An Interview with Mary Austin-Seymour, MD, FASTRO

By Ron R. Allison, MD, FASTRO and Colleen Lawton, MD, FASTRO

The following interview of Mary Austin-Seymour, MD, FASTRO, was conducted on August 30, 2019, by Ron R. Allison, MD, FASTRO and Colleen Lawton, MD, FASTRO.

Ron Allison: Ready? Your place of birth and where did you grow up

Mary Austin-Seymour: My father was in the Air Force. And I was born in an Army hospital in Indiantown Gap, Pennsylvania. But I grew up in the Midwest, predominantly, Minnesota and Wisconsin.

Ron Allison: How many times did you move because of the Air Force?

Mary Austin-Seymour: I think three times. But then we moved a number of other times while I was growing up as well. In St. Louis -- well, Minneapolis, St. Louis, Madison, Wisconsin. Those were the main places.

Ron Allison: Very good. So where did you end up doing your high school and college?

Mary Austin-Seymour: I went to college in Madison, Wisconsin. And then I went to college at St. Olaf College in Northfield, Minnesota.

Ron Allison: And were you interested in medicine at that point?

Mary Austin-Seymour: I was definitely premed. My interest in medicine had originated because when I was quite young, I had a very good friend whose mother had significant mental health issues. And I saw the impact that it had on her family. And so I always thought that I might become a psychiatrist. I really wasn't ever very interested in that once I got to medical school. But it was like, wow. Maybe this is a career that could have a positive impact on people's lives.

My parents especially my mother held up to me that the ultimate success is to become a physician. Her mother had died of cancer when she was six. I think the death of the grandmother I never knew and that my mother barely knew was part of my path to oncology, radiation oncology.

Ron Allison: So in medical school, did you become interested in radiation or was that after medical school?

Mary Austin-Seymour: It was during medical school. I went directly on from college to medical school at the University of Chicago. And I was primarily interested in internal medicine initially because at my medical school that was held in extremely high regard. I matched for an internal medicine residency. I did a rotation in radiation oncology in the spring - I think it must have been April or so - and I just loved it. Radiation oncology was a very different world at that time. And it wasn't so difficult to get a residency position.

My husband was in law school so I knew I had to stay in Chicago. So I talked to the people at Northwestern and then I joined the Northwestern radiation oncology residency program after my PGY 1 year at Northwestern in internal medicine. And I was there two years. At that time the program was adequate but not great. And so then I looked around and was able to get a position at Stanford and spent two more years there. So I actually did a four year RadOnc residency before it was required.

Colleen Lawton: So Mary, what did your husband do during this time? There had to be a compromise.

Mary Austin-Seymour: It was tough. He had finished law school in Chicago and had a job at an excellent law firm. I was offered a position at Stanford. And I called him and told him I wanted to accept the Stanford offer on the day he learned he passed the Illinois bar. That was rough. So then he passed the California bar. Then we moved to Boston and I was at MGH, and he took the Massachusetts bar. And then I was at UW, and he took the Washington bar. And when we moved to Oregon, he drew the line and said, I am done taking bar exams.

Colleen Lawton: He must be a good test taker.

Mary Austin-Seymour: He is.

Colleen Lawton: Did you have children along anywhere along this timeframe?

Mary Austin-Seymour: I had my daughter when I did a fellowship at Lawrence Berkeley Laboratory, which was a year after I finished my residency at Stanford. And then seven-and-a-half years later in Seattle, I had my son. So they're eight years apart in school and seven-and-a-half years apart in age.

Ron Allison: You've been busy.

Mary Austin-Seymour: Yes I was busy, especially since I was in academic medicine during those years.

Ron Allison: You guys were working full time each? Who was watching the kids?

Mary Austin-Seymour: I always worked full time. My husband was a little more flexible. We had au pairs when my son was born for four years, which helped a lot. But it was a very, very busy time. And I'm sort of seeing it again. My daughter is visiting. She had the baby in June and she's an internal medicine physician. She is till on maternity leave but it's like, oh, I know all about this juggling stuff.

Colleen Lawton: And there weren't the daycares that they have today. I mean, lots of people had in-home care because daycares, I mean, they existed but they were very few and far between.

Mary Austin-Seymour: They were very hard to find.

Colleen Lawton: So next on the list of questions is, did you go straight therapy, which you did. And then where did you go from there? So you finished all your training and then --?

Mary Austin-Seymour: Right. And so, I did a one year particle fellowship at Lawrence Berkeley Laboratory, LBL treated patients on protocols with helium, neon, and silicon. That program ended probably within five years after my fellowship. My mentors were Joe Castro, Bill Saunders and George Chen. And we did all kinds 3D Planning because, of course, 3D Planning came out of the particle world, initially. And then that led to, I think, Herman Suit's interest in me as a possible candidate to do proton work in Boston.

So we then moved to Boston for that. I spent half of my time was with the proton program at the Harvard Cyclotron Laboratory and the other time at MGH. I had amazing mentors in Michael Goitein and Lynn Verhey. Living in Boston was hard for my family, hard for my husband. Anyhow, we were so far away from our families in the Midwest and the West Coast.

After that Tom Griffin offered me a job at University of Washington. I did about half to a third of my work with neutrons. The only particle I did not use were pi mesons. But otherwise, I think I have used pretty much every particle that was used therapeutically through those years. I don't think anybody is using helium and neon now, except in Europe and Japan. But I haven't exactly tracked that recently. But at any rate, that was my uniqueness as a radiation oncologist.

Ron Allison: Expand that a little bit, what do you think about the particles and the way --

Mary Austin-Seymour: I think that they all have unique places in the spectrum of radiation oncology modalities. Neutrons are biologically interesting and effective against a fairly limited range of malignancies. But nonetheless for those rare malignancies, especially salivary gland tumors, they are pretty helpful.

Neon and silicon combine the increased RBE with the Bragg peak although they have more of a tail than protons. So they're a nice mix but they're extraordinarily difficult to produce and use. So I can see why they haven't exactly built a lot of facilities for those particles in this country.

Ron Allison: So if you had your choice, would you be using photons or particles?

Mary Austin-Seymour: That's a really an interesting question. For an adenoid cystic carcinoma I would definitely use neutrons. I'm not so keen on neutrons for anything else. For paraspinal tumors, uveal melanoma, pediatric tumors, skull base tumors, I think protons are amazing. And so, yes, I would refer patients -- you know, I spent the last 12 years of my practice in a community practice. And I would refer people out for those modalities when appropriate, if they could manage it. Not everybody can manage the cost of living in a different city for a while.

I've participated in an incredible change in treatment planning in radiation oncology. As a resident we used unbelievably simplistic treatment planning off of plain films in a simulator. The field moved to a CT-based treatment planning, which I experienced fairly early in my career in the particle world. Then it gained very wide acceptance in the photon world with all the commercial products such as the development of IMRT and VMAT and Cyberknife, and all these many others that I'm not mentioning. But there's incredible precision in radiation oncology now. Photons can compete with protons in many tumor sites.

Colleen Lawton: You're not going to get a disagreement from me but that's right.

Mary Austin-Seymour: It seems to be a somewhat polarizing topic.

Colleen Lawton: Well, for common tumors, I think that's a problem. You know, if you're talking about breast and prostate, I'm sorry but it doesn't. And yet to your point, there are just some amazing things that the protons can do. But I think we already have enough of those in our country and in the world that we don't need anymore. But that doesn't sell machines though.

Mary Austin-Seymour: Yes.

Ron Allison: So you were in academic practice for quite a while and then into community practice. Can you talk a little bit about that?

Mary Austin-Seymour: So I was in academic practice in Boston and then at UW for a total of 18 years. And I loved it. I became the vice chairman of my department at UW, and I loved that at first too. But the balancing of patient care, teaching residents, doing research, and administrative work became increasingly challenging with time.

The final straw was actually the hospital's unwillingness to give us up to date software and hardware. And it was like hitting my head against the wall. We didn't have direct transfer treatment plans even when I left in 2006, which was kind of appalling. And then shortly after I left, somehow they got the message. I don't necessarily think it was my departure. But they upgraded everything. So that problem was solved. But they burned me out, honestly.

So I decided to return to what I loved best about radiation oncology and that was taking care of patients. So it was a bit of a change because I had done the particle work and my other areas of expertise were breast cancer and head and neck cancer. I took a job in a community practice in Corvallis Oregon. I know some community practices are differently organized. We were a small group, only three of us and we all saw all types of cancers. So I quickly had to get up to speed treating everything. So that was a nice challenge.

Colleen Lawton: And Mary, through -- sorry. Through of all this, so I would ask you two questions. The first is, generally, who were your mentors. And specifically, beyond that, who was a mentor from a perspective of a female mentor that you could look to, to balance all of the aspects of your career including your family?

Mary Austin-Seymour: I would say my first academic mentors came from my training at Stanford. Rich Hoppe was the director of the residency program in my residency years. And I was lucky and then I got to work with Henry Kaplan. He died six months after I finished my residency. And so I got to experience working with him and his insights and the way that he managed patients. That was really quite lovely.

And of course, there is Sarah Donaldson who was a great mentor as far as a woman in medicine. Because she was even further on the forefront than I was. When I went to medical school at the University of Chicago, 25 percent of our class were women. But it took, I think, another decade for the entire field of medicine to catch up with that. And then of course, when my daughter went to medical school, half the students were female.

And then in my first academic job. I mentioned my mentors at Lawrence Berkeley Laboratory. And then at MGH, Herman Suit was a brilliant man and held up the highest possible standards to me. He was a leader who could do everything and extremely well - everything. And he was very good at having me explore all the different things that I could potentially do and challenging me to really produce. And I participated with some wonderful teams. As far as academic mentoring, I would have to give a lot of credit to the medical physicists that I worked with as well. George Chen at the Lawrence Berkeley Laboratory and Michael Goitein and Lynn Verhey at MGH in the proton project were brilliant people who loved to collaborate with physicians in clinical work. We were really exploring what we could do with protons.

I don't know if any of you ever saw the Harvard Cyclotron Laboratory. The patients would be, "Oh, my gosh. I'm going to be treated at the Harvard Cyclotron Laboratory." And it was this whole building. It's been demolished subsequently, obviously, when they built the facility at the hospital. But it was tube computer technology. We treated patients seated in a chair with a fixed horizontal beam coming out of the wall. And for the prostate, we used a perineal approach. That was the only way. We only had about 16 centimeters of range. That was the only we could get to those areas. So there was a lot of creativity required on the part of physicists and treatment planners to accomplish that. And Michael Goitein and Lynn Verhey were just inspirational thinkers and also really expanded my horizons. And I learned so much from them.

And as far as the parenting and academic balancing, that's harder. There were fewer women in radiation oncology who had children. There was a woman at MGH, Rita Linggood, who is British. Her kids are actually about the same age as my daughter. And so we bonded. Her husband at that time - he's now deceased - was also a lawyer. So we had that in common. And we were really quite good friends. We shared notes about how we were managing. So she was helpful.

I learned a lot from my colleagues at UW about neutrons when I was first there. George Laramore was the chair while I was vice chair. I learned a lot from him about leadership. So I've had many wonderful mentors in my life.

Ron Allison: Can you tell us a little bit about ASTRO and those organizations?

Mary Austin-Seymour: Initially I had done a variety of low level things with ASTRO, the nominating committee, et cetera. And then I went up for treasurer and actually won the election, which was very exciting for me. It fit with some of my natural interests in terms of finance and investments. So I was treasurer from '98 to 2000, which were very exciting times because that was when ASTRO became an organization independent of the ACR. But for instance as treasurer, ACR did my budget for me the first year. I didn't have to do a thing. And they took care of all the accounting. And basically, we were like a tiny section of the ACR.

And the decision was made by Larry Kun and Chris Rose in Larry's presidency to become entirely separate administratively, to have our own director, to have our own organization. We had sometimes separate interests when it came to negotiating with what was then HCFA (now CMS) and insurance companies - maybe separate interests when it came to lobbying.

And so that was a very exciting time to be involved with ASTRO as we became independent and spread our wings. As treasurer, I helped write the new investment policy. We didn't have our own investment policy before. I mean, we’d had funds invested in the market but they were managed by the ACR people. Then we hired our own manager for the investments, who had then several other managers who were experts in the various types of investments that we were participating in.

And I wrote my own first budget, of course, collaborating with the staff at ASTRO. It was a time of a lot of change. And we were all learning together. I remember I'd go to the board meetings and Larry and Chris would be pacing the halls of the hotel beforehand talking about strategy and how to accomplish this difficult separation and really becoming independent. This takes a whole different kind of infrastructure than ASTRO had previously had.

So that was a very exciting time. By the time I finished being treasurer in 2000, we had mostly figured all of this out. And we could hand it over to the next executive committee, treasurer, et cetera, and it was in place. But getting it in place was I was really only involved with the financial part of it as the treasurer and in the finance committee.

I would also like to give credit to my father, who was an equity manager. Colleen may know WARF, Wisconsin Alumni Research Foundation in Madison. My father was the equity manager for WARF for many years. And then he went into the private sector equity funds. He had also worked with numerous nonprofits and was very familiar with investment policies. So Larry and Chris would say, "We wish you'd bring your dad along sometimes so we could thank him for all of his work." So my father was incredibly helpful to me. He's now deceased from pancreatic cancer.

Colleen Lawton: So Mary, I know at one point ASTRO reached out to you to consider running for president. Am I correct about that?

Mary Austin-Seymour: You are.

Colleen Lawton: Tell me, I think the answer was no. But help us to understand what your thoughts were about that.

Mary Austin-Seymour: I did run. But I just lost.

Colleen Lawton: Okay. Very well. Who did you run against? Someone?

Mary Austin-Seymour: A man, I know that. I could tell you if I just looked up the past presidents. It was a while ago. It was a very difficult time for my family. My daughter was diagnosed with diffuse large B cell lymphoma.

Colleen Lawton: Oh, my goodness.

Mary Austin-Seymour: She was successfully treated at the Seattle Cancer Care Alliance. Since I was in the middle of all that, I was not sure that I should run. But Lou Harrison encouraged me to run. I think he was chairman of the board at that time. He said, you know, in your first year as president-elect, you're just learning. And I also my board experiences to draw on. So I did agree to run. But honestly, I was kind of relieved when I lost because that was a very hard time emotionally. There were other events in the extended family.

Colleen Lawton: And she is well now?

Mary Austin-Seymour: She is completely well. Ten years out.

Colleen Lawton: Oh, my God. Thank, God.

Mary Austin-Seymour: She has a child, it's all great.

Ron Allison: Congratulations.

Mary Austin-Seymour: All great.

Colleen Lawton: Yeah. I'm so sorry you walked through those steps. Good Lord.

Mary Austin-Seymour: Well, you know, you learn. I also had DCIS myself just as I got elected to treasurer. And so walking those steps really gives you insights. You ultimately gain from that experience. Obviously, we're both very well. So this is all great.

Colleen Lawton: Thank God.

Ron Allison: Can you tell us a little bit more about ASTRO and your involvement during the years, anything else that you wanted to mention?

Mary Austin-Seymour: So after I was on the board of directors and treasurer, there was a little bit of a gap. And I took over -- I believe, Colleen, this was your project - the corporate relations effort.

Colleen Lawton: Oh, gosh. Yeah.

Mary Austin-Seymour: Yes. So it was your effort. But then you were elected to another position as I recall.

Colleen Lawton: Yeah. I think I ended up on the board.

Mary Austin-Seymour: So then I became the chair of the first corporate relations committee. I mean, I don't think it was actually formally a committee when you were working at it. I could be wrong about that.

Colleen Lawton: I think it was just a council. I can't remember.

Mary Austin-Seymour: Yes. I think it was just the council. And then it became a committee. And it became a pretty big deal. And what was exciting about that was, again, it was a whole new thing. And there were various models as we all know in terms of relations with corporations. And there was the model where, maybe, the corporations had a little bit too much to say about how the program would be run. And then there was a model where that was hands off and ASTRO chose this approach. The corporations don't really have anything to do with the operation of the annual meeting or ASTRO policies or anything like that even when there could be big conflicts. We also had a meeting at the end of every annual meeting. And oh, my goodness, there would be grief coming from the corporate members and the exhibitors. But you know --

Colleen Lawton: Oh, god. I remember those. It's, like, my least favorite thing to do. We just go in and get yelled at. Yeah. That was awful.

Mary Austin-Seymour: I know. Fortunately, it was right before you got to go home.

Colleen Lawton: Yeah. Exactly.

Mary Austin-Seymour: ASTRO really maintained independence from the corporate members. Cheryl Reinhardt was a genius at doing it. She could have great relationships with corporations and get their support, but not really handing the reins to them at all. Everything that ASTRO did was hands off to them. There was a corporate council, of course. And so we heard what they had to say. But it was heard and that was about it. So I think we handled it really quite well.

There was some pushback from the members, too. You know, “what's the deal with all these corporations having big banners reflecting their level of support?” And that's become much more common. And anybody who knows anything about ASTRO finances understood the value of a corporate membership and sponsorship to the organization and the tremendous value on the annual meeting to the organization.

So I led that committee for about six years or something like that. I became past chair.

Then the board decided to have an ethics committee and a conflict of interest committee. Larry Kun was the chair of the conflict of interest committee and I was the vice chair. And this was a whole new endeavor for ASTRO. I just went off the committee maybe a year ago. It's been a major learning experience for everybody involved - the individuals who suddenly can't be on the advisory board while they're on the board of directors because of the conflict of interest. And again, it was a whole new area. There definitely was some pushback but very exciting and interesting to figure out what was really a conflict of interest and what wasn't.

And again, it was great to work with Larry in that role. I was supposed to be teed up to be the next chairman when my father developed pancreatic cancer. So I did not do that. There was too much family support required. So then David Brizel I think took over that and then became the chair. My memory may be incorrect on that. Laura Gogal was very effective on the committee and very helpful in helping to sort out these issues. One of the tests we would talk about frequently was the New York Times test. And it wasn't that long ago that the Memorial Sloan Kettering failed the New York Times test, as you all remember, right?

Ron Allison: Front page.

Mary Austin-Seymour: Exactly. Front page.

Ron Allison: You don't need that.

Mary Austin-Seymour: We were grateful that we had taken a pretty conservative approach to the whole conflict of interest issue. But we had to develop many policies and hash them out and rethink them as new situations came up. And it was also very exciting. I would have to say that all my involvement with ASTRO has greatly expanded my horizons and led me to think about some very difficult issues at times.

Ron Allison: You made a great contribution, too. So thank you for that. There's no doubt about it. Are there other major organizations that you've been involved with, like RTOG or anything?

Mary Austin-Seymour: No. I mean, ASTRO was really my main emphasis. I was chairman of our cancer committee here in Corvallis, ran our tumor board, and was responsible for getting our commission on cancer accreditation. That was at a much more local level.

Ron Allison: Before we move away from ASTRO, is there anything else you might want to have brought up or mentioned off the top of your head?

Mary Austin-Seymour: Not off the top of my head, no. No.

Ron Allison: Okay. So there's a big dark line. They want to know all about controversies in your career that's impacted your practice and research. Did you want to mention anything in particular?

Mary Austin-Seymour: Well, you know, as I alluded to earlier, there was always the great proton versus photon question. Colleen Lawton: Clearly, that's a major, it's still applicable today.

Ron Allison: Yeah, it always will be.

Colleen Lawton: Yeah, probably.

Ron Allison: So do you think being a sophisticated analysis is detrimental to your career when you know too much about it or --?

Mary Austin-Seymour: Well, I ended up in community practice on kind of being on both sides of it. I would certainly refer patients out with the tumors that I thought were best treated with those modalities. But when it came to things like prostate cancer, I was less convinced compared with the techniques that we used here even to treat those patients. And frequently, the patients would start the process— the insurance companies would then turn them down for getting treatment with protons. And they had gone that way all on their own and then would come back to me.

So I think that one of the treatment de-escalation in HPV positive head and neck cancers was very much a question. Just before I retired, I think some de-escalation was beginning. And I believe that a lot more has happened since then. We always knew those were a little bit different head and neck cancers than your typical smoker/drinker head and neck cancer, and responded to treatment differently, and were much more likely to be cured with standard treatment. They probably were over treated, I think, is what the conclusion has become. But that was an interesting controversy.

Ron Allison: I'm sorry. Had you de-escalated your dose before a lot of the publications because you had a large patient volume for that?

Mary Austin-Seymour: I hadn't. I retired in February of 2018. And the data was just starting to come out in the meetings and in the literature. And probably with a systemic treatment we'd be a little less likely to push it hard and tolerate sometimes a slight reduction in dose. But nothing major like I think is going on now in terms of less neck treatment required and less dose.

We were kind of heading that way but we were still, in the community practice, we followed the NCCN guidelines. We thought the treatment might not need to be as intensive but in order to not under treat people, we recommended following the same guidelines that we have for all squamous cell cancers. But I think that is changing.

Partial breast radiation became, of course, a great interest through all those years. I had participated in implants with way back at my Stanford residency and fewer in my own work at UW. But then we did get a Xoft unit that we did use for selected appropriate localized great cancers. We served a large geography all the way from the coast to the foothills of the Cascades. But some of the patients come from as far away as 100 miles. So those techniques were really helpful in that setting. So, clinically I think those were the major controversies that I dealt with.

Ron Allison: How about in your practice, any controversies in your practice? Have you ever felt like somebody said, "Well, she can't do this job" or anything like that?

Mary Austin-Seymour: That's an interesting question. You know, being a woman in medicine, I was always wondering, am I good enough to do this? Work harder. Study harder. Do better all the way to not have that feeling of not being quite as a good or whatever. I would say in medical school - I was in medical school from '74 to '78 - many things were said at that time to women individually and as a group, which would be highly offensive today. But it was a different world.

But after that in radiation oncology, I found that I mostly had tremendous support from both men and women attendings in my residencies and my faculty members as I progressed through my career. I mean, there was an occasional situation. But that was pretty rare. I'd say most of them were pretty supportive.

Ron Allison: Can I ask you this? Radiation technicians historically had been female. Did you have any issues that way?

Mary Austin-Seymour: Well, the nurses were mostly female. You know, because I did so much cutting edge stuff with the particles, I would say that the therapists that I worked with were half female and half male. I don't really remember having much pushback from the female therapists. I've always tried to be a fairly collegial person and value the participation of each member of the team and what they uniquely contribute to the care of the patient.

Colleen Lawton: Mary, what about patients?

Mary Austin-Seymour: Well, that was harder. I remember patients, especially when I was first in the field, when I was a resident saying, “you look like you're in high school or something like that”.

Colleen Lawton: I guess that's a good problem.

Mary Austin-Seymour: I suppose.

Colleen Lawton: Yeah, I know. Yeah.

Mary Austin-Seymour: Now I see the other side of it. You have patients in their 60s and 70s and they have no idea if you're 30, 25, or even 40. But I think that there was. I would have pushback from men, a male patient sometimes. In part, I think, I was protected from that, especially if they came to MGH for protons or they came to UW for neutrons. “We can't believe that she is the expert. But, you know, she is what we've got so we'll go with her.”

Ron Allison: So we're getting closer to the end and I want to make sure we get the last few even though we've touched on it. So you've already participated in the future of oncology but on the cutting edge, what do you think the next set of cutting edges are?

Mary Austin-Seymour: Now, keep in mind I haven't been doing this for almost a-year-and-a-half now. But I think we do a fantastic job on treating the tumor, defining the tumor and the appropriate target volumes and the involved or at-risk lymph nodes and knowing where they are. I think imaging is incredibly important. And I think metabolic imaging in particular is going to make our modality even more powerful as we're able to integrate that information into our very accurate treatments.

I was lucky enough when I was UW we were very active in what they called functional imaging section at that time. They do metabolic imaging with all kinds of different labels which yields a variety of different kinds of information. Of course, in the community, we have PET and PET fusion, the usual MRI and CT and all that. But I think the metabolic imaging is really powerful to assist us in our treatments.

Ron Allison: Back when you were at UW, were they able to use that clinically or was that more here and there?

Mary Austin-Seymour: Well, it was a mixture. A lot of those were research protocols. Image fusion technology was pretty primitive at that time. That's a more recent development in radiation treatment planning. Fusion techniques, obviously, are helpful with the metabolic imaging as both of those get better and better.

I think in the area tumor motion is we're making good progress with gating and I know there's all kinds of other fancy words for what we do now. Tracking the motion of the tumor and dealing with that is also part of the future.

Ron Allison: Yeah.

Colleen Lawton: I agree.

Ron Allison: So back in the day, did you go to the radiologist to have them help you define targets and see what --

Mary Austin-Seymour: All the time.

Ron Allison: Did you ever get the feeling they were helping you?

Mary Austin-Seymour: To the best of their ability because the reports would be pretty vague. Even here, we were in a separate building so it wasn't as convenient. At UW, the diagnostic radiology was immediately above us. And it was really easy to pop up there and talk to them. And I loved that. I got to know them pretty well here, too. They can say it was broad brush strokes about the tumor location. But we're dependent on, well, is it here or is it here? Where is that edge?

And actually depending on the radiologist, they actually for the most part, especially, in academic centers were very interested in helping me in thinking on a deeper kind of way about tumor localization and possible micrometastatic disease localization. So I found them to be for the most part pretty helpful.

Ron Allison: Now, once upon a time diagnostic and therapy where intermixed for most of the residencies. Do you think there's any reason to go back to something like that?

Mary Austin-Seymour: No I don’t think so since both areas are incredibly complex. I think we need to have good training in radiation oncology residencies about imaging. It is important to know how to read the images and how to work collaboratively with a radiologist and get the information that you need for treatment planning.

I did my residency like eons ago. And I think they had just split. And I knew plenty of attendings who had been trained in both. But I think to do that today you would end up superficially trained in both and an expert in nothing. Are they talking about that again?

Ron Allison: No. No. I was just curious of what you thought about it. Would you give any advice to anybody thinking about radiation now or how they would develop their career?

Mary Austin-Seymour: I have been involved with residents and medical students rotating through and helping them think about if it's the right thing for them. Radiation oncology is “high touch and high tech”. So it's both. So you have to be someone who loves both of those things - intense involvement with the patient and their family and also ability to work at a very high level thinking about tumor localization, treatment planning and working with the staff to do so.

Colleen Lawton: But I think your point is well taken, Mary, that we as a field can get really wound up with all of our biologic imaging and all this kind of stuff and forget to touch the patient and examine the patient, and that kind of stuff. So kudos to you to remember, that it takes both not just one.

Mary Austin-Seymour: Really good patient communication skills are very important. We have to be really good at telling people in simple words very complicated concepts. And it's a challenge.

Ron Allison: All right. It certainly is. The last couple of questions and then we'll open up to make sure that we didn't forget anything. You had touched on your family, thank you for that. Did you want to expand on any family members or anything in that regard?

Mary Austin-Seymour: Well, I think that my parent's high regard for medicine came through. My brother is a pathologist and my sister is an ophthalmologist. And she married an anesthesiologist. So we're a pretty medically intensive family. My daughter is the first of the next generation to enter medicine as a career. Maybe there will be others.

Ron Allison: Congratulations then. So you're retired and you're busy, right? Busier, or what do you do now that you're retired?

Mary Austin-Seymour: Retirement is a big change. My grandson is a source of great joy. When his parents go back to work, my husband and I are going to be taking care of him two days a week. We rented an apartment up there in Vancouver, Washington where they live. And so being retired, I have the ability to participate in that, which is really, really a gift. And otherwise, I've been participating in a variety of activities. I'm taking better care of myself physically. We have always hiked frequently. Now I am doing even more hiking and going to a trainer. One area I have difficulty with is that I loved what I did, and I understood that what I was doing was of great value and importance to my patients. So the biggest hole in my life after retiring was doing something of meaning to other people and being of service as well.

So I'm becoming active in our local domestic violence organization. I've done the 40-hour training. And I'm now doing shadowing. And eventually, I'll be on my own working in the shelters. I am also beginning to work as a volunteer at a Free Clinic in Vancouver Washington.

Ron Allison: So when did you start thinking about retirement? Was this a sudden thing or a couple of years? What brought you into retirement?

Mary Austin-Seymour: Well, my husband has retired. He was teaching at Oregon State University. He retired, probably, two years before I did. And so there was that talk between the two of us. There were also some difficulties within our practice. So it was kind of a mixture of personal and practical considerations especially for the future of the practice. I mean, I think I did improve the quality of the practice significantly while I was there. And I wanted to make sure that we would be able to hire really talented doctors who would continue at that level with the practice. It was a legacy that I wanted to leave with this practice. It was a rough transition but it's all fine now.

Ron Allison: Any locum tenens? Did you want to do any locum tenens back at your practice, to keep an eye on anyone?

Mary Austin-Seymour: Unfortunately my malpractice company made me sign that I would never practice medicine for pay in the future unless I kept paying my premiums. So I can work at volunteer clinics and am doing so in an urgent care center for indigent and uninsured patients.

Colleen Lawton: Maybe it's a blessing in disguise because it allows you to do this volunteer work that, maybe, you wouldn't have considered as strongly before. So who knows?

Mary Austin-Seymour: Well, possibly true.

Ron Allison: Okay. Do you want to leave us with any words of wisdom or anything we've forgotten or anything that you want to add?

Mary Austin-Seymour: No. This has been great.

Ron Allison: Well, I'm very delighted to speak to you on this. And I'm honored to be part of it. So thank you.

Colleen Lawton: Yeah, Mary. Thank you so much for your time. It was enlightening and it certainly brings back some fond old memories.

Mary Austin-Seymour: Well, it's great to talk to the two of you. Thank you so much.