September-October 2012, Volume 9, Issue 5
Westward Ho! From the South Bronx to Palo Alto
Published on: September 01, 2012
Professor of Medicine (Hematology) Active Emeritus, Stanford University School of Medicine
My story begins in a tiny, three-room apartment in New York’s infamous South Bronx. As a six-year-old child with recurrent fever and constant sore throats, I can recall regular visits to the home of my immigrant parents from a short, well-dressed doctor. Though he could not do much, I always felt better afterward, and I wanted to be like him.
In school, I loved biology, and I enjoyed reading dramatized medical science like Paul De Kruif’s Microbe Hunters and technical books on forensic pathology. At 10, I tried On the Origin of Species, but I found it difficult to get through. My mother, understanding my love of science, encouraged me to go to Bronx High School of Science; I was admitted in 1943. I continued my education at New York University, but having spent a summer with relatives in Denver, I fell in love with the West where I could fish, hunt, and hike in the Rockies. I transferred to the University of Colorado in Boulder before my junior year. I graduated in 1949, but despite good grades and test scores, I was hindered by the 10 percent Jewish quota (or maximum) and denied admission into medical school.
Attempting to find an alternative plan, I took an environmental science job with the U.S. Public Health Service (USPHS) and met a charismatic cardiologist, Dr. Allan Riemer, who encouraged me and helped me apply to his alma mater, Johns Hopkins University School of Medicine. I was accepted into the freshman class of 1950. Cash-strapped, I traveled three days by bus from Denver to Baltimore and was grateful to receive a scholarship for $500, which was a significant amount of money at that time. On arrival, I learned that each Hopkins class of 70 students had exactly seven Jewish students and four women, a remarkable coincidence. Still, my medical education at Hopkins was everything I had hoped for.
So why did I choose hematology? A highlight of the Hopkins week was the Clinical Pathologic Conference where Dr. Rich, professor of pathology, assumed he had the final word until he clashed with Chief Hematologist Dr. C. Lockard Conley. They both used morphology, but Dr. Conley gave me a great role model when he added kinetics and biochemistry to analyze a case. I became an intern at the Osler Center for Clinical Excellence where the prevailing rule was “no assigned time on,” which was a subterfuge to mean no assigned time off. About halfway through a grueling year, I had an epiphany, realizing that I could see my way through clinical complexity and critically analyze what was happening to my patients.
Later on, as a medical resident in Ann Arbor, about to be drafted into the Army Medical Corps, I received an unanticipated phone call from Dr. Alf S. Alving, professor of nephrology at the University of Chicago, asking if I would rather serve my military time as a member of the Commissioned Corp of the USPHS stationed at the maximum security Stateville Penitentiary in Joliet, IL. In the summer of 1956, I moved with my wife Peggy and our daughter and went to work at the jail. As a senior assistant surgeon, (LtSG), I had two major projects. For the first, I became a malariologist, learned how to do randomized clinical trials, and became the primary care physician for our inmate volunteers. The malaria project involved testing the hypothesis that primaquine was an effective prophylaxis against malaria and that the drug could cure Korean vivax malaria. The hypothesis was challenged by giving primaquine to American soldiers returning by sea from Korea during the 30-day voyage home.
My second project at Stateville changed my professional life. Just before I arrived, the group lead by Paul Carson discovered the red blood cell abnormality that led primaquine to induce a hemolytic anemia in the 10 percent of African Americans who had hereditary deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD). This observation sparked my imagination, and I found that I loved the study of red cell metabolism, a love that is undiminished after more than 50 years. As a side benefit of my USPHS experience, I spent one day a week at the University of Chicago working in the hematology outpatient department with Chief Hematologist Dr. Leon Jacobson. “Jake” was one of the major figures in hematology. He pioneered the use of radio-isotopes, was the first to use nitrogen mustard in the treatment of Hodgkin lymphoma, and initiated a search for erythropoietin. For two years, I had a weekly hematology tutorial from Jake, and in later years I was pleased to be counted as one of “Jake’s boys.”
Having finished my training in Chicago, I followed my wife’s advice and visited the San Francisco Bay area before choosing a place to settle with our now two daughters. Upon arrival, I met with Dr. William Creger, chief hematologist at Stanford University School of Medicine. Unexpectedly, the informational interview turned into a job offer. At that time, Stanford’s medical school was upgrading from a small San Francisco outpost to a new home on Stanford’s main campus. With outstanding science facilities, new faculty, including
Nobel laureates, and an expanded group of new-hire assistant professors, it was a time of excitement and creativity. I chaired the Stanford Hematology Division for almost 27 years.
When I started, I had teaching assignments, which at first did not come naturally to me. I tracked three excellent teachers, saw how they each differently identified what the students needed to understand, and from there developed my own style. I learned quickly that mentoring is a satisfying form of education but differs in that it requires a more personal relationship.
I won most of the major teaching awards at Stanford and put my experience to use when I chaired the ASH Educational Affairs Committee and also when I became the first hematologist editor-in-chief at UpToDate.
My research interests in red cell biology led me to a 20-plus-year effort to understand the pathophysiology of the thalassemias; that, in turn, led to projects in Israel, Italy, and Thailand, where there is a high rate of thalassemia and where I found expert, enthusiastic collaborators. Perhaps because of the experience of working at these sites, I am involved in ASH’s outreach programs such as the ASH-sponsored International Consortium on Acute Promyelocytic Leukemia (IC-APL), now the International Consortium on Acute Leukemia (ICAL), and in the Health Volunteers Overseas (HVO) programs in Uganda, Peru, and Cambodia. ASH has been a very important part of my professional life for many years. In every substantive issue in which I was directly involved, ASH was always on the side of the angels.
I am sometimes asked what in my career gives me the most pleasure. It is evaluating a complex patient illness, with a fellow, and together coming up with a formulation that improves the patient’s quality of life. That’s what that six-year-old kid growing up in the South Bronx wanted. An unexpected joy is to see the enthusiastic new and diverse medical residents and to realize that the quotas that were once my roadblock have vanished. I am now 83 years old and classified by Stanford as Active Emeritus. I currently have research grants on anemia of the elderly and amyloidosis, two weekly teaching sessions with medical students and house staff, and a burgeoning practice in consultative hematology.
I am grateful for my supportive family, wife Barbara, my blended family of five children, their mates, five grandchildren, friends, students, and great colleagues.
Thoughts From a Former Protégé
Jason Gotlib, MD, MS
Associate Professor of Medicine (Hematology); Director, Hematology Fellowship Training Program, Stanford Cancer Institute/Stanford University School of Medicine
Since his arrival at Stanford in 1959, and during his 27 years as chief of the division of hematology (1968-1995), Stan mentored two generations of hematologists in his triple role of physician, educator, and scientist – the latter focused on the pathophysiology of the thalassemias. I met Stan while he was attending on the inpatient hematology service in 1994; I was a green medical student on the first year of clinical rotations. My experience then, which remains true today, is that Stan’s starting assumption is that everyone should be captivated by hematology. He believes that the romance between hematology and the doctor-in-training should be love at first sight. If Stan senses that his audience is not immediately enamored with hematology, he will work hard to nurture this bond, and if medical students or residents don’t choose hematology for subspecialty training, they will have at least learned a great deal along the way. Stan knows that short of a love affair, a friend of hematology is still a relationship worth cultivating.
At age 83, Stan maintains a busy weekly clinic and an unflinching presence at all of our educational conferences, including his lead of microscope rounds. When I arrive at these venues, it is a warm and comfortable feeling to see Stan waiting for us to start. The quality and durability of his tenure at Stanford wills us to remember the historical roots of the division and to preserve his commitment to teaching and scholarship. His clinical acumen is of immeasurable value to our trainees – and yes, to faculty members as well – who still may lack Stan’s vast arc of experience. At the conclusion of such conferences, Stan often verbalizes that it was a “fascinating conference,” “great cases,” or “I didn’t know that.” He’s a master teacher who always savors an opportunity to learn.
Stan relayed to me a story about how he matriculated in a class titled “Speech” while attending college in New York. Although he expected it would be a boring waste of time, he remembers it today as a seminal experience. The teacher took Stan and his classmates on trips to Union City’s Hudson Theatre in New Jersey. This inspired curriculum introduced Stan to burlesque-era comedians, dancers, and other stage performers. The experience taught him how to gauge the temperament of the audience and to appreciate how the animated performance of the artist could help relay the essential meaning of a subject. Stan has adopted this dynamic teaching style, punctuated with his unique sarcasm. This method accentuates his core teaching objectives and would never be mistaken for style over substance. Stan will question trainees as part of this banter; in this regard, his exchanges should not be considered light fare. Stan’s legendary educator status has been recognized by many accolades, including the highest teaching awards bestowed by the Stanford University School of Medicine (Albion Walter Hewlett Award) and the entire Stanford University (Walter J. Gores Award). We remember Stan’s lectures in the same manner that he fondly recalls those tantalizing performances at the Hudson Theatre decades ago.
At the bedside, Stan is similarly legendary for his modeling of patient interactions. Stan does a lot of handholding and reminds us that it is okay to shed a tear with the patient as long as it does not interfere with care. When he holds a conversation at the bedside, he prefers to sit rather than stand. Stan recognizes that some patients may view a standing doctor as a fleeing doctor with one foot out the door, who is more concerned about the pace rather than the content of dialogue.
Oft referred to as a “hematologist’s hematologist,” Stan has left countless legacies. For me, Stan’s legacy began on that rotation in 1994 when I became an adherent to his “cult of hematology.” It is a secular form of worship borne from a passion for hematology, intense intellectual curiosity, and advocacy for each year’s trainees in order to maximize their potential as tomorrow’s academic stars. I faithfully try to execute this mandate as director of the University’s Fellowship Training Program, while continuing Stanford’s special interest in ASH that Stan has fostered over the years as an ambassador for the Society (e.g., as president in 2004 and through continued involvement with Health Volunteers Overseas). While Stan has offered many aphorisms over the years to guide success in academic life, as well as his avocation of winemaking, perhaps one of the more introspective moments of wisdom came when he stated the following: “There used to be a time when it was about being right, but I quickly learned it was about getting it right.”
No worries Stan; you got it right.
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