Chapter 05: Surgical Stress, Natural Killer Cells, A Mentor and a PhD
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Description
In this Chapter Dr. Pollock covers the period when he became an assistant professor at MD Anderson and explains the research he began to conduct on the link between surgery and immune functions. His fellowship at MD Anderson (extended to three years) included six-months of research work in the laboratory of Dr. George Babcock, who was interested in surgical stress (stress created by surgical procedures). Dr. Pollock was interested in how surgical stress might effect on natural killer cells that could protect against tumor dissemination. He was encouraged to apply for the NCI’s new KO8 Clinical Investigator Program (and was awarded a grant) and also received a grant through the Institutional Grant Program. During the latter grant process, he met immunologist Dr. Eva Lotsova, who became another of his mentors. She told him that in order to learn how to design long-term studies, he would have to get a Ph.D. Though Dr. Pollock was teaching a full load as an assistant professor, seeing patients, and managing his family responsibilities with young children, he began a degree program at the Graduate School of Biomedical Sciences. (He tells an anecdote about being rejected 24 hours after submitting his application.)
At the end of this Chapter, Dr. Pollock talks about how MD Anderson helped (and helps) faculty to grow. “It was Camelot,” Dr. Pollock says when speaking of the intellectual environment he enjoyed in the eighties and nineties.
Identifier
PollokRE_01_20121008-C05
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 - The Researcher The Researcher Professional Path Evolution of Career Professional Practice The Professional at Work This is MD Anderson Human Stories Offering Care, Compassion, Help Overview Definitions, Explanations, Translations Portraits Mentoring Ethics Professional Values, Ethics, Purpose MD Anderson Culture Multi-disciplinary Approaches
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
Tacey Ann Rosolowski, PhD:
So tell me how you shifted from being resident becoming an assistant professor here.
Raphael Pollock, MD:
Well, the fellowship is what did that. That was a very good experience. At the time, the fellowship program was basically a one-year program, but they selected one fellow every year to serve a second year. This was something that Dr. Romsdahl had put together. He cobbled together the financial resources to make that possible.
Tacey Ann Rosolowski, PhD:
What was the reason for doing that?
Raphael Pollock, MD:
To try to— If there was someone who was interested in more of an academic career, to give them that exposure, particularly six months in the research laboratory. So what ended up happening is I was actually very, very interested in this whole question of surgical stress impairment of perioperative immunity.
Tacey Ann Rosolowski, PhD:
Could you explain to me what that means?
Raphael Pollock, MD:
Yeah. At the time of surgical operations, there are remarkable changes that take place. Tissue is traumatized, there’s the entire neuroendocrine milieu internally has changed, anesthetic gases are administered, remarkable fluid shifts take place in some circumstances, massive blood transfusions occur with the injection of foreign protein that is implied with blood transfusion, and we know that therefore immunity is affected. Some of the different parts of the immune system may be important in controlling for cancer dissemination. So this is something that I was always very, very interested in. The man who was chairman of surgery at the University of Illinois that these individuals had as their chairman—Dr. Southwick, Dr. Romsdahl—was a man named Warren Cole, a seminal figure in American surgery—the first person to successfully perform a pneumonectomy. Interestingly, the patient who he performed a pneumonectomy on outlived him by two weeks. Cole himself died of lung cancer. Go figure. But he was very, very interested in this whole issue, as was Dr. [Robert] Hickey, who was here. So when I came here, it was something that I wanted to study, if possible, and pursue. And I recognize that that would require a laboratory research opportunity. I had never been in a research laboratory before. But when I was selected for this two-year fellowship out of the pool of fellows—and I don’t think it was a very stringent selection, mind you. I think that no one else was interested, so it was by default. But there was an immunologist in the department at the time whose name was George Babcock. George is now at the University of Cincinnati. But George was very interested in a type of cell that was called NK cell—natural killer cells—and that had interest to me because these were cells that are in the circulation and are thought to be the first line of defense against foreign invaders—typically viral invaders or bacterial invaders. But the question that we asked was is it possible that they might have a role in protecting against tumor dissemination, and if so, was their function impaired by surgical procedures per se? So that was the focus of the research interest. And I started working—I had the second year of the fellowship with the six months’ research time, and I started working in Dr. Babcock’s lab. We had some interesting, albeit very primitive, results. We developed an animal model of surgical stress and were able to show that NK cell function was impaired in that model.
Tacey Ann Rosolowski, PhD:
What were the animals you used?
Raphael Pollock, MD:
Little mice—C57BL/6 mice. And we published a paper out of it, the first time I’d ever had a scientific publication, so it was kind of neat. And what happened during that period of time, the National Cancer Institute developed a program called the (K08) Clinician Investigator Award Program, and this was designed to try to address the national shortfall in physicians who are interested in cancer-related laboratory research, because there was the perception that there weren’t enough of these people in the pipeline.
Tacey Ann Rosolowski, PhD:
I’m sorry, that’s the (K08) Clinical Investigator Program?
Raphael Pollock, MD:
(K08) Clinician Investigator Award. So this was the first year that the program had been in existence. They just sent out RFAs—requests for applications—and Dr. Romsdahl and Dr. Martin came to me and said, “Well, here’s this program. It’s for three years. Would you be interested in applying for this? We know of your interests, and they’re particularly interested in trying to attract surgeons.” I said, “Well, I’ve never written a grant before, but I would be happy to at least use this as a learning experience. I can’t promise that it will work out.” Dr. Martin said, “Well, if it does work out, that implies that you’re going to be with us for a three-year period of time during which you can pursue this.” So I worked very hard in putting together this grant during the time that I was in the lab. It was before word processors were available. It was even before IBM Selectrics. I typed the whole grant on my little Royal portable typewriter. I had hand-drawn pen and ink drawings. Grants Management was in an office over on the tenth floor of the Houston Main Building. You walk your grant over, and two days later they called you up to pick it up because they’d done all the institutional parts of it. So what ended up happening were two things: One, I applied for it, and, much to my total shock, I got it. And at the same time that I had applied for that, there was an institutional research grant program called the IRG Program, which still exists. At the time, however, the award was for $6000. But I figured, why not get double duty? I checked to see I’m using this application for that purpose. Can I truncate it—because it was a short app—and use it for the IRG? I was told, “Yes, you can.” So I applied. There was another research scientist here at the time by the name of Eva Lotsova, and Eva is another person who had just a tremendous impact in my life. We’ll come to that in a moment. But Eva was a very flamboyant person. She was a Czechoslovakian refugee. She and her husband had been smuggled out of Prague in the trunk of a car a week after the Russians invaded because they knew that they would not survive. Long story short, they asked her to review my IRG application, which was all supposed to be done anonymously and so forth. But what came back to me was the IRG application stamped approved, and on the back page she had written, “Interesting data. Call me,” and she put her phone number, which is not the way it was supposed to be. I was like, “Okay. A Professor is telling me to call, I’m going to call.” So I called. She said, “Come down. I want to talk to you about this. Bring your laboratory notebook.” So I go down, and I knew who she was. Anderson was much smaller then. It was maybe a fifth or a tenth of the size that it is now in terms of the faculty. So I knew who she was but I’d never met her before. This was the first time. I sit down in the chair, like you are, and she’s at her desk. She takes my notebook, and inside the notebook I had taped all of the gamma tapes, which were printouts from a gamma counter, like a Geiger counter, to detect radioactivity that was released when NK cells would kill tumor subsets. I knew if the NK cells were killing. She pulls out a red pen and starts crossing out numbers on my tapes. I said, “What are you doing?” She said, “Well, that’s wrong. This is wrong.” And so I was just stunned. I mean, just the audacity of it. I said, “What do you mean it’s wrong?” She said, “Well, look here. Can’t you calculate the mean and the standard error in your head? Can’t you see that that value is way off compared to the others?” And she was right. She was absolutely right. I mean, she had more experience. And it didn’t deflect from the conclusion; it just made the data much tighter to have the right numbers in place to do the calculations. Then, shortly thereafter, I got the word that I had gotten the (K08) award. George Babcock left the institution, got a promotion to go to the University of Cincinnati. I went to Eva and said, “I have this grant for four years. Can I work with you on this?” And she said, “Yes.” That’s her right there. That’s when I’m in her lab. She had this bright-red, hennaed hair and always wore very flashy clothes. She was a character—a character amongst characters—and was actually working very closely with leukemia people at the time. Ultimately, Dr. Martin recruited her to the department, where we enjoyed a very close relationship for a number of years.
Tacey Ann Rosolowski, PhD:
Now, what was her specialty?
Raphael Pollock, MD:
She was not a physician. She was a PhD immunologist and world class in what she did. NK cells were her thing. So I started working with her. I had a little lab that was across the hallway from this one—a little 600-square-foot lab, one technician. After about two to three months of working successfully, I went to her and said, “How do you design experiments for a longer period of time? Because, I can think about three to four weeks ahead, but how do you design experiments for five months or for a twelve-month period of time?” She said, “Oh, to do that you have to go to graduate school.” And I said, “Well, how am I going to go to graduate school?” I’m now an assistant professor of surgery, I’ve got a practice. At the time, I was married to someone who was also on faculty here. I think, parenthetically, I’m the only faculty member at Anderson who has been married to two Anderson faculty members. There’s a badge of distinction. But I had a one-year-old daughter. I said, “Eva, how can I possibly do that? I have all these other constraints.” She said, “Well, that was not your question. You asked how do you learn how to plan six months’ worth of experimentation, and I told you, you become trained as a scientist,” implying the ball’s in your court. She said, “Maybe you should apply to graduate school.” So I said, “Okay. That makes sense to me.” So I applied to graduate school. When I was in college, I had applied to graduate programs in history as well as medical school, and just to hedge my bet, a couple of law schools as well, and I ultimately had choices in all three directions but decided to go into medicine. I still had my GREs from fifteen years ago, which GSBS would accept. So I applied, and Eva wrote me a letter and Dr. Martin and so forth. So twenty-four hours after I applied I got a rejection letter. I took it back to her and I said, “Well, I was rejected, so I guess that ends that.” She had this thick Czech accent. She said, “Why were you rejected? Have you ever been rejected before in your life?” And I said, “I don’t know why, and, no, I’ve never been rejected.” “What does that make you feel? Aren’t you angry?” I said, “Well, come to think of it, I am kind of PO-ed. This doesn’t make any sense to me at all.” She says, “Well, maybe you should go over and ask them why.” So I traipsed over to GSBS, which was just this little building that’s no longer standing, and Paul Darlington, who is the Dean of Admissions, was there, and I asked him what happened. And he said, “Oh, there’s a standing rule in the University of Texas that you can’t be on a tenure track in one department and be earning a terminal doctoral degree in another department.” I said, “Okay. I guess that’s the answer.” So I went back to Eva and said this is what I was told. And she said, “Does that make any sense to you?” And I said, “Actually, no, it doesn’t make any sense.” She said, “It doesn’t make any sense to me either.” She sent a letter to Hans Mark, who was the chancellor of at the University of Texas, and said she had a student who was also an assistant professor of surgery who wants to get a PhD and will they grant a waiver of this rule, which he promptly did. I went back to the GSBS and was promptly accepted. So all during the time that I was an assistant professor I was also a full-time graduate student working with Eva. [Redacted] But a remarkable, strong woman who had been through so much and absolutely was intolerant of bureaucratic BS, apropos this episode. She was a very proud person. She refused to knuckle under. [Redacted] Bell Telephone hooked up a phone patch for her to run lab meetings from her house in West U to the rest of us in the lab. [Redacted] And she was very strong and very domineering that way. She would force you to declare yourself, and then she would come back and show you what needed to be. English was her second language. I was an honors graduate in history from Oberlin. I had written a lot as an undergraduate. I can tell you her English as a second language was better than mine. The first manuscripts I wrote came back—it was like a sea of red ink. I was chagrined and embarrassed and just a little bit irritated, but in reading it through, line by line, I recognized she was absolutely correct—that her way of expressing things was better. So from her I learned not to knuckle under to bureaucracies and I learned about the purity of science and the importance of defending the truth at all cost, even personal cost. And that was coupled at the same time that I was working so closely with Dr. Martin, with whom I had such a strong, strong relationship that revolved around his skills and his decency as a human being. In some ways, looking back, it was certainly the most rapid growth period of my time at Anderson and certainly the—I won’t say that it was nirvana, because I had all of the struggles of trying to catch on in an environment that was not home to me but was becoming home to me—all of the transitions, all of the emerging personal identity issues that for a young surgeon are very, very important. Can you cut the mustard? Are you able to do things? Are you going to kill people in the operating room? Can you develop autonomy without hurting anyone, and how do you walk that tightrope? All at the same time as I’m also a full-time graduate student. I had MD/PhD medical students doing their junior clerkships with me, and we were in the same lectures together. They would go from the clinic and take lecture notes and then teach me what I’d missed in the lecture that day, and I would teach them the surgery. It took a lot of flexibility, and all of that going on against the backdrop of young children at home and trying to be a good parent and writing a 500-page dissertation and so forth. So, it was a time of much challenge, but I was working with people whose integrity was absolutely unassailable, and that left such a strong imprint on me of how you should behave.
Tacey Ann Rosolowski, PhD:
I’m curious. You mentioned those identity issues. How did you negotiate that and what do you feel was the outcome?
Raphael Pollock, MD:
I negotiated it by never being afraid to ask for help. One of my throwaway taglines that I used then and still used now is, “Never be so smart as to not know that you need help.” And I saw that it was something that you should do simply because how Dr. Martin recruited other people. It was never about ego. The tagline that I refer to now all the time is, “The biggest ego in the room is the tumor.” That’s very different than the way most surgeons approach things or sort of the caricature of surgeons—always decisive, sometimes correct. You will always know what my opinion is, and we’re going to do it my way no matter what.
Tacey Ann Rosolowski, PhD:
I was going to ask you about that because the portrait—
Raphael Pollock, MD:
This is very, very different.
Tacey Ann Rosolowski, PhD:
The portrait you’ve been providing is so different. And do you think that’s an MD Anderson thing?
Raphael Pollock, MD:
It’s an Anderson thing. It was—or at least it was an Anderson thing at the time. I think that surgery has become much greener, if you will, over the—the pyramid programs have been eliminated—the old slash-and-burn department chairman no longer exists. It’s much more of a consensual and consensus building environments. But at the time, surgery was dominated by towering people who had humongous egos that needed constant stroking. And I came down here, and while the people were unheralded in terms of national academic politics, they were so good with their patients. It was so clear to me that the patients responded to that. They treated each other with such respect. I remember telling myself as a fellow that if I ever had a chance to be in an environment like that, I really want to be in that type of environment, as compared to the types of environments that I had trained in, which tended to be much harsher.
Tacey Ann Rosolowski, PhD:
Do you feel that it offered you a lot more room to grow than you would have had?
Raphael Pollock, MD:
Absolutely.
Tacey Ann Rosolowski, PhD:
I wonder if that’s a general rule. Or do you think it’s more a personality thing—that a more collaborative—? What’s your impression of that?
Raphael Pollock, MD:
I think that in the best scenarios—the best circumstances—Anderson facilitates people’s growth. The old Louis Pasteur quote, “Chance favors the prepared mind,” also applies. But the opportunities here, certainly then, I think still—although I’m not an entry-level faculty member—the opportunities were limited by your energy and your imagination and the ready availability of such outstanding mentors who were honest and good at what they did and were eager to bring younger people along and were selfless. It was Camelot. It really was. The people who trained at Anderson at that time will recognize what I’m talking about when they read those words. The institution had to grow, and I wouldn’t say that people like this were casualties of that growth; they were not. They could have certainly survived and thrived in the Anderson of today. But having said that, the Anderson of today is a very different environment, and we can talk about how those are different. Coming back to the journey through time—And I don’t know how much time—? Are we okay?
Recommended Citation
Pollock, Raphael E. MD and Rosolowski, Tacey A. PhD, "Chapter 05: Surgical Stress, Natural Killer Cells, A Mentor and a PhD" (2012). Interview Chapters. 1317.
https://openworks.mdanderson.org/mchv_interviewchapters/1317
Conditions Governing Access
Redacted
