From the Desk of Dr. Louis M. Weiner

I just completed a truly soul-filling and remarkable weekend. David, our youngest child, got married in Annapolis, surrounded by family and friends. He and his wife Kelly are wonderful people, wise beyond their years, funny and substantive. We simply could not be happier. It was a perfect weekend, starting with a wedding rehearsal dinner on Friday evening at the Harris Crab House, followed by a small golf outing the next morning and an utterly fabulous wedding ceremony and celebration. Our families get along famously, which makes it even better. After a goodbye brunch the following morning the weekend fun continued as Ken, Sarah and Ella came back to DC so we could babysit for Ella while her mom and dad went to yet another wedding of an old college friend. Family truly comes first.

One quick story. During the processional our son Ken, the best man, had already made it up to the chupah as David walked up. Ken produced a spoon from his pocket and flashed it at his younger brother. David remained stoic. Then in the middle of the ceremony, Ken, standing behind David again produced the spoon and flashed it so his sister Elana, standing behind Kelly, could see it. Elana immediately dissolved into hysterical, silent laughter, and Sarah, standing behind Elana, followed shortly thereafter. Nobody knew what was going on, though it added a sweet levity to the proceedings. Most thought that our grandchildren, Isaac and Ella were being mischievous in one way or another, after executing their roles in the processional to absolute perfection.

Wrong. It turns out this was an ultimate “inside joke” shared by our kids. When they were young we used to have nightly family dinners where we encouraged significant conversation (e.g., soliloquies by Dad). To relieve the tedium Ken invented a game – he would surreptitiously raise a spoon to just above table level and David inevitably would dissolve into laughter for some reason. Completely unaware of what was going on, I would get upset with David. Our kids, their spouses and their cousins, call it “showing the spoon.” Harriet and I knew nothing about it until yesterday. So, while the spoon made a guest appearance 15 years after its last performance it was an offbeat symbol of the bonds between our kids that have thrived through the years, and that just made our joy at the wedding of David and Kelly that much sweeter.

So now I can get back to work without worrying about wedding arrangements, and I have a lot on my plate. For starters, we have a Lombardi-wide scientific retreat on Monday. I am really looking forward to beginning a scientific strategic planning process that will prioritize our scientific activities. I do hope to see everyone there.

One final note – congratulations to Carolyn Hurley for her recognition as a master teacher, as she will be inducted into Georgetown’s MAGIS society in May. She is such a wonderful citizen of Georgetown–a superb scientist, a dedicated and remarkable citizen of the Department and the Cancer Center, and a superb teacher to boot. She truly does it all. And, in a delicious irony, her co-inductee is Miriam Toporowicz, whose daughter officiated at David and Kelly’s wedding on Saturday evening. Go figure!

Have a great week.

After a busy week I am writing my blog on a Friday night, preparing to go up to Philadelphia to attend the AACR meeting. But, first I have something else to do.

I can’t remember if I have told this story before in a blog, but I can’t let tomorrow pass by without sharing it. Anna Krigel, the daughter of dear friends, is getting married on Saturday evening in Philadelphia, and I would not miss the event for anything. Anna’s parents, Rob and Bonnie, moved to Fox Chase when I did, and we quickly found out we had a lot in common. Like me, Rob was a hematologist/oncologist with an interest in biological therapies. Though he was two years ahead of me, he was a graduate of Penn and then Mt. Sinai, though we did not know each other then. After I met Harriet, it turned out that she and Bonnie had graduated from the same high school. Our older kids were about the same age. Anna and our son David were born about three months apart. Our families vacationed together, and Rob was my roomie on the road when we went to scientific meetings. It was as if we were living the same life.

As our careers progressed I became more lab focused; Rob became well known for his work in lymphoma, biologics and HIV. He left Fox Chase in 1993 to become director of the Lankenau Cancer Institute in Philadelphia. Six months later, just after his newly refurbished facility had been dedicated, I got a call from him in the middle of the night. “Lou, can you take me to the ER? I think I may have “perfed” an ulcer.” After an ER evaluation, he was admitted. As luck would have it I was attending on the inpatient service, so he became my patient. We assumed it would be a quick and easy problem.

It was not. An astute trainee noted significant hepatomegaly. A CT scan, and then an MRI scan showed that his liver, spleen and bones were riddled with metastases. I then did one of the hardest things I will ever have to do in my career and in my life. I had to tell my best friend and his wife the findings of the studies. He insisted on looking at the films. So we walked over to radiology, and he looked at the films. I’ll never forget his response. His face sagged, and he said, “Oh!”, with an intonation of sadness, understanding and certainty that haunts me to this day. We walked back to his room. Behind us, everybody already knew, and were crying and hugging in the hallway. He had left Fox Chase, but was genuinely beloved for his distinctive blend of warmth, compassion, intellect and excellence. He, Bonnie and I sat down in his room, and he said, “Lou, I want you to be my doctor.” I begged him to let me off the hook. How could I be objective? He insisted. We compromised and agreed that I would do it, but with the help of an experienced senior fellow who would keep me honest. Nothing could have prepared me for being his doctor, but in a very real way, this experience completed my training. I finally found myself becoming the doctor I want to be by accepting and connecting to the emotional pain that comes with severe illness. It made me more sensitive, more connected and more determined to make a difference. It is my dear friend’s enduring gift to me.

We tried everything, but six months later he succumbed to his disease, which was utterly remorseless. As he lay in his hospital bed at home, gradually slipping away, I played basketball with his 11-year old son Jonathan to distract him a bit, while Anna, who was only seven years old, watched.

Rob was only 44 years old when he died. I was asked to give a eulogy at his funeral in front of all my coworkers, neighborhood friends and his family, so many of whom I knew. It was if I was speaking at my own funeral. I still don’t know how I was able to keep a shred of composure during my remarks. After he died, Bonnie, a strong woman, reached out beyond her desperate sadness and gave me one of his precious keepsakes, a roughly hewn wooden desktop Buddha that he had received from the survivors of one of his first AIDS patients.

The years have passed, but our friendships persist. Bonnie remarried Philip, a wonderful guy, himself a widower whose wife had died of Hodgkins Disease, and welcomed into the family his daughter Rebecca, now a fabulous young woman who graduated from GW a couple of years ago. Jonathan went to Washington University in St. Louis, where our son Ken was a student and gave him the nickname, “Freshman Jon.” He went on to become a clinical psychologist, and is married, with a little girl. Anna became a doctor and is now an internal medicine resident at Columbia. When she graduated from NYU medical school, where Rob worked before coming to Fox Chase, I had the fabulous pleasure of presenting her with the Buddha, knowing how much it would mean to her. Some of you may recall that little statue, which I kept on my desk; I now keep a framed photo of it in my office. Did I mention that Anna’s new husband’s last name is Wiener? (no relation, different spelling). The circles of life are indeed mysterious.

When Anna’s husband steps on the glass at the ritual conclusion of the wedding ceremony, reminding us of the fragility of life, I will close my eyes, raise my own imaginary glass and tell Rob, “You did well, my friend. The kids are alright.” Then it will be time to have fun!

In the world of cancer research and therapy we confront death, directly or implicitly, every day. Our lives are devoted to cheating death, prolonging the inevitable and minimizing suffering. It is noble work, and it embodies the sentiments articulated by the wonderful essayist, David Brooks, in this past weekend’s New York TImes Sunday Review. In his essay, titled, “The Moral Bucket List”, he makes the distinction between the resume’ – the list of worldly accomplishments – and the moral eulogy, which celebrates the inner fire and passion that inspires the best of us to make the world a better place by caring deeply, helping and having deep concern about the welfare of others.

When our lives are devoted to the moral eulogy, it is tempting to feel smug about our virtues, and to assume that our work is indeed transformative. But death all too frequently intrudes in our lives in unpredictable and mysterious ways. This past week I received a call from my father, who told me that his dear friend Joel had unexpectedly died in his sleep, following an ordinary work day. Joel, who was 88 years old, was the founder and CEO of Lutron Industries, the designers of dimmers found in so many of our homes. Joel lived a full, satisfying and emotionally rich life, having created an astonishingly successful business and changed countless lives in the process. There is no particularly good time or way to die, but even though his death is a source of enormous sadness for those who loved him, it is not a stretch to wonder, if only philosophically, if this was the best way to leave this life. I am sure things were left unsaid, but all good lives leave unfinished business at the end.

Contrast that with a call we received last week from our next door neighbors. Their 33 year old son Tom was found dead in his apartment on Wednesday evening. Tom was born with usually fatal cardiac defects, but survived heroic surgeries and grew up to be a remarkable young man with an acutely well developed social conscience. He actively worked to support progressive politicians and political causes, A graduate of Davidson College, he was a passionate sports fan, with an uncommon devotion to the Detroit Tigers (because tigers were his favorite animals while growing up in the then-barren baseball wasteland of Washington). And, as a testament to what a nice man he was, he had an exceptionally large group of very good friends. His sudden death, apparently caused by a cardiac arrhythmia, has been a source of agonizing grief to his wonderful parents, and indeed to everybody who knew him and knows and cares about them. So, in contrast to Joel’s death, Tom’s indeed seems unfair, as he left so much on the table of life – marriage, family, more contributions to the greater good and many more baseball seasons, undulating gently through the decades to come.

So how to make sense of all this? We all spend our days and nights working towards a time when cancer is controlled or eliminated. Joel had what might be termed a “perfect” end, while Tom’s death is tragic. But, what do we want for our lives and those of our children? Perhaps it is, if David Brooks is right (and I think he is) that we leave the world a little better that we found it, and that our children do so too. In his 33 years of life (all of which could be considered “bonus time” in the cruel calculus of cardiac physiology) Tom accomplished so much through his many friendships and by working so hard to build a society that embraces equal opportunity for all. So, in my humble opinion, both Joel and Tom made the world a better place, to our benefit.

Thank you, gentlemen, you have accomplished your missions. May both of you rest easy, and may your examples inspire us in our work and lives. No good life fails to have an impact, but through our work we aim to give our patients and the recipients of our research advances more opportunities to do good. Now, that’s what I call a bucket list.

Have a great week.

I hope you shared a wonderful holiday weekend with your loved ones and friends. It was especially sweet for me, having fully recovered from my kidney stone adventures. On Tuesday, I had a cystoscopy, laser removal of the stone, and a ureteral stent placed. I was able to see some patients on Wednesday afternoon, but took it easy for the next few days, since those stents can make one uncomfortable. The stent was removed on Friday morning – don’t ask – and I immediately went home, took a brief rest and then felt completely well. So, on Friday night we had a wonderful Passover Seder at our home with our son David and his fiancee’, Kelly, and then drove up to Philadelphia on Saturday to celebrate the second Seder with many other family members. They were magical reminders of the bonds of family and shared rituals that nurture us and provide enduring value to our lives. On Sunday we spent the day with our son Ken, his wife Sarah, and Ella, joined by Elana, Ben, Isaac and Aviva, and my brother, his wife and one of their daughters to celebrate Ella’s second birthday. Can any birthday be more magical than the second one? Ella was on Cloud Nine, and took all of us there with her. The ride back, on Easter Sunday, was long and harrowing, but it sure was worth it.

While driving back I was thinking about all of the impending changes at GUMC, and also about the enduring values that are embodied by the work of Lombardi’s investigators. Just in the past week I heard about the successful grant applications of Lucile Adams-Campbell (twice!), Jeff Toretsky and Jeanne Mandelblatt. I was especially pleased for Jeanne, whose R35 grant application (a new Outstanding Investigator mechanism) received a perfect score. While a funding notice still awaits, it seems like a pretty good bet. We have terrific investigators, and they continue to thrive, even in the current challenging external environment. Moreover, Carolyn Hurley has been nominated for a Magis Award for her teaching, and I was honored to be able to vote for her. Also, Mike Atkins has been asked to speak at the plenary session of the upcoming ASCO meeting, a sure sign of the national and international respect for his work. So, even though I am not supposed to eat leavened bread on passover, it seems as if we sure are on a roll!

Have a great week. I can’t wait, now that I am back in action and raring to go. I encourage everyone to attend Jack DeGioia’s GUMC Town Hall meeting on Tuesday afternoon.