Chapter 01: Learning to See the Human Side of Medicine

Title

Chapter 01: Learning to See the Human Side of Medicine

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Dr. Bruera begins this chapter by sketching his family background and experiences growing up in Rosario, Argentina. He talks about the impact of his father's work as a cardiologist. He explains his father's interest in both research and, most particularly, in clinical work. His father's discussions of interactions with patients and ethical issues enabled Dr. Bruera to see the 'human side' of medicine very early. Next, Dr. Bruera explains that cancer was 'a big taboo' when he was in his early medical career. He talks about the fear of the disease, prohibitions against speaking about it, and his early commitment to contribute to addressing this challenge. Next, he sketches his interest in sports in school. He talks about the importance of his interest in soccer, a team sport, and the 'communist' attitude he took toward coaching children's soccer.

Identifier

BrueraE_01_20180806_C01

Publication Date

8-6-2018

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 - Personal Background; Personal Background; Character, Values, Beliefs, Talents; Personal Background; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; Professional Values, Ethics, Purpose; Understanding Cancer, the History of Science, Cancer Research

Transcript

Tacey A. Rosolowsi, PhD:

All right, and our counter is moving. Today is August 6, 2018, and I am on the fifth floor of Pickens Tower today, with Dr. Eduardo Bruera, and I’m saying that correctly?

Eduardo Bruera, MD:

Perfect.

Tacey A. Rosolowsi, PhD:

Okay, good. The R after the B, those vowels can be a bit of a challenge for the anglophone mouth.

Eduardo Bruera, MD:

It’s not easy.

Tacey A. Rosolowsi, PhD:

But I got it, that’s good. This is our first interview session together and the time, just for the record, is about 1:29. I’m Tacey Ann Rosolowski and I am conducting this interview for the Making Cancer History Voices Oral History Project, run by the Historical Resources Center at the Research Medical Library at MD Anderson Cancer Center in Houston, Texas. Just for the record, Dr. Bruera came to MD Anderson in 1999, and correct me if I have any of these details incorrect, to serve as chair of the Department of Palliative, Rehabilitation, and Integrative Medicine, in the Division of Medicine at MD Anderson, and that’s a role he still serves. Similar record of service, in serving as executive director of the Palliative Research Group, is that correct as well?

Eduardo Bruera, MD:

Mm-hmm.

Tacey A. Rosolowsi, PhD:

Okay. And you have a joint appointment with the Graduate School of Biomedical Sciences.

Eduardo Bruera, MD:

Right.

Tacey A. Rosolowsi, PhD:

Okay. And we’ll go into a lot of other details, because I know you’ve served other interesting roles. This session is being held in Dr. Bruera’s office and thank you so much for making time.

Eduardo Bruera, MD:

Thanks for coming, it’s fine.  

Tacey A. Rosolowsi, PhD:

Yeah, I know how busy all of you folks are and it can be a real challenge. Well as I mentioned before we started, I want to just start in kind of the traditional place and ask you where you were born and when, and tell me a little bit about your family.

Eduardo Bruera, MD:

Wonderful. I was born in a city named Rosario that is the third largest city in Argentina, in 1955. My dad was a cardiologist, who basically loved what he did. He loved patients, he did home visits with the patients on his own, and he also loved academics, he loved teaching and he did some research. So if you PubMed my name, you will see that the first two papers are not mine, they are Bruera, E., but they’re my dad, and they were done in the ’50s or something like that. And of course I could not publish that paper, being one year old.

Tacey A. Rosolowsi, PhD:

As much as you would have wanted to. [both laugh]

Eduardo Bruera, MD:

Yes, I already had that.

Tacey A. Rosolowsi, PhD:

Now you said he loved home visits and he went on his own. Was that unusual at the time, to do home visits?

Eduardo Bruera, MD:

It was rather unusual, that a busy cardiologist would do quite a lot of visiting of his patients. It was perhaps more usual than now, but it was not that usual. I was surprised and I did not understand exactly why he would do that, but he sometimes would take me and my mom and my sister and leave us in the car, and then he would go into his visit and then take us somewhere else. Sometimes, I would accompany him in some of them, so I knew that patients loved the fact that their doctor would show up at their home and visit them.

Tacey A. Rosolowsi, PhD:

What did you observe about how he was with his patients and how did that affect you?

Eduardo Bruera, MD:

I think he was a great listener. My dad was a great listener, at a time when nobody really was emphasizing listening so much, he was a great listener of the stories of the patients. And then later, in an anonymized way, he would tell some of those stories at dinnertime, so that we would understand some of the patients’ experiences and what they liked to do and so on. So I found that the human side of his practice, it was very easy for me to perceive. He also had a great love for being rigorous and scientific. But of course in Argentina, getting to be an academic or a researcher was very, very hard, and so he basically did most of his practice as a clinician. That’s what he did, he did clinical care. I learned a lot at the dinner table. So I learned stories, a lot of what he had learned, and the importance of being very ethical with patients and families, and the importance of trying to pitch in to knowledge. My mom, on the other side—my dad’s side of the family was Italian and my mom’s side of the family was Irish. My mom was very caring and wonderful. She was also very practical and she basically wanted me to become a banker, so she wanted me to go into finance and she thought that being particularly adult like my dad, who would never bill the patients and so it was not such a wonderful investment. So whenever I was riding my tricycle and telling—and people were asking, “Where are you going?” I said, “I’m going to the hospital.” My mom would continuously say, “Okay, but after the hospital, you go to work at the bank,” and she would redirect me continuously, to the bank.

Tacey A. Rosolowsi, PhD:

[laughs] That’s really funny.

Eduardo Bruera, MD:

Where she thought I should be really working.

Tacey A. Rosolowsi, PhD:

Now, am I correct in assuming that your father’s first name is also Eduardo?

Eduardo Bruera, MD:

Yes. Yes, yes.

Tacey A. Rosolowsi, PhD:

Okay. And your mom’s name?

Eduardo Bruera, MD:

My mom’s was Beatrice, and they met actually, in Rosario, in a St. Patrick’s Day party, where he and his friends attended the St. Patrick’s Day party at the St. Patrick’s Association in Rosario, and there they met. I don’t know all the aspects of their courtship, but they had a very, very happy marriage and they did very well.

Tacey A. Rosolowsi, PhD:

Do you have brothers and sisters?

Eduardo Bruera, MD:

I have a sister who is two years younger than me, and she’s in Argentina right now.

Tacey A. Rosolowsi, PhD:

And her name?

Eduardo Bruera, MD:

Her name is Maria Beatrice, but everybody calls her Marichu, that is a Basque nickname for Maria. I don’t exactly know why but that stuck with her.

Tacey A. Rosolowsi, PhD:

Marichu?

Eduardo Bruera, MD:

Marichu, M-a-r-i-c-h-u.

Tacey A. Rosolowsi, PhD:

Huh. I’ve never heard that before either, yeah.

Eduardo Bruera, MD:

That’s a nickname for Maria in the Basque country of Spain.

Tacey A. Rosolowsi, PhD:

Yeah, interesting. Tell me about the impact of your dad’s profession on you. Did you decide—you know, here you are, a doctor, banker. Were you riding your trike to the hospital because you had decided you wanted to be a doctor?

Eduardo Bruera, MD:

I guess initially, I felt that my dad seemed to be really in love with his work. He basically died at seventy-nine and he was still going to his office, he still had some patients, and so he really loved what he did. I sensed that I could be comfortable in that, without knowing that much. And then I went to medical school, mostly I guess following what I had learned from here. I thought that I could be happy on this, but I wasn’t sure I wanted to work one hundred percent by his side. I also felt that cardiology was not necessarily what I felt was the most exciting, maybe it was a very new area when he started doing it. In my time and age, the big taboo was cancer, the big thing that people were almost afraid to even mention. My mom would talk with her friends and they would ask, “Your boy, he’s also a physician?” Yes, yes. What specialty is he training on, what specialty is he working on? She would say, “A bad disease.” She wouldn’t even like to name the word cancer at that time.

Tacey A. Rosolowsi, PhD:

Wow.

Eduardo Bruera, MD:

I was telling my mom, “Mom they’re going to think I’m into STDs or things like that, because…” So, you’ve got to learn how to call the name. At that time, especially when I was growing up in Argentina, cancer was such a taboo surrounding it. It was a disease that was perceived as being associated with so much suffering, that it was a terrible diagnosis to have, so I felt that to me it was a challenge and something that I would like to contribute to perhaps make it less of a taboo and make it more of a disease that people would be comfortable naming and of course living with.

Tacey A. Rosolowsi, PhD:

Let me ask you to kind of go back before medical school a bit and tell me a little bit about your educational path earlier. What were the things you were interested in, in school, and how did you find your own talents evolving?

Eduardo Bruera, MD:

I was very interested in sports and I was a soccer player, and I even went into college, but it didn’t take me long to see that—well actually, I thought I was a very good soccer player. I thought I was a very talented soccer player, until one day we had the chance to play with two professional soccer players, who came to play a friendly game with us. I saw those two guys and I said oh, okay, that’s soccer, that’s a different thing. Now I understand that what I thought was completely wrong and I’m so glad that I’m going to college, because I can see that I could never ever in my life, do what these two people are doing in such an effortless way.

Tacey A. Rosolowsi, PhD:

What did you get out of playing soccer, that kind of made you start fantasizing about being a professional player?

Eduardo Bruera, MD:

I think it was exciting, the game is exciting and is still exciting to me. My wife knows that whenever I see a television set and there’s soccer being played, any place in the planet where I am, I will stop and watch for a while. I will just spend a few minutes watching and enjoying it, and then I’ll move on. So it’s still a passion I have, but I also understood that you could work very, very, very hard at it, but there’s something else you had to have that is a very natural, special talent, that I clearly did not have, so that was a great lesson.

Tacey A. Rosolowsi, PhD:

It was. Well and also, how great that you were able to accept your own limitation and make a good decision around that.

Eduardo Bruera, MD:

Yeah, yeah, I think you’re right. The best decision I made was to understand that I wasn’t good enough.

Tacey A. Rosolowsi, PhD:

Yeah, and some people just, they don’t do that. Well I’m also curious, because a game like that has a lot of things like teamwork and strategic thinking, and it also has body intelligence, and I’m wondering if there were elements of that, that also got you psyched about the game, because those are lasting gifts that go into other areas too.

Eduardo Bruera, MD:

Oh, yes that’s right. I learned a lot from that and I actually coached soccer for fifteen years thereafter. I coached all my kids into soccer and I spent fifteen years coaching soccer, until I took the job in Houston. So I did coach soccer for children for many, many years and I enjoyed coaching kids and seeing them grow from not knowing what to do with the ball to, at the end of the year, at the end of the season, playing. I also had a very communist approach in the sense that everybody got the same time of playing, as long as they came to practice, so I was not favoring the stars. During my fifteen years of coaching, I’m proud to say that we never won a single championship or anything, but everybody had a lot of fun and learned, and I thought that was the whole thing. I enjoyed the game, it teaches a lot of discipline, a lot of teamwork, a lot of harmony that is necessary, and also I enjoyed staying in touch as a coach. I also played bass, I played music, and I enjoyed that very much, and I also had a great love for bass playing, and that ended also when a real professional superstar needed somebody to do a job, a gig in a club and they hired me to go there that night, and I saw those two young kids, who were about six or seven years younger than me, who looked absolutely helpless, and they did such an extraordinary job with the music that I said okay, that’s another one that I’m not good at. I’ve just seen what a good musician is like and I’m not one. So that was another wonderful lesson. It was fun, it was enjoyable, but then I had the chance to see extraordinary talent and say gee, well okay, I’m not that either.

Tacey A. Rosolowsi, PhD:

Reality check. [laughs]

Eduardo Bruera, MD:

Yes. And then medicine came and I was good at it and I had fun doing it, and basically that, I stayed in, but having had the two other experiences in life helped me a lot, to understand that those are areas where I was not doing that great, and this seemed to be an area where I was really doing great, so it helped me stay the course.

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Chapter 01: Learning to See the Human Side of Medicine

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