Chapter 02: MD Anderson in the Seventies; Developing a Focus on Hematology and Leukemia

Chapter 02: MD Anderson in the Seventies; Developing a Focus on Hematology and Leukemia

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Dr. Keating recalls the culture of MD Anderson when he first joined the institution as a Fellow in 1974 and notes that Dr. R. Lee Clark set up at MD Anderson to ensure that physicians were not motivated by monetary gain.

Next, he steps back in time, and talks about his previous medical experience at Saint Vincent’s Hospital in Melbourne when he came to focus on leukemia research. He tells an anecdote about the importance of respect for the dignity of a patient. He briefly describes the conditions of the fellowship that brought him to MD Anderson in 1974, then talks about his valuable experience setting up a database at Saint Vincent’s. He talks about his shift in interest to hematological malignancies.

Dr. Keating explains his concept of translational research, likening it to “falling in love.” He describes the process of learning a different research language while working as a collaborator.

Dr. Keating talks about his research collaborator, William Plunkett, Ph.D. [interviewed for the oral history project, 2013), who taught him to think about disease.

[The recorder is paused for about 3 minutes]

Identifier

KeatingM_01_20140513_C02

Publication Date

5-13-2014

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Path; Professional Values, Ethics, Purpose; Influences from People and Life Experiences; The Clinician; The Professional at Work; Offering Care, Compassion, Help; Mentoring; Professional Path; Inspirations to Practice Science/Medicine; Character, Values, Beliefs, Talents; Definitions, Explanations, Translations

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 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

Michael Keating, MD:

It was very different when I came over to the U.S., because the MD Anderson was all full-time salaried people. But the good thing was that I think R. Lee Clark set up this so that you were able to say, “Okay, I have a secure position as long as I do a good job,” and he was able to set up a very strong retirement program so that the longer you were there, the better the reward structure ended up being, and it took away the sense of seeing more and making more was the be-all and end-all of your practice, and it really established for me that the product was important. So at that time, MD Anderson was nothing like it is now. It was a whole bunch of people clustered into a single clinic room and bustling around, and there was never enough room, but somehow everything got done. Having all of these people, from professors all the way down to first-year fellows when I came, and I was a first-year fellow in 1974, and just hanging around with all these people whose names were legends, in my mind anyway, in the whole area of leukemia. So I was running the leukemia program over in St. Vincent’s before I came over here, so I was already an assistant professor, and then went back to being a first-year fellow, so that I thought I knew a lot about leukemia before I came over, and then I walked into a room of, say, twelve physicians and found out that four of them knew way more than I did about leukemia, and so I’d better learn something.

Tacey Ann Rosolowski, PhD:

How did you end up specializing in leukemia? And I notice that you made a shift between different types of leukemia as well.

Michael Keating, MD:

Yes.

Tacey Ann Rosolowski, PhD:

Tell me about that story.

Michael Keating, MD:

My first professor back in Australia was a professor who specialized in hematology. He was a very elegant man. His name was Carl Degruchy, D-e-g-r-u-c-h-y. In many ways I think he was a priest of medicine. He never married, but he was really a purist in medicine and always demanding proof of what he said. He also was a teacher that demanded respect for the patient, because I remember one time I was in examining a largish lady, and I was trying to listen to her lungs. There was not very much room on the bed, and to get around to the other side, I was reaching around her back and I deposited my bottom on the bed and examined her. And then I was about to report to the professor what I’d heard, and he took me aside and said, “Mr. Keating, you didn’t ask the lady if you could use her bed to prop you up for the examination. So could you go back and ask her if you could do that in the future.” And it was this whole sense of respect, and that was probably something that changed my whole sense of the doctor-patient relationship. We were both individuals of dignity, and we had to respect the dignity of the other’s. It was a good lesson for me. So I was going along, and Professor Degruchy developed melanoma. He was given a poor prognosis, and he decided to retire and concentrate on writing textbooks. He was replaced by another professor, Dr. Pennington, P-e-n-n-i-n-g-t-o-n, first name David. And most of the other people in the Department of Medicine didn’t like him. So Dr. Andy Burgess, who worked at MD Anderson before I did, he was running the Acute Leukemia Program over in St. Vincent’s, and he came over here to do leukemia infections with Dr. Freireich and Dr. Bodey. So when he left, there was no one looking after the Hematologic Malignancy Program, so Dr. Pennington asked if I was interested in doing that, so I did that.

Tacey Ann Rosolowski, PhD:

So how did you end up working with blood diseases anyways?

Michael Keating, MD:

Well, when I completed my final exams, the clinical school that I was at at St. Vincent’s, there were two guys that were first and second, and then there were three individuals, including me, that were equal third. And I didn’t know what I wanted to do, and so the other four all decided that they would take the four jobs in medicine, and I was asked, “Do you want to do surgery?” And I said, “Oh, yes, suppose so,” and so I was on a surgical track. My mentor there said, “Michael, you think like a surgeon, you like to deal with problems and get them solved, but you can’t cut and sew worth a damn, so you’d better get back into medicine.” And the only avenue at that point was to agree to work in the Special Clinic, and the Special Clinic was the first alcohol clinic that was ever set up in Australia. So I went there and did my first research on the number of deaths that were caused by motor vehicle accidents in the first thousand patients that came to the Special Clinic. So that was the first time I ever analyzed any data. Then I was in Internal Medicine. The two areas of specialization were hematology and alcoholism and liver disease. So when I was asked to do hematology, I said, “Yeah, that’s fine.” I was open to pretty much everything. It was all interesting to me, and that’s probably because it’s the patients that were interesting to me. I’m not sure whether you’re aware that in 1974 when I came over and we were first-year fellows, there were, oh, I think, twelve of us. They had a hotel kitty-corner from MD Anderson that was called the Center Pavilion, and the hotel had been turned into a hospital across the road. When we’re on call, which happened, oh, two and a half nights every week, the two full nights you would sleep here, and the other half you would go home at midnight. And if it rained when you were called over to the Center Pavilion, you used to have to walk over there in the rain and do all that stuff. In that very first year, you are not allowed to take a single vacation day. So the first three months I was in the clinic, a couple of weekends that I was able to have perhaps a day and a half off because the clinics were closed, but the last nine months was all inpatient fellowship and every day we just came to work.

Tacey Ann Rosolowski, PhD:

Wow. So how did you end up coming to MD Anderson? I thought you came as a—no, okay, you came as a fellow.

Michael Keating, MD:

Yes. Because in Australia I was running the Leukemia and Lymphoma Program at this clinical school.

Tacey Ann Rosolowski, PhD:

I should have asked you how that happened. Is that a good story to tell before we talk about coming to MD Anderson?

Michael Keating, MD:

No, it’s just that there was no one else there after they all left. There were a couple of people that worked in the lab, but not very many people wanted to look after the inpatient responsibilities.

Tacey Ann Rosolowski, PhD:

What did you learn from that experience? I mean, that was a lot of responsibility for someone that young, at least it seems to me. So what did you take away from that?

Michael Keating, MD:

I took away from the fact that you had to go from ignorant on how to manage things into how to organize thoughts and structure and how to figure out ways to follow treatment outcomes and to, I think, be critical of what you thought that you knew that you really didn’t know, and so that it was probably the time that structure was put in place of ADHD, that I had to get to the point where I could explain to the nurses, explain to the patients, explain to the medical students, etc., “This is how we do things and this is why we do it.” But it was also the first time that I set up a database to track how well we were doing, and it was the first time they’d ever had a database there, and it was a very crude database, but it was something that intrigued me from that time on. I was happy as a clam, sort of doing that. And my wife and I had four children in four years, so that we had a full family, and it was a great boon when I became an assistant professor because I had a reasonable salary to keep them fed.

Tacey Ann Rosolowski, PhD:

And your wife’s name is?

Michael Keating, MD:

Bernadette. She had been tremendous support as going on, because she had no idea what being the wife of a doctor was going to be, and she would never have imagined, nor would I, that we’d end up in the United States and doing what we’re doing.

Tacey Ann Rosolowski, PhD:

And just for the record, your children’s names?

Michael Keating, MD:

They’re Mark, M-a-r-k, and Paul and Anna and Simon. So their full names are Mark Andrew, Paul James, Anna Rachel, and Simon John. When we went back for Australia for that one-year time period and I took all their passports up, the guy said, “Oh, you’re a very biblical family, aren’t you?” [Rosolowski laughs. And I said, “That’s what happens when you’re raised Catholic. You always have to have—.” In fact, my name is Michael Joseph Patrick, which is the confirmation name, etc. So the thing that changed, because I was really having a good time and established myself as a relatively important young person at the institution, was that they decided that they would change the rules, and you had to do boards in hematology if you were going to—and that meant going back and working in laboratories for a couple of years and functioning as a fellow again. And I thought, well, the only things in hematology that I was really passionate about were the malignant hematology things, and I was just starting to do—

Tacey Ann Rosolowski, PhD:

Can I ask—I’m sorry, but why was it that your attention was really directed to the malignant hematology issues?

Michael Keating, MD:

Well, I think that the patients that had some of the blood disorders were biochemical abnormalities, and there was really nothing that you could do about them, whereas particularly the acute leukemias, it was either death or glory. You would treat them with something very toxic, and they were either tough enough to get through it or they died. The lymphomas were just starting to have a very high response rate. Multiple myeloma, it was a dreadful disease that would have people, when their bones would be breaking and their kidneys would be failing, etc., and there’s nothing good that we were doing for them. So I think it was back to what my surgical mentor told me, that, “You like to solve problems and fix things,” so the malignant hematology was the fixing part of it and the others were chronic insolvable things that you supported rather than did anything about. And the others were people with very benign hematology, deficiency in iron or vitamin B-12s and things like that, and that didn’t seem to be very challenging. Once you’d made the diagnosis, you would give them iron or vitamins, and they would get better.

Tacey Ann Rosolowski, PhD:

Can I ask you a kind of funny question? You know, you mentioned your ADHD, and I mean, that could be a downside, but I’m wondering if that thought process or the way your brain works has given you some benefits?

Michael Keating, MD:

I think it’s got a great benefit for me, because I continue to walk around with little unsolved ideas dangling down waiting for a connection, and so that I think it’s like having a computer where you get in and you just go through one program or you can open up all the windows. And when you find something that you think might be connected to something, you go from one window to another and keep on linking them up. And I think this is what happens, for example, in the Moon Shots Program, that you have people from all sorts of disciplines and somehow they have to be taught to think about things in the way that your colleagues think, as you have to learn from it. The concept that I had of translational research I likened to falling in love, in that you’ll go and listen to someone give a lecture and you’ll say, “Oh, that’s interesting. I wonder how that’s going to go,” and then you go along to a similar lecture by the same person six months later, and you can see that it’s moved along. Then you go up and introduce yourself and say, “Hello, I’m Michael Keating. I found your talk to be very interesting, and I hope it works out well.” Then the next time, you might say, “Well, I have a few ideas about that. Let’s go and talk about it.” And you have to learn the language of your collaborator, and that creates some effort, and that’s the same as learning what your loved one is all about. You have to learn what their interests are, what intrigues you about them, etc., etc., and you can’t force it to happen. Even though the textbooks and the journals say you should link this to this, if you don’t have the right person, it just never happens. So creating a structure I find to be very destructive, and pigeonholing people into, “You are a such-and-such person,” I just don’t like structure very much.

Tacey Ann Rosolowski, PhD:

I was going to observe, too, that, I mean, often when you’ve developed in a specialty, you don’t realize the way in which that specialty limits your thinking. I mean, you do absorb a structure, and that structure shapes your thinking. So when you suddenly have a collaborator who doesn’t have that, they may see around corners you don’t even know exist.

Michael Keating, MD:

Correct. The CLL, Moon Shot, my main collaborator is Dr. Bill Plunkett, who arrived around about the same time, and he taught me how to think about drugs. I was thinking about disease and you would have a recipe for the disease, but he taught me that you have to understand what happens when you put something in. It’s like being a cook. What happens if you put too much sugar in? That’s not a good thing. And if you add too much spice, if you don’t have enough liquid, etc. So that it was a way of understanding dosing and the interaction that occurs between different drugs, and it shouldn’t just be A-plus-B, but there should be some mechanism that suggests that combining things makes at least the major drug better. So that was a very important part that I learned from the time that I was in acute leukemia. And now we should turn off the recording so that I can go the restroom, because I had a big tub of coffee before I came.

Tacey Ann Rosolowski, PhD:

Absolutely. (laughs)

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Chapter 02: MD Anderson in the Seventies; Developing a Focus on Hematology and Leukemia

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