Abstract
The author reminisces about his training and career as a radiation oncologist.
My academic career had its roots in my residency. I had begun my residency at Stanford in what was then (1967) called general radiology, alternating every 6 months between diagnostic radiology and therapy for 2 years, before committing a final 2 years to one or the other. But after only 2 days of therapy training, I was hooked and requested not to rotate, but simply concentrate on the treatment side of radiology. When asked why, I simply responded that I didn't want to spend a month of my life doing nothing but barium enemas!
It's almost impossible to convey the thrill, excitement, and stimulation of oncology training at Stanford in the 1960s. Typically I would sing, whistle, or hum driving to work in anticipation of the wonders of the day. You learned a whole new way to think when you were around people such as Henry Kaplan, Saul Rosenberg, Mal Bagshaw, and the rest of a fabulous collection of junior faculty. You had to learn to think and reason logically if you were going to keep up with them. You needed data as evidence for your thinking but you also had to be able to interpret the data. Always, they treated residents with respect and never did they talk down to trainees or students.
Kaplan, in particular, was an astounding intellect. A large, imposing, restless man with an enormous grasp of science and a deep, resonating voice that he often cleared in an almost theatrical manner, he always saw the glass as half empty. He was arguably the best pure thinker in oncology, but also a man of enormous interests in literature, art, and music.
Rosenberg was no slouch as a thinker either. He was the quintessential physician by any and all parameters: compassionate, knowledgeable, and empathetic. He and Kaplan ran a joint lymphoma clinic that was generally staffed only by the senior residents from medical oncology and radiotherapy. Nonetheless, I worked voluntarily each week from my first year in the Monday afternoon clinic (which rarely finished before 6 p.m. and usually much later) because I wanted as much exposure to the two of them as I could get. And boy, it was worth it! Beginning from different positions they would usually come to the same conclusion on really difficult patients in follow-up. What was really impressive was the way each of them would reason the case. To me, it was all high drama and I loved it. Because I respected both of them so much, I never came away from this early experience in a conjoint clinic with any sense of an adversarial relationship between competing modalities but rather a true partnership, which I still treasure today. In those days in that conjoint clinic it would not have been unusual for the radiotherapy trainee to present a patient treated by radiation alone to Rosenberg, or the medical oncology trainee to present someone treated with chemotherapy alone to Kaplan. This crossfertilization only confirmed the true duality of this partnership. Moreover, although many people outside the department viewed me as “Little Henry,” I always thought of myself as more trying to emulate Saul than Henry.
There were other conjoint clinics at Stanford in the 1960s, which were less satisfying but still good. Bagshaw, in particular, was exceptional at teaching us about late morbidities of radiation treatment. As the Head of the Treatment Division, he had a policy of requiring his written permission if the attending radiation oncologist wanted to give a radiation fraction of more than 400 rad. To the best of my knowledge, he never gave it.
Following my residency, I spent 2 years at the newly formed Gray Laboratory in radiology at Northwood, a London suburb. During that time, I only carried out mouse experiments, under the tutelage of Jack Fowler and the late Julie Denekamp. I worked on quantifying the effects of single and multi-fractionated radiation therapy on the blood flow of normal kidney, liver, lung, skin, and muscle. Those were probably the happiest years of my career, although I didn't appreciate it at the time.
Following this, I returned as junior faculty at Stanford for 5 years before moving on to the National Cancer Institute for almost 15 years as the Chief of the Radiation Oncology Branch. These were probably the most productive years of my career. Certainly working with outstanding people such as Vince DeVita, Steve Rosenberg, Murray Brennan, Bob Young, Bruce Chabner, John Minna, Paul Bunn, Dan Ihde, and Marc Lippman (to name only a few) was very exciting and heady. During that time, I proved very successful at both recruiting and training truly excellent younger radiation oncologists, many of whom have gone on to become chairs of academic departments. These include such notables as Joel Tepper, Allen Lichter, Tim Kinsella, Jim Schwade, Ted Lawrence, Drew Turrisi, Gillies McKenna, Steve Hahn, and Dino Stea, again to name only some. The turnout of such high-quality leaders of radiation oncology has probably been my major accomplishment. During this same period, I was able to recruit Jim Mitchell to head our lab program. He remains a superb scientist as well as a close personal friend to this day.
For the past several years my passion has largely been photodynamic therapy for a variety of problems, but especially treatment of serosal surface carcinomatosis. There remains a lot of work to do yet, but I am optimistic that we will be able eventually to take this treatment to a curative level in the treatment of pleural and peritoneal carcinomatosis, which remains palliative at this time.
It has been my very good fortune to have worked with a very large number of truly outstanding people, only some of whom I've named specifically in this communication. It remains my very strong belief that, if you are recruiting for a position (any position), you need to recruit the very highest quality person that you can possibly get. You need also to understand that such high-quality people will virtually always receive other opportunities and they must be free to make choices that they believe to be in their own best self-interest, even if you believe it's a mistake. Everyone makes mistakes, on occasion. Just ask me!