Chapter 09: A Precarious Time for the Palliative Care Program

Chapter 09: A Precarious Time for the Palliative Care Program



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In this chapter, Dr. Fisch talks about a period when the Palliative Care Program seemed less valued than anesthesiology and the administration was splitting off groups from the department of Anesthesiology and Critical Care. He recalls that Dr. Bruera interviewed for a new job and he himself began calling about positions in Virginia. He tells an anecdote about where he was on 11 September 2001. He explains why he remained at MD Anderson and how, after a meeting with leaders, the situation for the department and program seemed to improve.



Publication Date



Houston, Texas

Topics Covered

An Institutional Unit; MD Anderson History; Obstacles, Challenges; Institutional Politics; Controversy


Tacey Ann Rosolowski, PhD:

So about how long—I mean, what was the arc of acceptance, do you think? I mean, you came in ’99. When did you begin to feel as though there was sort of a critical mass of people who could hear the message?

Michael Fisch, MD:

Well, you know, it’s a long arc, so we didn’t come and conquer very quickly. In fact, we came and it seemed like we were failing. It seemed like it was frustrating, and they started to sort of unbuild us. By the middle of 2000 or 2001, it seemed like they had delivered kind of a political insult to Dr. Bruera. I remember they were splitting off a cancer pain group. The anesthesia, we were sort of owned and managed by anesthesiologists, so anesthesia had some change of leadership and they were kind of interviewing us and sort of measuring our human worth. I feel like I was getting a human-worth biopsy in a roomful of my colleagues. “What do you do? What’s your training?” And it was sort of like, dud, not anesthesia. And then Dr. Bruera’s clinic, instead of being completely in charge, it seemed like he had taken sort of a political setback of some sort. I’m not sure what the reason for it was. I can’t remember. But we were sort of taken aback, and I remember wondering whether this was going to last. Eduardo was beginning to interview for some other jobs, so he was on the market. I remember wondering whether I—you know, time to leave. I started interviewing in private-practice jobs in central Virginia. In fact, I remember cold-calling some people in Lynchburg, saying, “I’m a faculty member at MD Anderson. I’m an oncologist. Do you have any jobs in Lynchburg?” Just cold-calling these people. And they’re like, “No.” Then I went and interviewed in Roanoke and would have taken a job there, but it wasn’t quite ready, the dude who would have to retire before the next job would be available. So they kind of were interested in me, but they weren’t quite ripe. Then the time between that—in fact, September 11th, 2001, that day, 9/11, I was at the Medical College of Virginia with Tom Smith, who will be here tomorrow giving grand rounds or giving the plenary talk at a medical issues and cancer survivor—so I’m going to meet with Tom tomorrow. Dr. Bruera and I will meet with Tom Smith tomorrow. But Tom Smith was hearing me talk about depression and cancer on September 11th, and it was a job talk. I was looking to leave on September 11th. And as I was talking to one faculty after another, I got a vague sense that there was something happening. Like 9/11, I missed it, and I couldn’t quite—because you’re so overscheduled, you just go in one place to another and talking to people the whole time. So I didn’t have a chance to just look up and try to understand what was going on. And I remember at one point I was talking like this, and somebody knocked on the door and say, “Yeah, I just wanted to let you know that some plane hit the World Trade Center.” We’re like, “Oh, huh. Awful.” Okay, right back to our conversation, like couldn’t quite grasp what he was trying to tell us. Sort of a strange experience. Then I got stuck in Virginia. I was at Tom Smith’s house for a number of days, so he and I shared that experience.

Tacey Ann Rosolowski, PhD:

Everything was shut down.

Michael Fisch, MD:

Yeah, the whole scene. But I actually gave my talk on depression and cancer at MCV that afternoon at, like, four o’clock, and people came. Not very many, but some people actually showed up to that conference. I think people—you know. Other freakish medical people who hadn’t been able to completely tune in to the gravity of what had happened to the world were still showing up to the kind of things that you might show up to at four o’clock. But, anyway, the point of that story is that’s where I was at. I was, like, ready to leave as the whole thing seemed like it hadn’t taken root, like this wasn’t going to go anywhere. But I didn’t. The MCV job wasn’t exactly in the right location for my family, and they decided they didn’t want me to go to that. The Roanoke job wasn’t ready, and Lynchburg didn’t have a job, so I was sort of forced to hang around a little bit longer. And in so hanging around, we found a better groove. Things got a little better. I remember at some point there was a meeting with some institution leaders where it seemed like it was a classic—they were sort of trying to make us feel better. They were making repairs with Dr. Bruera and the faculty. They decided that they weren’t ready to blow us apart. I remember Dr. Callender and who was the physician-in-chief, David Callender, and then maybe some other leader whose name I can’t remember, but I remember us eating in this little conference room and them pouring us tea. So the whole idea of junior faculty and all of us, and them pouring us tea in this sort of classic making repairs kind of mode. And I remember Dr. Bruera talking about so what it had felt like for all of us to be, in a sense, treated the way this group was being treated around that time.

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Chapter 09: A Precarious Time for the Palliative Care Program