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Why They Do What They Do

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How do people make the decision to become physicians or nurses?

And once they make that leap, how and why do they choose to specialize in the care of patients with cancer?

These questions were posed to three of the U-M Cancer Center’s newest faces – two physician-scientists and one nurse – as they cared for patients, discussed research projects and met with the senior faculty members who serve as their mentors.

From brief moments spent with these professionals, it may not be possible to draw sweeping conclusions about why people choose careers in cancer care. But it is clear that although their minds may have drawn them here, their hearts keep them here.What’s also obvious is that this is a road one doesn’t travel alone. Mentors are needed to inspire and push every step of the way, turning promising students into great doctors and nurses. Without them, it would be hard to imagine anyone taking the first step, let alone staying on course for the entire journey.

Dr. Hayes (left) and
Dr. Hayes (left) and
Dr. Smearage

Jeffrey Smerage, M.D., Ph.D.
Clinical Assistant Professor, Department of Internal Medicine

Daniel Hayes, M.D.,
Professor, Department of Internal Medicine

Clinical Director, Breast Oncology Program
U-M Comprehensive Cancer Center

Watching Drs. Hayes and Smerage review patient notes late one Friday afternoon, one can’t help but be caught up in their exchange, even if they seem to be speaking a foreign language. Clearly, they’re well-practiced at making the most of short conversations, and neither are startled by the frequent beeps of their pagers.

Smerage is the newest faculty member to join the U-M Breast Oncology Program.“I guess medicine was just a natural for me,” he says.“I’ve always loved working with people, and I’ve always loved science. Being a doctor is the best place to bring those two together.” But things could have gone in a much different, but equally demanding direction. Smerage pursued a dual undergraduate degree – pre-med and violin performance. Although he still plays alongside his seven-year-old son, in the end, medicine won out.

Specializing in oncology also proved a natural choice.“For me, the really interesting questions in biochemistry and molecular genetics seemed to relate to cancer – gene expression, how proteins interact in the cell – so my curiosity naturally led me in that direction.” But focusing that interest on breast cancer treatment and research was the result of meeting his current mentor, Dan Hayes.

Medical mentoring, it turns out, is something of a chain reaction. Now devoting time to mentoring Smerage and others in the clinic and the lab, Hayes’ own career in oncology might never have happened without the influence of strong mentors. “I really disliked my early cancer studies in medical school, and even asked to be moved to a different area during an oncology rotation in medical school – and med students really don’t get to pick and choose, you know! But fortunately, no one listened to me, and I was assigned to work with a young physician named Larry Einhorn. He was conducting an early trial using a drug called cisplatin to treat men with testicular cancer, which at the time was a deadly disease. He was seeing remarkable responses, and thousands of men were coming from around the country to be treated – cured – in his clinic. There I was, part of one of the most dramatic advances in cancer. Einhorn – who treated Lance Armstrong among so many others – became my first mentor in cancer, and I’ve shared his passion for it ever since.

"There's so much
we can do for
them. Because of
research, I can
face a patient with
optimism. We can
manage their
disease. We can
improve their
quality of life.
That's the promise
of science."

Jeff Smearage, M.D., Ph.D.

"It’s funny,” recalls Hayes, “I wanted to be a teacher long before I ever thought about being a doctor.What I didn’t know then was that being a doctor didn’t mean giving up teaching.The great thing about academic medicine is that we actually generate new information to teach! That’s what I love – making new discoveries and teaching them to others.”

Hayes is currently teaching about one of his latest discoveries in the lab, where he, Smerage and others are collaborating on the application of a technology he developed to separate the cancer cells circulating in the blood of women with metastatic breast cancer.As Smerage explains, “Dr. Hayes’ new method can determine accurately in a matter of weeks, rather than months like currently available tests, whether a therapy is working.That’s going to make a big difference to patients.

Jeff Smerage sees his career as still evolving, but, inspired by Hayes and others, he’s committed to cancer care.“Of all the medical specialties I experienced as a student, this is by far the most rewarding.There’s so much to be optimistic about in oncology, and I get so much out of working with cancer patients – so much more than I can say.”

Moyer and Chang
Dr. Moyer (left) and Dr. Chang

Jeffrey Moyer, M.D.
Lecturer, Department of Otolaryngology

Alfred Chang, M.D.
Professor, Department of Surgery

Associate Director, Translational Research
U-M Comprehensive Cancer Center

It’s a different kind of challenge to get Jeff Moyer and his mentor, Fred Chang, to reflect on their career paths. First, one has to wait for an opening in their conversation as they proceed down the first floor corridor of University Hospital. Even while their photograph is taken, they remain focused on the details of their current research collaboration, oblivious to the flash of the camera.

When the subject finally turns to what brought them to the U-M Cancer Center, they discover that they come from similar backgrounds.“ I never really considered any other career,” Moyer says. “Both my parents worked at the Centers for Disease Control, so there was always talk about medicine and science around our house. I started doing research in college, worked in a biology lab and did my honors thesis in cell biology.”

“My parents were academically oriented too,” says Chang.“My dad had a Ph.D. in biochemistry and was a cancer researcher – I guess he was my first mentor, guiding my interests toward both research and cancer.”

Each specialized in surgery for the same reasons, too, attracted by the idea of working with their hands, and the immediate reward of seeing the results of their efforts. For Chang, strong mentors were also driving forces in defining his career path.“In medical school, it seemed like I gravitated toward role models in the surgical area,” he recalls.

"People ask me,
isn't it the
hardest thing to
work with cancer
patients?
Sometimes it is
hard, but when
you see them do
well and know
you've been able
to help, it's the
most rewarding
job in the world."


Fred Chang, M.D.

Perhaps his most significant surgical mentor was Steven Rosenberg, then a senior resident at Harvard. Rosenberg, a pioneer in the field of tumor immunology, eventually became chief of the Surgery Branch of the National Cancer Institute (NCI). After Harvard, Chang followed Rosenberg to the NCI for a three-year fellowship, and continued on the NCI faculty for another six years.“Rosenberg was a terrific mentor, and my time at the NCI was one of the best opportunities I could have had as a young investigator.” Chang brought his interest in tumor immunology to Michigan in 1988. Since then he has inspired several clinician-scientists to follow the pursuit. Simply put, tumor immunology is the study of how the immune system reacts to cancers. Chang’s work focuses primarily on harnessing the activity of T-cells – white blood cells that help the body defend against cancer. His lab develops immunotherapies to treat a variety of cancers, including gastrointestinal cancers, kidney cancers and melanoma.

Jeff Moyer is Chang’s newest protégé in tumor immunology. The two met when Moyer completed a surgical rotation through the breast cancer clinic. “I’m interested in immunotherapy, and even though I’ve chosen to specialize in a different area – head and neck cancers – Dr. Chang continues to devote time to mentoring me.”To Moyer’s surprise, the relationship is even more valuable to him now than when he was a student. “I thought a mentor was someone who’d be helpful during medical school. But I actually rely on Dr. Chang’s guidance now more than ever. It’s great to have someone who’s had such a distinguished career help me as I start out my own career.”

As a mentor, Chang hopes to instill in new clinical scientists the impact research can play in the lives of patients. “The translational aspect of what we do is like icing on the cake,” he says.“Why do we beat our heads against the wall writing grants and spending hours in the lab? To bring something new – something extra – to our patients.When I see patients respond to immune treatments, that makes all the struggle and hard work worthwhile.That’s why we maintain both a clinical and a research practice.”

“It’s important to take a step back and remember that everything we do is about the patients, not about us,” adds Moyer.“We always have to focus on all of the positive, hopeful things we can offer them.”

Amira Deep, R.N., B.S.N. Amira Deep, R.N., B.S.N.
Blood and Marrow Transplant Inpatient Unit Nurse
University Hospital

Months confined to a hospital bed, facing a daily litany of lifethreatening complications.When it comes to taxing a patient’s physical limits and a family’s emotional resources, nothing in cancer treatment comes close to a bone marrow transplant.

That’s the reality Amira Deep faces every day treating patients on the Blood and Marrow Transplant (BMT) unit on floor 8A of University Hospital.Yet she says it’s the only job she ever wants. “I graduated college with a degree in biology, and my first job was working as a data manager for researchers doing clinical trials related to BMT,” she recalls.“Mywork involved tracking patient information for the National Marrow Donor Program.

"I thought I loved biology, but from the moment I first stepped onto

that floor, I wondered why I hadn't done this earlier. Nothing

compares with caring for these people."


Amira Deep, R.N.

Relying only on data, Deep followed patients from the day of their transplant forward. It was challenging work, but she felt she needed more. “I wanted to be involved with the patients,” she remembers.“On the one hand I knew so much about them, but at the same time, they were just names.”

Deep began working at the University of Michigan, assisting the nursing staff as a surgical/intensive care unit technician on 8A.“I wasn’t a nurse, but I was there for the patients,” she recalls. It was during that time she encountered one particular patient – her first mentor, although she didn’t recognize it at the time – whose experience removed any doubt about continuing down the nursing path.

“An unrelated bone marrow transplant takes you to hell and back, and this woman made several trips,” says Deep.“She spent six months on our unit. Every step forward was followed by two steps back. Each time she showed nothing but determination to get well, and she did. BMT patients and their families teach you so much, and caring for her made me realize I wanted to do more for them. Seeing her fight back made me realize that I wanted to fight for these patients every day. She showed me what I wanted to do – what I had to do.”

After earning her nursing degree, Deep joined the BMT team full time. She’s now surrounded by other mentors – the nurses and transplant physicians on the unit, who she credits with making a tough environment easier. “We go through so much – it helps that we stick together like a family,” she says.“The other nurses are incredible, and the BMT doctors really work as a team with us.Thanks to their support, and the inspiration she continues to receive daily from patients, Deep is now pursuing a graduate degree in nursing, hoping to expand the role she plays in BMT. She may just be a mentor in the making.

Fred Chang, MD

The Mentors Speak Out

“Young physicians have it much harder than I did when I started out. There’s more pressure on the junior faculty member to develop an independent laboratory program and secure funding in order to be promoted.With today’s medical economics and the private practice career options out there for them, there’s a need for institutions like ours to build more programs to help these individuals develop the skills they need, or the clinician-scientist will become an even rarer breed.”

Fred Chang, M.D.

 

Dan Hayes, MD

“Folks who choose academic medicine today make half the salary they could in private practice, and they come out of training with enormous debt. That choice shows enthusiasm and real courage. People – people who vote – need to understand that choice and support it. To keep making progress against cancer,we need a pipeline of promising clinical researchers, and they need funding – from federal grants and private philanthropy. Government funding for biomedical research is suffering. That’s wrong.We need to make cancer research a top priority.”

Dan Hayes, M.D.

Recruiting and training young clinical investigators and nurturing their research at its earliest stages are primary functions of the Director’s Leadership Fund at the U-M Comprehensive Cancer Center. To learn more, contact the Office of Development at 734-764-7170 or visit Make a Donation.

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