Conducted on Tuesday, August 4, 3:45 p.m.
ASTRO: Let me start by offering sincere congratulations on your being selected as ASTRO Honorary Member this year.
Dr. Lawrence: I’m very flattered! I think it’s just because I’ve outlived everybody else. [laughter] The people who proposed me were so nice. I am really flattered by this most unexpected honor at this late time in my life.
ASTRO: In 2015, you wrote a letter to aspiring physicians that was published in the Richmond Times-Dispatch that included this quote: “Every day is filled with new ideas (and problems), and every day is filled as well with wonderful interactions with patients, colleagues and, for some of us, medical students. For me, this variety makes every new day exciting.” What was the response to the letter, and how have you continued to inspire new doctors entering the field of medicine?
Dr. Lawrence: I had been chairman of admissions when I retired, and so the editor of the paper who knew me asked me to write it for a magazine that accompanies their paper periodically. Of course, medical students don’t read newspapers anymore! [laugher]. I did get responses to that letter from physicians and non-physicians who liked it. But then later, when I retired from the admissions process, and was then still teaching students, a number of the students told me that the current dean of student admissions distributed that old letter as sort of a reprint, so I did get some feedback from them.
ASTRO: How do you continue to inspire new doctors entering the field of medicine today?
Dr. Lawrence: I like to do it in tutorial sessions with the students to give them the idea there’s more to medicine than just doing tests or science. I always point out that medicine is sort of a mixture of science and social work, and I try to give them some thoughts about how you deal with patients when they have a problem and how important it is to listen and take histories and do physical exams. I’m trying to do the human side.
ASTRO: Isn’t that a great deal of it, though, the human side?
Dr. Lawrence: Most people who are in practice certainly learn that.
ASTRO: From 1952 to 1954, you served as Chief of Surgery for the 46th Army Surgical Hospital in Korea. What did you learn from your Army days about practicing medicine?
Dr. Lawrence: Well, I had almost finished my training when I went into the Army over to Korea. The first thing I got out of it was confidence. I suddenly realized I’d been supervised up till then as a resident, so it gave me lots of confidence being able to feel that I could do thing satisfactorily. The other thing I learned was how important it is to have follow-up and long-term follow-up on your patients. Because in the Army, when you operate in a M*A*S*H hospital near the front lines, you never see [the patients] again. In fact, they’re already evacuated in an ambulance while you’re operating on the next one. I came to the conclusion that surgery requires long term connections with your patients. I decided also that trauma surgery was the last thing in life I wanted to do.
ASTRO: Dr. Harry Bear wrote that “Hawkeye” from [the television series] M*A*S*H could possibly have been characterized after you.
Dr. Lawrence: That’s funny! There were several M*A*S*H hospitals in Korea. But I think all of us wanted to be known as the person Hawkeye was fashioned after, because we found him so delightful on the program. Harry was one of my students, then residents, and then partners, who wrote this nice thing about me in which he mentioned that I might be the person that was modeled for that program. But I think several other guys who had the same job have been also identified as the model. The practical fact is, I think whoever wrote that probably had some experience at some M*A*S*H other than mine. But I don’t mind them claiming I was the model, because I like Hawkeye so much in those programs.
ASTRO: You have trained hundreds of surgeons over the course of your career. Does any one event stand out in your mind as an example of focusing on what matters most?
Dr. Lawrence: There is one I remember very well. I moved from New York at Cornell to the medical college of Virginia here in Richmond. It was a time when we were doing what they called the bilateral adrenalectomy for breast cancer. I helped one of the senior residents do a bilateral adrenalectomy, and I saw the patient in the recovery room about suppertime and she had some problems. So, I called the resident to tell him about it and he made the mistake of saying he wasn’t on call. Of course, I was trained to think that once you operated on somebody or took care of them, you had a lot of responsibility. I gave him some kind of quite definite comment about getting down there to see the patient with me. And the thing that’s interesting and the reason I remember it is, he became the most conscientious surgeon I ever knew. I followed him all the way to his retirement in surgery, and we’re still very good friends.
ASTRO: You embraced radiotherapy as a crucial adjunct to surgery, in particular, post-operative radiotherapy for sarcomas and the effects of radiotherapy on wound healing. What was it about radiotherapy that first interested you and why?
Dr. Lawrence: When I finished my residency, I went to Memorial Sloan Kettering [at that time, Sloan Kettering Institute] for a fellowship. When you went for a fellowship in surgery in those days at Memorial, you had training in radiation therapy as part of your training. I had six months of training and I had very good friends and mentors that I was really impressed with...they were all radiotherapists there, and I got interested because it was clear that radiation therapy helped us out of the fact that we had failures in surgery. One of my concerns was its impact on wound healing, so while I was there, I initiated some animal studies on timing of radiation therapy and surgery as to when it was safe to operate after radiation therapy. It wasn’t that I was so brilliant; we were thrown into radiation oncology as fellows and I found it very fascinating. Some of my early papers were on wound healing in rats and radiation. There’s a big impact of radiation therapy on the actual wound healing process. The purpose of my research was to find out when the wound healing is improved enough to be safe to operate.
ASTRO: You are also credited with embracing multidisciplinary management of cancer. What is important when collaborating with other physicians, especially those whose philosophy differs from your own?
Dr. Lawrence: Well, all of us, whatever our specialty…we all get biased, and it took me a while to learn that I was just as biased as the rest of them. So I accept the fact that we all are cheerleaders for our own specialty, but I also know that we all have failures, and the teaming up of combination therapy has clearly shown benefits in so many ways over the time I’ve been working in this field. I think if we can learn to work together it works out better than ever.
ASTRO: You’re considered one of the “founding fathers” of surgical oncology and early on recognized the potential for combining surgery with chemotherapy and radiation therapy to improve the outcomes of cancer treatment. As an oncology surgeon, what about radiation therapy led you to embrace it in this multi-modal approach?
Dr. Lawrence: Well, part of my feeling was based on that experience at Memorial where we were having to deal with our with failures and finding teamwork sometimes worked better. The other is, the National Surgical Adjuvant Breast Cancer Project that Bernie Fisher started. We were overtreating a lot of patients surgically, breast cancer being the best of all in terms of examples. By working in combination with our fellow specialists in oncology, both in radiation and in chemotherapy, we were able to make our surgery less horrifying. Experience with team members in the other specialties got my thinking straight, I think. But this business of being any kind of visionary or leader: there were other people at the same time in surgery that had the same attitudes that I did, it’s just that I’ve outlived them. [laughter]
ASTRO: Well your peers have called you a visionary, and you’re named ASTRO 2020 Honorary Member for your life’s work. What do you take away from these honors?
Dr. Lawrence: Well, first of all, it’s very flattering. ASTRO is a wonderful organization in today's oncology world, and I am particularly grateful to my good friends in radiation oncology who thought I was worthy of this wonderful recognition! At the beginning, there were a number of us that had the same ideas. What I am really proud of in all this is that when I left Memorial, where we called ourselves cancer surgeons, I decided that if I went to a university department like I did here in Richmond, I wanted to have a — not a true specialty — just sort of a hobby group in surgery that knew more about cancer. I called it the division of surgical oncology. What I’m proud of is that the very first university division of surgical oncology was the one here in Richmond. About a third of the departments around the country had developed a division of surgical oncology within that very first 10 years after we initiated it here. So, I guess when I think of “What have I accomplished?” I got this idea of surgical oncology being an area of special interest to work with other specialties and do clinical trials. Even though I wasn’t the only one that thought of it, I got there first.
ASTRO: Lastly, you have lived in Richmond for over 54 years, but you were born in and attended school in Chicago. Cubs or Sox?
ASTRO: Oh! Always a Cubs fan!