Chapter 05:

Title

Chapter 05: "Coming to MD Anderson Was Almost an Obligation"

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Description

In this chapter, Dr. Bruera discusses how and why he left the Cross Cancer Institute to come to MD Anderson in 1999. He notes that twenty years ago there was not much understanding the United States about palliative care. He received a call from Andrew von Eschenbach inquiring whether he would bring the knowledge he had developed at Cross Institute to MD Anderson. Dr. Bruera describes his interactions with people at MD Anderson, the types of anxieties they expressed about bringing in this new perspective, and what he found exciting about the opportunity. Dr. Bruera notes that, given MD Anderson's reputation, if he could establish palliative care, he would be able to have an impact on other institutions as well. As a result, he felt that it was 'almost an obligation' to take the position at MD Anderson.

Identifier

BrueraE_01_20180806_C05

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 - Joining MD Anderson/Coming to Texas; MD Anderson Culture; Leadership; On Leadership; Professional Practice; The Professional at Work; MD Anderson Culture; Working Environment; Collaborations; Professional Values, Ethics, Purpose; The History of Health Care, Patient Care; Multi-disciplinary Approaches; Multi-disciplinary Approaches; MD Anderson Impact; MD Anderson Impact

Transcript

Tacey A. Rosolowsi, PhD:

Well, we’ve started talking a lot about what you’ve done here at MD Anderson, based on that learning process, long learning process at Cross. How did you make the move from Cross to MD Anderson and why did you choose to make the move when you did, which was 1999. Tell me how that happened.

Eduardo Bruera, MD:

Right. Well, I got a phone call from Andy von Eschenbach, who was the chief academic officer at that time, together with John Mendelsohn [oral history interview], and basically he said we’ve heard that you are doing this thing in Canada. We have nothing in palliative care at MD Anderson, we think we’re a little bit behind where we would like to be, and would you be interested in coming down to MD Anderson and do it here? And so they asked me to come and meet some members of their faculty and meet with them, and then they offered me the job.

Tacey A. Rosolowsi, PhD:

So who did you meet with and what were those conversations like, what were those first impressions?

Eduardo Bruera, MD:

Well the first meetings were with different department chairs who were working at that time, and the idea is to understand what I was going to bring, because there was not much understanding in the United States twenty years ago, about what all this was. And so they wanted to understand what could I do for patients and families and what could I do for a research driven clinical environment as MD Anderson. Part of my time was spent, or a large proportion of my time, was spent calming anxieties of colleagues, that we were not just going to come to talk about death, but we’re going to help people live well and get treatments. It did help me that as a background, I am a medical oncologist. So they could not feel that I was in a way against cancer treatment or anything else. A lot of the time, I think I had to spend calming down people’s concerns that I might be coming to do something that might be not aligned with the culture of the house.

Tacey A. Rosolowsi, PhD:

What did they imagine might happen?

Eduardo Bruera, MD:

Well, one of the concerns was that one might come and talk to the patients so they can stop their treatment and go to hospice or go back home, or not get involved in any experimental cancer treatments, or basically get a referral from a patient and make all kind of comments that the way they are being treated for the pain or the nausea or the depression or the anxiety before, had not been very good. So there is this natural concern that all these doctors --who have never seen a palliative care doctor, have never trained in this area in medical school-- had about this practice. So part of my challenge was to tell them that the idea was that their patients were going to be doing great and that their day might even get a bit shorter if I came and brought some people and hired some people, but it was a very difficult process. It was a very, very difficult process, to get this graft, get adopted.

Tacey A. Rosolowsi, PhD:

Now, I imagine that some of these anxieties, you had confronted already, in Edmonton. Were there certain dimensions, because of MD Anderson being what it is, that were unexpected to you? Surprises that you had to address? I’m talking here about early in the process, not kind of down the line, but wow, I’m just visiting, here I am, interviewing, this was a surprise to me.

Eduardo Bruera, MD:

One of the things that I have found exciting about MD Anderson is that it was in a sense the cancer capital of the world. So in a sense people, it was the phase one, phase two capital of the world at that time, and it has remained having a major role in that since then. This was a place where every leader of a cancer program in the world did a pilgrimage, to see what was new and what was happening at MD Anderson. So if I could make palliative care happen here, it would have global impact, because a lot of people, coming from all countries around the world, would come here. I’m not talking about palliative care people, I’m talking about administrators of cancer centers, directors of cancer programs, would come here and say wow, look, MD Anderson has a Palliative Care Unit on the twelfth floor, I think we should have one. MD Anderson has a Supportive Care Center, I think we should have one. Well, they never went to Edmonton. What we did in Edmonton was wonderful. But it rarely could become a template for the planet, simply because it was not even the largest in Canada, but, having the largest cancer center in the world starting to do these, would offer a nice template. What I perhaps was surprised, was by the amount of concern that this raised among cancer specialists. The idea that bringing the human dimension and putting it in the center, would be a threat to the way cancer care was being delivered. It truly had not—I had not experienced that to that degree. I had not experienced that concern that this program might be perceived as a threat by so many colleagues.

Tacey A. Rosolowsi, PhD:

Now that’s one of those gaps, right? To what do you attribute that, you know these folks looking at you across that chasm. What is their value system and training making them see in what you’re bringing?

Eduardo Bruera, MD:

I think the way I reflected on this is they are a product of all those hours of training that were invested in them, and all those scientific meetings that are attended, and those journalists that read. And so unfortunately, they are the product of a flawed system. I happen to be a fringe character who somehow saw the picture from a different color. These are good people, they’re great people, they went to medical school with me. They took training, they read the journals, they do the best they can, they reflect the state of the art. I am the one who is an outlier. Therefore, I need to respect their views and their practice, align and try to have them make me part of their repertoire with patients and with time, because these are good people doing good work, they are not good or bad in this story, it’s all the fact that we are in a system that did not change, did not adapt, and they are the products of that system. So the opportunity and the challenge lies on making them slowly and progressively see that there is an opportunity here.

Tacey A. Rosolowsi, PhD:

Now was taking that opportunity, as you mentioned, to be able to get palliative care accepted here at MD Anderson, would have this ripple effect throughout cancer care. Was that the main reason you chose to leave Edmonton, because it sounds like you were pretty happy there.

Eduardo Bruera, MD:

I was very happy, I was profoundly comfortable and happy. I think at a certain point, the offer was to come here and create a model that might have global impact, and I really liked that very much. Ventafridda, this old Italian guy who gave that lecture in that auditorium, and I kept meeting for conferences once in a while. He always said, “Eduardo, you’ve got to go to the United States. That’s where everything happens in medicine. Until you go to the United States, you can’t get things changed here, you have to go to the U.S. and change things there.” And so he continuously harassed me with this business of you’ve got to go to the U.S., because that’s where things happen. So I think it had that pressure also, that said you can make a contribution to other places by being where everything happens. In medicine, still today, where everything happens is in the United States. So basically, coming here in a sense was almost an obligation. If they call you from the director of a cancer center that is the best in the world and tell you, would you like to come here and do this type of work here, it was very difficult to say no. Because the challenge was very, very big, but the opportunity to make a contribution was such that nobody in Canada had any problem. When I announced they said of course, of course, I mean you’re going to MD Anderson. If I had gone to a private clinic somewhere else, they may have said wow, why would you somehow betray your academic principles and so on. But coming to work at MD Anderson was, for a hundred percent of the people I talked to, they said of course you have to go, that was the answer.

Tacey A. Rosolowsi, PhD:

Oh, so that’s lovely too. [laughs]

Eduardo Bruera, MD:

That was the response.

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