Bob Mennel (Figure 1) was born in Trenton, New Jersey, on July 27, 1944, and grew up there. After attending parochial schools he went to St. Joseph's College in Philadelphia, graduating in 1966, and then to the University of Pennsylvania Medical School, graduating in 1970. His internship and residency in internal medicine were at the University of Rochester, Strong Memorial Hospital, in Rochester, New York; he finished in 1974. From there he went to the US Naval Hospital in Portsmouth, Virginia, where he served as a staff physician for 2 years. In 1976 Dr. Mennel went to Baltimore, Maryland, as a fellow at the Johns Hopkins Oncology Center. After finishing his 2-year training, he stayed on the faculty at the Johns Hopkins Hospital for an additional year before coming to Dallas in 1979 as a member of the oncology division of the Department of Internal Medicine, Baylor University Medical Center (BUMC), and he has been here ever since.
Figure 1.
Dr. Bob Mennel during the interview.
Presently, Bob Mennel is associate director of medical oncology at the Baylor Charles A. Sammons Cancer Center. During his nearly 27 years at BUMC, Dr. Mennel has provided care to numerous cancer patients and has been extremely active in the teaching of internal medicine residents and fellows. He has written 20 peer-reviewed articles in medical journals. He and his lovely wife, Kathie, are the proud parents of 3 offspring. Bob Mennel is a very decent guy who has been a major player at BUMC for nearly 3 decades.
William Clifford Roberts, MD (hereafter, Roberts): Dr. Mennel, I appreciate your willingness to talk to me and, therefore, to the readers of BUMC Proceedings. Could we start by my asking you to talk about your early memories, your family, and your siblings?
Robert Gary Mennel, MD (hereafter, Mennel): I was born in July 1944 in Trenton, New Jersey (Figure 2), and lived there until college. My father was 1 of 4 children, and my mother, 1 of 9. My mother's family had come from Poland; 2 of her siblings had been born in Poland. Her father came over first, and then he brought the rest of the family over around 1913.
Figure 2.
At 8 months with his mother and father in Trenton, NJ.
Roberts: Your mother was born in the USA?
Mennel: Yes. My mother was next to the youngest of 9 children. My father's father was from Switzerland and was orphaned early. Both his mother and father died of an infectious disease after arriving in the USA. My fraternal grandfather was raised by another family member. Both my mother and father grew up in the Trenton area. My father was a baker, and my mother's relatives were butchers. We lived well as far as food went. We had many cousins in Trenton and spent a lot of time with them.
I went to grade school at St. Raphael's in Trenton. I went to high school in Philadelphia at St. Joseph's Preparatory School, and I stayed there for college (St. Joseph's College). Both were all-male Jesuit schools. The Jesuits are a very academic order of priests in the Catholic Church. I have one brother, Alan, who is 4 years younger than I am (Figure 3). He also went to St. Joseph's Prep and then to St. Joseph's College. A group of 9 of us commuted every day from Trenton to Philadelphia on the Pennsylvania railroad, and then we hitchhiked to our school, which was not in the greatest neighborhood. I enjoyed St. Joe's immensely (Figure 4). I was sorry that I had a 30-mile, 1-hour commute, because it prevented me from doing a lot of things that I could have done otherwise. It was tiring. Although it wasn't much further than driving from my home now to BUMC, the trip took longer.
Figure 3.
At 8 years with his younger brother, Alan.
Figure 4.
In high school
I met my future wife in high school (Figure 5). She attended Bishop Prendergast, an all-girls' school in Philadelphia. We met on a blind date and went together for 2 years of high school, 4 years of college, and 2 years of medical school before we married.
Figure 5.
Kathie in high school.
Roberts: Did she live in Trenton?
Mennel: No. She lived in Havertown, a suburb outside of Philadelphia. Kathie was 1 of 4 children. In high school I focused on academics but also played football for a short time, got a license as a ham-radio operator, and was a member of the debating team. The latter was very valuable for me; it taught me to think on my feet and to use data in an argumentative fashion.
Roberts: What topics would you attempt to argue?
Mennel: In extemporaneous speech, the debating team member would walk into a room, be given a topic, and have a few minutes to prepare a speech. An example might be the value of the Korean War. Some philosophical issues were also debated. We would have to know both the pro and the con arguments on an issue. One week one might argue the pro side, and the next week, the con.
Roberts: How many were on the debating team?
Mennel: There were 8 members my senior year.
Roberts: How many were in your high school?
Mennel: About 80 to 100 per class. Not all students took the same courses. The liberal arts track included both Greek and Latin classes. I had 4 years of Latin in high school and 2 years in college. Latin helped train me in logic, composition, phrasing, and vocabulary.
Roberts: What position did you play in football?
Mennel: Fullback. I was not quite as heavy then as I am now. I stopped playing at the end of my sophomore year, partly because of the long commute and mostly because the other fullback was better than I was.
Roberts: You went to St. Joseph's Preparatory School because it was academically better than the high schools in Trenton?
Mennel: There were Catholic high schools in Trenton, and I could have gone to one of them, but I won a full scholarship to St. Joe's in Philadelphia, 1 of 2 offered by the Diocese of Trenton. My parents felt it would be a good move for both my brother and me.
My father was very interested in education. He never wanted to be a baker. He wanted to be an engineer. He graduated from high school in the early 1930s (during the Depression), and his family could not afford to send him to college. His father also was a baker. My father read avidly. I was always impressed by that. For a person who never went to college, he had a tremendous knowledge of different topics. It always bothered him that he did not go to college. The day my brother graduated from college, my father sold the bakery business because he felt he had completed his job of educating his sons.
I worked with my father on weekends and during the summers in the bakery. He paid me, but he banked my whole paycheck for future education. Once I told my father that baking was an interesting profession and that maybe I should consider doing it. He said, “Over my dead body.” He indicated that the main reason he had the bakery was to get my brother and me through college.
Roberts: What was your father's name?
Mennel: John Robert Mennel. He was born in 1916 and died in 1977.
Roberts: What did your father bake?
Mennel: Everything: cookies, cakes, buns, and breads. He did not have a regular stone hearth, so things like rye bread and Kaiser rolls he got from the Jewish bakery down the street, but he baked everything else. My father, my uncle, my grandfather, my brother, and I all worked in the bakery together. By 4:30 am we had baked most of what we needed for the day. At that point we would ice buns and fill donuts, and the Jewish baker would deliver his rye bread and rolls. We would slice up the loaf of rye bread or pumpernickel and sit for about 15 to 20 minutes eating bread and talking. I learned the most about my family during those breaks. My grandfather, father, and uncle would tell stories about when they were growing up. I wish I had recorded those sessions. (My son, John, became very interested in genealogy when my wife's mother died, and subsequently he has done extensive genealogical work on our family.)
Roberts: Were you and your father close?
Mennel: Yes. Even though he was a strict disciplinarian, he was very kind and loving. There were rules that we had to follow, and he expected us to be responsible for certain things. When my son, John, was born, my father did things that he never would have done when my brother and I were growing up. We didn't have much time to be together until I started working with him in the bakery. On weekdays, he left home at 2:00 am. to go to the bakery. On a weekday, he would come home around 3:00 or 4:00 pm. He would go to bed at 7:30 pm. We always had dinner together, and that was when we talked about family things. When I became old enough to work in the bakery, I got even closer to my father and learned a lot more about our family.
Roberts: How far was the bakery from your home?
Mennel: About 12 to 15 miles. We lived in Hamilton Square, a suburb of Trenton. The bakery was near Ewingville.
Roberts: How many people worked in the bakery?
Mennel: It was mainly family: my father, my grandfather, my uncle Ray, and during the summers and weekends, my brother and me. Five of us baked. My mother and my aunt Mabel sold in the bakery. Two other nonfamily employees also worked in the front selling. Usually about 9 people worked at the bakery.
Roberts: Were the products sold on site?
Mennel: Yes. Customers came in every day. When my father started out in the bakery business, Saturday was their biggest day. Later, our biggest day was Sunday. When one baker opened his bakery on Sunday morning, all bakeries had to follow as these bakers would lose a major portion of their business. Customers wanted the goods fresh on Sunday. We had weekends together as a family, but they were all at work.
Roberts: The whole family worked Saturday and Sunday?
Mennel: Yes, my brother and I and my father would go in at about 9:00 pm Saturday and work through the night. We would open the bakery on Sunday at 6:30 am. My mother came in around 6:00 am and loaded up the counters and display cases. Customers would start coming in after the 6:00 am mass from the church down the street.
Roberts: Would you sleep on Sundays during the day?
Mennel: We would have done most of the baking by 2:00 pm Sunday. In college I worked most weekends at the bakery. I would head back to school after that. I had a car by then. In college I lived on the campus in Philadelphia. Kathie and I would usually go out on Friday night and then I would come home somewhere around midnight or so and then go into work early Saturday morning. After the Saturday work, we would go to bed and then start about 9:30 pm or so on Saturday night, work through, and then head back to college on Sunday afternoon. Fortunately, we were young enough to be able to sustain that schedule.
Roberts: You really didn't think much of it?
Mennel: No, not at all.
Roberts: Did your family have vacations when you were growing up?
Mennel: Yes. My father closed the bakery for 2 weeks every July and took a family vacation. We usually went to the Jersey shore to a place called Wildwood and stayed at the Oceanic Hotel, which was on the beach. We ate our meals in the hotel's dining room. My father and mother enjoyed these 2-week vacations so much that when they sold the bakery, right after my brother graduated, they bought three apartments and later a 30-unit motel at the Jersey shore. They sold it in 1974.
Roberts: Was it profitable for them?
Mennel: Yes.
Roberts: You mentioned that dinner was a big deal in your house. What was dinner like?
Mennel: We talked a lot about what was going on during the day. That was the major topic most of the time. My father and mother were always interested in what we were learning in school and what we were doing. My father would occasionally talk about more general topics.
Roberts: Did he dominate the conversation?
Mennel: No, not really. He would often steer the conversation. My mother tended to start most of the conversations. My father wasn't a person who talked for the sake of talking. He didn't say an awful lot, but when he talked, it was usually something of worth. He was more interested in what we were thinking about things.
Roberts: He was pulling things out from you?
Mennel: He listened and commented on things we said. Many discussions were about what other families were doing down the street or who had just gotten a television. I remember vividly when TV came along. Initially, only one neighbor had a television set, and we did not. My mother always knew where she could find me, because I was really intrigued by TV. I remember the big day when we got a television set. The programs then were probably more worthwhile than they are now.
Roberts: Is your mother still living?
Mennel: Yes. My mother, Virginia Regina Golinski Mennel, was born in 1917 and is 89 years old now.
Roberts: Is she healthy?
Mennel: Yes. She is starting to have problems with arthritis and high blood pressure, but she still drives. She lives by herself. She does some exercises.
Roberts: Where does she live?
Mennel: Trenton, New Jersey.
Roberts: So she moved back to Trenton?
Mennel: Yes. She lived here in Dallas for a while, because my brother and I both were here. Alan moved back to the Northeast with his business. She decided that she was going to be closer to her friends in Trenton. One sadness of getting older is that a lot of your friends die. That scenario is affecting my mom. She has only one living sister, so 7 of her siblings have died.
Roberts: Did most of those siblings stay in the Trenton area?
Mennel: Yes.
Roberts: The Mennel family was large?
Mennel: Yes, huge. One reason Kathie and I left the Philadelphia area after medical school was to give our immediate family a chance to develop our uniqueness without the pull of a very large extended family. Kathie also had a large extended family. Kathie's mom was 1 of 2 children, and her father was 1 of 5 children. If we had remained in Philadelphia, Kathie and I would have been expected to constantly participate in the extended families' activities. We figured that when we were starting our family it would be nice if we had some time to ourselves, even though there isn't a lot of time as a houseofficer. On the other hand, we are sorry during holidays that other family members are not in this area.
Roberts: What is your mother like?
Mennel: She is very active, very hardworking, very family oriented, dedicated to her sons almost to the point where we could do no wrong inside or outside the home (Figure 6). My wife tells a true story. While bending over, I split my pants. My mother's reply, defending her son, was that she was sure that the threads were rotten in the pants, not that I had a big rear end and blew out my pants. Both my parents were teenagers or young adults during the Depression years, which probably instilled in them a different ethic about work, money, and savings than teenagers have today. My parents didn't have much. They were looked upon in the Trenton area as being immigrants. My mother was very sensitive about Polish jokes, probably because she was the brunt of some of them when she was growing up. She wanted to succeed. She didn't get a chance to go to college. She was very proud that she went to business school and learned stenography and typing and could earn a living. During World War II, she worked in a defense plant (General Motors), which built airplanes for the war. She did riveting.
Figure 6.
Wiht his mom.
Roberts: When were your mother and father married?
Mennel: They married in 1942 and I was born 2 years later. My dad was in the war and did not see me for some time after I was born. My dad contracted rheumatic fever when he was in the service and was transferred back to the USA from the Pacific, where he had served in the US Navy. He was a cook and a tail gunner on a destroyer tender. He had many stories about his time in the navy. He was convinced the reason we won the war was because the Japanese had more jerks in their navy than we had in ours. He said they had a chief petty officer who got a case of Vitalis every week and never had his hair combed, which meant he was drinking it for its alcohol content. My father's rheumatic fever led to mitral stenosis with atrial fibrillation and finally to a fatal intracerebral hemorrhage. I was just finishing my second year of fellowship when he died. We were on a vacation in the Smoky Mountains when he became ill and we went home. I helped the neurosurgeon do an emergency angiogram on my father. That was a different experience for me.
Roberts: Your father, in a way, was an entrepreneur.
Mennel: It depends on how entrepreneur is defined. He knew if he had his own business he could most likely generate a better income for the family and have more control over sharing the profits than if he worked for someone else. He was a perfectionist in a lot of what he did. He was a very good baker. After he died, my mother gave me his recipe book, which I subsequently gave, with her permission, to the person who took over the bakery. The man who bought our bakery was a young guy that my father had trained. The recipes are the currency of the bakers. They didn't share their recipes unless they really liked you and trusted you. My parents had the motels at the Jersey shore because they still needed an income. Both my mother and father always worked very hard for their family.
Roberts: What was your house like when you were growing up in Trenton?
Mennel: We lived for about 3 years with my maternal grandparents when my father was in the navy. When my father returned from the navy, my parents built their own 2-bedroom home. I lived in that house through high school. When I went to medical school, they moved to Medford Lakes in southern Jersey. They lived there for about 4 or 5 years. Then my father took a job back in the bakery just to help out a friend. He would drive up to Trenton, about a 25-mile trip, to do that. Finally, my parents decided to move back to Trenton to be closer to family again, and they bought another house in Trenton, the one they were living in when my father died. My mother stayed there for a while and then moved to Dallas when both of her sons and all of her grandchildren were here.
Roberts: You and your brother shared a room as you were growing up?
Mennel: Yes.
Roberts: You mentioned that your father did a lot of reading. Were there a lot of books, magazines, and papers around the house? What did he tend to read?
Mennel: He liked history and biographies, not novels. He got books from the library. There were quite a few books around the house.
Roberts: What was the neighborhood like where you lived?
Mennel: They were all single-family homes, usually not very large homes but on nice lots. Most families had 2 to 4 children. The homes for the most part were each different, because there were a number of different builders in that area.
Roberts: Was it a heavily Catholic community?
Mennel: No. There were a lot of Catholics in Trenton, but we were probably the only Catholic family for about 3 houses on both sides of us.
Roberts: Did your father or your mother smoke cigarettes?
Mennel: My mother did not smoke. My father smoked about 2 packs a day. It was a point of contention for years between my parents. My father gave up cigarettes under duress a few years before he died.
Roberts: Did he smoke in the house?
Mennel: Yes, when we were growing up. Later, my mother forced him outside when he smoked.
Roberts: Was there alcohol in the house?
Mennel: There was alcohol, but there wasn't much drinking. My father didn't drink very much at all. They had a social club consisting mainly of my mother's family, her sisters, her brothers, and their spouses. They forced their husbands to go with them to a Saturday evening dancing school. They would take a lesson, and then they would all get together at somebody's house afterwards and practice what they had learned. They later made their kids take dancing lessons just before them. Thus, the whole family participated. At the social gathering after the dancing they might have a drink or two. I don't remember my father drinking during the week at all. They didn't drink wine.
Roberts: Did your brother get a scholarship to St. Joseph's Preparatory School also?
Mennel: I can't remember whether Alan had one or not. He may have. Alan reminds me a lot of my dad, because he is a very avid reader also. He likes history and politics. He married shortly after college. He was considering law school but decided against it and went into business.
Roberts: What kind of business did Alan go into?
Mennel: He sold linens. He started out in a department store in Trenton. He worked his way up and was the head of their linens department. He then went with a firm that had a number of stores in the Delaware-Pennsylvania-New Jersey area. He was in charge of about 20 stores and he bought merchandise for them. He then became a major buyer for another company. Finally he opened an Internet business that sells linens online.
Roberts: He lives in Trenton?
Mennel: No. He lives in Moorestown, New Jersey, a suburb of Philadelphia which is south of Trenton.
Roberts: Does he have children?
Mennel: Yes, 2. His daughter went to Texas A&M. She works with him in his business and probably will take it over some time. His other daughter is a sophomore in high school. She has done extremely well.
Roberts: How did your mother and father react when you brought your report card home in junior high and high school? Did they push you hard to make good grades, or did that sort of come naturally?
Mennel: Yes, they pushed us. I had to work. We were expected to do homework on the weekends despite working in the bakery at night. They expected us to work and they expected us to do well.
Roberts: Did any teachers have a particular influence on you in junior high, high school, or college?
Mennel: A number of them did, mainly nuns. There was Sister Ambrose, the principal of the school. I had her in the eighth grade. She was tough and critical but fair. I saw those characteristics in my dad. She prized learning for the sake of learning. I admired her. If you did what you needed to do, you were rewarded for it. Another teacher in high school was Bill Waters, a Jesuit priest who taught English. We got to be good friends. He was the priest who married Kathie and me in 1968 (Figure 7). It took some finagling to get Kathie's parish to allow him to perform the ceremony there. Kathie and I had some ideas for our ceremony that were not standard for the church. Bill Waters helped us. We wanted both families to escort both the bride and groom to the altar. That request was really tough for the parish priest to swallow, but Waters allowed us to do that. We also wanted to write some of our prayers. It took a lot of discussion to get Kathie's parish priest to agree to that. But anything worthwhile is worth going out on a limb for.
Figure 7.
With Jesuit priest Bill Waters on their wedding day.
Kathie's mother is Irish, and if she were living, she would probably still be fighting the Irish rebellion. Her father was English. Her mother said if she had known that Mr. Mullin was not the Irish Mullin but the English Mullin, she would never have married him. Kathie's family was Catholic. Kathie's mom's father died in his 30s, and her mother had to raise the 2 daughters in Philadelphia by herself. Kathie's father's family had lived on the Eastern Shore of Maryland for several generations.
Roberts: Were you tops in your high school class or do you know?
Mennel: I don't know exactly where I ranked. I was high.
Roberts: You decided to go to St. Joseph's College while you were in prep school. Did you have a scholarship for college, too?
Mennel: Yes. I had a Scott Paper Company scholarship.
Roberts: When did you become interested in medicine?
Mennel: I had rheumatic fever in 1954 and was bedridden for 4 months, missing half of fifth grade. A family practitioner, Swithin Chandler, came to see me about twice a week. We would talk about a lot of different things, and I got interested in medicine at that time. I also saw a cardiologist. Fortunately, I appear to have no residua of rheumatic fever.
Roberts: Were there any physicians in your extended family?
Mennel: No. The others were butchers and bakers. I was the first one to go to college in my extended family. My father made sure that I went.
Roberts: When it was time to apply to college did you apply to several?
Mennel: No. I was expected to work in the bakery so I had to be close enough to get there on the weekends. I got a full scholarship to St. Joseph's, which had strong physics and chemistry departments, and I knew I was interested in medicine. I had always been impressed by the Jesuit order, which staffed St. Joseph's College. Jesuits have to study 13 years before they can become ordained. Their 2 big missions are teaching and missionary work. I lived at college from Sunday night through early Saturday morning, and then I would head home to work.
Roberts: How did college hit you? Did you enjoy it?
Mennel: I liked it. It was good.
Roberts: What did you major in?
Mennel: I pursued a bachelor of arts in biology. That allowed me to take a lot of courses in English, history, Latin, etc.
Roberts: How big was St. Joseph's College?
Mennel: The day college was probably around 3000 students. The night college, for those working during the day, was probably similar in size.
Roberts: Were you impressed with the other students? Did most of the students at college come from the prep school?
Mennel: No. Most of them came from Philadelphia, southern New Jersey, Pennsylvania, and occasionally the New York area. Some students were very good, and some were not very impressive.
Roberts: Did you apply to several medical schools?
Mennel: Yes. I applied to Columbia but was not accepted. I got into the University of Pennsylvania, and once I got into Penn that was it. I interviewed at Harvard but had not heard when I got into Penn. Kathie and I knew we were going to get married in about 18 months. We got engaged my last year in college when I knew where I was going to be for medical school (Figure 8). She was teaching in a school district outside of Philadelphia. There was value to my staying in the Philadelphia area.
Figure 8.
With kathie.
Roberts: How did you finish up in college?
Mennel: I was in the top quarter. My grade point average was a tenth of a point from cum laude, like 3.49. I was in the middle of the class in medical school. I did better in the clinical than in the basic science portions. I was a B-type student in most of the basic sciences, but I made a C in biochemistry.
Roberts: How did medical school strike you? It seemed that competition was a little stiffer than it was in college.
Mennel: I liked the competition. At Penn, it was pretty much guaranteed that if you worked, you were going to graduate (Figure 9). It took a lot of work but was fun. Some really interesting people were there. Luther Terry was one of the deans. (He was the surgeon general who got the ban against cigarette smoking.) Peter Knowle, who had discovered the Philadelphia chromosome, was there. Baruch Blumberg won the Nobel Prize in 1976. He was a medicine attending. I had a really enjoyable time there. You were expected to work hard.
Figure 9.
Graduation day at the University of Pennsylvania Medical School, June 1970, with his father, mother, Kathie (who was 8 months pregnant), and brother Alan.
Roberts: How many were in your class in medical school?
Mennel: About 100. We had more women than did most medical school classes at the time. Penn had 4 women per class. That was a lot of women in a medical school in 1966.
Roberts: Did the science courses in high school and college come easy for you?
Mennel: Relatively.
Roberts: You liked them?
Mennel: Yes, I enjoyed science but I enjoyed most courses.
Roberts: Your extended family must have been enormously proud of you when you got into medical school.
Mennel: They were. They always asked me for a lot of medical advice. They never took the advice I gave them, but they always asked for it.
Roberts: Medical school was a good experience for you?
Mennel: It was a great experience (Figure 10).
Figure 10.
With Kathie—medical school “super heroes.”
Roberts: What medical school faculty really impressed you?
Mennel: A number of professors really impressed me. Roy Williams, a retired surgeon who was probably 70 years old, taught anatomy, but also philosophy at the anatomy table. Richard Wood, an internist, taught me a lot about dealing with patients and got me interested in internal medicine. Arnold Relman, chairman of medicine, was very impressive. Sam Their was a wonderful teacher and really enjoyed his students. He subsequently became head of medicine at Yale. Marty Goldberg, who was a mentor to Mike Emmett, was extremely good. I worked 3 summers with Claude Joyner, a cardiologist.
I was intent on becoming a cardiologist when I started my internship. I decided during internship and residency, however, that I was more interested in general internal medicine. I got into oncology when I was in the navy. I had to do a 2-year stint in the Navy because of the Vietnam War. I was stationed at Portsmouth Naval Hospital, a 1500-bed hospital. I was in charge of the medical students from Eastern Virginia Medical School and was an attending on an enlisted men's ward. It was fun. The navy was good for me because, in the navy, if you are willing to work, you could do lots. Residents are usually the low man on the totem pole. In the navy, I was right out of my residency and at the top of the heap. Some career navy doctors were not interested in teaching. Portsmouth was a good place for me. I enjoyed the medicine there and the interaction with the medical school.
Roberts: When you were going through medical school, did you have a hard time or an easy time deciding on internal medicine?
Mennel: Both easy and hard. The only thing I knew for sure was that I would never be happy being a psychiatrist. That is interesting because so much of what I do now is psychiatry. Surgery was interesting but so much of the time was procedure oriented, and that did not appeal to me as much as interaction with patients. We ask medical students to make up their minds very early about what they want to do in medicine, before they have experienced what each of these specialties actually does. When I was in medical school, internal medicine was the popular choice. It was academic medicine that appealed to me. There might have been a little snobbery in that.
Roberts: You mentioned that you wanted to get away from Philadelphia; you had been there a long time. Did you apply to several different places for internships?
Mennel: Yes. I took a number of trips. One trip was to upstate New York to the University of Rochester, then to Chicago, then Madison (University of Wisconsin), and then to Minneapolis (University of Minnesota). I then flew out to the University of Colorado. When I visited the University of Rochester, I knew I wanted to go there (Figure 11). It was both a clinically oriented and a research-oriented program. The house-staff appeared happy. Bill Morgan was in charge of the training program. (This year he had a professorship named after him.) He was an excellent teacher. As an assistant resident (postgraduate year 2), you spent the whole year on the wards. The second-year residency (postgraduate year 3) was set up as four 3-month subspecialty rotations.
Figure 11.
As a first-year intern at Strong Memorial, 1970.
One day of the month, Bill Morgan would reverse roles and make the first-year resident the attending while he acted as the first-year resident. We would go to the bedside and the intern presented the case. The first-year resident ran the rounds. Then we went to the ward's classroom and the first-year resident conducted the whole teaching rounds. It was nerve-racking. The first-year resident did not know which case Dr. Morgan would choose. At the end, he would reserve 5 minutes to critique your teaching technique. I really enjoyed Dr. Morgan. He was a general internist, but he did extra training in cardiology. He carried 2 stethoscopes: one with a diaphragm to listen to aortic murmurs and one with the bell to listen to mitral murmurs. He would not allow the housestaff to talk to drug reps. He required that the generic names, not the trade names, be used for all drugs when writing orders.
Roberts: You did your internship and 3 years of residency in Rochester. Did you like living there?
Mennel: I did. It is an interesting, active, fun, and upscale community. There were a lot of white-collar employees there. Eastman Kodak and Xerox had their offices there. Rochester Institute of Technology was there. The medical center was great.
Roberts: When you finished your training in Rochester, you planned to be a general internist?
Mennel: Kathie and I believed it would be fun to live in New England and practice in a small community there, and that was what we intended to do. My experience with the navy changed my mind (Figure 12). The navy hospital was a large referral center. We had a tropical medicine section there, so a lot of interesting patients came through. What I realized in internal medicine then was that if I wanted to practice high-class internal medicine, I needed to be in an academic center where we had great laboratories. I also realized that if I was at a really large medical center, the types of patients I would want to see with different interesting internal medicine problems were going to be sent to the subspecialists and not to the general internists. At that time, I started thinking about what subspecialty I could do that involved a lot of general internal medicine. I wanted a more horizontal cut through internal medicine rather than a vertical cut like cardiology or gastroenterology. Oncology was a brand-new field at that time. Its first board examination had just been given when I was applying for an oncology fellowship. I started looking around at different places in 1974 and started the fellowship in 1976.
Figure 12.
Lieutenant Commander R. G. Mennel, Portsmouth, VA.
Roberts: How did you decide on Hopkins?
Mennel: I looked at several places. I liked the people I met there, and Hopkins had plenty of patients. There was a nice mixture of research and clinical medicine. It also wasn't too far from Philadelphia.
Roberts: Did anybody in Portsmouth influence you toward oncology or did you figure that out yourself?
Mennel: I figured that out myself. I wasn't really impressed with the oncologists at Portsmouth when I was there.
Roberts: How did you like living in Virginia?
Mennel: I loved it. It was fun. Even though I was busy, I had more time than I had had previously. We used to go to Williamsburg and Jamestown a lot. Since we were military, we could go to the old Fort Story military reservation, which had a nice beach.
Roberts: How did Hopkins hit you?
Mennel: I liked Hopkins a lot. It was an exciting place. A lot was happening. It's not a lot different from BUMC. Most of the attending physicians were sort of second-line doctors, because the fellows took care of the patients.
Roberts: Who was head of oncology?
Mennel: Al Owens. Al was president of the American Society of Clinical Oncology (ASCO) one year. Marty Abeloff did breast oncology there, and he also was president of ASCO one year. He is now head of oncology at Hopkins. I went to the seventh or eighth meeting of ASCO; I thought it was big with 900 people there. Now the ASCO meeting has 28,000 attendees. I remember hearing Larry Einhorn give his groundbreaking paper on curing people of testicular cancer. It was a paradigm shift in oncology. Here was a solid tumor that could be cured.
Roberts: Was your training mainly in hematology or solid tumors?
Mennel: Solid tumors. We did a lot of hematology also because the members of the hematology department at Hopkins did not take care of the malignant hematological patients except for those with chronic leukemia. The bone marrow transplant program was under oncology. The oncology fellows ran the bone marrow transplant ward. All the acute leukemic patients were treated by the Department of Oncology. Even though I trained as an oncologist and am certified as such, the malignant hematologic disorders at Hopkins were treated by the oncologists. As a consequence, I treated many leukemia patients. The Hopkins training gave me the best of both worlds—solid tumors and hematologic malignancies. When I started at BUMC, all of us treated acute leukemia patients. Now most of the leukemia patients are treated by Barry Cooper, Houston Holmes, Art Molina, and Chris Maisel. Barry Cooper and I started at BUMC on the same day. I spend my time now essentially exclusively with patients with solid tumors.
Roberts: Your fellowship at Hopkins was for 2 years?
Mennel: Yes. I stayed on an additional year as junior faculty there. At the time we were working on a large program project grant involving L-phenylalanine mustard (Alkeran) for ovarian cancer. I was working with Mike Colvin, an oncology chemist. I was trying to decide what I was going to do: work in the lab or see patients. I didn't think of myself as a good basic science researcher. I thought I was probably not good enough to be both a good laboratory investigator and a good clinician. I think there are very few people in medicine who can do both well.
Leon Dragon, a fellow with me at Hopkins, came to practice in Dallas after encouragement from Larry Waterbury, one of our Hopkins professors, who had been a medical resident with Mike Reese, the founder of Texas Oncology, PA. In September 1978, Leon called me and asked whether I would be interested in coming to Dallas. I said, “Probably not.” Mike Reese said, “You really can't tell until you come and look at the practice.” Mike Reese sent Kathie and me 2 plane tickets so we accepted, thinking we would have a brief vacation. I met with Marvin Stone, John Bagwell, and Mike Reese, and I realized that BUMC was a very interesting hospital. The opportunity represented “private practice,” a bad word at Hopkins and some other academic institutions. But BUMC represented a very academically oriented private practice. There weren't many basically private practice institutions that had a person like John Fordtran as head of medicine. Although I enjoyed teaching, teaching was not investment capital for me to move up the academic ladder in a medical school, which usually advanced faculty on the basis of successful research. But BUMC had medical students, house-staff, and an oncology fellowship with Southwestern Medical School. Mike Reese was in charge of the housestaff program at BUMC at the time, and Ralph Tompsett was chairman of the Department of Internal Medicine (John Fordtran came the next year). So BUMC offered practice plus teaching and was also a community where very little clinical research in oncology was going on. I saw BUMC as a wide-open opportunity. I saw the hospital as having very good surgery, pathology, and imaging departments. At Hopkins, a computed tomography scan of the chest, abdomen, and pelvis was ordered for all oncology admissions because it took a week to get these scans done. When I came to BUMC, I ordered a scan of the chest, abdomen, and pelvis on the first patient I ever admitted to the hospital. To my surprise, it was all done that afternoon. So I came to BUMC on July 15, 1979.
Roberts: What did you think about Dallas initially? How did you get into the Dallas culture, and how has that worked out?
Mennel: It has worked out okay. Dallas was more ostentatious than other communities we had lived in. In Baltimore, you did not show off your wealth. The wealthy in Dallas tended to let their status be known. The thing that impressed me was that Dallas was also a place where you could get things done. It was a moving society. Philadelphia was 100 years older than Dallas. If you weren't in the right families in Philadelphia, it took a long while to work your way into Philadelphia society. Dallas was an exciting place for us. We really enjoyed it. It took us awhile to get into a lot of the different activities, especially since medicine has always taken up so much of my time. When we arrived in Dallas our 3 kids were 9, 5, and 3 years, and we spent much of our time with them. Dallas has been a good place for us medically, socially, and family-wise.
Roberts: You and Mike Ramsay have the reputation of spending more time at BUMC than any other staffer. In 1990, after you had been in Dallas for about 10 years, what were your days like? What time would you wake up in the morning? What time would you get to the hospital? What time would you leave the hospital? What time would you get home? What time would you go to bed? Most of your patients are critically ill.
Mennel: Many are critically ill. My practice was established quickly. BUMC is a busy place. Many people don't realize how busy BUMC is in oncology. In 2001, Hopkins was seeing about 1750 new oncology patients a year. At that time, we at BUMC were seeing 2800 new oncology patients a year. We have a number of tumor-specific conferences each week, and they usually begin at 6:30 am. Commonly, my day starts around 6:30 am in the hospital.
Roberts: What time do you wake up?
Mennel: Between 4:30 and 5:30 am, depending on whether I have something I want to read. I read better in the morning than in the evening when I am usually pretty tired. If I don't have a meeting, I make hospital rounds at 6:30 am. I then view my patients' radiographs taken the previous day with the radiologists and review the tissue slides with the pathologists. Providing clinical information to the radiologists and pathologists helps them determine what is going on. These activities usually take an hour. While my patients usually start arriving about 8:40 am, I typically get to the office at about 9:30 to 9:45 am, and I usually stay until about 6:15 to 6:30 pm. I'm always running behind, unfortunately. After I leave the office, I go back to the hospital to finish up. I see new consults and usually see the patients who require more discussion about their condition. If I'm really busy, I will leave at 10:30 or 11:00 pm. I am not having as many of the 11:00 nights as I used to, since we now have more partners.
Roberts: Are you taking a day off now?
Mennel: I have always taken a day off. Everyone in our group has 1 day off each week. We cover each of our partners. Nearly 8 years ago, I decided that I wanted to do more publishing and develop different computerized teaching techniques. I talked to Mike Reese, Marvin Stone, and John Fordtran and told them what I was interested in doing. They got me an additional day off each week from clinical responsibilities, a supporting salary, and secretarial support from the hospital to do different projects. I have responsibilities for computerization of the cancer center and teaching. I still haven't done what I really wanted to do because the computerization of the cancer center has taken an awful lot of time. I feel somewhat guilty if I have a fellow or resident rotating with me and I am not there on Friday. So I spend 1 to 1½ hours on Friday afternoon with the rotating resident or fellow discussing a topic of their choice. I still want to develop that third phase, which got me interested in the first place. Drs. Vinay Jain and Eric Nadler, also in the group, also got very involved in computerized data collection.
The computer is an educational tool, and that's what I'm working on. The way we learned medicine traditionally was by case solving. We put together a differential diagnosis—roughly a hypothesis of what is happening—and then we test it via the history and the physical examination and various laboratory and imaging findings. We use that information step by step to change our differential. The computer can be of great use here. We have categorized well over 1000 oncology cases. I want to present clinical vignettes and give the students, residents, or fellows 5 or 6 choices, allow them to pick one, and then give them the information they request. On the basis of their choice, 5 new questions would be asked and additional information provided depending on their choice. At the end, the efficiency of their problem solving can be discussed, and links to important articles on the topic can be provided.
Roberts: That is the way you conduct many of your teaching sessions. You seem to always start with a case. How often do you cover on the weekends?
Mennel: Every fifth to sixth weekend now since our group has gotten bigger. The covering physician is very busy on weekends since he cares for his own patients and patients of 6 other physicians. We provide coverage for all the leukemic patients.
Roberts: How many patients does the whole group usually have in the hospital at any one time?
Mennel: On a light weekend, my particular group sees probably 25 patients; on a heavy weekend, probably 40. We usually start rounding at 6:30 am. I'm not particularly efficient. On Saturday, I usually don't finish before 6:30 or 7:00 pm. However, there are 3 other groups—the solid tumor service, the bone marrow transplant group, and the gynecologic oncology group—also covering each weekend for the whole oncology service.
Roberts: The same on Sunday?
Mennel: Sunday usually moves along faster, because I know the patients better. I go through their charts completely on Saturday. I have met them and know what is going on and now know what to look for. Still, I do well to finish by 4:00 pm on Sunday. The day can be longer if the telephone or emergency department is busy.
Roberts: How much time do you take off a year for vacations?
Mennel: I usually take off 6 weeks a year, and that includes both vacations and meetings. Since our kids are grown and live in different places, I take more time off now to be with them.
Roberts: Where do you live?
Mennel: In Northwood Hills, literally 1 big block north of I-635 off of Hillcrest. I am 12 miles from the hospital.
Roberts: How long does the drive take at 6:00 am?
Mennel: Twenty minutes.
Roberts: When you first met Kathie, what were the features that attracted you to her?
Mennel: She was interesting, inquisitive, had her own mind, liked children, and was very family oriented (Figure 13). I owe a lot to Kathie because she gave up her career when the kids came along so I could pursue my career. She got interested in kids with learning disabilities and got certified in special education and academic language therapy. When Jenny, our youngest, was old enough to go to school all day, Kathie got retrained in teaching kids with learning disabilities. She has taught in elementary schools primarily. John, our oldest, had a mild case of dyslexia, and Kathie got very interested in how he learned. She spends about half of her time now in schools, where she provides one-on-one teaching, and the other half teaching individualized learning skills to students who come to our home from 3:00 to 7:00 pm. I have always tried to spend a lot of time with our children, but I have not spent as much time with them as I wanted.
Figure 13.
With Kathie in fall 2005.
Roberts: As you were growing up, you had dinner with the whole family at night. That's been a rare occasion for you with your own kids?
Mennel: On my day off and the weekends, we would have dinner together.
Roberts: That is 3 nights a week.
Mennel: Roughly, yes.
Roberts: What are your children's names?
Mennel: John Edward Mennel, who was born on June 22, 1970; Emilie Anne Mennel Collins, who was born on August 6, 1974; and Jennifer Aileen Mullin Smallwood, who was born on August 20, 1976 (Figures 14 and 15). Actually, Jennifer is our niece. Jen came to live with us when she was 1 year old. She is Kathie's brother's child. We had 2 biological children.
Figure 14.
With his daughters, Emilie (left) and Jennifer, November 1991.
Figure 15.
Christmas 2005 at Bob's mom's house. Kathie, John, Stew (sonin-law), and Emilie.
Roberts: So you raised her as your daughter?
Mennel: Yes.
Roberts: What does John do now?
Mennel: John lives in Bucharest, Romania. He graduated from college with a degree in medieval studies and Hispanic studies. He won a Ben Franklin fellowship at the University of Pennsylvania, where he was to study for a PhD in romance language philology. In high school, he got very interested in Russian literature. He lived in Russia for about 3 months in 1991, when he was a junior in college. He was supposed to come home on August 21, 1991, but that day Gorbachev was put under house arrest, so he couldn't get home right away. John went back to Russia in 1993 after finishing college; he had planned to spend 6 months there before he started his fellowship. I told him he needed a job, because I wasn't going to support him while he was there. He got a job with Deloitte and Touche as a translator. Deloitte and Touche had a major contract to privatize Russian industry at that time. They realized he could do more than just translate. They started teaching him the business. They initially taught him how to appraise property. He was about 27 when he sold a very large Russian steel mill to a group of Western investors, and then he was in charge of making the project profitable. After being in Russia for 6 months, he called the University of Pennsylvania 2 days before he was supposed to start his fellowship and told them he wasn't coming for he was now a businessman. He spent 4½ years in Russia and returned to the USA and got an MBA. He then went to Austin, Texas, and in the space of 5 years probably worked for 5 small computer companies. He put together the business plan for them, and they would then either get bought out or go public, and he would move on to another company. He met Laurie, his wife, there, and they had our first grandchild, Mary Kathleen (Figures 16 and 17). He then joined Booz Allen Hamilton and went to Macedonia to set up the business infrastructure for the country's computer industry, and he is doing the same thing in Romania right now.
Figure 16.
Laurie (daughter-in-law) and Mary Kathleen (granddaughter).
Figure 17.
Mary Kathleen Mennel (granddaughter).
Roberts: What do your 2 daughters do?
Mennel: Emilie is a physician. She went to the University of Texas Southwestern Medical School here in Dallas. She did her residency in internal medicine and is now a fellow in endocrinology at the University of Michigan. She is married to a cardiology fellow there, and they are going to have our second grandchild, their first, a son due in July 2006. Jennifer went to the veterinary school at Texas A&M. Her childhood interest in horses became a life desire for her. She is now an equine veterinarian in Lexington, Kentucky.
Roberts: You have been such a busy guy. Do you have time for any hobbies?
Mennel: I was hoping you weren't going to ask me about that. I like to work around the house. I enjoy gardening. I attempt to play the piano, but I don't play well and I still take piano lessons. The only time I practice is when the teacher is there with me. We spend a lot of time traveling with the family. I used to love to do woodwork but I haven't had the time for it.
Roberts: How many hours of sleep do you need to feel pretty good the next day?
Mennel: I need more now that I am older. I used to sleep only 4 to 5 hours each night. I usually go to bed between 11:00 pm and midnight, and I usually get up between 4:30 and 5:30 am.
Roberts: On the weekends you don't work, do you catch up a little?
Mennel: A little bit.
Roberts: What about sports? Do you have any time for golf or tennis or any other sport?
Mennel: I like fly fishing, but I do that just on vacation. I was a golfer in high school. I still swim and take walks. Kathie just had both of her knees replaced. Before her knees got bad, we did a lot of hiking. We have a place at the YMCA of the Rocky Mountains in Colorado. We donated the cabin to the “Y”. It is a gathering place for our family. It is adjacent to the Rocky Mountain National Park. We have kept our kids' names on the agreement with the YMCA. The cabin is in our family until 2040. We went there for the first time in 1980. Pick Scruggs and Lloyd Kitchens got us interested in it. Our kids refused to go anyplace else on vacation. We went there every summer.
Roberts: Did you push your kids to be such good students, or did that just come naturally for them?
Mennel: I think they did it pretty much themselves. They were interested in and they prized education. My father said your goal was to give your kids either a trade or an education. They enjoyed learning. They all are very different. All of our kids ended up going to private schools.
Roberts: What is your home like here in Dallas?
Mennel: We are in a house that is bigger than we need, but we needed room when the kids were growing up. We have kept it so it will be easy when they come home. We probably have about 4000 square feet that is finished and probably another 2000 square feet that is not finished in the attic. It is a 2-story home.
Roberts: Do you cook at home?
Mennel: Yes.
Roberts: Did your father cook when he came home?
Mennel: He was a very good cook, although my mom did most of the cooking. For me, cooking is a hobby. It relaxes me. Monday is my day off, and I usually cook the dinner that evening.
Roberts: What are your plans for the next 30 years?
Mennel: I will probably be in the ground for a few of those. I don't envision being fully retired as long as my head works pretty well, but I don't envision my practice being as busy as it is now. I enjoy the teaching part of medicine, and I really enjoy devising ways to use the computer in medicine. I hope to continue to pursue both of these interests.
Roberts: I could never be an oncologist. It would wear me down to see these extremely sick patients every day. You must be pretty beat by the time you get home.
Mennel: Yes and no. We can cure many patients of their disease. The patients who cannot be cured can still be helped a great deal. When a patient cannot be cured or made better, some physicians tend to give up. Patients can perceive that. A lot of these problems are horrible ones for families, as they have to deal with the idea of losing a loved one. There is satisfaction in helping the families through it, even though you don't cure the patient or make him or her better. You are right: oncology is not a field that you could practice solo. One would burn out very quickly. One needs breaks and partners.
Roberts: Bob, is there anything that you would like to discuss that we haven't touched on?
Mennel: I can't think of anything.
Roberts: Bob, thank you. You have poured out your soul, so to speak. I think the readers will enjoy getting to know you better.