Chapter 08: Strategic Educational Choices to Build a Solid Career
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Description
Dr. Sawaya begins this Chapter with recollections of his father, who was a physician and a mentor to him. He states that he saw his father make contributions to medicine and to society alike, and that by accompanying his father on house calls, he witnessed the impact a physician could have on an entire family. Dr. Sawaya then sketches his educational path, which took him away from Syria to a French University of Medicine in Beirut, where he could receive a superior education under the French system. He note his mentor in medical school, neuroanatomist Jedeon Mohassab, and neurosurgeon Fuad Haddad who eventually established the first neurosurgery center in the Middle East, and with whom Dr. Sawaya studied during a sub-internship. Dr. Sawaya then explains his decision to come to the United States to specialize in neurosurgery and describes the (lengthy) process of securing a surgical internship at Beekman Downtown Hospital in New York. He describes the educational and cultural adjustments he had to go through. He then sketches his Surgical Residency at Upstate Medical Center in Syracuse, New York. He explains why he did not feel ready to specialize in neurosurgery at this point, but notes that Dr. Robert King “opened the door” to his eventual specialization in neurosurgery. He then traces his training in neurosurgery, finishing at Johns Hopkins, where he was Chief Resident.
Identifier
SawayaR_02_20130625_C08
Publication Date
6-25-2013
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - Professional PathCharacter, Values, Beliefs, Talents; Personal Background; Professional Path; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; Obstacles, Challenges; Cultural/Social Influences; Women and Minorities at Work; Evolution of Career; The History of Health Care, Patient Care
Transcript
Tacey Ann Rosolowski, PhD:
All right. I’m Tacey Ann Rosolowski, and today is June 25, 2013. And I am in the office of Dr. Raymond Sawaya, head of Neurosurgery, for our second interview session. The time is—what time is it? It is 1:42. Thank you for participating again. I really enjoyed our last session together.
Raymond Sawaya, MD:
Great. Thank you. I’m glad to be with you.
Tacey Ann Rosolowski, PhD:
And I wanted to go back in time a bit at the beginning of this session and just get some background, such as where you were born and when and where you grew up.
Raymond Sawaya, MD:
I was born in Beirut, Lebanon, on Cinco de Mayo, May 5, 1949. My father was a physician and influenced me tremendously in my understanding of medicine and its impact on society. So he was—
Tacey Ann Rosolowski, PhD:
How do you mean?
Raymond Sawaya, MD:
He was an extremely compassionate person. And last time I talked a little bit about how I used to go with him to people’s homes. He would make house calls, which is something we don’t do much in this country. But I did grow up experiencing that and seeing the impact of a healer—a physician—on the whole family, not only on the patient. And that really—you’re appreciated much more in somebody’s home than in your office in the clinic. And then seeing how in my hometown, where I grew up—it’s a port city in Syria, called Latakia. It’s very much in the news now with all the civil war in Syria that’s going on. So I grew up in that town. And where I know my dad was very appreciated and loved for his practice—for what he gave patients and their families. So that’s my kind of social background. But then when I finished high school, I went to Beirut to Medical School. And I went to a French university, it’s called the French University of Medicine in Beirut. It’s run by Jesuits—French Jesuits—it’s called St. Joseph University. And the diploma that you receive there is a French state diploma. It is signed by the minister of education of France. And so I went there and very early on in my school years—in medical school, that is—I knew I wanted to go into neurosurgery. And that’s crucial, because that knowledge and that desire led me to want to come to the United States.
Tacey Ann Rosolowski, PhD:
But I ask you first, though, why you chose to go to that university for your—
Raymond Sawaya, MD:
Because—for one, I was French educated. There are two universities—or were—two universities in Beirut, where the education in the Middle East was the highest in Lebanon. So that’s natural if you want to get a good education and go to a good university, if you can go to Lebanon, this would be obviously a success. Within Lebanon there were two universities—the American University of Beirut, AUB, is the most famous one, and certainly the best known one in the United States, because it’s an American university. Their board is in New York. So it’s really led by the United States. The French university, as I explained earlier, is a French university. So their ties are with France. But I grew up French educated. My dad graduated from that medical school. So it was natural for me, once I decided to go into medicine, was to apply to that. So I did. I was accepted. What’s interesting is our class size was sixty students. When you think that the classes here in Houston—whether at Baylor College of Medicine or at UT Houston—the class size is between 160 and 200 students a year. We were sixty. Just imagine how much more attention we received from our teachers, from our labs, the anatomy lab, the dissection lab. I mean—we were very few students per station and per cadaver than they could afford to do here. So that added, I think, to the quality of the teaching and the learning. So as—
Tacey Ann Rosolowski, PhD:
So you sound like you’re very satisfied with the education you got there.
Raymond Sawaya, MD:
Absolutely. It was an outstanding school. The only problem—it was in French. And when I decided to come to the United States, I decided because I wanted to become a neurosurgeon. And I knew that early on, in part because I had a wonderful mentor, teacher, who was a neurosurgeon.
Tacey Ann Rosolowski, PhD:
And his name?
Raymond Sawaya, MD:
His name is a French name, Jedeon Mohassab. This is early—early in my neuro-anatomy classes and where I understood really the structure of the nervous system, the functionality of the brain and the nervous system—it all appealed to me. And that’s very common. I see that now in all the applicants whom we interview to enter the field of neurosurgery to become trainees, residents, in neurosurgery. That is a common trait. You know—if you don’t have that, then you’re probably picking the wrong field, the wrong specialty.
Tacey Ann Rosolowski, PhD:
And when—I’m sorry, just to make sure I understand. So when you say that what you see as the common thread is this simultaneous appreciation of structure, functionality—all those different planes.
Raymond Sawaya, MD:
Organization. The typical example that’s given is you create a lesion, you destroy a small part of the brain in one specific area, and you have a hand that is paralyzed. I mean, it’s that specific. And so—you know—for some people this is appealing, for others this is Chinese. They just don’t understand it. So for me, that was very obvious that I was very attracted to the field. And so I did everything in my power to improve my knowledge in this area. I did spend a year during medical school, like a sub-internship, with a pioneer neurosurgeon who trained in Montreal Neurological Institute under one of the biggest names in neurosurgery, called Wilder Penfield. Dr. Penfield established the first neuroscience institute, which is called the MNI, the Montreal Neurological Institute. And he was famous for localizing function in the brain during surgery with patients awake. So this professor of mine, by the name of Fuad Haddad, was his disciple and went back to Lebanon in 1956 to establish the first neurosurgical center in the Middle East. And I was lucky to spend a whole year with him—the year before I graduated from medical school. So all that combined increased my desire and eagerness to come to the United States and train as a neurosurgeon. It was not easy to get in coming from a French school not known necessarily in the United States. The path was not straightforward. I did receive more rejections than I can count. That’s the truth. And finally I was able to get in as an intern in this small hospital downtown New York.
Tacey Ann Rosolowski, PhD:
Now was the problem that the US acceptance committees didn’t know how to interpret your degree?
Raymond Sawaya, MD:
That’s correct. Yeah. I mean—I would write and say, “I would like to become a resident in your program.” Well, who am I, and who wrote letters on my behalf? These are all people that the universities here don’t know. And when you get a lot of applicants—you know—you look for reasons not to accept somebody, because you have too many applicants. So I wasn’t bitter about it, but it’s just to make the point that it was hard. It was really, really hard. But fortunately through some connection, there was a radiologist in New York in that hospital who was a friend of somebody who told the physician I was working with, he said, “Yeah, we have a surgical internship position open in that hospital,” which is called Beekman Downtown. And so I immediately applied, and they took me. So it was a one-year internship, and I did that. It was in New York City. So my first year in the United States in New York City—wow. That was amazing. Fortunately for me, this wasn’t a major university hospital where the academic level was so high that I would have had real difficulty adapting—you know—coming from a different system. It was a kind of small, private hospital. The level wasn’t—you know—very high, not an extremely busy hospital, small. So it gave me time to breathe and adapt and adjust, improve my English. And it was a stepping stone. So from there, once I got in—that’s the most important thing, you have to get in through the door somehow, somewhere. And for me, this was my entry level. And I knew that year wasn’t anywhere near what I needed to learn in the American system. So I applied for a surgical residency, and that’s when I ended up in Syracuse. There was another reason for me to go to Syracuse, is that their neurosurgery program there was headed by an absolutely phenomenal leader in neurosurgery, and I wanted to train under him in neurosurgery. He was considering me for 1975, but that’s the year when I just finished my internship. I didn’t feel I was ready. I just couldn’t. I wanted to do a year of general surgery, so I did general surgery in Syracuse. And then fortunately, by July ’76, Bob King—the name of the neurosurgeon—Bob did not have a position for me. He, I think, had a position in ’75, but I was not ready. So he was very helpful to introduce me to several other chairs of neurosurgery in the country. And the one that responded the fastest and offered me a job was in Cincinnati.
Tacey Ann Rosolowski, PhD:
Let me ask you, when you said you felt you weren’t ready, what did that mean at the time? What were you seeing in yourself?
Raymond Sawaya, MD:
That first year in New York, at times it felt like you took somebody off the street and put them in the hospital to work. Of course, it’s an exaggeration, but it’s to tell you the feeling that you come to a different language, and different way of doing things, different names of drugs, different way to order the drugs and to give them—all that is part of what you do as an intern or as a resident. If you don’t have that understanding, which you get from medical school—because when you’re a medical student, you rotate through hospitals. I did that, but I did that in the French system. I didn’t do it in an American system. And so coming here having so much to learn in not enough time—what is one year? I was just barely trying to adapt to a new culture, let alone the hospital and the medical field. So I clearly was not—I did not have the confidence to say, “Yeah, I’m ready to go into neurosurgery.” And I did well on that basis. I did do a year of general surgery that was probably one of the richest years of my career in terms of how much I was able to absorb in a good university on very excellent services. I practically lived in that hospital. And this was back in ’75-’76, at a time when there were no regulations. Now you’re not allowed as a resident to work more than eighty hours. So back then—gosh, I probably put in 150 hours a week. So it was very, very beneficial, but it did not afford me to train under Dr. King. But I did—to flash forward, when I celebrated the tenth anniversary of the Department of Neurosurgery at MD Anderson—I had established the department—I invited Bob King to be my honored guest. And I expressed my thanks and appreciation for pretty much opening the door for me to get into neurosurgery in the United States and therefore allowing my career to blossom. If I didn’t have that door opened for me, I would not be in. And I wouldn’t be where I am today. So I was saddened when Bob passed away, but I do keep this picture on my desk. This is Bob King.
Tacey Ann Rosolowski, PhD:
Wow, there he is. He has a nice smile—very warm-looking person.
Raymond Sawaya, MD:
Wonderful guy. And his wife, Molly, sent me a beautiful note. So she did write, “Bob and I treasured the time spent with you in 2001. He was so interested and proud of your accomplishments but even felt so comfortable with you as a person. You have much the same kindness toward others as Bob did. Thank you for your note. Molly.” So—life is made of connections, of influences, of mutual respect. And when you encounter something like this, you treasure it. It’s very important. So back to 1975 to ’76, not being able to train in neurosurgery in Syracuse, I went to Cincinnati, Ohio, where I spent five years. And I did general neurosurgery, obviously, including pediatrics. The chairman there, Bob McLaurin, and that’s by the way—Bob McLaurin is right there. See him? Yes, this one. He was my chairman during residency and a good neurosurgeon and an excellent pediatric neurosurgeon. He’s one of the pioneers of pediatric neurosurgery in the United States. And Cincinnati has one of the top children hospitals—Cincinnati Children’s Hospital. So I spent a nice year there. And then when I finished my training in neurosurgery at the University of Cincinnati, I had some leftover time. I had met all the requirements and learned all that I could learn from that place. I asked my chairman if I could—before I graduated—if I could go somewhere else, learn added skills including microsurgery. Because the microscope was beginning to be used more commonly in neurosurgery. And we wrote—I wrote to different places. And Johns Hopkins responded positively. Their chairman there, Dr. Donlin Long, became a wonderful friend, an outstanding neurosurgeon. He took me in as a chief resident. So that allowed me to do very advanced neurosurgery in one of the best centers in the United States. This was phenomenal. And it’s interesting that it’s only then that I decided—well two decisions I made.
Recommended Citation
Sawaya, Raymond MD and Rosolowski, Tacey A. PhD, "Chapter 08: Strategic Educational Choices to Build a Solid Career" (2013). Interview Chapters. 1544.
https://openworks.mdanderson.org/mchv_interviewchapters/1544
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