Chapter 03: Creating a Collaborative and Compassionate Neuro-Service
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Description
Dr. Sawaya begins this Chapter with comments on the challenges of creating collegiality among high-intensity personalities, citing the importance of looking at interpersonal skills while hiring. Dr. Sawaya affirms that the Department has developed a culture that does not tolerate selfishness and arrogance, noting that not all departments are like that. He says he is dismayed when he hears, “You’re nice for a neurosurgeon.” He explains that a diagnosis of brain cancer is “mind boggling” for a patient, and good interactions with the care team gives the patient confidence. He then Dr. Sawaya tells the story of a young man who was given a prognosis of only six months to live before coming to MD Anderson for treatment. He is still alive, married with children.
Dr. Sawaya describes a patient conference on brain cancers that he started at MD Anderson in the mid-nineties. It is now held every two years and designed to provide the public with information about all dimensions of brain cancer and treatment. Dr. Sawaya again talks about the “scare factor” of brain cancer, noting that it the surgeon must interact with the patient and family so the patient regains his or her confidence to begin the fight.
Identifier
SawayaR_01_20130604_C03
Publication Date
6-4-2013
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the InstitutionThe Administrator; The Leader; MD Anderson Culture; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; MD Anderson Impact; Patients; Offering Care, Compassion, Help; Patients; Cancer and Disease; This is MD Anderson; Beyond the Institution; Patients, Treatment, Survivors; Institutional Mission and Values; Information for Patients and the Public; Devices, Drugs, Procedures; Discovery and Success
Transcript
Tacey Ann Rosolowski, PhD:
So, I wanted to start with those general questions, and now I wanted to move on to some of the more chronologically— I'll kind of catch up on your career. But I wanted to ask, since we've addressed these issues, is there anything else that you wanted to say right now to set the tone for what we're going to talk about these two hours? William C. Satterfield, DVM My ending up at MD Anderson was serendipitous. I started out when I left school during the Vietnam era, having to spend some time with the military. As a result of that, I volunteered at the Pittsburgh Zoo and then—
Tacey Ann Rosolowski, PhD:
Can you tell me what it was that happened during your military service that made you move to volunteer at the zoo, or go to the zoo? William C. Satterfield, DVM The zoo was there, and the director of the zoo actually was a person that I had met while I was interning in Tampa, Florida. And the practitioner that I was interning with there was a consultant for Busch Gardens. So, when he was at—ended up in Pittsburgh, and I ended up there, too, then I reached out to him. And so, I started working on weekends, helping, doing things for him. They had a very limited budget and I had some resources that—medical resources, veterinary resources—I could make available to their children's-zoo-type of animals and could help them out. And I worked over there. We painted and scraped stuff and did things like that. Then after that, after I left the military, I ended up going to Boston in another zoo, fulltime zoo veterinarian up there. One of the six— I always say I was one of the five or six first fulltime zoo veterinarians that was fully employed in this country at that time. There was New York, San Diego, Washington, DC, and I'm not sure where else, maybe San Diego. Not San Diego, but San Antonio had a fulltime zoo vet. Then I became a fulltime zoo vet in Boston.
Tacey Ann Rosolowski, PhD:
Can I just skip back a little bit and catch myself up on kind of what led you to that point? First of all, just for the record, where were you born and when? William C. Satterfield, DVM I was born in Lexington, Kentucky, in 1942. I was a war baby.
Tacey Ann Rosolowski, PhD:
Is that where you grew up as well? William C. Satterfield, DVM And my dad was an engineer, and after being stationed in Key West, Florida, he—while he was down there—his little engineering group brought fresh water to Key West. Before that time, they didn't have fresh water brought in from mainland. They had to— I guess they had to truck it down or somehow or catch rain water. But after he was discharged from the Navy, my parents moved to Tallahassee, Florida, and I grew up in Tallahassee. Went to Florida State University, University of Florida, and attended veterinary college, my veterinary school, at Auburn University.
Tacey Ann Rosolowski, PhD:
Why did you decide to become a veterinarian? William C. Satterfield, DVM I like the science. That was always an interest of mine. I love biology, and my dear mother loved animals, and that rubbed off on me.
Tacey Ann Rosolowski, PhD:
Did you have animals in the house? I mean, what did she do that created that love—? William C. Satterfield, DVM She always had dogs, and she let us bring home stray cats and rabbits. Anything I wanted to bring home, she was good with it. Then we—my brother and I—always had some kind of animal around, and then I became interested in exotics, actually. When I went to Tampa—
Tacey Ann Rosolowski, PhD:
So let me just make sure I'm caught up here. So you got your Bachelor of Science in Zoology in '65 at Florida State in Tallahassee. And then you did your DVM at Auburn University in Auburn, Alabama, in '69. Is that correct? William C. Satterfield, DVM Correct.
Tacey Ann Rosolowski, PhD:
Okay. Why did you choose that particular school? William C. Satterfield, DVM I didn't really have any other choices, as a matter of fact, at that particular juncture. There were only—I can't remember now—maybe fifteen or sixteen or so veterinary schools. And we were— Florida had what they called a regional program. They bought—there was no veterinary school in Kentucky, Georgia. I take that back. Georgia had a school, but Florida didn't have one, and Alabama had Auburn, but Mississippi didn't have one, nor did Louisiana. And so each one of those states purchased a number of seats in the program at Auburn to subsidize that program. It was called a regional program because Auburn was a land grant institution.
Tacey Ann Rosolowski, PhD:
It seems so strange to me—I mean—in areas where agriculture is so important, not to have a veterinary school. So, what was that about? William C. Satterfield, DVM Very expensive and there—it was specialized. So since then, of course, Florida has a veterinary school. There is a school in Louisiana, a veterinary school. There's one in a number of the other states that were involved in the program. Tennessee was one of our feeder states. They have a school now, too, a school of veterinary medicine. We've got thirty now—thirty schools or so.
Tacey Ann Rosolowski, PhD:
Now, you worked with the US Department of Agriculture from '78 to '79 with foreign animal diseases? And I'm not sure if that's foreign animals or foreign diseases. William C. Satterfield, DVM In that particular reference that you've got there I was—while I was at the zoo, I attended a foreign animal disease course at the Plum Island facility off of New York, off of Long Island, actually. There was a facility that the Department of Agriculture—a high-containment facility—that they used to study all of the exotic things that are in Africa and other places that would devastate our agricultural economy here were they to be here. And that was what that was in reference to.
Tacey Ann Rosolowski, PhD:
Was that part of your interest in what you were calling "exotics"? William C. Satterfield, DVM Not really. It was related to that because we had a lot of— At the zoo, we imported animals. We had a lot of animals. Of course, we had a lot of African livestock, so that was why I chose to attend that—was to be part of that program. But it was during that period that I was able to participate, and it was a very unique experience because they only allowed a limited number of folks to be trained there.
Tacey Ann Rosolowski, PhD:
What did you get out of it? How was it—? William C. Satterfield, DVM What did I get out of it?
Tacey Ann Rosolowski, PhD:
I mean, how was it unique? What was—? William C. Satterfield, DVM It's unique in that it's like a high-security area. The only way to get to it was by a ferry boat that the government operated, and the only way to get off there was by that same ferry boat. And it showed up— You had to leave at 8:00, and you had to leave at 5:00. And if you didn't, you stayed right there. You got left behind. But going in and out was— It was a high-security area.
Tacey Ann Rosolowski, PhD:
And what kind of things were you looking at there? William C. Satterfield, DVM Foot-and-mouth disease, Rinderpest, certain other viral diseases that—African swine fever—those kinds of things that we don't have in our agricultural animals here because they would—it would wreck our economy.
Tacey Ann Rosolowski, PhD:
Interesting. I'm just trying to look through kind of the sequence, and you went from '80 to '83, the Tufts New England Medical Center School of Veterinary Medicine. And what was your reason for attending that program? William C. Satterfield, DVM I was an adjunct professor there, and I taught there.
Tacey Ann Rosolowski, PhD:
Okay, I'm sorry. William C. Satterfield, DVM And I taught a course there in zoo animal medicine, so to speak.
Tacey Ann Rosolowski, PhD:
Okay. And then the Department of Defense Wildlife Field Research that you did at Harvard School of Tropical Medicine in Boston, what was that all about? William C. Satterfield, DVM We were—they had a study on Lyme disease. They were studying Lyme disease. Lyme disease is originally from Lyme, Connecticut, if you're familiar with that part of the country.
Tacey Ann Rosolowski, PhD:
Yes, I am. William C. Satterfield, DVM It was sort of where Lyme disease was originally discovered. And there was a—or still is—a very endemic part of the Cape, Cape Cod, that has a high incidence of that Lyme disease there. It's a real problem. So I worked with some basic scientists there who were looking at the transmission of Lyme disease through its life cycle with the mice and the ticks and the deer and the humans. And that was kind of a side thing as part of my zoo experience there.
Tacey Ann Rosolowski, PhD:
So I'm trying to get a sense—I mean—through all of these experiences that you went through in that early professional development, when you look back, how did all of that influence your perspective? Because at that point you're about ready to come to MD Anderson, and so how did all of that affect what you brought here as a mission and philosophy? William C. Satterfield, DVM Yes. I did a lot of clinical work there with the zoo animals, just normal veterinary care, and had a whole, entire collection of everything from fish to elephants, which included primates—both chimpanzees, gorillas, orangutans, a lot of other African primates—and through doing this field work and other things, it rekindled my interest in basic biology. And we worked on, at the zoo, certain aspects of immunology because that was something that we kept bumping into in trying to care for some of that exotic stock. And so when I had an opportunity to come here— I was offered a chance to come here to work with chimpanzees and look at this new disease called AIDS. And chimpanzees were at that time the only—they were the closest animal to humans. And the NIH thought that they could perhaps design a vaccine or a treatment or understand AIDS in the same manner that they were able to develop a hepatitis B vaccine, which they were able to do successfully with the use of chimpanzees. Chimpanzees were also involved in the development of the polio vaccine as well. That's not as well-known either, but chimpanzees were critical in that—used in that as well. So, we didn't know when I came here what the cause of AIDS was. It was likely a virus, but the virus had not been identified. And so we started out doing hepatitis work, because that was the basis and the model again for trying to understand how to use a chimpanzee to figure out what was causing this immunodeficiency disease in humans—acquired immunodeficiency in humans—that people were dying from, as well as this Kaposi's sarcoma that they were developing. And the causative agent had not been identified. Then it was thought to be a human lymphotropic virus called HTLV-3, I believe, at the time. But most of the early work that I did was with hepatitis since I was working with the hepatitis laboratory. Dr. [Robert] Purcell, who had been reluctantly recruited to do HIV work or AIDS work based on his experience with chimpanzees and hepatitis, had been tasked with seeing if he could develop some understanding of what was causing this immunodeficiency syndrome in humans.
Tacey Ann Rosolowski, PhD:
So, how did that all work? You were in Boston and so at what point—? William C. Satterfield, DVM I was actually— I had actually left Boston, and I had taken a year off.
Tacey Ann Rosolowski, PhD:
Why? William C. Satterfield, DVM Just to— Why? That's a good question. The truth of the matter is that all zoos have a great deal of politics involved in them, and the politics there just got to be compromising their animal care and I couldn't— I felt like inevitably, I had to leave, so I left. And at the time I felt like I needed to take some time off. I took a year off, and during that year, I met one of the first veterinarians that worked here. I'd also known Dr. Keeling from my zoo work. I met Dr. Keeling through the zoo organization that I became president of. I had met one of his colleagues here who had worked at Yerkes as well. Both Dr. Keeling and Dr. Riddle, who were the first two veterinarians here—Ken Riddle and Michale Keeling—they both had done work at Yerkes. Then they came to Texas. They wanted to—the National Institutes of Health had all these chimpanzees that they had brought in to various labs for lots of different reasons, had outgrown their laboratory facilities. They needed a place for them to go. Yerkes couldn't take them or wouldn't take them, so Dr. Keeling and Dr. Riddle designed our compounds and our chimpanzee facilities here. R. Lee Clark, who had a ranch up here in Bastrop County, called Dr. Keeling down to his ranch one day and said, "Mike, I've got a donor that's got a million dollars. Can you put something together and do a world-class facility?" Basically, I don't know if he said "world class," but a first-class facility. They drew something out, and Dr. Clark said, "Go ahead." So, that's how they started this facility. So then, I came out of that Boston zoo with primate experience. They needed somebody to do primate work, chimpanzee work. There are not a lot of people walking around that had chimpanzee experience. They offered me a position here, and it just happened that I felt like I needed to go back into my professional life, so I accepted the position here.
Tacey Ann Rosolowski, PhD:
When you mentioned R. Lee Clark and the million dollars—R. Lee Clark, whenever anyone talks about him, “visionary" is the word that's used. I'm wondering what he saw in the early ‘80s. What were the possibilities for bringing the chimps here? What did he hope would happen with the NIH chimpanzees here in Bastrop, associated with MD Anderson? William C. Satterfield, DVM I think he felt like, and everybody felt like, it was an opportunity to get closer ties to National Institutes of Health. It was also an opportunity to have a unique animal model that could assist with understanding human diseases and because of the close similarities. They really didn't get used that much for research purposes in the early years, but they have, over the years, been used for human respiratory syncytial virus. They have been used for hepatitis work. They've been used for monoclonal antibody work. And you'll probably bring this up later on—I did DOD. It wasn't DOD, but it was Homeland Security-type of work with developing a treatment for smallpox.
Tacey Ann Rosolowski, PhD:
And when was that? I think I had— William C. Satterfield, DVM Smallpox studies were done in the late ‘90s and early 2000. We had a couple of animals that had an experimental history, and we keep extensive records on all of our animals. They had been vaccinated with vaccinia back in the late ‘70s or early ‘80s, and those were the two animals that we felt like we could boost those animals, because there are some parts of the vaccinia virus that are very similar to the smallpox virus. And that's why we get some vaccinia, and that's back in the old days—me included—had a smallpox vaccine, but it was a vaccinia, these cowpox on us, which is vaccinia. And that's what eliminated smallpox as a worldwide scourge—people dying right and left with smallpox. When they discovered that these milkmaids didn't get smallpox because of that vaccinia virus, then that became the way of treating or preventing smallpox. Try to understand. We were able to vaccinate our chimpanzees for this vaccinia, and then by using recombinant techniques in the laboratory—this is where the laboratory cell culture comes in—using both the animal as well as the genetics from the animal and doing the recombinant, they were able to develop a monoclonal antibody against the smallpox so that if you were exposed to smallpox, it would be too late to give you a vaccine. But we could treat you with this antibody and prevent the development of the disease. And that's gone into the National Stockpile. The National Stockpile is this theoretical—I guess it's there—they don't talk about it, but it's the Defense Department thing where they maintain agents against any kind of biological threat that could be used for bioterrorism.
Recommended Citation
Sawaya, Raymond MD and Rosolowski, Tacey A. PhD, "Chapter 03: Creating a Collaborative and Compassionate Neuro-Service" (2013). Interview Chapters. 1539.
https://openworks.mdanderson.org/mchv_interviewchapters/1539
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