Oncology, Etc. - Introducing Oncology, Etc.: Friendship, and the Majesty of our Profession

Oncology, Etc. is a monthly ASCO Education podcast exploring topics in oncology through interviews with emerging thought leaders, physicians, and innovators. In this episode, hosts Dr. Patrick Loehrer (Indiana University), Dr. Jamie Von Roenn (ASCO), and Dr. David Johnson (University of Texas) discuss the importance and impact that friendship has made on their careers.

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Air Date: 8/3/2021

 

TRANSCRIPT

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SPEAKER: The purpose of this podcast is to educate and inform. This is not a substitute for medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

PATRICK LOEHRER: Hi, I'm Pat Loehrer. I was born in Chicago, moved to Indianapolis when I was in high school, went to Purdue University, went to Rush Medical College, came here to Indiana University. And I've been on faculty ever since. I'm now a distinguished professor and the former head of our Cancer Center and Director of our Centers for Global Oncology.

JAMIE VON ROENN: So hi, I'm Jamie Von Roenn. I'm a medical oncologist and trained at Rush with Pat and subsequently stayed in Chicago at Northwestern and came here to ASCO as the VP of Education about eight years ago.

DAVID JOHNSON: Hi, I'm Dave Johnson. And I'm in Dallas, Texas. I'm a medical oncologist originally from Georgia, spent a large part of my career on the East Coast and in Tennessee before relocating to Dallas to become Chairman of Medicine in 2010. I stepped down from that position last year and now serve as an elder statesman [INAUDIBLE].

So we are excited to be here today for a new endeavor sponsored by ASCO, a podcast entitled Oncology, et cetera and with a heavy emphasis on the et cetera. We are here to talk with thought leaders, physicians, authors, innovators in oncology and beyond. To be honest with you, we have a lot of interests.

And so I'm going to turn to Jamie and ask Jamie, why are we doing this? Jamie is the instigator behind this. So Jamie, why are we doing this podcast?

JAMIE VON ROENN: So I think the primary reason we did this is to remind people why they chose oncology, that all three of us are people who are super excited about this profession, about what we've learned and what we've given and how we've shared it with each other and with the profession in general, that it's the science. It's the relationships. It's change. And it's incredibly fulfilling on all of those levels.

DAVID JOHNSON: Yeah, Pat, what are your thoughts?

PATRICK LOEHRER: When Jamie asked us to do this, this was something that we jump at. I love Jamie dearly. Dave and I both share this mutual admiration society. I deeply admire Jamie. And, to do something with Dave who is one of my closest professional friends, this was just a great opportunity.

We thought in our conversations, though, as we talked with other people, that it would be good just to talk among ourselves and particularly about the notion of friendship and what it means to each of us personally with the idea that maybe those listening might reflect on that in their own lives.

DAVID JOHNSON: Yeah, so you mentioned-- you made a distinction there, Pat. I'd like to know what that distinction represents. You said you had your personal friendships and your professional friendships. How do those differ?

PATRICK LOEHRER: Well, you know, I'm not sure how it is for you, but my wife is outside of medicine. I've known her. I had my first date with her 50 years ago. And I have friends that I really don't like to talk about business with. I just talk about other things, our kids, family, whatever.

Our friends in medicine are a little different. We have deeper conversations about our work. And there are certain aspects of our work that I think touch us personally. We have patients that we've become close to that are rough. And, many times, I don't share those interactions with my friends at home because it's just not important to them. So I treasure especially you guys, I treasure deeply. We've shared a lot over the years.

JAMIE VON ROENN: So it seems to me that friendships in general are built on shared experiences and that the experiences in medicine are so different from anything else. And, if you don't have friends in your profession, you may not actually have the opportunity to share and sort of have a sounding board for how difficult things are sometimes in spite of how inspiring it is.

DAVID JOHNSON: Yeah, I think I like your distinction. Both of you pointed out the shared experience. The world of an oncologist, viewed from the outside, may appear to be a rather morbid specialty, but, in fact, it's one that I personally find incredibly rewarding. But there are those moments that are challenging and difficult-- patient encounters, professional setbacks, et cetera. And it's nice to have someone within the profession itself that can relate to those experiences, especially failure. I know, Pat, you've had lots of failures.

[LAUGHTER]

JAMIE VON ROENN: I think we all have.

PATRICK LOEHRER: Thank you. Just as a background, there have been, in this group, five runs for ASCO presidency. And only one of them has been successful. So yeah, we know failure, Dave.

JAMIE VON ROENN: But I think it's important because no one is successful all the time. And it's your friends who actually get you through that and let you see, OK, yeah, I'm still OK.

And I think it's the other side of that too. Everyone who's honest has suffered from the imposter syndrome. And it's your friends you can openly share that with. And it helps you go the next step when you're struggling.

DAVID JOHNSON: So you mentioned that the two of you met during your residency training. What prompted that friendship then? And how has it been sustained over the last many years? I won't say the number of years, but a lot of years.

JAMIE VON ROENN: So we actually met when I was a medical student, and Pat was my intern who I worked with. And then, when I was an intern, Pat was the resident.

DAVID JOHNSON: So that accounts for all your problems in the medical field?

JAMIE VON ROENN: It accounts for how well trained I am.

DAVID JOHNSON: I see.

JAMIE VON ROENN: But I think it was the sense of joy in the profession that probably connected us and a love of people. I don't know. Pat, what would you say?

PATRICK LOEHRER: Well, it was a special time back then in medicine. Our particular hospital was a resident-run hospital. I think we acted first and then asked permission from the attendings later on. And it was really very special. There's a lot of people from Rush who have gone into oncology in many different areas. And so it was very special.

Jamie I knew. We really did not keep in touch until she gave a plenary paper at ASCO. And I remember writing her a note. And I was so proud to see her up there. And I wrote that in a note. And we started, basically, communicating and getting together regularly. And so, each year at ASCO, as you know, we get together, the three of us, collectively or individually, and have a dinner. It's really the highlight of the meetings for me.

DAVID JOHNSON: Yeah, I mean, I had the good fortune of Pat and I coming together, I think, shortly after I completed my fellowship. And Pat and I were both starting our academic careers, he at IU and I at Vanderbilt at the time. And we interacted through one of the major NCI cooperative groups that, unfortunately, no longer exists. It may have been due to our work, Pat, that caused the Southeast group to divide.

But it was through Pat that I met Jamie. And so that's been really one of the most rewarding relationships that I've had professionally over the last, now more than 40 years. I mean, it's been a long time really.

PATRICK LOEHRER: And we were on the ABIM together, the three of us, which was a riot. It's another one that seems like a thankless position, but we realized how hard it is to write very good questions. And we would spend a lot of time together doing this. I learned tremendously from the two of you and the others around the ABIM.

JAMIE VON ROENN: Yeah, that was a remarkable experience for us because it's a small group of people putting their ego outside the door and working together.

DAVID JOHNSON: And the challenge of maintaining one's knowledge base, I mean, honestly, I hadn't thought that much about it until I was invited to join the ABIM. And thank you, Pat, for making that possible. I consider it one of the highlights of my professional career is being a part of that. And I realize how controversial the work that ABIM is doing today, but, still, I think it was a wonderful experience.

JAMIE VON ROENN: We've been pretty lucky to share multiple professional activities. I mean, when you were president, Dave, I was on the board. We shared ABIM. We shared some ECOG work way back. It's been a lovely crossing of paths beyond friendship .

DAVID JOHNSON: Yeah, I mean, I think one piece of advice that I give to residents, and especially those who are interested in heme-onc fellowship, is find a friend. It's really important that you do so. I was fortunate to have the two of you and some other friends during the course of my career. And I must say, turning to a friend for advice, for assistance, for mentorship-- I can't remember who said it first. Having a friendtor is really, really important in the course of one's professional development.

JAMIE VON ROENN: It's an important message because it takes time. When people are in training, they often think they don't have time, but this is a value on every level. It's more than worth the time.

PATRICK LOEHRER: I just want to jump on that friendtor. We all have had people that we work closely with. In Indiana, it's been Larry Einhorn who was a role model for me when I was a medical student and then became a mentor when I was a fellow at a junior faculty. And he is, again, one of my closest friends. And he is one that gives me advice, but also just listens.

And, similarly, he'll come in and ask me advice, which was mind boggling that someone of his stature would lean on us. But I was trying-- I was just going to put a caveat or a corollary to your statement about finding a friend. Dave, what I tell people, I think it's more important to be a friend than to have them.

I think, if you get into the habit of helping other people and being a friend, you'll collect people close to you down the road, but, boy, it's not a one-way street. It really has to be the best friendships in which you give and you also happen to receive, but it's really a nurturing process. It just doesn't happen by chance. It happens because the people make an effort in it.

JAMIE VON ROENN: Absolutely.

DAVID JOHNSON: So what do you look for in establishing those friendships, Pat? What attracts you to an individual to even consider establishing a friendship?

PATRICK LOEHRER: Well, I like to have friends who are dumber and uglier than I am. And that's why I really migrated to you. I mean, I think, when I looked around the room, I said, this guy could be my friend.

DAVID JOHNSON: It's amazing. I saw myself in the mirror when I saw you.

JAMIE VON ROENN: So I'm going to take that more seriously and say I think what we have done with each other is looked for people with values that connect and that, in the end, whatever those values are, that's what makes the friendship last.

PATRICK LOEHRER: Well, it's interesting. As we talk about, in academics, one might think that you become friends with people in your own disciplines, but Jamie was a age researcher in palliative care. Dave, you were a thoracic oncologist. And I was a GI. And the loneliest friendship would be with thymoma people.

But none of us really merged together because of our own professional disciplines. It really was something else. I think there was a higher power that pulled us together.

DAVID JOHNSON: Oh, I think Jamie touched on it. I mean, it's the values that we share, I think. And I'll go back to something we talked about earlier, which is our shared love of the profession itself.

I think I was 10 years old when I first seriously thought about being a physician. You may argue that a 10-year-old can't think seriously about anything, but, throughout my youth, all the way through college and, ultimately, medical school, medicine was my goal. And I've never regretted making that decision.

I know there's a lot of unhappiness in the medical profession in this day and age and a lot of talk about burnout. One recent study actually even suggested that over half of all physicians would not recommend medicine to their children as a profession. I find that disheartening. I'd be delighted if my child were to choose such a profession. She didn't, but I would have been delighted had she done so. And I know, Pat, you have children who have pursued medicine as a career.

PATRICK LOEHRER: Yeah, I was-- actually, at my son's graduation, I was up in the balcony away from everyone else taking photos, but I did find myself with a tear coming down my eye watching him just because it was an affirmation that my life was something that didn't steer him away from medicine. I think he did find, in my life, the joy that you can find in this profession.

I want to change this a little bit to you guys, Dave, because you talked about the profession. And, several years ago, well, you both have had some really tough episodes in your life, but, Dave, you came down with lymphoma many years ago. And I do remember an ASCO presentation that I think Jamie helped put together in which there were several of you. I think Nick Vogelzang and Sandra Horning were up there. And you shared your experience of having cancer and shared some of the stories, I think, of friendship.

But I do remember the phrase that you used at the end of the talk about how you had a deeper appreciation about the majesty of our profession. That's always touched me, but can you reflect a little bit about your illness and having lymphoma as a cancer doctor and what you learned in terms of this topic of friendship?

DAVID JOHNSON: Well, we, as oncologists, think we know what it's like to have a serious illness. And I certainly was no different than most oncologists. But, when I myself was diagnosed with a malignancy, I must say, I had many of the emotions that I've witnessed in my patients.

And, also, suddenly, my brain went completely blank. I couldn't think about what it was that needed to be done. And I, like most patients, began searching for the perfect answer. How would I deal with this?

But I was also curious because, a few years prior to my own diagnosis, another faculty member at the institution where I was at the time had been diagnosed with ALS. And he wrote a very personal and moving piece that was published in The New England Journal about his experiences at that institution and how he was treated by his fellow physicians.

And, actually, what he had to say was not all that complimentary in some instances. And I wondered myself how I would be dealt with by my fellow physicians. And I must say, my experience was virtually the polar opposite. I was surprised, honestly, at how heartfelt the good wishes were, the way that my colleagues went out of their way to try to make sure that I was successfully treated, was dealt with appropriately, even colleagues at my institution that I had not known that well finding excuses and reasons to drop by the office that seemed manufactured, quite frankly, but were clearly, again, intended to lift my spirits and make me feel positive about my future.

It really made me realize just what a special profession we're in and then, to have friends that I could turn to, such as you and others, who really did a lot to lift my spirits. So, when you see that, you can't help but be really moved by the men and women who come into this profession and particularly those who choose oncologist as a specialty.

PATRICK LOEHRER: I had a colleague who succumbed to glioblastoma. And he was-- when he was first diagnosed, he told me there were three kinds of friends, he realized. There were the long-lasting friends that he's always had.

There were people who he thought were friends who kind of just faded away, mainly because they didn't know what to say. And then the third group were these unexpected friends, people that he didn't really know that very well, but came into his life and really made a difference. It was very insightful.

DAVID JOHNSON: Yeah, I mean, that's exactly the experience I had as well. And the group that unexpected was perhaps the most surprising to me, but really I came to appreciate greatly.

PATRICK LOEHRER: Many years ago, when we were doing the board questions, Jamie was not able to come because her husband Kelvin had been diagnosed and then, shortly thereafter, passed away from cancer. I knew him when I was a resident. He was a feared neurosurgeon. He made Ben Casey look like Dr. [INAUDIBLE]

He was an incredibly intense, wonderful man, but I've not talked much deeply about that. And, with some reluctance, Jamie, I don't know if you want to share a little bit about how you felt as a palliative care doctor, and then here's your husband who's dying of cancer.

JAMIE VON ROENN: Sure. And it kind of echoes what both of you have said. Here I was, a palliative care doc. And I thought I understood what death and dying was about. And, after Kelvin died, I was blown away. And I recognized, I said the right things, but I never really understood them. And it changed the way I talked to patients forever.

And I too had the same experience of friends who are new, old, and otherwise, those that disappeared because they were too uncomfortable. And I was shocked that there were partners, oncologists, who could never ever say anything to me because they were too uncomfortable talking about death. And here it was something they were supposed to be trained to deal with.

And, in fact, I remember, many times, Pat, you calling and checking in on me. And I remember in particular one day when I was down, and you said, wow, you are in a dark hole. And I was. And it took a long time, but it's friends that get you through and the ability to talk about what nobody wants to hear that helps you recover ultimately and move on. And those are life friends, but there's something different about people like the two of you who understand these experiences from a different perspective.

DAVID JOHNSON: Yeah, I mean, I think these shared experiences, they're not shared in the sense that we experienced it personally, but the fact that we were able to relate to one another and share those very personal moments only fortifies and solidifies an existing friendship. And there are a lot of people I would not have that discussion with, but there are a few. And you are certainly among those two that I would.

PATRICK LOEHRER: Well, I mean, you guys mean a lot. And I know-- I'm trying to think of the time. Back when I was thinking about becoming a heme-onc division chief. I gave Dave a call. Dave was head of heme-onc at Vanderbilt, I think, for 68 years or something. I can't remember. You were there for a long time.

And I called him up. And I thought for sure there would be this, yeah, Pat, you'd be great. You'd be a wonderful division chief, but there was just this silence. It was like, I don't know, about 90 seconds of just pure silence. And then you said, yeah, it's mostly a good job. Then you reflected a little bit about this. And, in terms of this rejection, I think the other thing you taught me is it's OK not to be the first choice. But I can't remember. What choice were you for the division chief?

DAVID JOHNSON: 11.

PATRICK LOEHRER: 11. Yeah, I love that. I love that.

DAVID JOHNSON: That's true. I mean, they interviewed 10 people before I was offered the job. So I knew I was in the top of all candidates.

PATRICK LOEHRER: Top hundred, huh? This is like Rock and Roll Hall of Fame [INAUDIBLE].

DAVID JOHNSON: They ran out of candidates.

PATRICK LOEHRER: Well, you know, that part, I've got to be honest with you. The stories with you guys have helped me out quite a bit because junior people would look up and say, oh, look at these guys. Aren't they successful? But they don't realize that we have stumbled and failed over the years in many things. And the best thing you can do is just laugh about it when you try.

But, going back to the notion of friendship, there is no greater joy than I have is to see you guys, who are my friends, succeed. And a definition, I think, of a friend, at least a minor definition, is, when someone gets an award, that you find greater joy in them getting the award than you would if you got it yourself. If you find yourself kind of jealous and wondering, well, I wish I had that, probably, it wasn't your friend then. But I've gotten so much joy in watching you guys succeed.

JAMIE VON ROENN: So I think there's a corollary to being a good mentor, which is, when your mentees surpass you, then you were successful. And it's the same with friendship.

PATRICK LOEHRER: I'm one of the most successful people in the world then.

DAVID JOHNSON: I was getting ready to say, I think we've all succeeded wildly then.

[LAUGHTER]

JAMIE VON ROENN: But that is the goal. I mean, what's the point of being able to help people if you don't make them the next set of stars?

DAVID JOHNSON: We've been lucky to have a lot of really terrific men and women who we've been able to work with over the years and call them mentees, but, in reality, we've been their mentees. They've been the ones that have taught us so much. I'm very proud of all of them.

JAMIE VON ROENN: Yeah, I think that is something to be proud of. And, when I look back, it's those things that make me most excited about what I've accomplished.

PATRICK LOEHRER: Well, I think, every good relationship, you really get more out of it than you get into it. Even as we have our heart to hearts with our patients and having end of life discussions, I usually get so much out of that in a reflection of their own personal love for each other and their family and what they treasure in life. But, again, with you guys, unabashedly, I'll say this in public. I love you deeply. And I appreciate your friends.

CS Lewis had a book called The Four Loves in which the most unnatural of the four loves was friendship, but it's what he actually thought was probably the most important one because it's so unique. And it's not expected, but you guys, I think, are an important part of my life. And I thank you for that.

JAMIE VON ROENN: I love you both and feel the same. It's the luckiest thing there is.

DAVID JOHNSON: Yeah, absolutely, absolutely. Thank you so much for that. Well, I think our time is about up for today. I want to thank all the listeners. I'm sure there's tens of thousands listening to this. Well, I just called Pat's friends and told them listen.

So we plan to do this monthly. We already have a scheduled guest for our next podcast. It'll be Dr. Otis Brawley who I think many of you know by reputation, one of the leading luminaries in oncology in the United States. He's now at Johns Hopkins.

I think it'll be a really enlightening and fun conversation to hear what Otis has to say about the current state of oncology in this country. So, with that, we'll sign off until next month. Thanks, everybody.

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