Chapter 02: College Influences: A Research Project, a Book, and Working as an Orderly

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Chapter 02: College Influences: A Research Project, a Book, and Working as an Orderly

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Dr. Dmitrovsky begins this chapter by explaining how he selected Harvard University for his undergraduate education (AB, MA conferred 1976). He explains that he majored in biochemistry, an honors major, because it afforded him the opportunity for in-depth experience with research and writing an honor's thesis. This was one of three very significant college experiences, and Dr. Dmitrovsky next describes his research project, which focused on the communication junctions between cells. Current theories held that cell communication influenced cell malignancy. Dr. Dmitrovsky also wanted to work with Dr. Goodenough's laboratory because of the state of the art molecular imaging in use. He goes into detail about his research. Next, Dr. Dmitrovsky explains that he also wanted to have some clinical experiences to confirm that he should pursue a career in medicine, so he worked as an orderly at a geriatric hospital. Being able to see through the eyes of patients and their families provided him with a second significant experience. Dr. Dmitrovsky talks about witnessing the "grace of families" who cared for their elderly loved ones and how that convinced him of the importance of involving families in care. Dr. Dmitrovsky concludes that these experiences convinced him that he wanted to make progress with complex medical problems and have an impact on patients and families. He then talks about a third influence on view of a medical career, the book Stay of Execution: A Sort of Memoir, by Stewart Alsop, who was diagnoses with a rare form of leukemia. Dr. Dmitrovsky says that this book showed him how scientific discovery influenced medicine and patient experience. He also notes that he became intrigued that there could be a hospital that focused specifically on rare and difficult to treat disease.

Identifier

DmitrovskyE_01_20150303_C02

Publication Date

3-3-2015

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Educational Path; Overview; Definitions, Explanations, Translations; The Researcher; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; Understanding Cancer, the History of Science, Cancer Research; Technology and R&D

Transcript

Tacey A. Rosolowski, PhD:

So tell me about selecting your college.

Ethan Dmitrovsky, MD:

So I grew up in the suburbs of Boston, in Needham, Massachusetts N-E-E-D-H-A-M. And I'm of an age I guess would be the way you say it is that you oftentimes went to local schools this idea of traveling around the country to go to any school is a relatively recent event. You tended to be educated near home, so I ended up going to Harvard, because that was the place that strong students went to in the Boston suburbs, and I didn't really look beyond New England and in driving distance of Boston.

Tacey A. Rosolowski, PhD:

Not too shabby for a hometown school.

Ethan Dmitrovsky, MD:

And it's not more complicated. And it's so funny, because at that time in education, you were grouped based on your I wouldn't say capabilities, but your performance, so many of my classmates ended up going with me to Harvard, because there was a cohort that I was with since elementary school.

Tacey A. Rosolowski, PhD:

So that's really interesting.

Ethan Dmitrovsky, MD:

Yeah.

Tacey A. Rosolowski, PhD:

So you had like a readymade social

Ethan Dmitrovsky, MD:

Social system. It was surprisingly, that was the case, yeah.

Tacey A. Rosolowski, PhD:

Huh, interesting.

Ethan Dmitrovsky, MD:

Yeah, so then I went to Harvard, and I majored in biochemistry.

Tacey A. Rosolowski, PhD:

Mm-hmm. Why?

Ethan Dmitrovsky, MD:

Well, it was an honors major, and I wanted to have a rigorous undergraduate experience. And biochemistry, at that point in time, was a precursor to what we call molecular biology, so it was the molecular biology of the cell was the was what the content was about. And it was an honors major, meaning that you had to write a thesis, so I wrote a thesis with a very distinguished professor at Harvard Medical School named Daniel Goodenough G-O-O-D-E-N-O-U-G-H who was a professor in the then anatomy department, and it was later fused with the cell biology department. And so I was very interested in science, and I didn't feel that I necessarily had any skills in doing research, but I wanted to have an in-depth experience. And at the same time, I worked in hospitals. Actually, I wanted to see what it was like caring for patients at a in a sense an entry level. So I worked in the summers as an orderly in a geriatrics hospital. I wanted to really, you know, see what it was like to be a staff member, to see if doing medicine might appeal to me. And both of those experiences I found very positive and decided to, you know, continue pursuing medicine as a career, because that was my goal when I entered Harvard, and then went on to Cornell Medical School.

Tacey A. Rosolowski, PhD:

Before we move on to that, tell me a little more about your thesis experience. Was that that was your first real immersion in this research?

Ethan Dmitrovsky, MD:

That was my first real immersion in research, and it was a thesis surrounding structures that are called gap G-A-P junctions. So when cells touch each other, they have specialized membrane structures. Some are called tight junctions. They're called "tightbecause they actually are points of junction that are fairly tight, meaning the word "tightrefers to that fact that it's a barrier to movement of molecules into the inter-cellular space. At the same time, there are other specialized membrane structures that are called gap junctions, and they actually permit communication between cells. So this was appealing to me because one of the features of malignancy is the loss of contact inhibition, so normal cells will stop dividing when they touch each other, but malignant cells lose that capacity. And there was a theory at that time that it related to the inherent physiology of either tight or gap junctions, and so it was an appealing project for that reason. I was also particularly drawn to that laboratory because it was one of the handful of labs in the world that was truly focused on molecular imaging and molecular imaging just above the level of x-ray diffraction. So these were images that you actually could see structures. It was at the very limit of electron microscopy, and this laboratory was world-leading in electron microscopy and another technology called freeze fracture, and that allowed you to look at structures membrane structures. So I was drawn for the physiologic reasons, and that experience was a wonderful learning experience, and I tucked away the idea, "Well, maybe science might be part of my career.

Tacey A. Rosolowski, PhD:

And the clinical dimension, and your work as an orderly at the

Ethan Dmitrovsky, MD:

Yeah.

Tacey A. Rosolowski, PhD:

the hospital, how did that influence you?

Ethan Dmitrovsky, MD:

Well, that really gave you a vantage point of what the life of a patient was about, as you can imagine, because an orderly is his task is actually to help the nursing staff in all the any activities: moving patients, caring for them. And I wanted to have the vantage point of the patient. I wanted to see what the patient's experience was like, because if I was going to devote myself to the care of patients, I wanted to see what their what the experience of a patient was at the bedside in the hospital, and oftentimes, in the hospital that I was working in, very debilitated patients. I wanted to know whether that was an experience that could illuminate I was still deciding for sure whether to have a career in medicine I wanted to really see that. And I learned a great deal of the value of caring and compassion and to listen to people's stories older people really are great storytellers and to learn from their wisdom of years. And it was really a very valuable experience for me, professionally and personally, yeah.

Tacey A. Rosolowski, PhD:

Sounds like it was a great decision.

Ethan Dmitrovsky, MD:

I mean, I think the other thing you see is in elderly patients who are hospitalized because they're debilitated, you see the grace of their families. And I guess that's another learning lesson that I took from that experience, was to see the grace of families who cared for their patients, some of whom had cognitive disorders and didn't fully recognize them, and others who had severe neurologic impairment were able to recognize them. It taught me a lot about how important it is for a family to be involved [in care?], and so I wanted to try to tackle, in my career, complex medical problems for several reasons. One is I thought the ability to positively influence the lives of patients and their families was of the very nature of that greater than other disciplines. And secondly, I wanted to tackle an area where I thought there would be tremendous progress, and that's why I always thought about oncology.

Tacey A. Rosolowski, PhD:

Yeah, I picked up on that when you were talking about how, even with that early project, there was a cancer connection there

Ethan Dmitrovsky, MD:

Yeah.

Tacey A. Rosolowski, PhD:

and so that was always on your horizon.

Ethan Dmitrovsky, MD:

And many of the patients were, at that point, in the end stage of cancer, because that's why they were hospitalized. So it would be either end-stage cancer or neurologic impairment, as the largest group, so I saw what end-stage cancer was like and that experience, you know?

Tacey A. Rosolowski, PhD:

So tell me about the next step to medical school.

Ethan Dmitrovsky, MD:

Yeah, I was going to just tell you one other points is

Tacey A. Rosolowski, PhD:

Sure.

Ethan Dmitrovsky, MD:

there's a very famous book by Alsop A-L-S-O-P called Stay of Execution. And during this time I'm an avid reader I read the book by Alsop. I'm just looking I think they're two brothers. Do you know the famous Alsop brothers? They were greatly renowned reporters and commentators in the 1960s and "˜70s, and I think it was Stewart Alsop that had a I'm just looking up his book now.

Tacey A. Rosolowski, PhD:

What did we do without our Google-searching phones.

Ethan Dmitrovsky, MD:

Yeah, so he was a renowned commentator, journalist, and he wrote a book about his experience. So the two brothers were Joseph and Stewart Alsop, and I'm just trying to see which one wrote the book. So he was diagnosed with a very rare form of leukemia that really befuddled diagnosticians. So he was referred to the National Institutes of Health to sort out divine the precise nature of his leukemia, and ultimately, it became one of the early recognized cases of a syndrome called refractory anemia of excess blasts. He was cared for by John Glick at the National Cancer Institute. And the reason that I mention this is because that book had a large and positive effect on me, because the book told the story of how scientific discoveries helped this renowned journalist, who then chronicled his illness.

Tacey A. Rosolowski, PhD:

I can search it later.

Ethan Dmitrovsky, MD:

Could you? Because it just

Tacey A. Rosolowski, PhD:

Sure, no problem.

Ethan Dmitrovsky, MD:

has the brothers' names and the book, but it doesn't say who

Tacey A. Rosolowski, PhD:

Who wrote it.

Ethan Dmitrovsky, MD:

who wrote it, yeah.

Tacey A. Rosolowski, PhD:

I'll check it later, because as you noticed, I'm taking a lot of notes.

Ethan Dmitrovsky, MD:

And so it was in college that I read that book, and it had a really it really intrigued me that there could be a hospital that was devoted to diagnoses that befuddled regular doctors and that needed the specialized expertise that was available. So actually, I decided that during medical school, I would do a rotation at the National Cancer Institute, which I did do. And to get ahead, I ultimately did my fellowship there, because the book just was such a kind of a beacon that attracted me, and that was a great experience, too.

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Chapter 02: College Influences: A Research Project, a Book, and Working as an Orderly

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