Chapter 04: Discovering a Mentor and a Specialty at MD Anderson
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Description
Dr. Pollock talks about coming to MD Anderson in 1982 for a surgery fellowship, in the process making many observations about the culture of the institution. He begins by describing the process of applying for his fellowship. He made a trip to Houston some months prior to beginning his fellowship to attend an MD Anderson conference (Cancer Care in the Year 2000).
Dr. Pollock tells an anecdote about a security guard who gave him a one and a half hour tour –only the first instance of the culture of care he would come to value. Dr. Pollock says that people at MD Anderson feel they have a calling, and the institution has a mission that people believe in and can act on. He notes that he has been offered positions at seven other institutions and describes why he has always turned them down.
Dr. Pollock next continues with his description of the conference, where he met Dr. Richard Martin (his “hero in modern surgery), with whom he would establish “one of the most important relationships in his professional career.” Dr. Martin was interested in soft-tissue sarcoma, which became Dr. Pollock’s specialty as well.
Dr. Pollock defines sarcomas –a rare type of cancer representing only 1% of adult solid tumors, and “a true teamwork disease,” as he describes it. Dr. Pollock explains that he had no experience of sarcoma as a resident. Just before coming to MD Anderson of Fellowship, he saw one patient with an osteosarcoma in the emergency room at Rush Hospital –and scheduled him for a radical amputation. When he arrived in Houston, he began on the sarcoma service and followed a sarcoma patient’s treatment through chemotherapy, radiation therapy, surgery, and artificial joint implantation.
Identifier
PollokRE_01_20121008-C04
Publication Date
10-8-2012
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Raphael Pollock, MD, Oral History Interview, October 08, 2012
Topics Covered
The Interview Subject's Story - Joining MD Anderson/Coming to TexasPersonal Background Professional Path Inspirations to Practice Science/Medicine Influences from People and Life Experiences Evolution of Career Professional Practice The Professional at Work Formative Experiences Patients Patients, Treatment, Survivors MD Anderson Culture MD Anderson History Institutional Mission and Values Personal Reflections on MD Anderson This is MD Anderson Human Stories Offering Care, Compassion, Help Joining MD Anderson Overview Definitions, Explanations, Translations
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
Raphael Pollock, MD:
Right, but I want to just mention one little factoid that’s an interesting little historical nugget. As a chief resident, Rush let all of the residents go to one meeting—they paid for you to go to one meeting. Almost everyone else in the residency went to the American College of Surgeons Clinical Congress, which is the big general surgery meeting every year. At that point I had been accepted and had accepted the offer to MD Anderson. At the time, Anderson had two major conferences—a fall conference, which focused on a clinical issue, and a spring conference, which was more focusing on a laboratory research issue. Well, the fall conference—and I wish that I had saved the program. It’s probably available somewhere. It’s called Cancer Care in the Year 2000. I thought this was really interesting, because the brochure said there were going to be lectures from leading authorities such as Eleanor Montague, who is a radiation oncologist, J Freireich [Oral History Interview], many of the surgery people will speculate about what cancer care will look like in the year 2000. So I decided to do that instead. Clip B: Institutional Mission and Values C: Personal Reflections on MD Anderson C: This is MD Anderson C: Human Stories C: Offering Care, Compassion, Help A: Joining MD Anderson “An Introduction to MD Anderson’s Culture of Care”
Raphael Pollock, MD:
+ I’d never been to Houston. I came down. The conference was during—you know—Wednesday, Thursday, Friday type thing, so it must have been a Tuesday night that I came down. So I came down. The conference was held at the Shamrock Hilton, which is where the Texas A&M Research Institute is now. I checked in. I’d never been to Houston. The Westside Medical Center, where Rush was located, was in the middle of a pretty bad neighborhood. So I remember after checking in, it was about 7:00 or 8:00 at night, I went down to the lobby and asked the concierge, “Could you point out where MD Anderson is?” And he pointed towards MD Anderson. I said, “Is it safe to walk over there?” My frame of reference was the Westside Medical Center of Chicago where it very definitely was not safe. He looked at me kind of cockeyed and said, “Of course.” So I walked over, and it was at the time when the entrance to the hospital was through the Lutheran lobby. I came in, and there was a little security desk with a guard there, and he said, “Can I help you?” It must have been about 8:30 at night. I went up to him and said, “Well, yes. I’m a surgery resident. I’m here for the conference, and I’m going to be starting the fellowship here in surgical oncology this coming summer. I’m wondering if I could just—I’ve never been here before—could I just walk around a little bit?” And he said, “Well, it’s a quite night. I’ll check with my supervisor.” He had a little handheld. He was told, yeah, you can go and give this doctor a tour. So he spent the next hour and a half walking me all over the hospital. I was so touched because this was very, very different than the experiences that I had had at other hospitals up north—were just big, burly—patients didn’t matter. If you were lost, that was your problem. That was my first exposure to what is to me one of the absolutely precious things about Anderson—that the people here look on this as a calling, that there is a spirit of caring, that it actually has a mission, and that the mission is what we actually all believe in and try to practice. It’s not just smarmy Sunday school behavior, and there are subtle little indicators of that. You can be walking across the bridge that goes across Holcombe Boulevard, and if there’s a scrap of paper on the floor, guaranteed, within five seconds, someone is going to bend over and pick it up and throw it out. Or if you go in the Lutheran lobby and look all lost, guaranteed someone is going to come up and ask if they can help you find where you need to go. That’s very unusual—very, very unusual. I’ve had the opportunity through my career here to look seriously at seven major positions outside of the institution and have turned all of them down to date for the simple reason that I’ve yet to find an institution that is as honest about its mission and where the spirit of collaboration across all departments and pay grades is so strong. That’s been something that has sustained me in this environment through thick and thin, and it’s still very important to me. But getting back to the conference—I’m just sorry that I didn’t save that brochure. It was great fun. I met a number of people including the man who is my hero in American surgery and that’s Richard Martin. Dr. Martin was the chairman of the surgery department, and as I found, once I came down here—and I’m arguably jumping a little bit ahead, because my first rotations were not on the surgery services. I’ll come back to that because that’s part of why I got interested in sarcoma. But Dr. Martin was the most amazing combination of total technical surgical brilliance with absolute personal humility that I’ve ever seen in a surgeon ever in my entire career. He was so oriented and caring about the patients as the top priority, and he had this remarkable ability to know what you were and weren’t capable of in the operating room. We used to joke as fellows that when you were scrubbed with Dr. Martin, that you held the scalpel and he moved the table underneath and then the tumor popped out. And it almost felt that way. He was very economical in his moves as well as his words. But I came to enjoy a very deep relationship with him that was one of the most important in my professional career. When I look, frankly, at all of the people that I have had the responsibility of reporting to, the four years that I reported directly to Dr. Martin were definitely the four years that I reported to the best boss that I ever had in my life.
Tacey Ann Rosolowski, PhD:
How did he influence you?
Raphael Pollock, MD:
Well, it would be presumptuous for me to say that I assimilated all the lessons that he had to teach, but I think the orientation around patients was part of this. The commitment to trying to be the best technical surgeon that you could become was part of it. Those were two very, very important influences. We used to have something called the faculty associate program. What that was was an additional year after the fellowship where you were not a fellow but not a full-fledged staff member, and you would be paired with Dr. Martin. So you had operating days the same days that he did. You had clinics at the same time, but they were separate. So he was there and available if you needed help, and yet he wouldn’t micromanage or insert himself if you didn’t ask for the help, which was a tremendous opportunity to develop self-reliance but also to come to understand what your limitations were. And one of the things that I found out was that one of the diseases that Dr. Martin was very, very interested in was soft-tissue sarcoma, so that triggered—was part of the reason why I was interested. None of us knew that Dr. Martin had contracted chronic active hepatitis in an accident in the operating room when he was serving in a MASH in Korea, and that ultimately killed him. That was his demise. As I said, I was very close to him. His family asked me to be the eulogist at his funeral. I still have the eulogy. I’ll provide it to you because I think you may find that of interest and value—give you some sense of the reverence that those who trained with him have and to this day still hold. But coming back to the sarcoma story—
Tacey Ann Rosolowski, PhD:
Could I ask you just one quickly? What is a sarcoma, and why is a different kind of cancer than others?
Raphael Pollock, MD:
Well, when we think of cancers, there are two broad classifications—one is carcinoma, and one is sarcoma. Carcinomas are tumors that are formed of epithelial cells, and those are the cells that make glands. Breast, colon, stomach, prostate, lung—those are all gland-forming organs on the microscopic level, and they’re made of epithelial cells. Sarcomas are a totally different creature. They are tumors of connective tissue origin, meaning tumors of things like bone, cartilage, tendon, nerve sheath, those types of tissues, and they’re very rare. They are approximately one percent of all adult solid tumors. A little bit more common in children—about ten percent of the tumors—because there is a genetic component in the pediatric age group. But in the adults, they’re very, very rare. And they actually are made up of or comprise of over 100 different distinct types of cancer, so it’s an exceptionally complex tumor system. One of the things that I always thought and was very attractive to me was that it’s a true teamwork disease. There’s a definable role for medical oncologists, chemotherapists, radiation oncologists, and surgeons of all different varieties, so one of the hallmarks of the Anderson program has always been that we have planning conferences that involve all these different specialties. So attending those conferences, first as a trainee and then later as a young faculty member—particularly under the wing of Dr. Martin and Dr. Romsdahl, who is also very interested in sarcoma—it gave me a tremendous education and exposure to a very complex type of disease that was also just very, very interesting. And I don’t mean to use that word in a detached sense, but I really felt that I could engage both my intellect and my positive energy in the service of this. If people like R. Lee Clark—and he was very interested in sarcoma—and Richard Martin and Marvin Romsdahl held that as a core passion, and what they did with their careers, I knew I wouldn’t be far off the mark if I chose to focus on that as well. It was a disease that I had essentially no experience in as a resident, as compared to breast cancer or colon cancer, which apropos our discussion earlier that there are certain cancers that are general surgery, I had had exposure to that. I understood at least the rudiments, but sarcoma was a totally different creature. And as much of my career has hinged on the sort of patient care inflection points, I had a very dramatic experience that got me very interested in this initially, and that was that one of the last patients I took care of as a general surgery resident, when I was in Chicago— A young man showed up in the emergency room with a large osteosarcoma, which is a bone sarcoma, involving his humerus—the bone of his upper arm. I spoke to my attending, and he said, “Oh, that’s an oncologic emergency. He needs a radical amputation,” which is what we did the next day. That was on a Tuesday or a Wednesday. Packed up the U-Haul with all my belongings and drove down to Texas over the weekend to start the fellowship on a Monday or Tuesday the next week. And as pure coincidence and chance would have it, the service that I was placed on was the sarcoma medical oncology service. I had a rotation of medical oncology. It was on the sarcoma service. Bob Benjamin was my attending. One of the first patients that I saw there was a young man who had been flown over from Italy in an air ambulance with the same type of tumor problem. His was what we call a telangiectatic osteosarcoma, which is more serious than the garden variety one that I had taken care of in Chicago. Not only that, but the bone had pathologically fractured because of the presence of the tumor. So I saw this patient and did the history and physical, and then we were making rounds that afternoon. Dr. Benjamin said, “What’s the treatment for this?” And I was certain that I knew because I’d just seen something like this a week earlier, and I said, “This young man needs a radical amputation.” And I remember Bob hitting his forehead and saying, “What are you talking about? He needs chemotherapy.” And so I had the opportunity to participate in the chemotherapy, because I was on the medical oncology service. I next rotated through radiation, and he was down in the radiation therapy unit getting radiated. Then, when I came out to surgery, I had a chance to scrub on his case with Dr. Martin and Dr. [John] Murray, who was the chief of orthopedics at the time. Two surgeons working together, which I’d never seen before I came to Anderson. The tumor was removed, the margins were negative, and artificial joint was put in place. The patient was free of disease and back to playing tennis five months later. I rapidly came to the conclusion that I know something about breast cancer, I know something about colon cancer, but I know nothing about sarcoma.
Tacey Ann Rosolowski, PhD:
That’s so dramatic—I mean—from the radical surgery, which was the origin, to limb salvage.
Raphael Pollock, MD:
Yeah.
Tacey Ann Rosolowski, PhD:
Incredible.
Raphael Pollock, MD:
And again, I got to know this kid. His parents had rented a suite in the Hilton. They had me over for dinner. It was a very total package that when he would come to me with questions and I wouldn’t know the answer, I’d tell him, “I don’t know the answer, but I’m going to go to the library and find the answer and bring it back to you.” So he developed a trust in the information that I was providing to him. It spoke to my need to be of service, and that kind of triggered that as my interest, which has remained my interest for the rest of my career here. I consider myself to have worked very hard on behalf of MD Anderson, but MD Anderson has also worked very hard on behalf of me. It’s created remarkable opportunities for me to pursue this interest and develop an international presence in the disease, to be able to be of service throughout the world. I’ve traveled to 38 countries to lecture about sarcoma, carrying the Anderson banner in my hip pocket. Patients from literally everywhere come here to get care from our sarcoma team. It’s been a fantastic run for the money in that regard.
Recommended Citation
Pollock, Raphael E. MD and Rosolowski, Tacey A. PhD, "Chapter 04: Discovering a Mentor and a Specialty at MD Anderson" (2012). Interview Chapters. 1316.
https://openworks.mdanderson.org/mchv_interviewchapters/1316
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