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  Chapter 05: “The World’s Authority on Infectious Diseases”

  Gerald P. Bodey MD and Lesley W. Brunet

  In this chapter, Dr. Bodey outlines his significant contributions to medical research. He begins by discussing his work in infection control for neutropenic patients and methods for measuring microbial presence in the throat. He also highlights his pioneering research into intravenous aminoglycosides, which improved treatment options for leukemia patients. Another major contribution was his work with carbenicillin, which increased survival rates from pseudomonal infections by 75%. Publicity from this work raised awareness of advancements in infection control for cancer patients.

  Dr. Bodey also discusses his collaborations with pharmaceutical companies in developing new antibiotics and chemotherapy drugs based on initial research conducted at NCI.

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  Chapter 06: Hospital Departments – Department of Medicine and Department of Therapeutics and Changes to MD Anderson’s Organizational Structure

  Gerald P. Bodey MD and Lesley W. Brunet

  Dr. Bodey describes an institution in flux. He begins the chapter by discussing multiple search committees for a new head for the Department of Medicine which culminated in merging the departments of Therapeutics and Medicine with Dr. Ira Krakoff as the head. Following this were several departments and divisions being created and merged during this time.

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  Chapter 07: Evolution of Medical Practices in Neoplasms and Drug Therapy

  Gerald P. Bodey MD and Lesley W. Brunet

  In this chapter, Dr. Bodey highlights innovations in cancer treatment in relation to anti-cancer drugs. Antibiotics, such as anthracyclines and actinomycin D, being used as anti-tumor agents, are more commonplace. An increase in pharmaceuticals in cancer care led to increased committee work and Dr. Bodey served on the Pharmacy and Therapeutics Committee. He briefly discusses some changes to dispensing drugs to patients – including having nurses administering medications instead of doctors and moving to a centralized pharmacy on campus.

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  Chapter 08: Professional Activities and Working with NASA and NCI

  Gerald P. Bodey MD and Lesley W. Brunet

  Dr. Bodey discusses his accomplishments beyond the institution. He was a prolific speaker, participating in several international meetings and symposiums, including speaking in all fifty states. His work on infectious diseases also led to a collaborative project with NASA during the Apollo missions. His research with the laminar airflow rooms was considered for preventing extraterrestrial contamination from space.

  He also participated in an American-Soviet chemotherapy program to share cancer treatment knowledge between the United States and the Soviet Union. While the program was not as successful as hoped, it germinated the idea of expanding the model to other countries, albeit with mixed results.

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  Chapter 09: A Calling to Treat Leukemia

  Gerald P. Bodey MD and Lesley W. Brunet

  Dr. Bodey concludes the interview by discussing his early inspiration to practice medicine, which stemmed from a missionary conference he attended in his youth. His father was a missionary, and his uncle was a missionary doctor in Africa. He also mentions other key influential figures in his life, including Dr. Charles Mangel and Dr. Emil J. Freireich, who both provided mentoring and professional collaboration throughout his career. For Dr. Bodey, being a physician who treats leukemia was his true calling.

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  Chapter: 01 Education Leading to Work with J Freireich at the NCI

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  Dr. Bodey begins by noting that his father was a minister and he himself originally planned to become a medical missionary. He describes the medical role models he saw around him, including the family physician who suggested that he apply to Johns Hopkins Medical School. Dr. Bodey explains how the draft for the Vietnam War led him to apply for a position as a clinical associate Dr. Emil [J] Freireich at the NCI in Bethesda Maryland (’62 – ’65). He next moved to Seattle, WA for his residency.

  Dr. Bodey then gives an overview of how infectious diseases effect cancer patients and traces how his interest in the specialty grew during the sixties. He became interested in the problem while working at the NCI with Dr. Freireich. His interest in cancer dates a little earlier. He notes that during medical school, he worked with Dr. George Gey, who published a book on a patient with endometrial cancer: Dr. Bodey did some of his own research under Dr. Gey and learned about tissue growth.

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  Chapter: 02 Recruited by J Freireich and Moving the Family to Texas

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  Dr. Bodey begins this segment by noting that during his residency he realized that he would not be a medical missionary. However, in 1966 he was recruited by Dr. Emil [J] Freireich to join the Department of Developmental Therapeutics. He recalls his trip to Houston to visit the Department and his decision to relocate because of the professional opportunities MD Anderson offered .

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  Chapter: 03 New Research in the Department of Developmental Therapeutics

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  Dr. Bodey begins this segment by recalling that Developmental Therapeutics was a unique place devoted to research on the diagnosis and treatment of leukemia patients. He comments on the role of pharmaceutical companies such as the Beecham Group and Pfizer in providing institutions with antibiotics for testing. He studied the effect of carbenicillin on pseudomonas (a gram-negative bacteria) resulting in a drop in mortality from seventy or eighty percent to twenty percent. He notes other research project, his interest in chemotherapy, and the role of the NCI in supporting work on antibiotics.

  Dr. Bodey then explains that he had very good relationships with the drug companies. Only on rare occasions did he have to refuse a drug company’s request to do or say something because it seemed unethical. He speculates on why the situation has changed since the sixties.

  Dr. Bodey then quickly sketches his work on antibiotic combinations, explaining why pairing drugs can work. He covers the problem of resistance and how drug resistances can be specific to an institution. Dr. Bodey next notes a big problem for leukemia patients: they will start out with bacterial infections and then get fungal infections, with candida representing the biggest problem. He explains hepatosplenic candidiasis.

  Dr. Bodey tells an anecdote from his residency in Seattle that shows his gift for treating infections. He was on rounds and “somehow was attuned to the fact” that a patient had candida in the liver and spleen. Dr. Bodey gave the patient an antifungal drug leading to recovery.

  Dr. Bodey notes that he may have investigated the first pairing of two beta-lactam drugs, cefoperazone plus aztreonam. He notes that he studied the prophylactic use of drugs, explaining that patient at risk would often die of infection before receiving their full course of treatment for leukemia.

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  Chapter: 04 Building MD Anderson’s Laminar Air-Flow Hospital Units

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  Dr. Bodey begins this segment by providing some background on the first laminar airflow unit developed by J.M. Matthews. The early units were called “life islands” and Dr. Bodey describes the protective environment they provided against organisms. MD Anderson had some units in 1966, and Dr. Bodey recalls one patient who remained in a unit for about a year.

  Dr. Bodey describes some of the challenges of setting up the units to be completely sterile environments. He then describes in more detail how the laminar flow of air originated on one wall of the unit, with the filtered air all flowing in one direction. The patient would be located as close as possible to the source of the filtered air.

  Dr. Bodey then recalls that he had difficulty convincing Dr. R. Lee Clark to fund laminar air-flow units, as they were expensive to operate and took up three beds for every two, resulting in a loss of income for the institution. Dr. Clark eventually agreed to fund two units. When the Lutheran Pavilion was constructed, funds were allocated to build twenty units on the top floor. Dr. Bodey explains that the staff offices were in the center of the floor plan, with the laminar air-floor units arranged an a circle around them. The outermost ring was a corridor that family members could use to visit with patients by telephone: the walls of the patient units along the corridor were glass.

  Dr. Bodey recalls that the NCI also gave grants to support the units. He recalls working with an air conditioning company in Albuquerque, New Mexico: they created the air flow system. Dr. Bodey notes that the laminar air-flow units were the last elements of the Lutheran Pavilion to be built. He describes some of the investigations that were run on the units to identify and quantify the organisms presents in the units: studies of organisms on the patients’ skin; studies of how sterile the environments remained. He concludes this segment by noting that, given their cost to build and operate, the benefits of the units were not dramatic enough to warrant continued operation. The institution ceased using them after 1995 and now semi-protective units are used in some circumstances.

  [The recorder is next paused for about 5 minutes]

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  Chapter: 05 Outreach Overseas and Some Post-Retirement Activities

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  Dr. Bodey comments on some of his activities involving international groups. He first mentions European Organization for Research on Treatment of Cancer, which first looked at anti-tumor agents, but then organized the Antimicrobial Therapy Project Group in 1973. Dr. Bodey explains how he became involved and also why there were few instances of inter-institutional collaboration on infectious diseases in the United States. He briefly talks about his many lecture trips overseas. He also explains that, even after his retirement in 1995, he continued to lecture at MD Anderson, however this year he has “closed the door on MD Anderson.” He comments briefly on institutional changes that took place prior to his retirement. He notes how pleased he is that he was recently named a Distinguished Alumnus for his class year at Johns Hopkins Medical School.

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  Chapter: 06 Research on Bacterial and Fungal Infections

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Bodey discusses papers of importance that he produced during his career. He begins with “Hypersplenism Due to Disseminated Candidiasis in a Patient with Acute Leukemia,” indicating how this work helped identify a sequence of treatments for this patient. He then talks about an NCI-funded study of causes of death in leukemia patients that helped to establish different types of antibiotic treatments. Next Dr. Bodey discusses a key paper, “Quantitative Relationships Between Circulating Leukocytes and Infection in Patients with Acute Leukemia” (1966), the first paper to quantify the white cell count levels at which leukemia patients would be extremely vulnerable to infection. Next, he talks about his work on carbenicillin and its significant role in combating pseudomonas. He sketches what an infection can do to a cancer patient, then talks about an article in the Houston Post that reported the carbenicillin results.

  Next Dr. Bodey talks about the results of the first paper studying the use of anti-biotics in patients treated in Life Islands. He notes the psychological effects of the life islands on patients and how carefully they screened patients for their studies. Dr. Bodey then notes that he provided support for Dr. Emil J Freireich and others who studied chemotherapy treatments. He explains the “semi-quantitative total body skin culture” studies, in which he measured the populations of bacteria and fungus growing on different parts of patients’ bodies when they were in the protected environments. He notes another paper on carbenicillin that resulted in a 90% reduction of pseudomonas in leukemia patients.

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  Chapter: 07 Research on Chemotherapy and Anti-Fungal Therapy

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Bodey first sketches the causes of death in cancer patients, noting that 47% of patients would die from infections. He notes that the work he conducted with others at the NCI and at MD Anderson helped improve this figure, and they determined that early intervention was very important. He then talks about his work on a study of “late-intensification chemotherapy” then moves on to sketch his studies of many types of infection and techniques for protecting patients from infection. Much of this information, he notes, came from the Protected Environment studies, adapted to help patients in ordinary hospital situations. ;

  Dr. Bodey then returns to the topic of chemotherapy, noting that the work originated at the NIH and studies conducted by J Freireich. Dr. Bodey had clinical responsibility for patients with acute leukemia and Dr. Freireich was responsible for the drug regimen. Once at MD Anderson, Dr. Bodey was also involved in analyzing data. Dr. Bodey talks about a controversial but successful four-drug combination that Dr. Freireich proposed. He also speaks about the successful Adriamycin studies. ;

  Dr. Bodey states that, in his research career, he was very gratified to work with Dr. Freireich and make progress against leukemia as well as infectious diseases.

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  Chapter: 08 The Office of Research Protocol and the Department of Medical Specialties

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Bodey talks about how he established the Office of Research Protocol, which provided oversight for clinical studies. He then talks about the purpose of the Department of Medical Specialties, which he headed (1987 – 1995): to address the cardiac, neurological, gastrointestinal, and other medical issues which might arise for a cancer patient. He talks about his long-term goals for that department and notes that he was not able to secure the resources to create a truly independent department also involved in research.

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  Chapter: 09 MD Anderson Presidents

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  Dr. Bodey begins this segment on the MD Anderson presidents by recalling the late Dr. R. Lee Clark was “like a general” and a very wise man. He recalls Dr. Charles LeMaistre was a “Fine Christian gentleman” who projected a good image for the institution. ;

  [The recorder is paused briefly.] ;

  Dr. Bodey addresses the issue of MD Anderson’s explosive growth, asking How big do you want to be and Does it fit in with our objectives? He makes some observations about changes to the institution’s culture that have come with growth.

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  Chapter: 10 Christian; Grateful to Work at MD Anderson

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  Dr. Body begins this segment by noting that being a conservative Christian has greatly influenced his life and professional work, particularly in the stress he has placed on telling the truth. He returns to his discussion of the pharmaceutical industry (addressed in Session 1), and notes that regulations have been tightened because of some physicians who did not act appropriately in their dealings with drug companies. He affirms that only once or twice did a drug representative attempt to influence what he said. In general, he felt he was performing a service by disseminating information on good drugs. ;

  Dr. Bodey then talks about his post-retirement activities. He notes that he would like to become more involved in his church. ;

  Looking back, Dr. Bodey says that he is very grateful that he was able to work for MD Anderson, with his associates, and with others for whom he has great respect. ; ;

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  Chapter: 11 Early Experiences at MD Anderson

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  Dr. Bodey begins the segment by noting the importance of the work done by Dr. Emil Frei and Dr. J Freireich at MD Anderson. He then observes that, prior to his own arrival at MD Anderson, no one had done large-scale studies of infectious diseases. Dr. Bodey tells two anecdotes about attending conferences.

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  Chapter: 12 Key Studies of Infection in Leukemia Patients

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  Dr. Bodey begins by observing that in the sixties the antibiotic genomycin was commonly used but was not effective against infections in neutropenic patients. He talks about the studies he did when carbenicillan became available. He conducted the first study of carbenicillan’s effectiveness against pseudomonas, finding a 91% cure rate and dramatically influencing the survival rate for leukemia patients.

  Next Dr. Bodey talks about a definitive study he conducted while working with Dr. J Freireich at the NCI in Bestheda: Quantitative Relationships Between Circulating Leukocytes and Infection in Patients with Acute Leukemia. He describes the importance of this paper, which established findings he would build on once he came to MD Anderson. Dr. Bodey explains why MD Anderson could support large scale studies.

  Dr. Bodey next talks about how Developmental Therapeutics conducted studies of chemotherapy using new drugs and new combinations. He reflects on the philosophical differences Developmental Therapeutics and the Division of Medicine over using aggressive experimental protocols on patients.

  [Note: The recorder is paused]

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  Chapter: 13 Contributing to Advances in Treatments for Leukemia Patients: Drug Studies and the Laminar Air Flow Units

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Bodey first explains the typical approach to treating infections in cancer patients when he began in the field: an oncologist would only start antibiotics once the type of infection had been identified, often too late to save the patient. He tells an anecdote to dramatize how ineffective this approach was, then describes starting antibiotics in a woman with abdominal pain.

  Dr. Bodey next talks about the Life Islands he was responsible for at MD Anderson, explaining that an individual from the NCI approached him at a conference and asked him if he would be interested in evaluating them. Dr. Bodey explains the evolution of the Life Islands and tells an anecdote about a young father who stayed in one of the protective environments for 206 days.

  Dr. Bodey then sketches some key points in his career. He notes that, over the years, he studied almost every antibiotic and antifungal available. He lists his responsibilities while serving as Chief of Chemotherapy (1975 -1983).

  Dr. Bodey recalls the exciting news from the NCI that a researcher had cured uterine cancer. He explains that this announced the beginning of organized therapies that could make a difference in patients, illustrating his point with Dr. Freireich’s four-drug combinations in pediatric leukemia patients, some of whom were cured. He describes these advances as creating “an exciting and optimistic time” when researchers were able to offer leukemia patients another six months or a year to live.

  Dr. Bodey briefly notes his work as Director of Clinical Research, overseeing the laminar air flow protective environments in the Lutheran Pavilion.

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  Chapter: 14 Collaborations in National and International Networks

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  Dr. Bodey notes that he was a member of the Southwestern Oncology Group. He also explains that between 1974 and 1978 he was part of an NCI sponsored collaboration between American and Soviet oncologists. Dr. Bodey describes going to Russia and also entertaining Soviet oncologists who came to MD Anderson. Dr. Bodey also explains that he initiated the idea of creating another NCI collaboration in South America. Several cancer centers were involved, and Dr. Bodey worked with a cancer institute in Rio De Janeiro, Brazil and also a Peruvian center. He explains the impact of these collaborations. He talks about his relationship with Carlos Villejos who was a fellow at MD Anderson and became head of a cancer institute.

  Dr. Bodey expresses his appreciation for the opportunity to make friends and work with colleagues internationally. He comments on the importance of these global connections and briefly compares American research with programs overseas, including Italian oncology research. He briefly talks about moving his office to the twelfth floor of the Lutheran Pavilion.

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  Chapter: 15 Reflections on Contributions, Colleagues, and MD Anderson

  Gerald P. Bodey MD and Tacey A. Rosolowski PhD

  Reflecting on his career, Dr. Bodey says that he feels that “God blessed me greatly.” It was a “wonderful experience,” he says, to work with the new drugs coming out and make a difference for patients.

  Dr. Bodey offers a personal view of Dr. J Freireich, describing his generosity and expressing his deep personal affection for him.

  Dr. Bodey reiterates that it was a privilege and honor to work at MD Anderson. He then speaks briefly on his research on the effectiveness of the laminar air flow protective environments. He then offers an overview of how MD Anderson evolved, under Dr. R. Lee Clark’s leadership, from one building into a huge complex. He notes that Dr. Clark could be dictatorial at times but led MD Anderson successfully. Dr. Bodey concludes the interview by noting that he wrote many publications and received opportunities that most people do not over the course of his career.

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  Chapter 01: Experiences with Cancer Bring a Young Scientist to MD Anderson

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about his personal and professional background, his first exposure to the ravages of cancer, and how he came to know about and eventually work at MD Anderson. He also discusses how his first wife lost her battle with cancer at a young age and beginning his career during what he calls the “golden age of biomedical research.”

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  Chapter 02: R. Lee Clark’s Vision for MD Anderson: A Hospital, Research Institution, and a Setting Where Everyone Belonged

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about coming to work at MD Anderson, his reflections on the institution’s early days, and how MD Anderson developed both a medical and an academic character. He also discusses the institution’s organizational structure and explains why people, “Once they got to M. D. Anderson, they never wanted to work anyplace else.”

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  Chapter 03: The Creation of Basic Science Departments Focused on DNA (50s – 70s) and A Fellowship Year Using Drugs to Study Viruses

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about his work at MD Anderson as a postdoctoral trainee and his impressions of MD Anderson’s president, Dr. R Lee Clark. He also discusses the development of the virology department at MD Anderson and the “pervasive, and sometimes overwhelming, but most of the time reassuring, sense of family in the group in those days.”

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  Chapter 04: A Year Away; Reorganization of the Basic Sciences; a Return to a Faculty Position

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about research and the working environment at MD Anderson. “The feeling of walking into M. D. Anderson in those days is hard to describe,” he said, “but it was a sense of the becoming a part of something that made you much bigger than you could ever be as an individual. And it is not just me. Everybody I knew had that sense.” He also discusses why he “never really wanted to spend my career anywhere but at M. D. Anderson.”

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  Chapter 05: NIH-Sponsored Contracts Spur A Large and Influential Virology Program at MD Anderson

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about how the National Cancer Institute impacted research at MD Anderson, the emerging field of viral oncology, and how he made time to work directly with patients. He also discusses the development of the Department of Virology at MD Anderson.

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  Chapter 06: A Love of Teaching and Discovering that Administration Can Impact Research

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about his involvement in teaching and administrative duties at MD Anderson, his love of teaching, and his work “helping nonmedical, nonscientific people learn more about cancer.” He also discusses his involvement in securing research grants for the institution.

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  Chapter 07: Building Dr. Clark’s Vision of the Basic Sciences in the Early 70s: Science Park, and New Departments

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about growth during the 1970s at MD Anderson, the development of the virology program, and Dr. Clark’s vision for expansion. He also discusses the emergence of the Science Park research facility in Smithville, the development of basic sciences departments, and new international training programs, such as one in Italy, that MD Anderson sponsored.

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  Chapter 08: Charles LeMaistre Becomes the Second President

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about the leadership of MD Anderson president, Dr. Charles LeMaistre, and how he came to become the institution’s new leader; his own personal leadership of the newly created Department of Molecular Carcinogenesis; and the further growth of MD Anderson. He also discusses the legacy of Dr. R. Lee Clark.

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  Chapter 09: Dr. LeMaistre’s Division System is a Framework to Develop Basic Sciences Research (1979/1980)

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about the leadership of Dr. Charles LeMaistre and institutional growth during the 19070s and 1980s. He also discusses the recruitment of top scientists and physicians to MD Anderson and state concerns that the institution not become “too academic.”

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  Chapter 10: Taking on Executive Roles to Develop Education Under Charles LeMaistre

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about the expansion of his role at MD Anderson into education. He also discusses the specific position as Vice President for Academic Affairs, his decision to close down his own laboratory, and his mission of “informing lay people about cancer, about cancer prevention.”

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  Chapter 11: Prevention: Acting VP for Cancer Prevention and Adding Prevention to the Mission Areas

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about the vision of Dr. Charles LeMaistre and his own new role as Vice President for Cancer Prevention. He also discusses the blending of education with research and patient care and the development of a strategic plan to enhance this.

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  Chapter 12: MD Anderson and Other Texas Medical Center Institutions

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about research at MD Anderson, the development of MD Anderson’s brand and reputation, and its overall role within the Texas Medical Center. He also discusses the important “inter-institutional collaboration” that goes on here in Houston and “the constant exchange of ideas and sharing of training efforts.”

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  Chapter 13: A Shared Culture of Commitment to Mission

  James M. Bowen PhD and Louis J. Marchiafava PhD

  In this chapter, Dr. Bowen talks about the culture, history, and mission of MD Anderson. He also discusses “the individual and collective sense of ownership of M. D. Anderson's mission.”

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  Chapter 01: A Childhood in Rural Texas and Dallas During Segregation

  Cecil C. Brewer RN, BSN, MS and Lesley W. Brunet

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  Chapter 02: Discovering Nursing as a Desirable Career Path; One of a Few Male Nursing Students

  Cecil C. Brewer RN, BSN, MS and Lesley W. Brunet

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  Chapter 03: Nursing Training in Houston and at MD Anderson

  Cecil C. Brewer RN, BSN, MS and Lesley W. Brunet

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  Chapter 04: The 1970s at MD Anderson: Renilda Hilkemeyer, the “Mother of Oncology Nursing” and Innovations in Oncology Nursing

  Cecil C. Brewer RN, BSN, MS and Lesley W. Brunet

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  Chapter 05: Advancing Nursing Care for Head and Neck Patients in the 1970s

  Cecil C. Brewer RN, BSN, MS and Lesley W. Brunet

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  Chapter 06: Significant Nurses in the 1970s; Recalling a Segregated MD Anderson; Final Thoughts

  Cecil C. Brewer RN, BSN, MS and Lesley W. Brunet

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  Chapter 01: The Youngest Son in a Sharecropper Family in Texas

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  Mr. Brewer begins this chapter by sketching his life as the youngest of ten children in a sharecropping family in the town of Rosser in rural Texas. He sketches his family’s modest means, which taught him how to survive and gave him an appreciation of life in a small community. He then talks about his education in a small school for black Americans during the period of segregation. He then talks about the culture shock he experienced moving to Dallas in 1960. He sketches some of his family’s early history in Rosser, Texas.

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  Chapter 02: Early Education and the Idea of Going to College

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  In this chapter, Mr. Brewer explains that despite modest educational resources, his teachers prepared him to study and learn, though he had no clear idea of going to college. He explains how he worked throughout his school years. On relocating to Dallas, he explains, he was exposed to different teachers and different professional roles for African-Americans and, by his senior year, was thinking about going to college. One sister had attended vocational nursing school and another had attended a small black college. He discusses the turbulent environment of the 1960s and explains how he started at Bishop College in Dallas, Texas.

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  Chapter 03: An African American Man in Nursing School in the 60s

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  In this chapter, Mr. Brewer sketches his decision to enter nursing school and talks about the challenges for men in the nursing profession in the 1960s. The story begins when he and a friend decided to apply for jobs as orderlies at a Dallas hospital, where he became interested in medicine and nursing and entered the program at Dallas Vocational Nursing School (1967-1968). He discusses the fact that he was the only male in his class and one of five black students and tells stories to demonstrate his ability to succeed in this environment. Next he explains his decision to enter the four-year nursing program at Prairie View College [Prairie View A&M University, 1968 – 1972; the nursing program located in Houston, Texas]. Mr. Brewer then talks about the different roles he served in a hospital and the experience he gained.

  He then turns to the sources of suspicion and difficulties accepting male nurses at the time. He explains limits on how and where men could practice. He also talks about the advantages he had interning at a county hospital, where he was given unusual levels of responsibility.

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  Chapter 04: Working at MD Anderson as a Student Nurse

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  Mr. Brewer begins this chapter explaining that he spent the clinical years of his RN training in Houston because the nursing program of Prairie View College there in 1968. He came to work at MD Anderson as a student nurse in 1970. He notes that there were no male RNs at that time and no male LVNs that he can recall. Mr. Brewer then provides a view of oncology nursing.

  [The recorder is paused.]

  Next, Mr. Brewer talks about the scope of responsibility of LVS at that time (comparing it to today). He talks about the model of team nursing under the registered nurses and notes that some of the models for organizing work were unique to MD Anderson.

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  Chapter 05: Working as a Registered Nurse in the 70s: An Overview

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  In this chapter, Mr. Brewer talks about nursing at MD Anderson in the 1970s, beginning with his work on the Head and Neck surgical floor after graduating as a registered nurse on the staff. He recalls how ill patients were and how brutal their surgeries might be. He compares the state of treatment and supportive care then to today.

  He then discusses Dr. Jesse’s philosophy that it took a team to care for a patient, noting that this thinking was ahead of the curve in offering multi-disciplinary care, and it was a “hallmark” of the Head and Neck practice. He also explains that the team approach was the beginning of subspecialization for nurses, and how this was of help when a patient was transferred to other services. Nurses worked across units and shared their expertise with others.

  He then comments on radiation therapies offered at the time and the types of research conducted. He notes the collegial environment where young nurses were invited to multi-disciplinary conferences and asked for their input.

  Mr. Brewer then sketches his series of promotions into management and leadership positions, discusses the organization of nursing and the wards, and describes how technology made changes in deliver of care. He gives the example of dose delivery systems that had a positive impact on patient care.

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  Chapter 06: Moving into Management Roles in Nursing

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  In this chapter, Mr. Brewer sketches his promotion track and reflects his leadership qualities and on the working environment for nurses at MD Anderson. He notes that his career evolved in tandem with advances in technology and cancer treatments: he had the ability to keep up with the changes required as nursing became more specialized, adapting research into bedside care practices. He gives examples of specialization and of his contributions to management. He talks about a program he initiated to make nurses more aware of the need to be good stewards of resources.

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  Chapter 07: The Organization of Nursing Under Joyce Alt and John Crosley: Giving Nurses Autonomy

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  In this chapter, Mr. Brewer gives an overview of how nursing was organized and strengthened under two Division heads, Joyce Alt [oral history interview] and John Crosley, stressing the responsibility and autonomy afforded nurses. He talks about his work on committees responsible for planning the design of new facilities, noting that he could bring detailed knowledge of the processes of care and patient flow essential to plan good design.

  He then explains that the autonomy nurses enjoyed under Joyce Alt was unique to MD Anderson. He explain that nurse training was continuous to keep up with treatment advances, and this expectation made oncology nursing different from other specialties. He gives examples of research and technological advances that changed nursing practice.

  Next, Mr. Brewer talks about John Crosley, who became Division head in 1995/’96, at the same time that the VP of Clinics, Donna Sollenberger [oral history interview], implemented the multi-disciplinary care model in the Ambulatory Care Clinic. He defines the model and discusses how the reorganization was received. He then talks about the subtle differences in vision that Ms. Alt and Mr. Crosley brought to nursing.

  Mr. Brewer then describes what teamwork looks like in the care of ambulatory patients in a complex ambulatory center that brings together twenty specialties.

• 

  Chapter 08: A Leadership Role as a Center Administrative Director

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  In this chapter, Mr. Brewer talks about initiatives he undertook as Center Admin Director Center (1996 – 2004) with oversight of the Ambulatory Treatment Center, the Clinical Translational Research Center, and the Emergency Center. He explains that he was hired to address “a lot of broken processes” and used a “fishbone analysis” (also known as an “Ishikawa diagram”) process well known in process management at that time. He explains some specific issues he had to address and how he went about correcting them. He then lists roles he served before his promotion to a CAD and identifies the dates.

• 

  Chapter 09: The Philosophy behind CADs [Center Administrative Directors]

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  In this chapter, Mr. Brewer provides an overview of the CAD role [Center Administrative Director] that was created by Donna Sollenberger [oral history interview] in nursing at MD Anderson in the mid-nineties, and that resulted in a general reorganization of nursing. He explains that this role brought a new philosophy of nursing management. This model was designed to address the fragmentation of clinics by organizing groups of clinics into centers administered by key decision makers (CADs) in charge of budget, staff, operations, and clinical care. He then talks about the advantages of this organizational structure and the fact that all the CADs are nurses. He explains challenges of instituting this new structure, which required individuals to reapply for their jobs and train for them. He notes that, twenty years later, the system is still in place.

  Next, Mr. Brewer talks about the impact of the CAD system on patient care, citing patient safety as an example. He also gives examples of where the system could be improved. Reflecting on the community of nurses as a whole at MD Anderson, he explains that it can be difficult for nurses to see beyond the boundary of their own specialty and gives the example of differences between in-patient and out-patient nursing care.

• 

  Chapter 10: Two Inventions to Facilitate Care of Head and Neck Surgery Patients

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  In this chapter, Mr. Brewer discusses two devices he invented [and patented] to address the care of head and neck surgery patients. He began work on the first device, a “suction kit,” around 1980, when he identified problems in suctioning airways of post-surgical patients. He explains how this created risks of infection. He talks about the process of identifying the problem, proposing a solution, creating a pilot device to test, and the process of receiving a patent. He then talks about the second device that addressed oral care and open-wound care. He talks about the process of testing the value of these devices for patient care.

  Next, Mr. Brewer describes the positive environment in which he was able to push his innovative ideas further, noting that he was able to inspire other nurses to present their ideas. He talks about the support he received from medical staff and the Patent Office, and describes in particular the collaborative and supportive environment of the Department of Head and Neck Surgery. He notes that he received licensures for other devices.

• 

  Chapter 11: Center Administrative Director: Philosophy of Leadership

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  In this chapter, Mr. Brewer addresses the period in which he served as Center Admin Director for the Ambulatory Treatment Center, the Clinical Translational Research Center, and the Emergency Center (1996 – 2004). He talks about the growth of these areas as the institution grew and his own philosophy of management. He talks about the complexity of the workflows in these centers and the need to give employees autonomy to make decisions and problem solve.

• 

  Chapter 12: Center Administrative Director: The Emergency Center (2002 – 2010)

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  In this chapter, Mr. Brewer talks about his role as Center Administrative Director for the Emergency Center between 2002 – 2010. He talks about the areas of improvement needed, most stemming from the enormous growth in patient volumes during the late nineties and into the early 2000s, and the fact that the majority of patients would come into the MD Anderson system through the Emergency Center.

  Mr. Brewer first discusses the challenge of bringing the image of the Emergency Center into alignment with the overall image of the institution as a center for multidisciplinary cancer care. Next he talks about what was involved in getting the Emergency Center designated as a Level 3 emergency center, including controversy over this decision.

  He also covers the unique demands on the medical staff, who needed expertise in emergency medicine as tied to oncology. He discusses partnerships he established between MD Anderson’s Emergency Center and Level 2 and 3 centers in the Texas Medical Center. Mr. Brewer then discusses his approach to recruiting for the Emergency Center’s specialized work environment. He also discusses his involvement in the design for the new Emergency Center, which opened in 2007 and received an architectural award (2008?). He lists the wide array of services that were built into the design. He discusses the electronic patient tracking system he implemented. He notes that work on the Emergency Center was a career high point.

• 

  Chapter 13: A New Challenge in the Office of Institutional Diversity (2010-2011)

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  Mr. Brewer begins this chapter by explaining why he left his role as Center Administrative Director of the Emergency Center in 2010 and took on the role of Director of Diversity Community Partnership in the Office of Institutional Diversity (2010-2011). He cites the ongoing stress of the job and describes with examples the lack of support that leadership provided to the Emergency Center even as it was growing.

  He next explains the role he took on working with students (K – 12 and college students) to inspire them to pursue college and careers in the sciences and oncology. He explains that diversity was an important topic in the institution at that time, as evidenced by the creation of an Office of Diversity headed by Harry Gills. Mr. Brewer specifies that in his role, he was not tasked with addressing diversity issues as they presented themselves within the institution.

  Next, Mr. Brewer describes initiatives he worked on to bring resources to students to pursue higher level scientific work. He talks about a project on healthcare information initiated with the Houston Chronicle, noting that approval has been reached only to have the entire diversity program discontinued and the Office of Diversity disbanded.

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  Chapter 14: The Physicians Network and Final Thoughts on a Long Career

  Cecil C. Brewer RN, BSN, MS and Tacey A. Rosolowski PhD

  Mr. Brewer begins this chapter with a discussion of his role as Quality Coordinator of MD Anderson Physicians Network (2011 – 201). He notes that this role drew once again on his skills in building partnerships, in this case with community oncologists. His role was to study and measure physician practices in the community to improve processes and patient outcomes. He talks about the challenges of setting up these partnerships and the rewards of the work.

  Next, Mr. Brewer talks about his retirement in 2014. He notes his work with a company he co-founded, Alcove Medical, and his continued work developing and marketing medical products.

  In the final moments of the interview, Mr. Brewer gives an overview of accomplishments he is proud of and his perspective on his long career.

• 

  Chapter 01: Setting Sights High in Chemistry and Concerns about the Draft

  William A. Brock PhD and Tacey A. Rosolowski PhD

  Dr. Brock begins this chapter by sketching his upbringing in modest family and discussing the influence of his father, a hard worker with strong ethics. He talks about why he began to focus on science and discusses the influence of a brother in law who encouraged him to apply to top graduate schools to further his education. [B.S. Microbiology, Ohio State University, 1962-1967; PhD, Chemistry, Yale University Graduate School, conferred 1976]. He explains how his graduate education was intertwined with his concern to not fight in the Vietnam War; he eventually got a deferment and also aged out of the draft.

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  Chapter 02: Graduate School, Immersion in Developmental Biology, and Transition to Radiation Oncology at MD Anderson

  William A. Brock PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Brock sketches the development of his scientific and research interests during his graduate program at Yale University. He first covers what he found intriguing about the field as it evolved in the 1970s, and the focusing of his research interests on isozymes and early studies of gene regulation of hormones. His explains that no one was looking at the role of isozymes in the reproductive systems of male mice, and he began to focus on this. His attempts to describe the cells in the mouse testicle led him to the work of Marvin Meistrich [oral history interview] at MD Anderson, and his decision to come to this institution for his postdoctoral work, during which time his focus shifted from developmental biology to radiation and side effects. He describes his research focus and notes that when he began looking for a job, a position opened up in Experimental Radiation Oncology.

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  Chapter 03: Research on Fibroblasts and the Decision to Transition to a New Role

  William A. Brock PhD and Tacey A. Rosolowski PhD

  Dr. Broch gives his initial perspective on the institution and the tight social and working environment of the Department of Radiation Oncology under Rod Withers. He then talks about shifting to work with Lester Peters, MD on several studies attempting to predict the radio-sensitivity of normal tissue by looking at fibroblasts. He describes the frustrations with these studies, which culminated in diminishing grant money. Dr. Brock explains that he began to think about retiring at this point.

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  Chapter 04: Discovering the Need for an Ombuds Office

  William A. Brock PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Brock begins the story of how he came to the role of founding Director of the Ombudsman's Office. This began, he explains, with faculty dissatisfaction in the late nineties and Dr. John Mendelsohn's [oral history interview] request that he join a blue ribbon committee to study the grievance process, resulting in a new "Faculty Appeals Policy."

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  Chapter 05: The Ombuds Office: Early Challenges and Faculty Concerns

  William A. Brock PhD and Tacey A. Rosolowski PhD

  Dr. Brock begins with his first steps in setting up the Ombuds Office and establishing its basic policies for delivering support services. He notes that after a year, it was clear that non-faculty would also benefit from conflict resolution support, and an expansion of the program was warranted. [The recorder is paused.] He then talks about how he and his colleagues in the Ombuds Office raised awareness of their new services for faculty, the impact of their services, and the concerns that faculty brought to them. He notes some of the issues at play that prevented faculty from taking advantage of the Ombuds Office. He explains the differences between services offered and those of HR.

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  Chapter 06: The Ombuds Office: Early Lessons Learned and an Expansion of Services

  William A. Brock PhD and Tacey A. Rosolowski PhD

  Dr. Brock begins this chapter by talks about the lessons he learned personally and professionally through this early work with the Ombudsman's Office. He talks about the array of issues brought to the Office. He discusses the actions taken when issues are brought to the attention of upper level leadership and the reasons for the lack of action.
  
  Next, Dr. Brock talks about the process of expanding ombudsman services beyond the faculty and hiring Anu Rao to head the office and develop a program for all employees. Interview Session Two: 22 January 2019

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  Chapter 07: Developing the Ombudsman's Office: John Mendelsohn and Anu Rao

  William A. Brock PhD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Brock discusses the growth of the Ombudsman's Office under Anu Rao. He begins, however, with comment on how John Mendelsohn, MD (3rd president) was interested in addressing the climate of faculty elitism and establishing more equality among faculty and staff. Dr. Mendelsohn's support for the Ombud's Office was an outgrowth of this commitment.
  
  Next, Dr. Brock explains that Ann Rau "hit the ground running" when she took over directorship of the Ombud's Office. He mentions how she raised awareness of the Office and also explains how Ms. Rau worked with the legal department to define the confidentiality of the Office's client records.
  
  Next, Dr. Brock explains how an ombudsman for nursing was hired during the period prior to Ms. Rau's arrival, when he was head of the Office. He explains his belief at that time that the Office needed people with different specialties to address the needs of employees. He notes that Ann Rau said this was "a bad idea" once she arrived, and he explains how his own view of this changed by shifting his focus to the characteristics that all conflicts share.
  
  Next, Dr. Brock talks about what he learned about the institution once the Ombuds Office offered services to all employees. He then sketches the high points of Ms. Rau's plan for developing the program: marketing services and creating a very popular training program for dealing with conflict, difficult conversations, and other communication challenges. Dr. Brock explains that the Ombudsman's Office at MD Anderson is not alone in finding it very difficult to assess the financial impact of mediating conflict.

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  Chapter 08: Thoughts on the Culture of MD Anderson

  William A. Brock PhD and Tacey A. Rosolowski PhD

  In this chapter, discusses his impressions of MD Anderson culture as he took on different roles. He explains that non-faculty "carry the culture here" and the majority take great pride in working at MD Anderson. He contrasts this with how the faculty relate to the culture (the institution as a means of furthering their careers).
  
  Next, Dr. Brock talks about changes that occurred once Dr. Ronald DePinho became president. (noting that he was retired to part time service in the Office at that point). He recalls he was excited about Dr. DePinho's scientific credentials, but saw new themes arising in conversations with individuals who came to the Office with concerns, notably complaints about fairness, a growing elitism, salary inequity, and bullying/belligerent behavior. Dr. Brock then comments that he is happy to see Dr. Peter Pisters' focus on civility, but is waiting to see the outcome of some of the new initiatives to build culture. He talk about faculty "super bullies," explaining that it is difficult to shift culture when problem people are very powerful. In his view, training for leadership is key.

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  Chapter 09: On the Long-Term Relevance of the Ombudsman's Office and Retirement

  William A. Brock PhD and Tacey A. Rosolowski PhD

  Dr. Brock begins this chapter by explaining that the Ombudsman's Office will always be relevant because institutions always confront conflict. The Office has a lot to offer because so much can be done to teach people how to manage conflict. He gives some examples.
  
  Next, he talks about his current work on the Office's database. He then gives his view of the Ombudsman's Office in the future.
  
  Next, Dr. Brock talks about his retirement and his travels to see the United States. Finally, Dr. Brock talks about his proudest accomplishments: his focus on science and his role in establishing the Ombudsman's Office.

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  Chapter 01: Learning to See the Human Side of Medicine

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  Dr. Bruera begins this chapter by sketching his family background and experiences growing up in Rosario, Argentina. He talks about the impact of his father's work as a cardiologist. He explains his father's interest in both research and, most particularly, in clinical work. His father's discussions of interactions with patients and ethical issues enabled Dr. Bruera to see the 'human side' of medicine very early.
  
  Next, Dr. Bruera explains that cancer was 'a big taboo' when he was in his early medical career. He talks about the fear of the disease, prohibitions against speaking about it, and his early commitment to contribute to addressing this challenge.
  
  Next, he sketches his interest in sports in school. He talks about the importance of his interest in soccer, a team sport, and the 'communist' attitude he took toward coaching children's soccer.

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  Chapter 02: Turning to the Human Side of Medicine: "An Impeccable Diagnosis is Not Sufficient"

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bruera begins to sketch his medical education. He begins by explaining his selection of a medical school and the education he received (MD conferred, 1979; Universidad de Rosario, Rosario, Argentina). He also speaks about professors who had a great impact on him and how he keeps their influence in mind through keepsakes in his office. He describes this as an important kind of ritual and symbolism he integrates into daily life. Next he describes shifts in his interest in medicine. He began, he explains, with a fascination with disease and how it causes processes to break down in the body. However, as his clinical experience deepened, he became more interested in 'the person around the problem.' He tells several anecdotes from his oncology training that inspired him to shift his focus (Certificate of Specialist, 1984 or 1982, Medical Oncology, Universidad del Salvador, Buenos Aires, Argentina). He explains that his director cautioned him against focusing on what was a 'fringe area' at that time.

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  Chapter 03: Working "On the Fringe": Establishing Palliative Care as a New Area of Service

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bruera talks about his work at the Cross Cancer Institute in Edmonton, Canada. He talks about Dr. Neil MacDonald, the Institute Director, who brought him in on a fellowship to begin to establish palliative care.1 He explains that Dr. MacDonald wanted to put patient experience at the center of the Institute's services. He then describes the situation on the ground with attention to patient experience and how, through surveys and research, he and a team began to establish evidence based approaches for addressing pain and other dimensions of the cancer experience. He also talks about the pushback against these efforts and how publications documenting evidence were effective in building acceptance.
  
  Next, Dr. Bruera discusses why it has taken so long to develop the 'fringe area' of palliative care and to build acceptance for it. He then discusses his team's most significant accomplishments during his 15 years at the Cross Cancer Institute. He talks about the development of the Edmonton Injector for delivery of pain medication, the discovery of how effective it is to shift a patient's pain medications, the discovering of methadone's effectiveness as a pain medication. He also talks about the value of discovering that team work is the best way to deliver care.

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  Chapter 04: Building Teams by Building Culture and Developing Collaborative Leadership

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bruera talks about the lessons he learned about building teams at the Cross Cancer Institute, a model he brought to MD Anderson. He begins by describing the environment needed for a functioning team (a safe place where everyone has a voice and works for consensus) and uses the metaphor of a 'symphonic concert' to characterize the working relationship that results. Dr. Bruera then makes the connection to teams he has set up in the department at MD Anderson, saying that 'we depend on people referring patients to us' and this kind of team ensures the quality of care that brings in new patients. He notes that the department makes operational changes eight to ten times per year, assessing the results. He describes how the department plans and manages these change processes and gives several examples, including a 'failure' that required the department to return to a former procedure.
  
  Next, Dr. Bruera talks about the stresses of palliative care and the support the department has created to address this. He shows two informative handbooks on self-care distributed to all department members. Dr. Bruera then talks about his view that burnout and stress are linked to the 'superstar model' of how resources and prestige are assigned in departments. He says that too much of medicine is geared toward supporting the individual. He talks about how Palliative Care balances expectations among the faculty to establish a more equitable and less ego-centered culture more geared to team work. He discusses how he has shaped his own persona as a leader to role-model this mentality.

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

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  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.

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  Chapter 06: Establishing Palliative Care at MD Anderson: First Challenges

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bruera sketches what services existed at MD Anderson when he arrived in 1999. He notes that his mandate from Dr. John Mendelsohn [oral history interview] and Andrew von Eschenbach was to recreate what he had accomplished at Cross Cancer Institute on a "huge scale," including a research component as well as a clinical service. He explains that his own personal goal was to establish an intensive inpatient unit for care of suffering as well as an outpatient clinic for supportive care, a combination that was virtually non-existent in the United States at that time.
  
  Next, Dr. Bruera discusses how some of his expectations for beginning this new enterprise were immediately compromised because of Andrew von Eschenbach left the institution and there were other leadership changes that eliminated the sources of administrative support he had expected.

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  Chapter 07: Starting a Palliative Care Service

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bruera begins the story of how he set up an entirely new palliative care service upon arriving at MD Anderson. He begins by reviewing some of the context discussed at the end of the last session. He anticipated support from Dr. John Mendelsohn and Dr. David Callendar, but administrative shifts brought in new individuals for him to report to. He describes how this shifted perception of this new initiative to bring in palliative care from - the executive leadership wants it- to this newcomer, Dr. Bruera wants it. He describes a conversation with John Mendelsohn that resulted in transferring the Palliative Care Department to the Division of Cancer Medicine under Dr. Waun Ki Hong [oral history interview]. Dr. Bruera then describes how he began to operate in this situation and the importance of a very positive external review of the program conducted in 2003 0r 2004, which enabled Dr. Bruera to go to Dr. Hong with concrete evidence of success. Dr. Hong authorized additional resources to build the program.
  
  Next, Dr. Bruera talks about his strategies for assessing the institution's need for palliative care and support services. He explains why he avoided giving presentations to introduce services.

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  Chapter 08: Growing Through Balance in Clinical and Research Activities

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bruera talks about the challenges his faculty face balancing research efforts with substantial clinical responsibilities. He notes that developing research was essential to building the credibility of palliative care, but with few faculty, it was difficult to organize adequate time to conduct studies. Dr. Bruera explains a creative approach he took, establishing international partnerships to gather data. These studies then served as the foundation for two of the department's 3 RO-1 grants.
  
  Next, he explains the department's growth pattern, noting that as a 'fringe' department, he was never provided funds and resources in anticipation of growth. However, he notes, the department demonstrated it could sustain itself, which led to additional resources. Dr. Bruera then discusses strategies the department instituted so faculty, fellows, and staff could support each other in this stressful environment. He notes that his department is one of the most successful and research-productive in the country. He comments on Dr. Waun Ki Hong, Division head, as a fair leader. Dr. Bruera also sketches the egalitarian culture he has established in the department and shares his view that clinical work is an essential counterpart to conducting research in the field of palliative care.

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  Chapter 09: Shifting the Perception of Palliative Care and Related Services

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  Dr. Bruera note that by 2008 and 2009, after a decade, the institution was more comfortable with palliative care. However, because the department had a perception problem, being known as a kind of "pre-hospice" with the result that clinicians were sending them patients too late in treatment. Dr. Bruera explains a survey the department conducted to assess the impact of the names "palliative care" versus "supportive care." Fewer than 30% said they would feel comfortable sending patients who were early in their treatment process to palliative care. He explains that that he was able to obtain official approval to change the name of the patient center and the mobile teams, and within six months the services had grown by 41%.
  
  Next, Dr. Bruera talks about the wide range of patient issues that supportive care addresses. Dr. Bruera also explains that the Department's growth in business came exclusively from word of mouth referrals of patients and their success was totally unplanned by the institution. He notes that over the past eight years, the supportive care program has been the fastest growing program at MD Anderson, despite the resources that the institution has devoted to growing other areas.

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  Chapter 10: Palliative and Supportive Care in a Changing Institution

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bruera explores how attitudes toward palliative care reflect larger institutional priorities and focus on cancer. He begins by setting the institution's lack of support for palliative care despite its success, in context of what this says about institutions, the educational backgrounds of leadership, and the traditional disease-focus of cancer centers and other medical practices. He notes that Houston lags behind other cities in shifting this focus. Dr. Bruera admits he is disappointed that a person-focus has not 'exploded' over the course of his career at MD Anderson and that the institution has remained very disease focused. However he is hopeful, given some statements by new president, Peter Pisters, that this may be about to change and that Dr. Pisters may be shifting the focus away from cancer and the history of cancer to the person who has cancer.
  
  Next, Dr. Bruera responds to a question about institutional changes under fourth president, Ronald DePinho and how they effected the view of clinical practice. Dr. Bruera responds that he saw no real change under Dr. DePinho, as the institution even under John Mendelsohn was very disease focused rather than person focused. He notes again that he has seen a change over the past 6 months, under Peter Pisters, in that palliative care is viewed as more mainstream and essential to treatment. He notes that Palliative Care has saved the institution millions in costs. He notes the work of Ben Nelson in using positive financial data to generate a more up to date view that palliative care and support services are not simply 'touchy feely' but useful for a vitally functioning institution.

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  Chapter 11: Creating a Department Culture of Support and Wellness

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bruera talks about the practices he has instituted to support faculty, fellows, and staff as the department has growth through very stressful times with challenging workloads. These include creating 100% transparency in decision-making about operations, workflow, and hiring. Dr. Bruera specifies that this is to provide department members with a sense of autonomy and control over their work environment. He also explains his own open-door policy, his views of serving as a role model for the rest of the department, and the use of anonymous surveys to assess the results of decisions and his own performance. He also discusses how the department has assembled a good team over the years, citing the fact that all the faculty have been fellows and trained through a rigorous monthly review process to perform according to the department's standards for excellence and emotional intelligence. Dr. Bruera shares an anecdote about a VIP patient and how he had full confidence that anyone on call on the supportive care service could provide the appropriate standard of care.
  
  
  
  Next, Dr. Bruera talks about the high rates of burnout in palliative care. He also explains how the department has created a culture the values self-care and support among faculty and staff. He explains the department's self-care handbooks, how they were created and how the department is not reviewing them to make them even more effective. He notes that instituting this kind of self care is good ethical practice for the institution.

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  Chapter 12: Committee Service: An Issue of Leadership and a Voice for Palliative Care

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bruera sketches his service on institutional committees. He notes some significant lessons he has learned from work as a board member of the MD Anderson Network Association: that organizations that seek to improve their operating systems value the opportunity to work with a highly credible state, not-for-profit institution like MD Anderson.
  
  Next, Dr. Bruera discusses the significance of having palliative care represented on high-level committees and he talks about strategies he has used to build credibility with other committee members whose values and languages for discussing institutional issues are very different. Dr. Bruera stresses the strategy of discussing palliative care with data rather than soft rhetoric about the value of palliative care. He gives examples of what "irritates" administrators about introducing palliative care into the discussion of institutional processes, noting that palliative care's patient centered approach threatens an administrator's perception of his/her "area of control." Another challenge, Dr. Bruera observes, is that there are no models in other institutions of well-established palliative care practices that administrators can look to.

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  Chapter 13: Building the IAHPC [International Association for Hospice and Palliative Care] and the Challenges of Cross-Cultural Care

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bruera talks about his work developing the IAHPC [International Association for Hospice and Palliative Care]. He explains that around 2000 he brought the headquarters of this organization to Houston to better manage its evolution and its ability to promote hospice and palliative care globally. He sketches some of the work done to foster regional organization of these care services.
  
  Next, Dr. Bruera discusses the very significant issues that arise when adapting patient centered care to other cultures with different senses of family and social organization, meaning, and spirituality. He gives two main examples. The first covers differences in practices about disclosing a cancer diagnosis to patients. He notes that in the West, the original practice was not to disclose a diagnosis to a patient/family because of fears surrounding the disease, a practice that changed with shifts in medical ethics. The second example focuses on challenges in cultures where the family serves as the patient's advocate and sometimes comes to meet with the care team before the oncologists see the patient. He discusses challenges for Western physicians working in those contexts as well as clinicians from the culture who are educated in Western medicine, but need to adapt back to practicing in their own cultures.

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  Chapter 14: Committee Work, Care Guidelines, and ASCO Acceptance of Palliative Care

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  Dr. Bruera begins this chapter by talking about his involvement in the WHO's Cancer Pain Management Committee. He describes the challenges and limitations of working with an intergovernmental organization, then talks about the committee's work in developing guidelines for both cancer pain management and palliative care, the latter expanding the scope of guidelines to other diseases. Dr. Bruera notes that palliative care was 'born out of' cancer suffering, and the expansion of the guidelines underscores a focus on 'personhood care' rather than disease based care. He then discusses work on the EAPC [European Palliative Care Committee]. Dr. Bruera then discusses the importance of the Palliative Care Task Force convened by the American Society of Clinical Oncology [ASCO]. He notes that acceptance by ASCO around 2012 marked an important moment in the mainstreaming of palliative care. CLIP He makes some final comments on the fact that palliative care is not exciting to organized medicine, which is fixated on cure.

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  Chapter 15: The Future of Palliative Care

  Eduardo Bruera MD, FAAHPM and Tacey A. Rosolowski PhD

  Dr. Bruera first talks about his dream for the evolution of palliative care. He says he would like to large, centralized and multidisciplinary supportive care services available to all patients at institutions, with care programs tailor made for each individual. He explains why the idea of multi-disciplinary supportive care is controversial for traditionally-trained clinicians. He acknowledges that medicine is far from reaching this dream.
  
  Next, Dr. Bruera notes how proud he is of the many individuals he has mentored in the Department. He then talks about the challenges he sees as the field moves forward. First he talks about the danger of palliative care attempting to "be everything to everyone." He explains the importance of staying focused on suffering brought about by cancer and other diseases. Next he talks about the challenge of convincing organized medicine and the healthcare system to embrace palliative care.
  
  Next, Dr. Bruera explains how this process is connected to administrative structures in organizations. He also offers his evolutionary schema of how palliative care is accepted after processing through several stages he bases on Elizabeth Kubler-Ross's phases of grief: denial; palli-phobia; palli-lalia (nonsense talk with no action); palli-active. He notes that most of the nation is in the stage of "palli-lalia". Dr. Bruera concludes the interview by saying he is optimistic about the future of palliative care and its acceptance.

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  Chapter 01: Neuropathology and MD Anderson's Neuropathology Services

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  Dr. Bruner begins the first chapter with a brief overview of her field and clinical service. Few patients know what a neuropathologist does (even physicians can be unclear on the role). Dr. Bruner defines neuropathology and explains the neuropathologist's activities and contributions to a patient's diagnosis and care. She also describes the organization of MD Anderson's neuropathology services, noting its strengths, some of the analyses performed (including a rapidly developing area of immunohistochemistry testing and gene-sequencing), and the methods of its accreditation.

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  Chapter 02: The Young Scientist and the Pathologist's "Eye"

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  In the next chapter, Dr. Bruner sketches her love of science and her educational path. She notes her love of mysteries as a young person, and draws an analogy to pathologist as a detective solving the mystery of tissue. She traces her path to a pharmacy degree and then to medical school (as opposed to graduate school), explaining how she discovered pathology in her second year of medical training at the Medical College of Ohio, Toledo. She gives a very complete definition/description of a pathologist's "eye," on which good diagnostic capabilities rely. Dr. Bruner observes that today she sees fellows struggling to develop this "eye" "some are able to develop it, others are not.

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  Chapter 03: In Medical School

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  The next chapter begins as the Interviewer recaps Dr. Bruner's educational track, providing institution names and dates. Dr. Bruner then explains the professional and personal reasons why she left Toledo for a medical school in Ann Arbor, then returned to study at the Medical College of Ohio. She covers her experiences in a unique, year-long student clerkship at the latter institution, and offers a moving anecdote about performing an autopsy on an elderly man who had been stabbed seventy times, an experience (among many) that convinced her she did not want to enter forensic pathology, as she first thought she might.

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  Chapter 04: Discovering Neuropathology and Houston

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  
  
  Next, Dr. Bruner covers her decision to specialize in neuropathology, a decision that brought her to Houston to study at the Baylor College of Medicine. She flourished in her program, however she recalls that the process of moving to Houston from the mid-west was "just awful." Though she and her husband, Charles, had no intention of staying more than two years, they came to love the city.

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  Chapter 05: Practicing Pathology at MD Anderson

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Bruner traces how she became a faculty associate at MD Anderson in 1984 (becoming an assistant professor in 1985). She had already become familiar with MD Anderson's electron microscopy service while at Baylor, working closely with Dr. Bruce Mackay (and she almost specialized in electron microscopy). Dr. Mackay helped arrange for her faculty associate position, during which she divided her time between general pathology and neuropathology (she was the only neuropathologist on staff). She was very impressed with MD Anderson pathologists, who "loved to practice," and she compares the collegiality and the unique work ethic in the pathology lab with others she had experienced. Dr. Bruner recalls two memorable cases from this period, when she had to overturn pediatric diagnoses made by senior physicians much less experienced with neuropathology than she, and notes that Dr. Batsakis eventually required that she see all the neuropathology cases.

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  Chapter 06: A Sketch of Pathology Research

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  Here Dr. Bruner briefly sketches her focus on molecular genetic research when she arrived at MD Anderson (and later the harvesting of tissue to determine how classes of invading lymphocytes might be influenced). She collaborated with researchers from other disciplines and performed studies that would have an influence on patient treatment, not merely the determination of diagnoses.

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  Chapter 07: The MD Anderson Tissue Bank

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  The subject of research in the 1980s leads Dr Bruner to describe how some MD Anderson faculty began to bank tissue "lymphoma, breast cancer, genitourinary (prostate) tissue, and some bladder cancer. She herself began banking brain tumor tissue "the origin of the Brain Tumor Program still in existence today. Originally, this tissue "bank" was in fact scattered among different researchers' laboratories and continued to be scattered, though the records were centralized in 1998. (Dr. Bruner tells an anecdote about Dr. John Mendelsohn's attitude toward the scattered tissue repositories.) Dr. Bruner then talks her role as Consultant for Central Brain Tumor Registry of the U.S. (1996-present). One of the Registry's tasks is to help foster accuracy of diagnosis: the reality is, the majority of diagnoses of brain tumors around the country are done by general pathologists. The Central Brain Tumor Registry uses data from other registers to track trends in how cancers are interpreted. In cases of multiple mistakes, it creates systems to clarify the evidence that a physician must consider to reach a correct diagnosis.

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  Chapter 08: Few Women at MD Anderson in the early Eighties

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  In this brief section, Dr. Bruner touches on her research path, and notes the other women employed in the Department of Pathology when she arrived. She also recalls that she did not feel aware of prejudice against women at the time.

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  Chapter 09: The Neuropathology Lab in Detail

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  Next Dr. Bruner details the work of the neuropathology lab, which handles 70-80 thousand cases per year and processes over 1000 tissue blocks (tissue set in paraffin blocks for slicing) per day. She describes the measures taken to insure the accuracy and efficiency of the diagnoses, including the bar-coding of anything related to a sample to prevent mix-ups. The mechanization of various instruments (e.g. for staining slides) has aided in the service's speed. The laboratory also scans slides sent by other services, increasing the repository of examples that diagnosticians can use for reference. Dr. Bruner closes this section with interesting reflections on whether pathologists will eventually examine only digital images. She notes differences between the pathology image and images in radiology, and concludes that, for now, pathology is "an analog specialty in a digital world."

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  Chapter 10: Becoming the First Woman Chair of a Clinical Department

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  Here Dr. Bruner talks about the process that ended in her becoming the first woman chair of a clinical department (Pathology and Laboratory Medicine) at MD Anderson. She began to build her administrative skills by attending courses in leadership. She applied for the position of Division Head when the Divisions of Laboratory Medicine and the Division of Pathology were combined. (Dr. Bruner talks about the administrative reasoning behind this move.) Given her qualifications she feels she was passed over because the selection committee "couldn't quite envision a woman division head." She notes that the Department of Pathology was in limbo while the search for the new division head and chair was in progress. She lists the qualities of MD Anderson that convinced her to stay at the institution: term tenure, the all-funds budget, the interdisciplinary integration of specialties, and the physicians who love what they are doing. When the new Division head came in, he chose her for the Chair of Pathology in 1998.

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  Chapter 11: Administrative Philosophy

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  In this final chapter, Dr. Bruner reviews advice she received on how to prepare for administrative roles. She then speaks very compellingly about her own philosophy of the administrator's role: to allow people to grow and reach their highest potential, even if that means they outstrip your own achievements.

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  Chapter 12: Women at MD Anderson in the Eighties

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  Dr. Bruner begins the second interview session with observations on women at MD Anderson. She reflects on being the first woman appointed to chair a clinical department, then notes that many women were hired during a period of expansion in the eighties. She notes that Dr. Clark's vision for the institution is still felt today and praises the system of remunerating faculty in a way that there is no financial incentive to order procedures that do not benefit the patient. She speculates on why the glass ceiling for women takes shape at the chair level and notes that woman (and men) need to think about leadership as a distinct aspect of their careers that must be cultivated like any other skill.

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  Chapter 13: Cultivating Leadership at MD Anderson

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  Here Dr. Bruner talks about leadership development at MD Anderson, beginning with the courses she took via the American College of Physician Executives. She notes that MD Anderson offered few opportunities for leadership training in the nineties, but that changed in early 2000, when the Office of Faculty Development hired the Executive Development Leadership Group to offer formal training. She talks about the courses offered and also describes how the pace of the first courses was too slow for MD Anderson's high speed culture where minds move quickly. She then talks about the creation of the Faculty Leadership Academy (in 2002/3) whose goal was to offer a curriculum of basic leadership principles that faculty aren't exposed to during professional training, but that are needed in most roles: supervisory skills, conflict resolution, evaluation, mentoring, hiring and firing, etc. At the end of this chapter, Dr. Bruner gives an example of a departmental dilemma requiring complex skills

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  Chapter 14: The Pathology Department: Becoming Chair and a Controversial Move to Subspecialize

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  Dr. Bruner begins this section with a problem she inherited as Chair of Pathology "more faculty than the workload demanded. She then discusses her controversial initiative to subspecialize the Department, a major departmental transformation and a controversial one at the time, though the aim was to align the knowledge bases of pathologists with the specific subspecialties they served. She notes the influence of an article that documented how Massachusetts General Hospital's pathology department divided into subspecialties. MD Anderson's Pathology Department was successfully subspecialized in September 1999, and Dr. Bruner sketches the process of this "great achievement" that required a lot of communication, planning, and mental preparation. She notes with satisfaction that the Pathology Department had visitors from Memorial Sloan-Kettering Cancer Center to see how MD Anderson managed the change.

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  Chapter 15: Expansion and Transformation in the Department of Pathology

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  In this section, Dr. Bruner first discusses other initiatives she undertook while Chair of Pathology. She notes the new computer system she selected for the Department; she authorized transcriptionists to work from home, a move that greatly improved their productivity and ability to meet the 2-hour deadline to transcribe reports. (She says that sometimes she wants to go back and change a detail in a report, only to find that it has already been transcribed.) Dr. Bruner has been Deputy Head of the Division of Pathology and Laboratory Medicine since 1998, and here she explains that her role is to serve as the Division's second in command, representing Dr. Stanley R. Hamilton, M.D., at meetings with upper administration. She then turns to changes made in the Pathology Department once the Mays Clinic opened. The Clinic spurred huge growth in the Department, since MD Anderson pathologists are very involved in providing information during treatment decisions and surgery. A frozen section room was built in the Mays Ambulatory Clinic. Dr. Bruner explains that it is so critical to locate some pathology services very close to operating rooms, so that information from intraoperative frozen sections (tissue samples frozen and analyzed during surgery) can be quickly communicated to surgeons as they work.

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  Chapter 16: Financial Stress, Satellite Services, and Changes to MD Anderson Culture

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  In this short section, Dr. Bruner recalls the early nineties, when managed care put the institution under threat and the Department had to fire 25% of its employees (including some faculty). The notes how Dr. John Mendelsohn's reaction to the financial stress was different from Dr. Charles LeMaistre's, and Mendelsohn "exploded us out of the doldrums." She also admits to nostalgia for the smaller MD Anderson. She also has some questions about how well quality of service can be maintained at MD Anderson's satellite locations, where analyses are made by general pathologists, rather than subspecialists.

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  Chapter 17: Pathology: A Specialty Still Not Fully Understood

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  Dr. Bruner states that the administration seems not fully understand the role that pathology plays in patient care, nor the art that is involved in making diagnoses. She also talks about the culture of team work among this Pathology Department, noting again that the pathology dealing with cancer is still the most challenging. She notes differences between pathologists in private practice versus at MD Anderson.

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  Chapter 18: The Pathology Fellowship Programs

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  In this chapter Dr. Bruner talks about the growth of the Fellowship programs from 12 Fellows in 1984 to 14 Fellows in General Pathology and 15 divided among the different subspecialties "the largest pathology fellowship program in the country. Dr. Bruner describes the training of Fellows and the Department's goal of tracking Fellows to academic practice (they fund Fellows' research). While acknowledging that Fellows provide the Department with "cheap labor," she says that the Program aims to fully educate them in this specialty. Fellows, she notes, add a vitality to the intellectual environment. Their training is very hands-on, and she describes the microscopes with multiple heads (two, six, eleven, eighteen) so many people can examine and discuss a sample. The Fellows carry MD Anderson's reputation out into the world and they send cases back to MD Anderson for second opinions. She notes that the Department has an annual reunion.

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  Chapter 19: The Physician-Scientist in Pathology: A Challenging Career

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  Here Dr. Bruner talks about the challenges to a physician-scientists in pathology. (Noting that they do not have the responsibility of being on call for patients.) She notes that there is a different between the passion for laboratory work and an interest in thinking about problems that come up in the laboratory. The laboratory research career, she says, takes internal drive, and the Department of Pathology attempts to support those who have it with time and laboratory space. She mentions some young faculty members who have that drive and observes that all researchers need early support and mentoring to become successful.

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  Chapter 20: A New Department: Hematopathology

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  Dr. Bruner sketches how she worked with Dr. Hamilton to set up (in 2002/3) the Department of Hematopathology, a very unusual structure that links Lymphoma and Leukemia (and that serves 1/3 of the patients at MD Anderson.) She touches on the Department's fellowship training program.

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  Chapter 21: Current Administrative Appointments

  Janet M. Bruner MD and Tacey A. Rosolowski PhD

  Dr. Bruner first talks about her new (one month) position as an Ombudsman, describing how she got the position and her role in creating a confidential environment for faculty and staff to talk about work issues before they approach Human Resources, Legal, or undertake a grievance process. She notes some of the issues that staff bring and describes special issues for the faculty. She next talks about her involvement with the Women Faculty Leadership Group and their aims to raise the profile of women and their involvement at higher levels of administration. She then speaks about her experience on the Promotion and Tenure Committee, describing the challenges of creating criteria applicable to faculty in many different fields. At the end of the interview, Dr. Bruner notes Dr. DePinho's enthusiasm and focus and her optimism for the institution.

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  Chapter 01: A Strong Family and Early Experiences with Leadership

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Buchholz talks about his years growing up in family: because of his father's frequent moves for work, he experienced different socioeconomic communities. Dr. Buchholz also talks about the impact of the years the family spent in Brazil for his sense of courage to try new things and mix with people of many different backgrounds.
  
  Dr. Buchholz discusses his involvement in athletics in school, noting that he was first selected for leadership roles in this area. His leadership, he explains, grew organically. He did not specifically plan or seek out leadership roles. They were suggested to him, he believes, because of his ability to connect with people and create trust.He also talks about the values his parents instilled in him, noting that he learned about leadership from conversations he had with his mother after school.

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  Chapter 02: The Decision to Enter Medicine

  Thomas A. Buchholz MD and Tacey A. Rosolowski PhD

  Dr. Buchholz begins this chapter by talking about the impact of moving to Rye, New York for his senior year of high school. He then talks about his decision to attend Bucknell University for his undergraduate education (Lewisburg, PA; BA in Philosophy conferred in 1984). He notes his attraction to ""what's life all about"" questions to explain his major in philosophy. He also notes that this interest matches well with issues that arise in oncology. He then talks about the opportunity he had during sophomore year to shadow a doctor, an experience that convinced him to go to medical school.