Chapter 04: A Revealing Internship and Residency

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Chapter 04: A Revealing Internship and Residency

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In this segment, Dr. Rodriguez talks about her residency and her decision to focus on oncology. She explains that she chose to do her internship in internal medicine at te UT Health Sciences Center in San Antonio (1/1979−1980) because she wanted to focus on health issues in the Hispanic population, particularly diabetes. She stayed in San Antonio for her Residency in Internal Medicine (1/1980−1982) and decided during her first year to focus on oncology. Next she decided to do a fellowship and approached Dr. Daniel von Hoff about working in his laboratory. (Research Fellow, Cancer Therapy and Research Center 1/1982−1983.) She explains that she wanted a year to familiarize herself with this new field and to take time for personal reflection. Dr. Rodriguez also describes the research she conducted at the time, relating to Dr. Hoff’s theory that treatments could be personalized to the specific sensitivities of a tumor. She explains the work she did on the research projects and notes that this intellectual environment influenced her thinking about cancer. Dr. Rodriguez then explains why she elected to do her fellowship in hematologic cancers (Fellow of Hematology/Oncology, University of Arizona Cancer Center, Arizona Health Sciences Center, Tucson, 1/1983−1986).

Identifier

RodriguezA_01_20150220_C04

Publication Date

2-20-2015

Publisher

The Historical Resources Center, Research Medical Library, The University of Texas Cancer Center

City

Houston, Texas

Topics Covered

Professional Path; Professional Path; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; The Researcher; Understanding Cancer, the History of Science, Cancer Research

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

Alma Rodriguez, MD:

At that point, I still wanted to do primary care. And I chose my training in internal medicine in San Antonio, one, because I had been there in college, and I liked San Antonio, but also because the population base for the medical school in San Antonio and for the training in San Antonio is largely Hispanic. And I sincerely wanted to learn more about healthcare in the Hispanic population, the Hispanic community. Diabetes is a very major issue, very major health problem. I thought I might veer in the direction of diabetes-related care and illnesses. But again, as I did my oncology rotation, I again found that very interesting. I also had a very dynamic attending. It makes a very big difference.

Tacey A. Rosolowski, PhD:

And what was your attending’s name?

Alma Rodriguez, MD:

Daniel von Hoff.

Tacey A. Rosolowski, PhD:

OK, that’s right, I do remember that name. Yeah. What was so inspiring about him?

Alma Rodriguez, MD:

Well, he was very energetic. He was a clinical and laboratory researcher, and he had come to—he was young in his career. He had come to San Antonio from the National Cancer Institute, and he was very passionate about what he did, and he was an enthusiastic and engaging individual, and very supportive of residents who expressed interest in oncology. So he sort of took me under his wing and I did a year’s fellowship in his lab.

Tacey A. Rosolowski, PhD:

Oh, wow!

Alma Rodriguez, MD:

After my residency.

Tacey A. Rosolowski, PhD:

OK, yeah. So just for—so, for the recorder, the dates. So you did your internship from 1979 to 1980, and the ’80 to ’82 was the residency in that system as well.

Alma Rodriguez, MD:

Correct.

Tacey A. Rosolowski, PhD:

Yeah. So tell me about the research project that you did during that. Did you do research during this first residency? Or was it during your fellowship period afterwards?

Alma Rodriguez, MD:

It was afterwards.

Tacey A. Rosolowski, PhD:

Afterwards. OK. So from 1982 to ’83, you had the cancer research fellowship at the Cancer Therapy and Research Center.

Alma Rodriguez, MD:

Correct.

Tacey A. Rosolowski, PhD:

So but you—and was that Dr. Hoff’s lab?

Alma Rodriguez, MD:

It was in Dr. Hoff’s lab, yes.

Tacey A. Rosolowski, PhD:

OK. But so the first couple of years you were kind of getting to know him, and making your selection.

Alma Rodriguez, MD:

Correct.

Tacey A. Rosolowski, PhD:

So tell me about the process of selecting the focus on oncology. You know, when did you know that you were going to kind of separate and pay more attention to the area of oncology?

Alma Rodriguez, MD:

My senior year in residency, the second year of residency I really was sure about that. And that’s what I approached Dr. von Hoff about during the year of—in his lab, simply because I wanted to really cement that in my mind. Also, quite frankly, it had been, like, six years from medical—if you include the three years of medical school, the three years of residency and internship, it had been six years of really relentless, unending, go-go-go-go without pause for reflection, if you will. And so I wanted that year to both familiarize myself more with the work that he was doing in the lab, but also to do some self-reflection about whether this was really what I wanted to do.

Tacey A. Rosolowski, PhD:

What were the issues you were weighing in your mind at the time?

Alma Rodriguez, MD:

Well, certain—I mean, for one, it’s not a trivial decision to make—so select a sub-specialty, because then one has to commit to further training in a fellowship.

Tacey A. Rosolowski, PhD:

Yeah.

Alma Rodriguez, MD:

So that’s additional time. It also, depending on where or what type of fellowship, that would mean yet another geographic change, interviewing all over again, going through the round of interviews, going through the rounds of selection and waiting to hear are you accepted or not. I mean, it had been sort of that process from college, medical school, the residency and now again fellowship. So it felt like I had been under the scope and for so many years now, in my life. So I had to think about that carefully. Did I really want to go again through another round of— But, you know, it turns out life is an endless round of interviews! (laughter) But anyway, and I just wanted to be certain of what it was that I wanted to do. And I also wanted more time to spend with my parents, because they had moved to San Antonio, actually. Along the way, they had decided that they did not—they wanted to closer to a place where they had access to airports, because they knew both my sister and I likely were never going back (laughs) to Roma. So they wanted to have—be closer to access to travel that would be easier for them. And they had moved to San Antonio, so I spent that year with them, as well. So anyhow, that’s how I really cemented my decision for oncology.

Tacey A. Rosolowski, PhD:

What was the research that you were doing?

Alma Rodriguez, MD:

Well, at that time, he was—at that time, there was a concept that one could—it’s interesting to me how ideas sort of come around, they cycle. So the idea that Dr. von Hoff had, and still has—he’s still conducting research along these lines—was that one could personalize the treatment, depending on the sensitivity of the tumor to certain drugs.

Tacey A. Rosolowski, PhD:

Wow!

Alma Rodriguez, MD:

So his concept for how one did that was that one would take the cells from the patient’s tumor, grow them in the lab in petri dishes, or some other medium, and then test pretty much similarly to one how tests bacteria. You grow them in the lab and then you apply the antibiotic to the plate where the bacteria are growing, and then you observe whether the bacteria die or not. And to what degree do they die when they’re exposed to the antibiotics. Well, he had the similar concept for cancer cells and chemotherapeutic agents. So if one grew the cancer cell successfully, and that’s a big barrier, first of all, getting the cancer cells to grow. Secondly, one would test specific drugs, Drug A, Drug B, Drug C, and whichever one of those drugs give the highest level of tumor kill, that would be the appropriate treatment for that individual patient. That was his model, or his concept.

Tacey A. Rosolowski, PhD:

Now, what did he believe made the difference between patients? Why did he believe that tumors were slightly different in different patients?

Alma Rodriguez, MD:

Well, there’s just a clinical observation, that’s a fact.

Tacey A. Rosolowski, PhD:

OK.

Alma Rodriguez, MD:

You know, some patients respond very well to chemotherapy, others don’t. And yet, they have the same diagnosis, right? Assuming that physiologically these individuals are not that different—and that’s a big assumption, in reality that’s a big assumption—but let’s say that both individuals supposedly will metabolize the drug in the same way, then the only explanation for why they get different responses is that the tumors are different.

Tacey A. Rosolowski, PhD:

Yeah.

Alma Rodriguez, MD:

The tumors are biologically different. And at that point, was the beginning, as well, of genetic testing in tumor cells. So along with the drug testing, there were also cytogenetic analyses that were done in parallel. Now, I was not doing the cytogenetic testing, I was more doing the laboratory processes, testing various laboratory processes. So my involvement at the time was primarily just to test different media, design different environments for the growth of the tumor cells to see which ones would be best, and so on. So it was more of a cellular biology project that point, and that we were investigating the techniques by which one would grow the cells and which one was successful.

Tacey A. Rosolowski, PhD:

Did this view affect your own conceptualization about cancer? I mean, it’s a very, you know, interesting and kind of avant-garde way of looking at it.

Alma Rodriguez, MD:

Right. Right.

Tacey A. Rosolowski, PhD:

How were you affected by that intellectual environment?

Alma Rodriguez, MD:

Well, intellectually, I think I’ve always understood that, you know, cancer in individual A is not the same as cancer in individual B. I’ve always understood that there are unique characteristics of the biology of the cells that, despite appearing similar under the microscope, there are other inherent characteristics of the cells that will make the malignancies different from individual to individual. I think that we’re beginning now with the genome project and looking at exquisite analyses of the profile, genomic profile of each tumor, we’re now beginning to appreciate what those subtle differences are— What are the similarities and what are the differences, as well. But that was philosophically, if you will, and empirically we had observed that for many years. We’ve known that for many years.

Tacey A. Rosolowski, PhD:

So what turn did life and research take next? I mean, when during this fellowship period, you know, what was the next step?

Alma Rodriguez, MD:

Well, that was only a one-year experience. I then did a formal fellowship in hematology and oncology at the University of Arizona in Tucson. And specifically, the focus of my research was in multiple myeloma. That’s how I ended up in the Department of Lymphoma/Myeloma.

Tacey A. Rosolowski, PhD:

Oh, OK. Yes. Why did you choose to go into blood diseases?

Alma Rodriguez, MD:

One of the reasons is, you know, hematologic malignancies are much easier to culture in the laboratory, or at least at the time. It was simpler to obtain tumor samples of blood cell malignancies than it is for cell—it’s still true today. I mean, a patient with leukemia, one can do a blood draw, and the malignant cells will be in the blood sample. One doesn’t have to invade the body any more than that. Whereas in solid tumors, you know, usually it will involve having to do some deep cavity biopsies. And that can be traumatic for the patient, as well as difficult, and costly, etc. So hematologic malignancies have been traditionally model for cellular and biological investigation of malignancy processes. So that’s what makes it, in part, attractive. The other is that the biology of cancer, the studies of the biology of cancer, have been also more advanced in hematological malignancies. Hematological malignancies have been always, you know, a couple of jumps ahead of the biology analyses of solid malignancies, precisely simply because they’re easier to study and analyze. And thirdly, because there were two individuals; specifically Dr. Salmon and Dr. Durie in Arizona, who were world-renowned at the time for their work in multiple myeloma, so—

Tacey A. Rosolowski, PhD:

Could you repeat their names again? Dr.—

Alma Rodriguez, MD:

Salmon, S-A-L-M-O-N.

Tacey A. Rosolowski, PhD:

S-A-L-M-O-N, OK.

Alma Rodriguez, MD:

And Durie, D-U-R-I-E.

Tacey A. Rosolowski, PhD:

D-U-R-I-E. OK. So you went specifically to study with those individuals?

Alma Rodriguez, MD:

Yes.

Tacey A. Rosolowski, PhD:

You know, and let me just backtrack a tiny bit, because I realize I neglected to ask about another dimension of that experience in San Antonio. Because you said you had gone there because you wanted to also provide some—do you need to take a check on that?

Alma Rodriguez, MD:

I need to just check—

Tacey A. Rosolowski, PhD:

OK, let me just pause the recorder really quickly. [The recorder is paused]

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Chapter 04: A Revealing Internship and Residency

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