Reunion, Regrets and Rebirth


Leonard Zwelling     

Great Hall at the new Semons Learning Center at Duke was packed. Grand Rounds
that morning, the start of Medical Alumni Weekend, was a special one. Dr. Ralph
Snyderman, Chancellor Emeritus of the Duke Health System was telling the story
of how Robert J. Lefkowitz, his closest friend, had risen from humble
beginnings in the Bronx to become the first Nobel Laureate in Duke’s illustrious
history. Four national championships in men’s basketball, but no Nobel
laureates until 2012. This was a really big deal.

         It was a big deal for me, too, for in the audience sat my

         My best friend for 42 years, Genie was by my side.

seats away was James B. Wyngaarden. Jim was my chief of medicine when I was a
Duke house officer and claims that it was my nomination that placed his name
successfully in the competition to be the NIH Director in the early 80s. He
became famous for discovering end-product feedback inhibition in
the purine biosynthesis pathway and was one of the fathers of the biochemical
approach to human disease. His research was the basis for the development of
allopurinol to treat gout. His textbook, The Metabolic Basis of Inherited
Disease, was a landmark work, compiling and explaining the biochemical nature
of genetic disorders.

not for Jim, there would have been no Research Training Program for Duke
medical students, no laboratory training for me, no chance to fight the Viet
Cong from Bethesda as a “yellow beret” instead of in the Mekong Delta, and no
career in molecular pharmacology.

         There also would have been no disappointment and regret at
not having been an “early intern” at Duke. This was a program to move students
directly from the third year of medical school to the first year of intense
clinical training. Jim felt I wasn’t ready after my third year. He was right. I
am not sure I was ready after my fourth either for the rigorous Duke internal
medicine training of the 1960s and 1970s, but I did it anyway. This was a time
when there were no limits to an intern’s hours other than the available 168 per

         Jim is 89 and not quite as cognitively sharp as he was when
he grilled me during morning report in 1973. 
Despite being aware of this, I leaned over and reintroduced myself for
we had only seen each other sporadically after I came to Houston. All I said
while shaking his hand was,

         “Thanks for everything”.

         Genie was the first medical student in Ralph Snyderman’s lab
after his return to Duke from five productive years at the NIH. Working in
Ralph’s lab she had won all of the research awards at her medical school
graduation. Without Ralph, Genie would not have known about a unusual researcher in Frederick named Josh Fidler that Ralph recommended she seek out
when she later went to work at the National Cancer Institute. Without Josh, no
MD Anderson. No MTP clinical trials. No survivors from osteosarcoma that Genie
treated in her trials who otherwise would have died. Even that was attached to
regrets for Josh and Genie had wanted to do the early clinical trials of MTP in
Bethesda, but the leadership there said no without Genie having to do another
fellowship. Houston was more fertile soil for ideas like the ones Genie and
Josh had.

more of our teachers and classmates were in the room listening to the saga of
how Lefkowitz, a brilliant only child of a doting immigrant father and a demanding,
but loving mother, became the first Nobel Prize winner in the history of Duke

         Snyderman is also a product of New York City (Brooklyn). He
too had risen from modest means to be the Chancellor of one of the most
productive university health care systems in the world after having been a vice
president at Genentech.


liberally among the attendees was person after person from all over the world
who had come to Duke to make their names and had done so to the credit of the
university, their families and themselves.

         But by far, the most unlikely attendee in my mind was me.
What the heck was I doing among this collection of medical standouts? My
thoughts went to three things, the words in the title of this piece.

was reuniting with the culture as well as my classmates that so formed my outlook on medicine and
learning. Yes, there had been some regrets along the way. There were big ones
(or they seemed big at the time) of not having been an early intern despite
that being the right decision by Dr. Wyngaarden. There were small ones, too,
like little examples of my uncivil behavior to my fellow classmates which they
had probably forgotten but which I had remembered even to this day. And then
there is rebirth.

rebirth is not a Duke specialty. Reinventing yourself at Duke once cubby holed
as a “clinical toad” or “research wonk” was not easy. But rebirth is an MD
Anderson specialty.

seriously doubt I could have had the roller coaster career swinging from
clinician, to investigator, to administrator to health policy maven anywhere
else but MD Anderson.

         During the Saturday lunch the next day at the home of a
classmate on the Duke faculty, the 13 members of my class who returned reminisced
about our time together, but mostly just looked at each other in disbelief that
we were still there and still ourselves. That evening when the photographer
came to our dinner for our class picture, we had to walk down a long hall to
get to the spot he had chosen for the group pose. I remarked how great it was
that we were all still able to walk to the spot.

sitting in my new office at Legacy or in the audience listening to a Nobel
laureate, I keep coming back not to the regrets, but to the amazing fortune I
have had to have this life in medicine. Without the strong ethic of service and
leadership drummed into me at Duke and brought into the present at the reunion,
I would never have survived my internship or the rigors of the NCI or MD
Anderson. I was reminded of the expectation set by our Duke Dean of Admissions
the late Syd Osterhout : “Duke doesn’t produce cookies. We produce cookie

just as important is the culture of MD Anderson that so tolerates unusual and
certainly not cookie-cutter personalities like the ones produced by Duke
Medical School (exhibit 1=me) and then allows them to reinvent themselves in
service of the greater good of MD Anderson.

final thought is that this characteristic of MD Anderson is worth fighting
for—don’t you think? The faculty controls its own destiny in this regard. The
MD Anderson of collegiality, clinical excellence one patient at a time, and
being the foremost destination for those most in need of specialized cancer
care, and not the site of high throughput, high volume, wholesale cancer care
is not dead unless the current faculty let it die. But about now, it could use
a little rebirth.

rather not look back from my next reunion in 5 years with regret because I
watched the faculty of MD Anderson not ignite the rebirth of the Once and
Future MD Anderson.

Leonard Zwelling