thinking about where the American fleet is located. I was invited to Bahrain as well. I think we dealt with most of the countries that I have collaboration with. I think just a few points here just to tie it up. Let me say that I’ve been in medicine now— I practiced medicine for fifty years. I have been in medicine for fifty-six years since I’ve been retired for six years, and it’s been very satisfying, a very, very enjoyable experience. It’s also been a very devastating one. I will not deny that. But I think that you can achieve a great deal of personal satisfaction because life is not always 100 percent. I mean, there are highlights and the lowest ebbs of life in life, and one must recognize that. If one is prepared to accept and understand that, then I think you can find medicine is a very satisfying occupation. My idea was to have the opportunity to train individuals to accept that as a way of life. I asked for each one of the individuals whom I trained that I required no touch of genius from them. I only wished them to be honest, conscientious, and hardworking. Every fellow who rotated through my service—three months, which was the system employed at this institution—they would rotate through my service for three months—was expected to write a paper and have it published in a journal, and that was done in at least eighty to ninety percent of my fellows. Happily, I was sought after as one of the individuals who they would like to have in terms of a rotation, in terms of a mentor, a teacher, and an administrator. I had people from all over the world, as I indicated, people from Turkey, Egypt and so on, as I’ve indicated. We have kept a close collaboration and relationship with them. It’s been a very, very happy association. I think that one must not expect what the world can give you but what you can give to the world, and I’ve tried to do that in terms of my philosophy and understanding. I think that ties up whatever we need to say about my view, my understanding, my approach to medicine and my journey through this particular field of life. It’s not the end that it is important. It is the journey that is important. The journey has been satisfying, invigorating, thrilling, and depressing, and that’s the only way I can summarize my life on this earth. I have nothing further I think that I can add. I’m happy to answer any other questions you might have.

Tacey Ann Rosolowski, PhD:

That does sum up your philosophy.

Conditions Governing Access

Redacted

Chapter 13: Building Collaborations and Treating Patients from Around the Globe

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