Chapter 03: Medical School and Other Training: Breaking into Opportunity

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Chapter 03: Medical School and Other Training: Breaking into Opportunity

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Dr. Balch begins this chapter on his medical training by noting that the process of applying to medical school was a "breakout moment" when he was encouraged to apply to top schools rather than setting his sights on a regional medical school. He talks about the culture shock he experienced going to New York City to attend the Columbia College of Physicians & Surgeons (MD conferred, 1967). He explains that he focused on cardiac physiology and was able to begin conducting research. Dr. Balch notes that he wanted to be in an academic medical center and explains his motivations: to focus on creating new knowledge and teaching. Next, he talks about the prominent physicians who mentored him and his ambition to become a cardiac surgeon. He mentions his internship in surgery at Duke University Medical Center (1967-1968) and his clinical residency in surgery at the University of Alabama in Birmingham (1970-1975).

Identifier

BalchC_01_20181022_C03

Publication Date

10-22-2018

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Path; The Researcher; Professional Path; Evolution of Career; Military Experience; Mentoring; On Mentoring; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; The History of Health Care, Patient Care; Understanding Cancer, the History of Science, Cancer Research

Transcript

T.A. Rosolowski, PhD:

So how quickly did you discover that you wanted to be a surgeon? I mean, was that

Charles Balch, MD:

During pre-medicine

T.A. Rosolowski, PhD:

That was it. So that was it.

Charles Balch, MD:

So I ended up doing night courses at the university, working during the day at the hospital, because they wanted me around to help at surgery because I could first assist very well and they didn't have many alternatives. In fact, it led to a whole program that there were about a dozen of us that were doing that at Toledo Hospital. But the heart surgeons there, the two of them, really took me under wing. They mentored me. I operated on all of their cases. And it leads to an interesting story. When I was applying to medical school in my third year, instead of my fourth year, because I'd been accepted at Michigan Dental School the year before, I was applying to all the regional placesOhio State, Case Western Reserve, Michigan, and so forthand the heart surgeon said, "You should apply to Harvard and Columbia." So I went home and told my mom, who said, "Oh, you shouldn't do that. You would never get accepted." But he came back and said, "You'll never know unless you try."

T.A. Rosolowski, PhD:

Can't win if you don't play. [laughs]

Charles Balch, MD:

So I applied to Harvard and Columbia, among those other places, and guess what: I got accepted to interview at both Harvard and Columbia, as a third-year student, not a fourth-year student. So I went to do my interviews on a Friday at Columbia, and my interviews at Harvard were on a Saturday. The last person I interviewed was the dean, who made all the final decisions, and I told him at the end of my interview, because I was, I guess, very relaxed, I wasn't expecting I'd get in. This was just for the dry run before I applied the following year. But I told him I had to get on a plane to go up to Boston because I was interviewing at Harvard the next day. And he said, "Now, if you were accepted at both Harvard and Columbia, which one would you choose?" So in my mind, I wasn't expecting to get accepted to either one of them, and so my answer to him was, "I'll cross that bridge when I come to it." [laughter] The next Tuesday I had a letter of acceptance in the mail at Columbia College of Physicians and Surgeons, and later on he told me that that is one of his key questions he asks his candidates. "If you'd have said Columbia I might not have accepted you, but I'm looking for independent thinkers." Now, it was the wrong reason, but it really was a seminal event in my life that got me out of a regional mindset into one of the best medical schools in the country. And from there, I was able to succeed in leadership roles in my surgical training, in my immunology training, and so forth. So this was really a breakout for me that I might otherwise have been an ordinary candidate in the Midwest instead of going to a stellar medical school in the East, which was a culture shock for me, and I had to adopt and succeed, but it really launched my career in medicine.

T.A. Rosolowski, PhD:

Yeah, interesting. So tell me about that whole shift. First of all, the culture shock, coming to New York City. [laughs]

Charles Balch, MD:

Just coming from the Midwest to Manhattan was a culture shock itself. My competition was the people who were coming from Harvard, Princeton, Yale, and Columbia, and I had to really buckle down and be serious about my studies, and organizing my time, so that I could not only pass the courses but excel.

T.A. Rosolowski, PhD:

Did you find the expectations radically different in medical school, in these

Charles Balch, MD:

They were much higher, yes. And it's interesting: at Columbia at the timethis was in the '60s80 percent of the class was from the Ivy LeaguesHarvard, Princeton, Yale, and Columbia10 percent were women, which was radical, and the other 10 percent were geographic distribution from the rest of the country. So I was part of that geographic distribution. However

T.A. Rosolowski, PhD:

So you startedI'm sorry to interrupt youyou started in medical school in '63, then. That was the year that you got your

Charles Balch, MD:

Correct. In my junior year, but the University of Toledo allowed me to transfer credits back from medical school. I was eight credits short. And that allowed me in 1964 to get a bachelor's degree from the University of Toledo, even though I was enrolled in medical school.

T.A. Rosolowski, PhD:

Wow, okay. Now, one detail I didn't ask you about from your undergrad experience at University of Toledo is that you have listed on your CV that you focused on immunology.

Charles Balch, MD:

Yes.

T.A. Rosolowski, PhD:

That's remarkably early for that. So tell me about that.

Charles Balch, MD:

Well, actually, I was focusing on cardiac physiology when I was in premedical school. I was interested in immunology later in my career at Columbia, and when I was at the NIH. You have to remember, in the '60s nobody knew about the immune system. We knew about immunoglobulins, and we knew that lymphocytes had some functions in immunity, but we didn't know their functions. But I worked in the dog lab and did some biomedical research on cardiac physiology during pre-medicine, and I think that really helped in setting the stage for me. And from pre-medicine through medical school, and even early in my surgical training, my ambition was to be a cardiac surgeon because all my role models were cardiac surgeons, including in medical school.

T.A. Rosolowski, PhD:

But you were putting all the pieces in place, even very early. I mean, you wanted to go do the lab work. You wanted to have the direct surgical experience at the hospital

Charles Balch, MD:

Yes.

T.A. Rosolowski, PhD:

and you wanted to do research. So what was the impetus to doing the research piece?

Charles Balch, MD:

I think it was getting back to my father as a role model who was vice president for research, and then who was an academic person at the university, both first as chair and then as a dean. And intuitively I always wanted to be in an academic center, even from the earliest days.

T.A. Rosolowski, PhD:

So you never thought about private practice.

Charles Balch, MD:

No.

T.A. Rosolowski, PhD:

Yeah, okay. What did being in an academic center mean to you at that age? I mean, that's pretty young, so what were you envisioning?

Charles Balch, MD:

Creating new knowledge, and teaching. So even early on, those were aspects of my own career goals is to do research and teaching, in a clinical practice.

T.A. Rosolowski, PhD:

Yeah, exciting, exciting thing to be looking at. So a lot of this, a whole new universe opening up coming to Columbia. So what were you finding when you got into your medical school training? How were things starting to open up inside you and for you?

Charles Balch, MD:

So medical school was very challenging, intellectually and academically. And at the end of four years, just to finish the story, among the top 20 students at Columbia 15 of the 20 were either women or part of the dean's geographic distribution. And I think the reason for that, because we talked about it, we had to prove ourselves we'd come from outside of the Ivy League, the academic elite, and I think a lot of it was the determination and the drive to prove that we could succeed at Columbia, even though we didn't have that preparation at an Ivy League school.

T.A. Rosolowski, PhD:

What were some high moments for you during that training period? I mean, it's just real learning moments, transformational moments.

Charles Balch, MD:

My surgical mentors, when I got into my junior and senior year, it just kept reinforcing that I really wanted to be a surgeon, an academic surgeon.

T.A. Rosolowski, PhD:

Who were those folks?

Charles Balch, MD:

My cardiac surgery was Jim Malm, M-A-L-M, who was the Chief of Cardiac Surgery. And another person, Dr. Rogers, who wasI did a research project with him on the cardiac sounds, and how you interpret murmurs in the diagnosis of cardiac disease. I actually operated with a very famous person named Cushman Haagensen, who is the father of the radical mastectomy.

T.A. Rosolowski, PhD:

Cushman?

Charles Balch, MD:

Haagensen. So he learned from

T.A. Rosolowski, PhD:

Actually Halstead is the name I associate with that. Interesting.

Charles Balch, MD:

Yes, so Halstead trained Cushman Haagensen. Halstead was dead at the time. Cushman Haagensen was the person who was perpetuating the value of the radical mastectomy.

T.A. Rosolowski, PhD:

Wow, okay. So was that when? Because another question, of course, is when oncology came onto your radar, but maybe that's not the right time to ask that question.

Charles Balch, MD:

No, that came later, because at that time my whole ambition was to be a cardiac surgeon, and all of my mentors, all of my research was in cardiac surgery. And that led me to do my internship at Duke with Dr. David Sabiston, who was the Chair of Surgery there, and was probably one of premier academic cardiac surgeons in the country. Duke was

T.A. Rosolowski, PhD:

So you started that

Charles Balch, MD:

one of the favored places for an internship.

T.A. Rosolowski, PhD:

And you started that internship in 1967.

Charles Balch, MD:

Correct. Now, the other part of the story is the Vietnam War was going on at the time. All of us were in the draft, and by lottery we had a randomly assigned deferment of between one and five years after finishing medical school. So I drew the lot that I had to go into the military after one year, after my internship. Dr. Sabiston was on the NIH committee of General Clinical Research Centers [GCRC], and he actually arranged for me to be invited to join the public health service, and to go on to the general clinical research centers program at the NIH for my military deferment. Now, this also was very important to me, learning about clinical research, because the GCRCs [at the time] were the largest grants in the NIH program.

T.A. Rosolowski, PhD:

GCRC is the?

Charles Balch, MD:

General Clinical Research Centers. And I was assigned because I was a surgical trainee to be the staff person for the 30 transplant centers in the United States. All of the transplant programs in the United States, both organ transplantation and bone marrow transplants, were all done in GCRCs, and I was the NIH staff that organized the site visits, that wrote up the site visit report on behalf of the committee, and was the administrator for the grants for all of the [leaders] in transplantation. So

T.A. Rosolowski, PhD:

So that's a really quite amazing administrative role pretty early.

Charles Balch, MD:

Yes, as a young person, there were only five of us in that branch coordinating the largest program in the NIH.

T.A. Rosolowski, PhD:

That's amazing.

Charles Balch, MD:

At an administrative level.

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Chapter 03: Medical School and Other Training: Breaking into Opportunity

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