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Three interview sessions: 6 March 2014, 14 May 2014, 23 May 2014
Total approximate duration, 5 hours.
Interviewer: Tacey A. Rosolowski, Ph.D.
About the Interview Subject:
Carmen Escalante, M.D. (b. 30 August 1959, Raceland, Louisiana) joined the faculty of MD Anderson in 1988 as an instructor in the Section of General Internal Medicine. She has served as Chair of the Department of General Internal Medicine since 2005. Dr. Escalante was involved in the first initiatives to set up a formal General Internal Medicine service at MD Anderson. Her research has focused on deep venous thrombosis; dynspnea and the development of risk models that predict imminent death for acutely ill patients with this condition; cancer-related fatigue. In 1998 she set up the first clinic for cancer fatigue in the nation.
Major Topics Covered:
Personal and educational background
Evolution and growing acceptance of the internist’s role at MD Anderson
Research: deep venous thrombosis, dynspnea and risk models, cancer-related fatigue
Clinical activities in the chemotherapy service
Establishing: the Cancer Fatigue Clinic, the Inpatient Hospitalist Program,
Creation of the Department of General Internal Medicine
The Emergency Medical Service
The Chemotherapy Clinic
Roles heading the Department of Internal Medicine
Experiences as a woman professional in medicine
Evolving status of women at MD Anderson
A note on transcription and the transcript:
This interview had been transcribed according to oral history best practices to preserve the conversational quality of spoken language (rather than editing it to written standards).
The interview subject has been given the opportunity to review the transcript and make changes: any substantial departures from the audio file are indicated with brackets [ ].
In addition, the Archives may have redacted portions of the transcript and audio file in compliance with HIPAA and/or interview subject requests.
The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
Interview Session One: 6 March 2014
A Sketch of a Family
Chapter 01 / Personal Background
Encouraged to Get an Education and Leave a Small Town
Chapter 02 / Personal Background
Deciding to Practice General Internal Medicine
Chapter 03 / Educational Path
Selecting a Medical School
Chapter 04 / Educational Path
Uncertain about a Career at MD Anderson
Chapter 05 / Joining MD Anderson/Coming to Texas
The New Section of General Internal Medicine in the Late Eighties
Chapter 06 / An Institutional Unit
Choosing to Stay at MD Anderson
Chapter 07 / View on Career and Accomplishments
Learning to Build a Research Career
Chapter 08 / The Researcher
Research into Dyspnea
Chapter 09 / The Researcher
Research into Cancer-Fatigue
Chapter 10 / The Researcher
Research into Venous Thrombosis
Chapter 11 / The Researcher
Interview Session Two: 14 May 2014
Research on Hypertension, A Side Effect of Inhibitors
Chapter 12 / The Researcher
General Internal Medicine: From a Section to A Division and Department
Chapter 13 / An Institutional Unit
Section Chief and Department Head: Learning to Lead
Chapter 14 / The Administrator
A New Department is Created: Growing the Department
Chapter 15 / The Administrator
The Hospitalist Program
Chapter 16 / Building the Institution
Developing Educational Initiatives in the Department of Internal Medicine
Chapter 17 / Building the Institution
Developing Station 19 and the Emergency Medical Center
Chapter 18 / Building the Institution
A Chemotherapy Clinic to Serve the World’s Largest Ambulatory Clinic Center
Chapter 19 / Building the Institution
Work on Significant Committees: Disaster Committee; Transfusion Committee; Medical Practice Committee
Chapter 20 / The Administrator
Interview Session Three: 23 May 2014
Changes for Women at MD Anderson
Chapter 21 / Diversity Issues
Changes at MD Anderson Under a New President: for the Institution and General Internal Medicine
Chapter 22 / Institutional Change
Refining Policies While Serving on Executive Committee of the Medical Staff
Chapter 23 / The Administrator
A Girl Scout Leader Pursues Her Passion for Women’s Advancement
Chapter 24 / Personal Background
Interview Session One: 6 March 2014 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Personal Background)
A Sketch of a Family (listen/read)
In this Chapter, Dr. Escalante names her family members and sketches their ethnic and economic background (Mexican/Cajun).
Chapter 02 (Personal Background)
Encouraged to Get an Education and Leave a Small Town (listen/read)
Dr. Escalante talks the value of education in her family and the encouragement she received from her parents to a good education. She tells a story about her mother opening savings accounts for her children, to be used specifically for a college education.
Dr. Escalante next talks about two woman who mentored her in high school, confirming that she had the ability to excel and encouraging her to become a doctor. She explains what she found exciting about a medical career. She finishes this Chapter with memories of her two mentors and their responses when she sent them each a copy of Legends and Legacies: Personal journeys of women physicians and scientists at MD Anderson Cancer Center, a collection of essays by women physicians and scientists at MD Anderson.
Chapter 03 (Educational Path)
Deciding to Practice General Internal Medicine (listen/read)
Dr. Escalante explains how she chose to attend Nicholls State University in Thibodaux, Louisiana (BS, Chemistry 1981). She notes the lack of direction she had in making choices because of her own inexperience and the lack of informed support in her family and the small town where she was raised and educated. She also talks about the concern with money at the time. She worked throughout college and asked her family physician about jobs. She eventually worked as a ward clerk in a local hospital and Dr. Escalante explains how this experience added to her understanding of what medical practice involved. She also explains that she majored in chemistry, as opposed to biology, because she was attracted to the “rigor and challenge” of chemistry. She notes that she always had to work hard to excel, but wanted to distinguish herself.
Chapter 04 (Educational Path)
Selecting a Medical School (listen/read)
In this Chapter, Dr. Escalante explains why she chose to go to Louisiana State University for medical school (MD 1985) and how she was suddenly competing with other top students and had to adjust to not always being the best in the class. Next she describes how her rotations at Charity Hospital led her to focus on Internal Medicine. She speaks at length about the negative impression she had of surgery because of her rotation. She found Internal Medicine the most stimulating because it was intellectually challenging and involved looking at the whole patient.
Chapter 05 (Joining MD Anderson/Coming to Texas)
Uncertain about a Career at MD Anderson (listen/read)
Dr. Escalante explains her career moves as she was nearing the end of her residency and describes the process that brought her to MD Anderson in 1988, to be part of the new Section of General Internal Medicine headed by Edward Rubenstein. She recalls that she had done a rotation at MD Anderson when she was an intern and found it very difficult to adjust to a context in which patients were doing poorly. When a position opening in 1988, she wasn’t certain it would be a good fit, but decided to take the job for a year to think things out.
Chapter 06 (An Institutional Unit)
The New Section of General Internal Medicine in the Late Eighties (listen/read)
Dr. Escalante talks about MD Anderson’s section of General Internal Medicine (GIM), the first to open in the country. She explains the roles that GIM physicians serve in treating oncology patients and the supporters of GIM at MD Anderson, though it was novel for internists to be on staff at a cancer center. Dr. Escalante explains her daily routine and notes the increasing for services. She talks about the role of GIM in Station 19 (the Emergency Service). She traces changes in how internists’ services were tracked and charged for.
She notes that her appointment at that time was 100% clinical, with no protected time and no discussion with her superiors of how to move to promotion. (She notes that GIM faculty were considered “help.”)
Chapter 07 (View on Career and Accomplishments)
Choosing to Stay at MD Anderson (listen/read)
Dr. Escalante describes why she decided to stay at MD Anderson despite her original misgivings. A primary consideration: she like the people and the patients. Dr. Escalante explains how oncology patients have taught her a lot and helped her “reset her life priorities.” She also explains that she would never have predicted a career for herself that included academic medicine. She also notes that it was of benefit that she didn’t fully visualize her future, as this kept her open to opportunities.
Chapter 08 (The Researcher)
Learning to Build a Research Career (listen/read)
Dr. Escalante next describes how she expanded her career vision to include a research program, noting a few mentors, but the general lack of attention to career development within her department. She explains that Dr. Robert Bast [Oral History Interview] came in as Head of the Division of Medicine and changed the requirements for promotion, raising the standards for publications. She describes the process she went through to learn how to write reviews and research papers without formal mentoring.
Dr. Escalante then explains that Dr. Andrew von Eschenbach helped further her career by arranging for her first administrative appointment on the Disaster Committee (which she eventually chaired). She observes that committee work provides valuable opportunities to network and learn about the institution.
Chapter 09 (The Researcher)
Research into Dyspnea (listen/read)
Dr. Escalante explains that her first research focused on symptoms that patients presented in the emergency service, Station 19. She first looked at dyspnea, combing through records to discover what kinds of patients presented symptoms of shortness of breath, eventually developing a derivation model that predicted who would die from dyspnea, a signal that “the end is coming.” She explains the significance that this information could have for physicians, patients, and families making end of life treatment decisions. Dr. Escalante explains that she conducted this research with very little money (none at the beginning) and learned research methods from the bottom up. She describes the impact her findings might have had, but observes that in practice this information is not used enough to have long term impact.
Chapter 10 (The Researcher)
Research into Cancer-Fatigue (listen/read)
Dr. Escalante describes cancer-fatigue then tells how MD Anderson established the first cancer-related fatigue clinic in 1998. She describes services that patients received and notes that the MD Anderson clinic served as a model for others all over the world. She explains what was offered for patients: treatment for depression, anxiety, sleep deprivation, “cheerleading”, and advice about exercise. She notes that she enjoyed the level of interaction with patients and the confirmation that “we can make a clinical difference”. Dr. Escalante explains that, at first, she served as medical director and both managed and staffed it on her own. She and others are now working on national guidelines for treating cancer fatigue and she has given lots of interviews and lectures for other providers and patients. She describes how the clinic really functioned as a “virtual multi-disciplinary clinic” with connections in services all over MD Anderson.
Chapter 11 (The Researcher)
Research into Venous Thrombosis (listen/read)
Dr. Escalante explains that she is the Site Principle Investigator for a national study investigating how to treat blood clots in cancer patients. She explains why cancer patients develop clots and describes the results: the superiority of low molecular weight Heparin over Coumarin (Warfarin). Heparin is now standard of care and covered by insurance.
14 May 2014 (listen/read)
Interview Identifier (listen/read)
Chapter 12 (The Researcher)
Research on Hypertension, A Side Effect of Inhibitors (listen/read)
Dr. Escalante describes her studies of hypertension control, work begun when inhibitors were prescribed to cancer patients. She talks about the severity of the hypertension and the research questions that she posed. Dr. Escalante explains that her team began to do data-mining to design prospective studies and also collaborated with clinical trials to study side effects. She describes the process of acquiring data from data pools and patient charts. She also compares the electronic medical records systems, EPIC and ClinicStation. Dr. Escalante notes that she will be presenting this work at a conference this June. She also explains that this information will help community physicians treating patients and survivors as well as providing opportunities to inform the public and health professionals about drug toxicities.
Chapter 13 (An Institutional Unit)
General Internal Medicine: From a Section to A Division and Department (listen/read)
Dr. Escalante notes evidence that it has taken a relatively long time for internists to be accepted as part of oncology teams. She lists the individuals she recruited to the Department of General Internal Medicine once funding began. She says she is pleased with the progress this young Department has made in the past nine years.
Dr. Escalante sketches the history of the Division and the Department of General Internal Medicine, noting increasing acceptance of generalists. She explains that “we need a team approach to take care of these patients.” She discusses ways in which MD Anderson is far ahead of other institutions in allotting resources to General Internal Medicine and notes the creations of support care teams that provide patients with services not available at other cancer centers.
Chapter 14 (The Administrator)
Section Chief and Department Learning to Lead (listen/read)
Dr. Escalante begins this Chapter with a description of how she replaced section chief Ed Rubenstein in 1997 because of complaints about his leadership. She explains that morale was very low in the section during this difficult time for her and for the section. A central problem: when she replaced Dr. Rubenstein, she was also promoted above him. Dr. Escalante next talks about the challenges she faced during this period when she had to cope with a great deal of conflict within the section. After a year, she explains, she went to her supervisor, and Dr. Rubenstein was moved to another section. Dr. Escalante talks about her leadership style: she stresses consensus, but she is also a decision-maker. She has learned a great deal about organizing administrative structure effectively and also cultivates leadership talent within the department.
Chapter 15 (The Administrator)
A New Department is Created: Growing the Department (listen/read)
Dr. Escalante explains how she came to be Department Chair once the Section of General Internal Medicine was reorganized as a Department within the Division of Internal Medicine. She applied internally during the search process, which lasted until 2005, a difficult period in which she was a leader, but without any resources to build the Department. In 2005 she received a package and was able to develop both research and clinical activities. She gives an overview of what has been accomplished in the last nine years. Next she notes that Dr. Robert Gagel instructed her to build a research program. She reports that he also told her that he never thought she would be able to do it and speculates that this was a gender-motivated comment and might also have been influenced by the fact that she does not have an Ivy League degree.
Chapter 16 (Building the Institution)
The Hospitalist Program (listen/read)
Dr. Escalante talks about the Hospitalist Program, beginning with the need that this program addresses. She talks about controversy over integrating hospitalist support to care teams. She lists supporters of the Hospitalist Program and those who are interested in establishing a connection with the service. She talks about the three existing service teams and explains the difficulties that an internist can face working as part of an oncology team. She explains how a focus on general internal medical conditions has resulted in a different process for admitting patients. She notes that the Hospitalist Program is one of the most important in the Division and how its services will be important to bundled care structures as it decreases the number of consults.
Chapter 17 (Building the Institution)
Developing Educational Initiatives in the Department of Internal Medicine (listen/read)
Dr. Escalante explains her educational mission as Department head. She talks about programs to develop educational initiatives to the same level as research and clinical programs. She notes that, in collaboration with Sai-Ching [Jim] Yeung and Robert F. Gagel she wrote the textbook, Medical Care for the Cancer Patient. She actively attends conferences on cancer patients and survivors. She notes that Dr. Jeong Oh received an Educator of the Year award. She explains that everyone in the Department has exceeded her expectations and her success is due to her good faculty.
Next, Dr. Escalante explains what remains to be done to develop the Department: build up the Hospitalist Program, invest in research, and develop the Suspicion of Cancer Program, which enables patients to obtain a diagnosis and get care at MD Anderson.
[The recorder is paused for about two minutes.]
Chapter 18 (Building the Institution)
Developing Station 19 and the Emergency Medical Center (listen/read)
Dr. Escalante talks about her role as Director of Station 19, later developed and renamed, the Emergency Medical Center.
She explains the administrative re-structuring of Station 19 as well as changes in physical location. She explains the staffing of the Emergency Center and the challenges of hiring faculty for these positions. She recalls Station 19 when she first worked there and notes the growth and improvement in treatment of patients since that time. She explains that, in 2010, Dr. Robert F. Gagel decided that the Division of General Internal Medicine was too big and split Emergency Medicine into a separate department, with positive results. She notes that Chairman Dr. Todd is developing a research program and filling clinical positions. She also notes that the economic crisis has created a lot of stress in the emergency service.
Chapter 19 (Building the Institution)
A Chemotherapy Clinic to Serve the World’s Largest Ambulatory Clinic Center (listen/read)
In this Chapter, Dr. Escalante explains her role as Medical Director of the Chemotherapy Clinic. She notes that services have grown immensely and that the Clinic serves the largest ambulatory clinic in the world.
Chapter 20 (The Administrator)
Work on Significant Committees: Disaster Committee; Transfusion Committee; Medical Practice Committee (listen/read)
In this Chapter, Dr. Escalante explains that the committees she worked on helped her grow as a leader, with each being a step up in importance. She mentions the Disaster Committee and Transfusion, then goes into detail about some of the issues examined when she served on the Medical Practice Committee. She also explains how this committee worked with the JCHO in the credentialing process and notes her role on the Credentialing Committee, indicating the types of issues addressed. Dr. Escalante explains the lessons she learned from this process and explains that this kind of close review of processes have led to evaluation of quality of care, formalized with hiring of Quality Officers. Dr. Escalante then sketches the leadership skills she acquired through her committee work.
23 May 2014 (listen/read)
Interview Identifier (listen/read)
Chapter 21 (Diversity Issues)
Changes for Women at MD Anderson (listen/read)
Dr. Escalante provides an overview of the status of women at MD Anderson.
She begins by talking about what Margaret Kripke, Ph.D. (Oral History Interview) contributed to the institution after her arrival in 1984. She also points out what needs to be done, particularly in seeing women represented in executive leadership, and notes the contributions of Elizabeth Travis, Ph.D. who administers the Office of Women Faculty Programs designed to promote women. Dr. Escalante explains what she believes women bring to leadership.
Next Dr. Escalante notes generational differences in attitudes about family and work/life balance. She talks about her own difficulties in arranging time to address family issues in a Department that was inflexible about scheduling meetings. She cites changes to tenure clock policies as an indication of positive progress and notes that younger women have started a faculty moms’ group.
Chapter 22 (Institutional Change)
Changes at MD Anderson Under a New President: for the Institution and General Internal Medicine (listen/read)
Dr. Escalante offers observations about changes that Dr. Ronald DePinho has brought to the institution after assuming the role of president in 2011.
She first discusses Dr. John Mendelsohn’s contributions to the institution, recalling times of uncertainty. Today, she explains, there are shifts in leadership at the senior level and a lack of information from senior administration about budgets and institutional directions has made it difficult for her, as a Division Head, to communicate effectively with her faculty and staff.
Next, Dr. Escalante talks about the uncertain future of the Division and Department of General Internal Medicine, given that “we’re not the group that’s going to cure cancer.” She also notes that the balance between clinical and basic research is shifting, with clinical functions pressured to become much more efficient and funds for research shrinking. She explains that these shifts raise questions about faculty responsibilities, requirements for promotion.
Chapter 23 (The Administrator)
Refining Policies While Serving on Executive Committee of the Medical Staff (listen/read)
Dr. Escalante reviews her decade of service on the Executive Committee of the Medical Staff and notes the networking opportunities it offered. She explains how the Committee works and lists some of the issues addressed.
Chapter 24 (Personal Background)
A Girl Scout Leader Pursues Her Passion for Women’s Advancement (listen/read)
In this Chapter, Dr. Escalante explains that she is a very private person, then notes that she is very passionate about women’s rights and providing opportunities for women even in her life outside work. Because of this, she took became a leader of her daughter’s Girl Scout troop. She describes some of the activities organized for the girls and expresses how much enjoyment she derives from this role and from “teaching them to be leaders.”
Original Interview Profile #49: Carmen Escalante, M.D.
Submitted by: Tacey A. Rosolowski, Ph.D.
Date: 2 June 2014
This interview with Carmen Escalante, M.D. (b. 30 August 1959, Raceland, Louisiana) takes place over three sessions in spring of 2014 (total approximate duration, 5 hours).
Dr. Escalante came to MD Anderson in 1988, joining the faculty as an instructor in the Section of General Internal Medicine. Today she is Chair of the Department of General Internal Medicine in the Division of Internal Medicine, and a Professor in that department. She has a joint appointment with the Texas A&M Health Science Center College of Medicine and with the Department of Internal Medicine at the University of Texas Health Science Center, both in Houston, Texas. This interview takes place in Dr. Escalante’s office in the Department of General Internal Medicine in Pickens Academic Tower on the main campus of MD Anderson. Tacey A. Rosolowski, Ph.D. is the interviewer.
Dr. Escalante received her Bachelors in Chemistry in 1981 from Nicholls State University in
Thibodaux, Louisiana, and her MD in 1985 from Louisiana State University School of Medicine in New Orleans. She served her internship at the University of Texas Medical School at Houston (1985-6/1986) and her residency at the same institution (1986-6/1988). Dr. Escalante was involved in the first initiatives to set up a formal General Internal Medicine service at MD Anderson. Her research areas are: deep venous thrombosis; dynspnea and the development of risk models that predict imminent death for acutely ill patients with this condition; cancer-related fatigue. In 1998 she set up the first clinic for cancer fatigue in the nation.
In this interview, Dr. Escalante traces how the role of the internist has evolved at MD Anderson, gradually gaining acceptance and respect among researchers and clinical teams. She talks about her research and her clinical activities running the chemotherapy service, setting up the Cancer Fatigue Clinic, and the Inpatient Hospitalist Program (2007). She also discusses the creation of the Department of General Internal Medicine in 2000 and heading the Department since that time. Dr. Escalante also comments on the evolving status of women at the institution.