Chapter 07: Plans to be a Cardiologist and a Key Fellowship with the NIH

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Chapter 07: Plans to be a Cardiologist and a Key Fellowship with the NIH

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In this chapter, Dr. Benjamin explains that he planned to be a cardiologist when he got his medical degree in 1968. He applied for a public health fellowship with the NIH to avoid going to Vietnam and got into a program at the Baltimore Cancer Research Center treating septic shock in leukemia patients. He believed that this experience would be transferable to cardiology patients. He notes that he was selected because of his laboratory experience, but he negotiated opportunities to work with cancer patients during his laboratory year as well as his clinical year. Dr. Benjamin then describes the Cancer Center in Baltimore and how the staff knew very little about oncology (as the field was in its infancy). He says that, because of his training during his internship and residency, "I was perfect for it," though others were very stressed by working with the cancer patients.

Identifier

BenjaminR_01_20141212_C07

Publication Date

12-12-2014

City

Houston, Texas

Topics Covered

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

Transcript

Robert Benjamin, MD:

But I wanted to go into academic medicine. I didn’t know what I wanted to do. I also knew that I wanted to go into medicine, not surgery. So this is 1968 when I graduated from medical school. A hundred percent of doctors got drafted, so I was set to go into the air force. The only way you didn’t get drafted was if you got into the Public Health Service and went to NIH. But since I was interested in academic medicine, I thought NIH is a good thing. I knew a lot about NIH because one of my father’s friends had gone there as a section head when I was a little boy, and I remember my father making a big deal out of the fact that he had a position at NIH. So I thought well, going to NIH is good and, of course, hard to get in.This is probably where some of Dr. Farber’s recommendations probably helped me a little bit, because he was there. But basically I looked at the application for NIH and they listed all of these different programs that they were working on, and you were allowed to apply to any that you wanted to go to, and you weren’t supposed to rank them. And I was told basically most people choose three or four of the programs that they want, and the programs choose which people they’re going to take. And I looked down the list and I said, “Would I rather do this or Vietnam? This or Vietnam? This or Vietnam?” And I listed forty-two programs.And then so they wrote back to me and said, “Well, ordinarily we don’t ask you to rank your programs, but since you have such a comprehensive list of interests, could you please give us a ranking so we can get an idea of where your interests really lie?” And so I gave them a ranking, and the program I ranked first was a program at the Dental Institute, because they were studying other aspects of glycosaminoglycan metabolism, and I thought that was similar to what I had been working on in the lab with Dr. Schubert, so I would clearly have a fit there. And the second program I listed was at the Baltimore Cancer Research Center, and I listed that program because among the many things they had in their description, one of them was a program in treating septic shock in patients with leukemia. And I thought, septic shock, doesn’t matter whether the patient has leukemia or not, that’s something that will apply to all of medicine. And I actually thought I was going to be a cardiologist at the time, but I figured that was a good thing.So that ended up being the program that chose me. They chose me not at all because of any of the clinical things, but because I had had so much laboratory experience in medical school and they thought that that would clearly be a candidate for one of the laboratory programs that they were working in. Didn’t matter what it was on, at least I knew my way around a lab. When I went down to visit, I guess when I first came down after I’d been accepted, I went down to visit them, and I said, “Well, you know, I’ve just come out of my first year of medical residency, and I don’t want to forget everything I’ve learned about medicine. If I just spend the next two years working in the laboratory, would I be able to see some patients as well?And they looked at me as if I was entirely crazy, said, “You want to see patients with cancer?”I said, “Yeah.”And so they said, “Oh, great. We can work out a program. Here’s something where you can spend your first year, you’re going to be primarily clinical, and your second year, you’re going to be primarily in the laboratory, but you can spend one half a day a week in the clinic seeing some patients for continuity.”I said, “That sounds great.” And so I wound up at the Baltimore Cancer Research Center.

Tacey Ann Rosolowski, PhD:

And so what year did you start there?

Robert Benjamin, MD:

1970.

Tacey Ann Rosolowski, PhD:

1970. So tell me about that. I mean, that must have really changed things for you. (laughs)

Robert Benjamin, MD:

So that changed everything. So the one other bit of pre-Baltimore information is that one of my senior residents when I was a resident applying for these NIH positions had said to me, “You know, NIH is absolutely great on your CV. It will give you a major advantage in terms of applying for future positions. But the very best thing is if you actually like what you’re doing there, stick with it, because that will give you not only the NIH criteria on your CV, but it’ll give you two years of advantage over all of your contemporaries who weren’t doing that for the previous two years.”

Tacey Ann Rosolowski, PhD:

Good advice.

Robert Benjamin, MD:

Went into the memory bank, because I was going to be a cardiologist, but I figured at least at the Cancer Institute I would see some sick patients and I could remember how to take care of sick patients. So, started out in the clinical period when I was taking care of these sick patients, and it was also a transition time in the Baltimore Cancer Research Center, which was a freestanding branch of the National Cancer Institute but totally separate. It was located at the Public Health Service Hospital in Baltimore as opposed to the Bethesda main campus. And the laboratory people who were there had all sort of established themselves pretty well, and I had been hired basically by one of these laboratory researchers as his clinical associate—research associate, he thought, when he hired me, but then I turned out to be clinical associate because I was seeing patients.But the summer before I got there, I guess the spring before I got there, because I got there in the summer—July is the beginning of the academic medical career sort of everywhere, the branch chief—I don’t remember. I guess the branch chief was still there, but he had a major conflict with the clinical chief at that unit, and the clinical chief had wanted to be the branch chief, and this other guy got the position, and so he left. And it was a pretty small operation, so they didn’t have a whole—I mean, oncology was totally in its infancy. Nobody really knew very much about it. There weren’t a lot of people there.So my teachers at the Baltimore Cancer Research Center when I got there, there was one guy who I still for the life of me don’t know why he was there or what he did, but he was one of the head people. There was a second-year clinical associate who was the major teacher, but that was sort of like Bellevue. I mean, the resident taught the intern, the second-year resident taught the first-year resident, so I was used to that sort of thing. But there was nobody who really knew very much about things. There was a former clinical associate at the program who was doing formal oncology fellowship at Hopkins, and he would come by once a week and make rounds and sort of help us with our complicated cases. The guy who left and went into private practice would come once a week and make rounds with us. So those were my teachers, that and my second-year resident, who had learned something.So it was pretty much on the Bellevue model of you see a sick patient, you figure out what you think you want to do, and then you sort of run that plan by the next level up and make sure that it’s not totally crazy. But usually the next level up didn’t know much more than you did, so you did what you wanted to do.

Tacey Ann Rosolowski, PhD:

Did you think of this as stressful or was it a good opportunity?

Robert Benjamin, MD:

No, this was fun. I mean, this was what I had been doing at Bellevue before. I was perfect for it. My colleagues, who had trained at Harvard and Yale and wherever, were the ones who were stressed by it, because they were used to being told what to do. Plus they didn’t know how to put in a subclavian catheter, they’d never done a liver biopsy, because liver biopsies were done by the liver fellow. What liver fellow? And I could put an IV into a stone, because we never had an IV team to teach us, and I had learned as a medical student at Bellevue how to do IVs. So from the point of view of these sort of minor but critically important procedural things, plus dealing with a situation where there wasn’t an authority figure to tell you exactly what to do, my training was absolutely on target in terms of dealing with this situation, and I loved it.

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Chapter 07: Plans to be a Cardiologist and a Key Fellowship with the NIH

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