Chapter 06 : Building Intensive Care at MD Anderson
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Description
Dr. Ewer begins this chapter by explaining how he found out about an opening at MD Anderson and the interview and selection process. He joined the institution in 1978 and notes that he only expected to be at MD Anderson for six months to work on the cardiotoxicity of chemotherapeutic agents.
He then talks about how he assumed the de facto leadership of the intensive care unit, a role he served until the early 1990s. He talks about a prevailing attitude that had an impact on the perceived value of intensive care: that cancer is more interesting in the early stages, when medicine could have more impact than at the end of life. He talks about the growing acceptance of critical care at the institution and also recounts advice he received from Robert Benjamin, MD [oral history interview], who told him never to get tunnel vision about medicine. He talks about working with Dr. Benjamin on a heart biopsy program and conducting two thousand procedures with no deaths.
Identifier
EwerMS_01_20180524_C06
Publication Date
5-24-2018
City
Houston, Texas
Topics Covered
Building the Institution; Overview; Joining MD Anderson; Personal Background; The History of Health Care, Patient Ethics; Building/Transforming the Institution; Multi-disciplinary Approaches; Obstacles, Challenges; Devices, Drugs, Procedures; MD Anderson Culture; Working Environment; Cancer and Disease; This is MD Anderson; Critical Perspectives on MD Anderson; MD Anderson History; MD Anderson Snapshot
Transcript
Tacey A. Rosolowski, PhD:
Okay. So tell me about coming to MD Anderson.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
There was an ad in the Annals of Internal Medicine, or maybe I placed the ad and somebody responded to the ad, and I came down for an interview, and I was interviewed by a number of very, very interesting people. Among the people that interviewed me was Dr. John Stroehlein [oral history interview], and Dr. John Stroehlein is still here. Until recently, Ray Alexanian [oral history interview] was here, and he was on the committee that interviewed me. And then, of course, there was Dr. Hickey, and I got to meet Dr. Clark, and all of these people were there. Dr. Hickey was more interested in what I thought about the Civil War than what I knew about medicine. It was a very strange interview, but we talked about the Civil War. And I must have said something right, because they made me an offer.
Tacey A. Rosolowski, PhD:
What were your impressions of the institution during that interview phase?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
I expected that I would be here for six months, and help sort out the problems of anthracycline cardiotoxicity, which was the impetus to get somebody with my training and my background down here. We had a cardiologist here. He had been here for ten years.
Tacey A. Rosolowski, PhD:
And his name?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Was Dr. Ali, A-L-I. And Dr. Ali was trained in pulmonary and cardiology, and he was interested in getting somebody who was not tunnel-visioned, so that I could do and cross-cover some of the pulmonary with him, and do a little of this, and do a little of that, and was I comfortable reading cardiograms, and was I comfortable doing pulmonary function tests. And my lecture—they asked me to give a lecture when I came down—was about how we could use cardiac ultrasound as a tool, and how it was being used as a tool to look at the anthracycline toxicity question, which was the big deal back in 1977, when this interview took place. And so they hired me. I remember coming up to whatever that was in the old building—I think it was the top floor; anyway, they changed the numbers—and Dr. Hickey inviting me in for a 15-second conference, and said, “Well, welcome to the Anderson. Just wanted to let you know we’ll be watching your progress very carefully. Thank you for coming up.” (laughter) that was my introduction. And Dr. Ali said, “Oh, don’t worry about that. We’ll do fine.”
Tacey A. Rosolowski, PhD:
Now, what was your sense? Were you looking at other options at the time? You know, what was your reason for taking this particular position?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
I called the person who had originally hired me at Norfolk, and who had been a supporter through all of that nonsense, and I said, “Don...” Don Drew. And he said, “If Anderson makes you an offer, you jump, and on your way up you ask, ‘How high?’ And if they say, ‘We’re not going to pay you very much,’ you say, ‘Thank you for what you’re going to pay me.’ And you have something that they will come to appreciate, and you will come to appreciate them.” And so I took it. I took his advice, and I came. Accepted it. There were other places that I was interviewing at, and I just—when the offer came, I accepted it immediately.
Tacey A. Rosolowski, PhD:
How were you about moving down to Texas? I know you’d already been in Dallas for a couple years, so...
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Yeah. I was fine. Yeah.
Tacey A. Rosolowski, PhD:
How about Jane?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Jane never, ever provided any resistance to any of the big questions. She never gave me any trouble about being on a ship. She never gave me any trouble about moving to Houston. Was not a problem.
Tacey A. Rosolowski, PhD:
Well, that’s good. That’s good that that was not a source of conflict.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Yeah, I mean, we had two small kids, and...
Tacey A. Rosolowski, PhD:
Yeah. Now, did she continue working, or was she—
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
She continued to work. She worked for the Diagnostic Center here until they folded about ten years ago, and she’s been a retiree since.
Tacey A. Rosolowski, PhD:
Okay. Well, tell me about, after getting that 15-second welcome from Dr. Hickey, (laughs) what did you embark on? Because you were an instructor at the time, and then you were going to shift roles, so...
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Well, the first thing that happened, or among the first things that happened, is I went to our four-bed intensive care unit. And I had been doing some critical care in my training, and I looked at that, and there was nobody running it. And I evolved very quickly into somebody who had interest in that. And while I didn’t get the title of Director of the NICU until a little later, I basically took that over from day one. And I ran Critical Care here until, I guess, early ’90s, whenever it was that they moved it to Anesthesia and Critical Care.
Tacey A. Rosolowski, PhD:
Now, why was this under-resourced and under-organized in this way?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Because we’re a cancer hospital. People who develop life-threatening problems could be sent to Hermann, could be sent to other places. I came to learn the philosophy that cancer is more interesting, or at least it was at the time, in its early stages, when we could have impact, versus end stage, where people developed horrible problems, and where our options were to provide critical care towards the end of life. And nobody really was... That was not exciting. It was exciting to come up with new therapies. And one of my first experiences, although not a terribly pleasant one, was when this guy comes up to me, looked about my age, and says, “Who are you?” I said, “Oh, I’m Dr. Ewer. I’m a recently hired cardiologist.” And he says, “What are you doing here?” I said, “Well, I’m here because they seem to have some problems with one of these new oncology drugs, and thought maybe having a cardiologist would help.” He said, “Well, you’re in the wrong place.” “I beg your pardon?” “Well, if you’re a bad cardiologist, we don’t want you. If you’re a good cardiologist, what the devil are you doing here? Go somewhere to a heart hospital and take care of heart patients.” And I said, “You know, I’m really lucky I don’t know who you are. I know you’re not Dr. Clark, and I know you’re not Dr. Hickey, but I don’t know who you are, so I can mouth off at you. Instead of telling me how to succeed—I don’t like what you’re telling me. So before you leave, and before you turn around, you give me some bit of advice that’s going to help me succeed here.” And he said, “Okay, come with me.” He walks me to his office, and he hands me a book about three inches thick, an oncology book. And he says, “If you have any hope of succeeding here, you need to know more oncology than any other cardiologist in the world. Read the book, and when you’re through, read it again, and then come to me. I’m Dr. Robert Benjamin [oral history interview].” (laughter) And I did. It was the best advice anybody could ever give anyone from the subspecialties that come to this institution, is do not become a tunnel-visioned subspecialist in anything. Broaden your horizons, and say, “How does this tiny bit that I contribute fit to the huge arena of oncology?”
Tacey A. Rosolowski, PhD:
So what were some immediate ways that that learning about oncology started to affect what you did, and how you operated with people within the institution?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Well, the giants of that era, the McCreadys, were those people that thought they could do critical care by themselves, and I offered them things. “Oh, we have to send this patient for a temporary pacemaker.” And I said, “Why? I can have a temporary pacemaker put in in less than a minute.” And I did. I mean, I got the reputation at the Medical School of Ewer the Skewer, (laughter) because I was really among the most capable of doing interventional procedures. When that same Dr. Benjamin then developed the biopsy program, heart biopsy program, I was the one who then got to do that with interventional radiology. And Dr. Sidney Wallace and Dr. Benjamin and I ran the biopsy program. It was later turned over to me, and I did 2,000 heart biopsies—by the way, without a single death. And so, I mean, all of this fit in. But I ran Critical Care, and that was what I did most of for, what, a decade and a half, or 15 years.
Recommended Citation
Ewer, Michael S. MD and Rosolowski, Tacey A. PhD, "Chapter 06 : Building Intensive Care at MD Anderson" (2018). Interview Chapters. 808.
https://openworks.mdanderson.org/mchv_interviewchapters/808
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