The Lost Narrative of MD
Anderson: What Ever Happened to “We”?


Leonard Zwelling

         There were many things about MD Anderson that startled us
when we got here. Houston was an open, friendly place that was the antithesis
of the cold, impersonal Washington, DC we had just left.

         At MD Anderson, people went out their way to help you and
include you. You were immediately part of the family. You were invited to
things rather than being left out as we were in DC. People actually seemed to
care about you for if you succeeded, MD Anderson succeeded and that was the
goal that was made clear all the way from the executive suite and from Dr.
LeMaistre himself. Mickey was one of the most unique leaders I had ever
encountered in that way. He seemed to intrinsically know how to act, what to
say, how to make you feel as if you were the only one in the room, and how to
conduct himself so that he would represent all of us in the best way possible
no matter what the event. And make no mistake about it, he worked at it and was
incredibly conscious of his job and his role and his responsibility to all of
us and to the patients. He wore the crown lightly, but it was a heavy crown. He
wore it for all of us. He wore it for WE.

         During the first decade of our tenures at Anderson, if there
was one word that characterized the story of MD Anderson, what could be called
its narrative, that word was WE. I had no idea how important that narrative was
until it was no more.

         On Sunday evening, we heard the great Israeli journalist Ari
Shavit speak at the closing night of the JCC Book Fair. He discusses in his
must-read book, My Promised Land: The Triumph and Tragedy of Israel, the
narrative of the early days of Israel in the 1950s and how it was lost. It too
was a narrative of we. Israel is struggling now because it is no longer a we.
It is many factions vying for control of land, resources and the hearts and
minds of Jews and Arabs alike. But Israel is a geopolitical artificiality
established in what was the British Mandate of Palestine along with a host of
other made-up countries. Israel then took it upon itself to show the world it
had become a real country, establish new borders in 1967, almost losing them in
1973 and since then continuously trying to find itself in what Shavit calls “a
really bad neighborhood.”

         MD Anderson is not in a really bad neighborhood. It’s in the
Texas Medical Center. It, unlike Israel, is not surrounded by hostile neighbors
(no they really aren’t) wanting to kill everyone in it. On the contrary, most
people in Texas want MD Anderson to succeed and are deeply troubled by the
seemingly non-stop headlines emanating from the cancer center that have nothing
to do with curing cancer or even making it history.

         What happened to the narrative of WE at MD Anderson?

         Once the leadership of Anderson began to create WE vs. THEY
within the walls of Anderson, THEY triumphed and WE disappeared. The grasping
for personal riches, the conflicts of interest, the association with felons,
the influx of true carpetbaggers, the nepotism, the self-dealing and the
incredible meanness have perverted what little WE was left and turned what was
once a truly unique house of WE into the Jungle of Me.

         Can we refind our narrative of WE?

         Of course we can because the people left from the WE Generation
still want to leave the WE narrative to the younger faculty. How can that

         I am afraid the current leadership must be seriously coached
or replaced for these people represent the worst of what happened to a great

         The monetary scorekeeping among departments must stop. MD
Anderson is one pot of money. Let’s not delude ourselves into thinking anyone
on this faculty ever needed to be driven to perform by financial incentives,
particularly in the clinical arena. That’s just horse hockey. Patients come
first, last and always. This is still true even despite the leadership making
this behavior as hard to adhere to as possible (and just wait for EPIC if you
think your life is hard now).

         Major investment in infrastructure is needed and I don’t
mean more buildings or vice presidents. I mean a good hard look at how work
gets done and how the systems and people that support the faculty are not
getting it done for them but instead are getting more hours extracted from
them. Here’s a bulletin HR. You work for the faculty not the other way around.
Ditto lawyers, clerks, IS and forgive me all, nurses. For goodness sakes it’s a
hospital with clinics that doctors ought to be running not MBAs and I am both
so know the difference.

         Finally, let’s lift the salary on grants nonsense and get
back to where each individual was valued (and paid for) and nurtured and where
the career of the one was subjugated to the betterment of the many. MD Anderson
was almost socialist in that thinking when we arrived. How novel would it be to
return to our past? Individual achievement is a great thing, but it is not the only
mark of a great institution.

the reason MD Anderson had no members of the National Academy of Sciences on
the faculty was not because the science wasn’t good enough but because we were
too busy being a WE to worry about an I. I know, I know, there’s no I in team,
but there’s a ME in there if you juggle the letters. Let’s stop juggling. I am
fine with studying sea urchins to understand the basics of biology that may
translate into new understandings of cancer. I am not ok with believing that
sea urchins define MD Anderson. Clinical care and clinical research do and at
least for now, that’s not as scientific as we like to believe it will be
someday, but is more about those core values especially caring and integrity. Caring
and integrity are at everyone’s fingertips always. Discovery takes a little
work and a lot of luck.

         The narrative of WE vs. THEY has really become the narrative
of ME. This is a choice and we have had the wrong one made for us for over 15
years. Let’s go back to the future and give what worked for 40 years a try again
when we all got up in the morning to fight cancer without flagellating
ourselves for not having made it history by 5 PM. 

Leonard Zwelling