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Sawaya (Raymond), MD, Oral History Interview: Home

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Interview Profile

 

Interview Information:

Three interview sessions:  4 June 2013, 25 June 2013, 16 July 2013
Total approximate duration: 5 hours
Interviewer: Tacey A. Rosolowski, Ph.D.

 

For supplementary materials:

Please contact, the Historical Resources Center, Research Medical Library:

Javier Garza, MSIS, jjgarza@mdanderson.org

 

About the Interview Subject:

Raymond Sawaya (b. 5 May 1949, Latakia, Syria) came to MD Anderson in 1990 to assume the chairmanship of the Department of Neurosurgery and create a comprehensive, multi-disciplinary, brain and spinal cord tumor program, with clinical, educational, and research activities.  Dr. Sawaya is known for his research into the role that fibrinogen plays in allowing cancer to invade the brain; he has also conducted work on primary and metastatic brain tumors, third ventricle, brain stem and pineal region tumors. He has made strides in enhancing the accessibility and safety of brain tumor surgery.

Dr. Sawaya still holds the position of Chair of Neurosurgery.  In 2001 he formed and headed the Brain Tumor Institute; in 2005 he helped create and became head of a joint program in neurosurgery established with the Baylor College of Medicine.

Major Topics Covered:

Personal and educational background

Research: fibrinogen; surgical techniques

The special challenges of brain surgery and working with brain cancer patients

The Department of Neurosurgery and neuro-services at MD Anderson: history of; developing a multi-disciplinary approach; recruitments

The Neurosurgery Database

The Tissue Bank

The Brain Tumor Institute: history of, vision for

Technology and neurosurgery

Neurosurgery training programs

Leadership: philosophy, skill, lessons

MD Anderson in periods of change

 

Regarding the Transcript and Audio Files

In accordance with oral history best practices, this transcript was intentionally created to preserve the conversational language of the interview sessions.  (Language has not been edited to conform to written prose).

The interview subject was given the opportunity to review the transcript.  Any requested editorial changes are indicated in brackets [ ], and the audio file has not correspondingly altered. 

Redactions to the transcript and audio files may have been made in response to the interview subject’s request or to eliminate personal health information in compliance with HIPAA.


 

Table of Contents

 

Interview Session One: 4 June 2013

 

Coming to MD Anderson for Resources to Support a Vision
Chapter 01 / Joining MD Anderson/Coming to Texas

 

Creating a Comprehensive Neuro-Service – and the Best Service
Chapter 02 / Building the Institution

 

Creating a Collaborative and Compassionate Neuro-Service
Chapter 03 / Building the Institution

 

Interpersonal Skills and Philosophy of Leadership
Chapter 04 / Character and Personal Philosophy

 

Recruitments for the New Department of Neurosurgery
Chapter 05 / Building the Institution

 

The Neurosurgery Database and Tissue Bank
Chapter 06 / Building the Institution

 

Developing Clinical Research Initiatives: Challenging Surgical Conventions
Chapter 07 / Building the Institution

 

Interview Session Two: 25 June 2013

 

Strategic Educational Choices to Build a Solid Career
Chapter 08 / Professional Path

 

Specializing in Brain Tumors –Once an “Orphan Disease”—And Research on Fibrinolysis
Chapter 09 / The Researcher

 

Big Visions for the Tumor Program and Frustrations
Chapter 10 / Building the Institution

 

Technology to Support Neurosurgery
Chapter 11 / Devices, Drugs, Procedures

 

Complex Training for Neurosurgeons
Chapter 12 / The Educator

 

Interview Session Three: 16 July 2013

 

A History of the Brain Tumor Institute
Chapter 13 / Building the Institution

 

Leadership Principles and Values
Chapter 14 / The Administrator

 

The Neurosurgeon: Making Decisions about Course of Treatment
Chapter 15 / Overview

 

MD Anderson in Periods of Change and Crisis
Chapter 16 / Institutional Change

 

Defining What Neurosurgery Should Be and Looking Ahead to an Institute
Chapter 17 /
View on Career and Accomplishments

 


 

 

Chapter Summaries

 

 

Interview Session One: 4 June 2013 (listen/read)

 

Chapter 00A
Interview Identifier (listen/read)

 

Chapter 01 (Joining MD Anderson/Coming to Texas)
Coming to MD Anderson for Resources to Support a Vision (listen/read)

 

Topics Covered

  • Joining MD Anderson
  • Professional Path
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • MD Anderson History

Dr. Sawaya tells the story of how was recruited by Dr. Charles LeMaistre to come to MD Anderson in 1990.  He begins by explaining why the decision was made in the late eighties to turn the Section of Neurosurgery into a department and create a Brain Tumor Center.  He recalls his first visit to MD Anderson.  He also speaks about the possibilities the institution offered for the future –and his vision for a comprehensive neuro-surgery department-- because of resources and institutional support to build a brain center (in stark contrast to the limitations at the University of Cincinnati Medical College, where he was on the faculty until 1990).  The interviewer comments that Dr. Frederick Becker [Oral History Interview], Vice President of Research, was quoted as saying that the creation of a comprehensive brain and spine center was a priority for the nineties.  Dr. Sawaya also recalls that the NIH had declared the 90s to be the “decade of the brain.”

 

Chapter 02 (Building the Institution)
Creating a Comprehensive Neuro Service –and the Best Service (listen/read)

 

Topics Covered

  • Overview
  • The Researcher
  • The Clinician
  • The Administrator
  • The Educator
  • The Leader
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Institutional Mission and Values
  • MD Anderson Culture
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • MD Anderson Culture
  • MD Anderson History

Dr. Sawaya states that his goal was to create a comprehensive neuro-service that was the best in all activities, a vision he (literally) illustrates by reference to an image entitled, “Neurosurgical Oncology.”  (See image next page.   Dr. Sawaya explains that he sketched the image and Dr. Ian Suk, a medical illustrationist, created the final design.)

Dr. Sawaya explains the elements of a comprehensive neuro-service: high-level surgery supported by technologies, infrastructure (such as a tissue bank); a database; and education and training. (Dr. Sawaya notes that he created the first neurosurgical oncology fellowship program in 1990, accepting its first fellows in 1991.)  He goes on to explain other features of a comprehensive neuro-service.  Next he notes that pain is an essential element of neuro-oncology and describes how a patient’s suffering and reliance on opiates can be surgically alleviated in some cases.  The surgeon creates a tiny brain lesion that destroys the patient’s ability to sense the cancer pain.  Dr. Sawaya sketches the Department’s growth (300 procedures/year in 1972 to 1,700 during 2012), and notes that the faculty works well together.

Figure I: Concept by Dr. Raymond Sawaya, MD; Drawing by Ian Suk, PhD.  Reproduced with permission.

 

Chapter 03 (Building the Institution)
Creating a Collaborative and Compassionate Neuro-Service (listen/read)

 

Topics Covered

  • The Administrator
  • The Leader
  • MD Anderson Culture
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  •  Growth and/or Change
  •  MD Anderson Impact
  •  Patients
  •  Offering Care, Compassion, Help
  •  Patients
  • : Cancer and Disease
  •  This is MD Anderson
  •  Beyond the Institution
  •  Patients, Treatment, Survivors
  • Institutional Mission and Values
  • Information for Patients and the Public
  • Devices, Drugs, Procedures         
  • Discovery and Success

Dr. Sawaya begins this segment with comments on the challenges of creating collegiality among high-intensity personalities, citing the importance of looking at interpersonal skills while hiring.  Dr. Sawaya affirms that the Department has developed a culture that does not tolerate selfishness and arrogance, noting that not all departments are like that.  He says he is dismayed when he hears, “You’re nice for a neurosurgeon.”  He explains that a diagnosis of brain cancer is “mind boggling” for a patient, and good interactions with the care team gives the patient confidence.  He then Dr. Sawaya tells the story of a young man who was given a prognosis of only six months to live before coming to MD Anderson for treatment.  He is still alive, married with children.  

Dr. Sawaya describes a patient conference on brain cancers that he started at MD Anderson in the mid-nineties.  It is now held every two years and designed to provide the public with information about all dimensions of brain cancer and treatment.  Dr. Sawaya again talks about the “scare factor” of brain cancer, noting that it the surgeon must interact with the patient and family so the patient regains his or her confidence to begin the fight.

Chapter 04 (Character and Personal Philosophy)
Interpersonal
Skills and Philosophy of Leadership (listen/read)
 

Topics Covered

  • Character, Values, Beliefs, Talents
  • Personal Background
  • Professional Path
  • Inspirations to Practice Science/Medicine
  • Professional Practice
  • Patients, Treatment, Survivors
  • Patients
  • Human Stories
  • Offering Care, Compassion, Help
  • The Administrator
  • Leadership

Dr. Sawaya begins this segment by explaining that he learned his interpersonal skills from his father (recently deceased) who was an internist and his mentor.  Dr. Sawaya credits his father with introducing him to the life and work of a physician, most importantly by taking him along on house calls.   

He next says that that he knew he would be a neurosurgeon when he took his first neuro-anatomy course in college: he was fascinated by the organization of the brain.  He goes on talk about being mentored by superb neurosurgeons, then notes how proud he is of the group that he trains.

Dr. Sawaya underscores that he has not advocated a departmental culture where everyone is the same, going on to explain some of the leadership principles he has relied on to build the department (understanding strengths, building collegiality, giving credit).  

 

Chapter 05 (Building the Institution)
Recruitments for the New Department of Neurosurgery (listen/read)

Topics Covered

  • The Administrator
  • The Leader
  • MD Anderson Culture
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Portraits
  • Evolution of Career
  • Professional Practice
  • The Professional at Work
  • Leadership
  • On Leadership
  • Professional Values, Ethics, Purpose
  • Overview
  • Definitions, Explanations, Translations

In this segment, Dr. Sawaya begins to sketch the process he went through to turn his vision for a neuro-service into a reality.  He first talks about recruitments.  He first hired Dr. Justi Rao, a basic scientist whose work on brain invasiveness supported his own interest in the subject.  He notes that the Department’s research portfolio has diversified significantly since that time.

Dr. Sawaya next hired neurosurgeon Ian McCutcheon, who worked on mapping the brain.  Dr. Sawaya explains the problems brain surgeons face when trying to locate tumors, focusing in particular on the challenges that base-of-skull tumors present.[1]  He notes that he hired Dr. Frank Delmonte to address tumors in this region. 

Dr. Sawaya next hired neurosurgeon Sam Hassenbusch, who became the director of the pain program and the stereotactic surgery program.  Dr. Sawaya explains the equipment that makes stereotactic surgery possible. 

Dr. Sawaya next hired Dr. Zia Gokaslan to develop the program in spinal oncology.   He then goes on to talk about the “rough patch” with managed care in the mid-nineties, and the way he managed to hire Dr. Fred Lang in 1996 as Director of Clinical Research, despite budget limitations.  Dr. Sawaya notes that by 1996, he had established the nucleus of the Department.

 

Chapter 06 (Building the Institution)
The Neurosurgery Database and Tissue Bank (listen/read)

 

Topics Covered

  • Building/Transforming the Institution
  • Research, Care, and Education
  • On Research and Researchers
  • Overview
  • Healing, Hope, and the Promise of Research      
  • Discovery, Creativity and Innovation
  • Devices, Drugs, Procedures
  • The Researcher
  • The Clinician
  • MD Anderson Impact
  • Research, Care, and Education
  • On Research and Researchers

In this segment, Dr. Sawaya recounts how the Department established a database to record detailed information about all surgical procedures performed by clinicians.  He begins by explaining why it is important to have a volumetric measurement of brain tumors.  Dr. Sawaya explains how recording the size of brain tumors resected helped resolve controversy over the surgical treatment of glioblastoma.  A 2001 publication of the results has been cited over 7000 times, and Dr. Sawaya explains how the database provided hard numbers about percentages of resection, replacing the vague terms surgeons previously used to determine how much tumor and normal tissue to remove.

Dr. Sawaya next says that a “very amateurish” database was started in June of 1993, but professionalized in 1997, when the Department hired Dr. Dima Suki.  He explains how Dr. Suki developed the database and data collection.  He describes how data is collected from surgeons about the procedures they perform so the information can be preserved in the database.

Dr. Sawaya explains how fundamental data and data management are in neurosurgery, and explains the strict protocols that govern data collection and entering.  The Neuroscience database is IRB approved, a very rare designation, he notes.  It is also important that Dr. Suki oversees audits of the database and manages any mistakes to maintain database credibility.

Dr. Sawaya next talks about the Department’s tissue bank was developed to preserve tissue samples from each patient treated.  He notes the link with personalized therapy, then goes on to explain why tissue is time sensitive, requiring special handling.  The Department received funding in 2001 to support handling of tissue samples. 

 

Chapter 07 (Building the Institution)
Developing Clinical Research Initiatives, Challenging Surgical Conventions (listen/read)

 

Topics Covered

  • MD Anderson Impact
  • Ethics
  • Healing, Hope, and the Promise of Research
  • Discovery, Creativity and Innovation
  • Research, Care, and Education in Transition
  • Career and Accomplishments
  • The Researcher
  • Discovery and Success
  • MD Anderson Impact
  • Technology and R&D
  • Overview
  • Definitions, Explanations, Translations
  • Professional Practice
  • The Professional at Work

Dr. Sawaya explains that Dr. Fred Lang established the infrastructure for the research program in the Department of Neurosurgery.  He describes the types of questions that the Department’s research projects investigate. He next discusses the Department’s controversial study of surgery performed on patients with multiple brain metastases, a taboo intervention according to conventional surgical wisdom.  The Department performed a retrospective investigation of data which then went to a randomized  trial documenting the effectiveness of the procedure.  Dr. Sawaya contributed to these studies and the findings that changed therapy nationally.

Dr. Sawaya briefly speaks about his work with lasers, then explains a surgical probe that uses a GPS system to establish its location.  He discusses the many challenges that tumors present and some of the technology used to determine tumor location and size.  He stresses the importance of learning much more about brain anatomy.

 

 

Interview Session Two: 25 June 2013 (listen/read)

 

Chapter 00B
Interview Identifier (listen/read)

 

Chapter 08 (Professional Path)
Strategic Educational Choices to Build a Solid Career (listen/read)

 

Topics Covered

  • Character, Values, Beliefs, Talents
  • Personal Background
  • Professional Path
  • Inspirations to Practice Science/Medicine
  • Influences from People and Life Experiences
  • Obstacles, Challenges
  • Cultural/Social Influences
  • Women and Minorities at Work
  • Evolution of Career
  • The History of Health Care, Patient Care

Dr. Sawaya begins this segment with recollections of his father, who was a physician and a mentor to him.  He states that he saw his father make contributions to medicine and to society alike, and that by accompanying his father on house calls, he witnessed the impact a physician could have on an entire family.  Dr. Sawaya then sketches his educational path, which took him away from Syria to a French University of Medicine in Beirut, where he could receive a superior education under the French system.  He note his mentor in medical school, neuroanatomist Jedeon Mohassab, and neurosurgeon Fuad Haddad who eventually established the first neurosurgery center in the Middle East, and with whom Dr. Sawaya studied during a sub-internship.  Dr. Sawaya then explains his decision to come to the United States to specialize in neurosurgery and describes the (lengthy) process of securing a surgical internship at Beekman Downtown Hospital in New York.  He describes the educational and cultural adjustments he had to go through.  He then sketches his Surgical Residency at Upstate Medical Center in Syracuse, New York.  He explains why he did not feel ready to specialize in neurosurgery at this point, but notes that Dr. Robert King “opened the door” to his eventual specialization in neurosurgery.  He then traces his training in neurosurgery, finishing at Johns Hopkins, where he was Chief Resident.

 

Chapter 09 (The Researcher)
Specializing in Brain Tumors–Once an “Orphan Disease”—And Research on Fibrinolysis (listen/read)

 

Topics Covered

  • Character, Values, Beliefs, Talents
  • Personal Background
  • Professional Path
  • Overview
  • Definitions, Explanations, Translations
  • Professional Practice
  • The Professional at Work
  • Discovery and Success

Dr. Sawaya first explains that the outbreak of the Civil War in Lebanon helped convince him to stay in the United States.  He then explains his decision to specialize in brain tumors, a field that did not appeal to most physicians in the seventies, and his application to the NIH to investigate why tumors invade the brain, work that led to his eventual publication of Fibrinolysis and the Central Nervous System (1990).  He explains where he developed his experience with research design; notes that he joined the faculty at the University of Cincinnati College of Medicine (advancing to full professor in 1990).  Dr. Sawaya then explains the mechanisms by which tumors invade the brain, using fibrinogen as a kind of scaffold to crawl into brain tissue.  During this discussion, Dr. Sawaya refers to Figure 4 from his book, Fibrinolysis and the Central Nervous System (see below).

Figure:  Taken from Raymond Sawaya, Fibrinolysis and the Central Nervous System (Philadelphia, PA: Hanley and Belfus, Inc., 1990), p. 15.

 

Chapter 10 (Building the Institution)
Big Visions for the Tumor Program and Frustrations (listen/read)

 

Topics Covered

  • The Administrator
  • The Leader
  • MD Anderson Culture
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Obstacles, Challenges
  • Controversy
  • MD Anderson History
  • Understanding the Institution
  • Institutional Processes
  • Portraits

Dr. Sawaya notes that MD Anderson attracted him because resources at the University of Cincinnati were limited and he was unable to build an adequate neuroscience team.  He notes that when he arrived at MD Anderson to head the Department of Neurosurgery, he turned his research over to Dr. Justi Rao to run his RO1 grants.  He was pleased with the balance of his responsibilities: 60% program building, 20% clinical, 20% educational.

Dr. Sawaya  explains that in 1997 he offered Dr. John Mendelsohn a plan for a “truly multi-disciplinary” brain tumor program.  The plan was rejected, and Dr. Sawaya speculates on why that happened. He next explains that he now has plans for a whole new building to house the neurological program.  He speculates on the reaction of new president, Dr. Ronald DePinho, to this proposal.  (Dr. Sawaya thinks out loud during this segment, planning his strategy of presenting his proposal.)  He also explains why physical proximity enhances the effectiveness of multi-disciplinary teams and helps prevents problems with accountability and coordination of activities.  Dr. Sawaya also notes the difficulty of promoting multi-disciplinary research and other initiatives, when there is no formal system of accountability in place to hold individuals to the plan.   

Dr. Sawaya next says that Dr. Mendelsohn named him Director of the Tumor Institute in 2001, speculating that Dr. Mendelsohn felt “he owed” him the favor.  Dr. Sawaya admits that he was so frustrated at the time that he almost left MD Anderson.  He explains why he stayed and lists some of the concessions he received: the Directorship; the executive committee that was allowed to raise dedicated funds; permission to recruit a Director for Research (Dr. Oliver Bogler) for all labs in brain tumor programs (and that resulted in a SPORE grant).  He reports that a review of the program by five outside reviewers listed MD Anderson’s tumor program as one of the top if not the top program in North America.

Dr. Sawaya believes that more could be done for the neuro patient in a “brick and mortar” institution wher all activities related to all tumors of the nervous system were located under one roof.  He describes what would be possible.  He then notes that an article about him in the Texas Medical Center News states that he “dreams big.”

 

Chapter 11 (Devices, Drugs, Procedures)
Technology to Support Neurosurgery (listen/read)

Topics Covered

  • Overview
  • Definitions, Explanations, Translations
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Technology and R&D 
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Professional Practice
  • The Professional at Work

Dr. Sawaya begins this segment by noting that Dr. John Tew, chair of Neurosurgery at the University of Cincinnati Medical College in the 1980s, saw that technology was essential to a strong department. Dr. Tew secured many of the first prototypes of devices in order to test them.  When Dr. Sawaya came to MD Anderson, he made sure that he secured all of the technological advances.  Dr. Sawaye describes the advantages of the following: brain mapping; drills to open the skull; navigation systems for the brain and spine; the first robotic microscope and surgiscope; BrainSuite and the Intra-Operative MRI; Vector Vision.

Dr. Sawaya states that the next important advance will be the ability of the MRI to image microstructures in the brain, such as the speech areas.  He also notes that a professor of neurosurgery in Calgary, Canada, has built a robot for use in the operating room.  Dr. Sawaya explains the importance of robotics for neurosurgery, then talks about mastering the challenges of Brain Suite.  He admits that he hesitated about investing in BrainSuite, but was convinced when he realized that it would allow surgeons to remove an entire tumor, leaving no pieces behind.

 

Chapter 12 (The Educator)
Complex Training for Neurosurgeons (listen/read)

 

Topics Covered

  • The Administrator
  • The Educator
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Education
  • Understanding the Institution
  • Institutional Mission and Values

Dr. Sawaya first sketches the usual educational requirements for a neurosurgical specialization: seven years after medical school, including a year of research, then a period of training for subspecialization.  He then explains the one- to two-year Tumor Fellowship begun at MD Anderson in 1990/’91 with one fellow (there are now four).  Very few institutions have training in tumor surgery, and MD Anderson’s program is very specialized.  Dr. Sawaya describes what it offers to fellows: a large volume of patients, opportunities for constant use of technology; frequent awake craniotomies.  Dr. Sawaya notes that MD Anderson fellows are very desirable hires after their training.

Dr. Sawaya then talk about his role as head of the joint program in neurosurgery established in 2005 between MD Anderson and the Baylor College of Medicine.  He tells the story of why Baylor was interested in setting up such a program and how he was approached to serve as Chair.  (He tells an anecdote about going to John Mendelsohn after the five-year review of the joint program: Dr. Mendelsohn asked him at that meeting if he wanted to submit his name as a candidate for MD Anderson’s president, as Dr. Mendelsohn was leaving.)  His contract to serve as Chair was renewed for another five years, and Dr. Sawaya notes that the program hired thirteen faculty in the first three years. 

Next Dr. Sawaya explains what neurosurgery residents bring to the Tumor Program and to MD Anderson.  He then explains the computer matching process that links residents with institutions whose programs they might enter.  He then describes the process of selecting residents and how a residency unfolds, noting that fellows have a different mindset than residents.  He talks briefly about employment for neurosurgeons, which is a very small specialty.  He briefly compares MD Anderson with Memorial Sloan-Kettering. Dr. Sawaya notes how the diversity of specializations and functions housed in the Department of Neurosurgical Oncology has enabled each to grow stronger.

 

Interview Session Three: 16 July 2013 (listen/read)

 

Chapter 00C
Interview Identifier (listen/read)

 

Chapter 13 (Building the Institution)
A History of the Brain Institute (listen/read)

 

Topics Covered

  • The Administrator
  • Institutional Mission and Values
  • MD Anderson Culture
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Philanthropy, Fundraising, Giving to MDACC
  • MD Anderson Impact
  • Beyond the Institution
  • Devices, Drugs, Procedures
  • The Administrator
  • Understanding the Institution
  • The Institution and Finances
  • The Business of MD Anderson

Here Dr. Sawaya tells the story of MD Anderson’s Brain Tumor Institute.  He begins by noting that the multi-disciplinary Brain Tumor Program is one of the top three programs in the country and that it is the product of three decades of accumulated development.  The story begins, he says, when Dr. Victor Levine was recruited from the University of California San Francisco to head the Department of Neuro-oncoloy, and brought with him an initial vision of a multi-disciplinary program with basic and translational research.  In the mid-nineties, Dr. Levine secured the first program project grant from the NCI to study the molecular biology of gliomas.  Dr. Sawaya describes the significance of that grant for MD Anderson and then goes on to talk about Dr. Peter Steck’s work on the genetics of brain tumors.  This work led to the discovery (1997) of the tumor suppressor gene, PTEN –a major discovery that “crowned the project program effort.”  Over the course of this time building research, Dr. Sawaya and Dr. Levine were also hiring clinical faculty, among them medical oncologists and neurooncologists.  Dr. Sawaya created the largest brain tumor surgery department in the country and expanded neuropathology and neuroradiology as well.

Dr. Sawaya then explains that Dr. Levine was asked to step down, “a significant change.”  Dr. Sawaya’s next move (1998) was to propose to Dr. John Mendelsohn that all the neuro-related activities be housed in  a single brick and mortar location.  He explains why Dr. Mendelsohn rejected this proposal, allowing Dr. Sawaya (2001) to lead the multi-disciplinary effort of the brain tumor program, including giving him permission to raise dedicated funds.  Dr. Sawaya describes the composition and activities of the Brain Tumor Institute Executive Committee, which has had monthly meetings for the last 12 years.

Dr. Sawaya explains that the presidential permission to fundraise allows the Brain Tumor Institute to establish a premiere class tissue bank.  He eplains that validation of the tissue bank came when the NCI decided to perform genetic studies of five cancers and selected the MD Anderson Tissue Bank to provide the samples of glioblastoma.  Dr. Sawaya then explain how he worked with Development to identify donors.  In the process he gives an overview of how Development presents possible projects to donors to secure their support.

Dr. Sawaya next explains that funding for the Brain Tumor Institute initiatives is never funneled to individual research programs but is used to build core facilities for research, including the Animal Core, the Tissue Bank, specialized equipment, and other shared resources.  He then notes that when the Mitchell Building was constructed, he was given permission to consolidate all the research laboratories in one place (2005).  He explains the key role that new-hire Dr. Oliver Bogler played in organizing research in the new location and in securing the SPORE grant for brain tumors. He talks about the difficulties that neurosurgery had in getting this kind of grant and how Dr. Bogler was able to “get them back on track” so MD Anderson could be a “major player” in brain research.  Dr. Sawaya then summarizes the evolution of the Brain Tumor Institute and what it required.

 

Chapter 14 (The Administrator)
Leadership Principles and Values (listen/read)

 

Topics Covered

  • Leadership
  • On Leadership 
  • Character, Values, Beliefs, Talents
  • Professional Values, Ethics, Purpose
  • MD Anderson Culture
  • The Administrator
  • Professional Practice
  • The Professional at Work
  • Ethics
  • Leadership
  • Character, Values, Beliefs, Talents
  • Professional Values, Ethics, Purpose, Commitment to Work
  • MD Anderson Culture
  • The Administrator

Dr. Sawaya begins this segment with a statement about how it is key to recognize the individual when implementing complex plans, such as those he undertook to develop the Brain Tumor Institute.  He explains how individual recognition is a motivator and how a leader must balance recognition of individual efforts with a larger vision.  He states that the Brain Tumor Institute has reached a point of “maturity” that must now be maintained.  He then acknowledges that the Brain Tumor Program trains high-level leaders and that some senior faculty are leaving to lead other departments and programs.  He also notes, however, that individuals often see so many advantages at MD Anderson, that they do not feel the need.

Dr. Sawaya next explains that he always had an “inner drive” to be a leader.  He explains that he saw the difficulties arising from a lack of good leadership while he was at the University of Cincinnati.  He notes that integrity is essential in leadership.  He tells a story about attending a leadership course at Rice University.

Dr. Sawaya summarizes his philosophy of integrity and honesty.  He tells a story about a senior leader at MD Anderson who made a promise to Dr. Sawaya, then did not stick by his word during a public meeting.  Dr. Sawaya specifies that this was not an instance of someone changing his mind and failing to communicate.  Next he talks about his experiences in the Faculty Leadership Academy (2005) and in the leadership course offered at Baylor (2008-2009), a course he helped plan and then attended.  He then explains that an institution must provide leadership training because physicians and researchers do not cultivate those skills during their professional training curricula and they inevitably find themselves in situations where they must pay attention to systems and direct complex activities.  He notes that his faculty have ambitions to chair departments, but lack skill. He then tells a story about a woman in one of his leadership classes who was not suited to administration.

Dr. Sawaya then talks about the composition and function of the Executive Management Committee, which he serve on from 2005 – 2007).  The committee included executive vice presidents and three other individuals “from the trenches” to ensure that the vice presidents were not too separated from the working reality of MD Anderson.  Dr. Sawaya explains that the Committee gave him an inside look at the working of the institution at a very high level and changed his perspective on top leaders.

 

Chapter 15 (Overview)
The Neurosurgeon: Making Decisions about Course of Treatment (listen/read)

Topics Covered

  • The Clinician
  • Professional Practice
  • The Professional at Work
  • Professional Values, Ethics, Purpose
  • This is MD Anderson
  • Institutional Mission and Values
  • MD Anderson Culture
  • Character, Values, Beliefs, Talents
  • Leadership
  • On Leadership 
  • Patients
  • Offering Care, Compassion, Help
  • Discovery and Success
  • Patients
  • Patients, Treatment, Survivors

Dr. Sawaya says that it is easy for a neurosurgeon to take a conservative, timid approach to a patient’s course of treatment, but that is a losing proposition.  He explains how the mindset at MD Anderson is to “shift the risk from the patient to the surgeon” and go after the tumor in the most aggressive way.  He emphasizes that the development of new technologies have to accompany this approach, as neurosurgeons need tools to help them preserve the function centers in the brain.  He explains that the Department routinely images every patient before and after surgery and takes tissue samples for volumetric analysis of tumors.

Dr. Sawaya explains how he works with patients to advise them of the risks and benefits of surgery. He notes how important it is to spend time to build trust.  He concludes that “This is the best form of leadership I know,” where a surgeon distills and transmits knowledge to help a patient.

 

Chapter 16 (Institutional Change)
MD Anderson in Periods of Change and Crisis (listen/read)

Topics Covered

  • MD Anderson Culture
  • MD Anderson History
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Obstacles, Challenges
  • Controversy
  • The Business of MD Anderson
  • The Healthcare Industry
  • Politics and Cancer/Science/Care
  • Critical Perspectives on MD Anderson  

Dr. Sawaya begins this segment by noting that the periods of major change at the institution are tied to administrative changes.  He first reviews the period of change that came when Dr. John Mendelsohn [Oral History Interview] replaced Charles LeMaistre [Oral History Interview] in the aftermath of the Sharp Report and Charles LeMaistre’s successful attempts to convince the Texas Legislature to allow patients to self-refer to MD Anderson.  Dr. Sawaya recalls the dramatic increase in the numbers of patients seen at the institution, with more business and money coming in.  He also notes some of the programmatic expansions made under John Mendelsohn.  He then notes that after Dr. Mendelsohn’s tenure, the institution was due for a change and welcomed a major scientist such as Dr. Ronald DePinho.  He explains, however, that the institution is currently facing “a crisis” caused by too much controversy surrounding Dr. DePinho.  He notes that the faculty feels ‘disenfranchised” and that morale is low.  Though, as he says, the situation is not yet affecting patients, he has concerns for the long-term damage to the institution.  Dr. Sawaya then explains that he uses the term “corporate” to describe a situation in which senior leaders are separated from faculty.

[The recorder is paused]

Dr. Sawaya says that an institution is greatly influenced by how a leader responds to employees’ concerns.  As MD Anderson in still in the midst of crisis, it is not possible to answer questions about this administration.

Chapter 17 (View on Career and Accomplishments)
Defining What Neurosurgery Should Be and Looking Ahead to an Institute (listen/read)

 

Topics Covered

  • Career and Accomplishments
  • Contributions to MD Anderson
  • MD Anderson Impact 
  • Professional Practice
  • The MD Anderson Ethos
  • MD Anderson Culture
  • Understanding the Institution
  • Giving Recognition
  • Dedication to MD Anderson, to Patients, to Faculty/Staff
  • Character, Values, Beliefs, Talents

Dr. Sawaya notes that he has led the development of two major programs (at MD Anderson and Baylor) and will transition out of administrative positions in each.  He would ideally like to act on his vision to create a free-standing neurosurgery institute at MD Anderson that houses all laboratory and patient care activities under one roof.  He suspects that MD Anderson is the only place in the country where this kind of development could happen.

Looking back, Dr. Sawaya states that he is pleased that he has defined neurosurgery “as what it should be.”  He makes reference to the tree image discussed in Session I, noting that this is a model that others would like to emulate, but cannot.  He emphasizes that this multi-disciplinary approach is not theory, but can and has worked and is thriving. 

Dr. Sawaya states that each member of the Department of Neurosurgery should understand that they exist in partnership with a great department with the full backing of what MD Anderson is as an institution.  MD Anderson is also stronger, he says, because of what each individual offers and creates.

 

[1] For an image of the skull base see http://chantal-gaudel.com/img/base-skull (date of access, 6 June 2013).