HCDM 37 | Pediatric Oncologist

 

What is it like to take care of patients with cancer, particularly pediatric patients? Richard Marn, MD brings over to the show someone who can answer that question and more. He interviews Dr. Alexander Chou, a pediatric oncologist specializing in the treatment of pediatric sarcomas, rare cancers of the bone, and soft tissues. Dr. Chou takes us into his profession, sharing the challenges and disheartening situations of seeing kids fighting for their lives and how he helps them along the way. Speaking to those interested in pursuing this field, he then shares his experiences in medical school, what students need to think and prepare, and what he thinks the future will look like for the profession.

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The Challenges Of Being A Pediatric Oncologist With Dr. Alexander Chou

Have you ever wondered what it’s like to take care of patients with cancer? What if that patient is a pediatric patient, a child who has cancer? Taking care of those patients on a routine basis must have some notable challenges. In this episode, we’re going to talk to a pediatric oncologist, someone who specializes in children and his sub-specialty being sarcoma. His name is Dr. Alexander Chou. Alex works in New York City. He’s a great friend of our family. His two kids also happen to be best friends of my two kids. It’s awesome and wonderful to have him as a guest on this show.

A little bit about Alex, he received his undergraduate degree at the University of Pennsylvania with a specialty in Biology. He then went on to Cornell University Medical College, where he got his MD degree. He did an internship in Pediatrics at New York-Presbyterian Hospital/Weill Medical Center and did his pediatric hematology-oncology fellowship at Memorial Sloan Kettering Cancer Center. After his fellowship, he stayed on as an instructor and assistant professor at Memorial Sloan Kettering Hospital. In the last few years, he’s now been at the Albert Einstein College of Medicine and Children’s Hospital at Montefiore, where he’s an Associate Professor, Medical Director and Clinical Director for the Division of Pediatric Hematology-Oncology.

He would soon be transitioning in February of 2021 as a Director of Clinical Services for Pediatric Oncology at Weill Cornell. He’s an academic clinician and physician. He not only takes care of patients but also teaches medical students, residents and fellows. He’s involved in the research. He’s put up a number of papers and several book chapters and has some administrative duties as well. Before we jump into his interview and conversation, check out my Instagram account, @DrRichardMarn. If you like what you read on this blog, please rate us in whatever app you use or listened to. I’d love to hear feedback from you if there’s any way that I could help improve this show for you. Let’s jump into this conversation with Alex.

Alex. How are you doing?

I’m good, Uncle Rich. That’s how we know you as, Dr. Richard.

How do we know each other?

We live in the same building.

You do look familiar. I thought I saw you. People reading, Uncle Alex’s kids are best buds with my kids. They grew up together when they could barely walk.

They met in the mailroom.

They’ve taken pictures there. Is that where they met?

That’s what they say.

Let’s get to the meat of this episode. We’ve known each other for a long time. We’re both in healthcare. Alex is a pediatrician that specializes in oncology or cancer. I would think that’s a little niche field especially because you’re a specialty within the specialty of oncology. Anyway, tell me how you describe your career and what you do.

I take care of kids with cancer. I always knew I wanted to be a pediatrician. I always knew I wanted to work with kids but I didn’t always think that I would be taking care of cancer. It was during residency that through a whole host of different experiences and meeting this 110 that made me realize that the things I wanted to do with medicine and what I’m good at encompassed in all of pediatric oncology.

What do you do in pediatric oncology? You only take care of kids who have cancer.

Pretty much.

What kind of cancers are these kids have that you’re taking care of?

My particular sub-specialty is I take care of kids with sarcomas. These are cancers of the bone and muscle. In terms of taking care of cancer, the most common type of patient cancer are things called leukemia and blood cancers, and that’s by far, in a way, the most common type. I take care of a type that counts for a 10th of the kinds of cancers that you see in kids. Kids’ cancers are rare. If you think of the number of cases of breast cancer or prostate cancer, all those other adult types of cancers, there have been hundreds of thousands a year. Kids with cancer, we only see on the whole, 12,000 to 15,000 new cases each year. It’s a small sub-specialty.

You also take care of other kids with cancers, but for sarcoma, you’ll be one of those people that people could refer to you because of taking care of those cases. Tell me what that experience is like taking care of those kids because sometimes, it’s disheartening.

It can be. One of the misconceptions or misnomers about what I do is when I go to a social event or meet someone, “What do you do?” “I’m a Pediatric Oncologist.” They’re like, “It’s a sad face.” They walk away from you and they’re like. “I don’t want to talk to that guy, that guy has bad stories.” The truth is, in our field, we cure 70% to 80% of all the kids that come to us. Years ago, close to 100% of kids that were diagnosed with cancer died. I can cure 70% to 80% of them. It’s always hard. Anyone who talks about having cancer as a child is always hard because their life is entirely interrupted.

Imagine their future to be is changed forever and that’s scary. The truth of it is nowadays, we can cure mostly kids that we see. I get to be part of that team that cures these kids. They come in with sarcoma. Again, these are cancers of the bone and muscles. They can’t play football or basketball because their knee hurts or whatever. I work with other specialists and we give them different medications. We even do surgery. At the end of nine months or so, you’re more often than not, cured of cancer. They go on and live incredibly fruitful full lives.

Would you say that’s the best part of your job?

It is. Also, there were a bunch of great parts of my job. I get to know these kids and their families. As you can imagine, when someone’s side of this cancer, it’s an intense time in their lives. I had the privilege of being a part of that. These families allowed me into their lives to help them. I talked to them sometimes daily and I get to be a huge part of their lives. It’s not the treatment part of it, but I’ve been invited to kids’ graduations and their weddings. They started the family after. They sent me their pictures of their kids. I would say the best part of my job is getting to know these families, but then seeing these kids grow up and become extraordinary people because this ordeal that they’ve had to go through changes them. Some of them pursue music to express themselves. Others become doctors and this experience has changed them that they want to do the same thing and help another child.

That’s different than my job.

What do you mean? You make me feel good.

Having cancer as a child is always hard because their life is entirely interrupted, and their future is changed forever. Click To Tweet

Anesthesiologist? Who’s that? I don’t remember any anesthesiologist when I had my surgery.

You did your job, right?

Presumably. Would you say that the least favorite part of the job is what I envisioned?

Probably. If you look at the different subspecialties in pediatrics. The different kinds of medicine of practice in taking care of children. There is cardiology, heart-pulmonology, there’s the lungs, asthma, or all these things. Pediatric oncology has the largest share of seeing kids die. That’s the hardest part of the job. Even the fewest 70% to 80%, there’s still that 20% or 30% that we can’t get. That’s the hardest part. I’ve been in this for many years. I’ve seen my fair share, you lost my fair share of it. It doesn’t get any easier but thankfully, we can cure a good number.

What is your typical day like?

It depends. One of the things about this field is there’s a lot of variety. Meaning that most pediatric oncologists are not in private practice. They are not employed by themselves or they’re not a small private practice group. They were put in a hospital. Most hospitals, especially the type of care that we deliver, need to be attached to a medical school. Part of what we do is taking care of patients and part of it is teaching. Teaching medical students, residents, fellows, and these are different kinds of trainees that we see. We do researches. Some of us are in the laboratory doing basic science research. There are people like me who do clinical research on patients. We’re testing out new drugs and new ways of treating these cancers. Each day is a little bit different.

Now, I have a clinic day, so I saw patients in my clinic. I saw twenty patients, mostly with sarcomas. I gave them chemotherapy. I talked to a few that were off treatment so they’re finished their cancer therapy. They’re there for follow-up. I have a bunch of kids that are undergoing active chemotherapy. We see patients who are brand new diagnoses of cancer. We see all of that on any given day. Now is a clinic day so I saw them on the outpatient side. Next time, I’ll be on the inpatient service. When kids getting admitted to our hospital, I get to take care of them as part of my job duties. That is entirely a slightly different way of practicing this.

When do you show up in the morning and when do you leave?

It depends. I’ll be at the hospital when I see patients at 7:00, but then I don’t see patients every day. I don’t need to see, I have to be in that hospital by 8:00 or 9:00. I’m out of the hospital by 5:00 or 6:00. As you go through training, your ability to dictate your schedule is increased. When you’re an intern or a resident, you don’t get to dictate your schedule as much. You need to be there at 5:00 in the morning and you don’t get home until 10:00 at night. If you’re attending, you walk in at 9:00, get coffee, you go to the golf course at 3:00.

Which specialty you’re talking about?

Not my specialty.

Are you on call often even on weekends, working late at night?

Not at this stage. I’m on call one weekend every 2 to 3 months.

Are you going to have to stay in a hospital or you can do the work, or you can go to the hospital but you can still sleep in your own bed?

For the most part, I sleep in my own bed. I’ll get calls in the middle of the night from parents or the hospital, but that only happens once every few months.

You would describe your work-life balance is good.

In general, many of us can dictate our schedule well enough that we do have a good work-life balance. It’s also something that people need to watch out for because of medicine. There’s always work to be done. It’s something that I’ve been cognizant of ever since I became an attending because there’s work that we can do, but I’ve chosen to be sure to place my family above my work. I’ve been able to do my part. I’m in perfect balance all the time. There are seasons in our life where you have to be at the hospital more than you have to be at home. There are times where you can be and you should prioritize your family over your work in general.

You alluded to this a little bit early on, but what are some misconceptions people have about your career?

As I said before, it’s not always sad. It’s a mix. There are some high highs and low lows but I do think that, in general, there are more highs than there are lows. The lows are pretty high. One of my favorite times is when this kid that I got to know as a resident is before I became an oncologist, but I was still exploring what I wanted to do. I took care of this kid who had this aggressive type of cancer. I was part of his treatment team because I helped out. I got to know him and his family. Thankfully, he was cured. About a year after he finished treatment, he and his family invited me and my wife out to dinner. I was a resident. He took us to some fancy Korean place. It’s the best thing ever. It shows you the bond that you can have between a family and a physician. It made me realize this is something that I was good at but it also reinforced that it’s this bond that I wanted to have, and that made me want to go into medicine. Your question was about misconceptions, right?

Yes, but your answer led me to think about how you got started in oncology. Was that the starting point where you started thinking about being an oncologist?

It planted the seed. When I started medical school, I always knew I wanted to be a Pediatrician ever since I was eight years old. I knew I wanted to be a doctor. Everything I did in my life, except for there’s a brief detour when I want to be a comic book artist, but that didn’t pan out.

How old were you then?

I was in high school. I took first prize in my senior art show.

Why were you even thinking about pediatrics as a kid?

HCDM 37 | Pediatric Oncologist

Pediatric Oncologist: It doesn’t matter how smart you are or how well prepared you think you are telling a parent that their kid is not curable. Death and dying are hard.

 

As a kid, I love my pediatrician.

Really? That was the reason?

Yes. The guy has the coolest job. I thought he had the coolest job because, in his office, he had all these pictures on his wall that were drawn for him by his patients. I’m like, “I want a wall like that. I want all those pictures. If I could be that guy, I’ll get all these pictures.” He committed well with the kids. As time went on, I’m way better at talking with kids than adults. I connect a little bit better with the kids. I still play video games. I still read comic books.

Are you still drawing?

I still draw. I like toys. I feel like I’m a child most of the time. I’ve always been drawn to that medicine. I’ve always thought that helping kids was an important way to contribute to society. I didn’t think of that when I was ten years or even older. Later on, in medical school, what is it that I could do? I could become a doctor in internal medicine. I thought of being a surgeon for a second, but I didn’t like their lifestyle. I’m not sure that I saw any surgeons that were happy or had a good work-life balance.

It’s a different field. Pediatricians, in general, were happy most of the time. They were fun, cool, and they could hang out with kids. I always knew I wanted to be a pediatrician. Initially, when I was going through medical school and then even at the beginning of the residency, I want to be a Pediatric ER, doc and then I rotated through Pediatric ER, and I was terrible at it. I am terrible in the ER. I can’t make those decisions. I need space to think. I need things that plan things out. I realized that about myself. There are things that I didn’t even realize about myself until I was put in those situations.

As a medical student, you’re learning about what you might be good at or not.

You might think you’re good at one thing because it’s cool or whatever. When you think that you did look part of it, you think, “I’m good at this.” We become the person who’s responsible for doing them. I soon realized I was no good at ER so I had to shift my idea of what I wanted to do.

Before you jump into how you thought more about that, what were you like as a high school student and college student were you?

Nerdy.

Were you a nerd?

I’m totally nerdy. I study a lot. I was singularly focused in medical school. I was laser-focused. Everything I did in a hospital, I shadowed my aunt who was a physicist and a radiation oncologist. These are those who plan radiation treatment. I shadowed her for a while.

It didn’t pan out.

Not on radiation oncology.

You’re in medical school, you’re toying with all these different ideas, and then you were even thinking about oncology but you did a pediatric residency, which is after medical school. During your rotation, you came across this oncology patient who invited you and your wife to dinner. By the way, was that the first time you were ever invited to dinner by a patient at that time?

Yes. As a resident, you don’t usually pass time.

Was it you and your wife or a consortium of different people?

Just me and my wife.

This kid brought his family with him too?

His parents who barely spoke English sit around. It was great.

It started the ball rolling towards that fellowship of pediatric oncology. Reflecting back, would you have done anything differently?

I don’t think so. I enjoy what I do. People think about, “I should take some time off.” I couldn’t wait to practice medicine. I wanted to do the work. This showed how naive I was the first couple of weeks of internship. I would tell my fiancé, “I can’t believe they’re paying me to do this work. They wouldn’t pay me very much.” I remember saying that.

You’re enjoying it. You’re in there and in the environment.

I’m enjoying walking around the halls of the hospital because it was quiet and you can get the work done. I would hang out with my co-residents in the hospital. It would be 3:00 in the morning. It was quiet. We sneak off and we would play video games. In pediatrics, there’s always a video game house party. We will find it and we’d go play. Everyone is asleep and we’d be playing NHL Hockey. It’s awesome. I had fun.

We have already hit the ceiling in pediatric oncology. Click To Tweet

It sounds like it.

I still have fun now. After I became an attendant, our child life people, these are specialists that work with kids. They’re not medical professionals, but they have some medical background because they’ve often been around hospitals.

One of my guests was a child life service specialist. By the time your episode will come out, hers will have been published.

They help these kids through play, whether it’s art, music and video games. I’m like, “I’ll go play video games with these kids. I’ll play rock band with them. I’m like a guitar hero. I’ll beat them.”

To make them feel good. If you win one game, I win another.

You get to know the kids. That’s the reason for it.

Would you recommend this career for students?

As much fun as I’ve had to be a pediatrician hanging out there, the death and dying that we end all is hard. It doesn’t matter how smart you are and well-prepared you think you are, telling a parent that their kid is not curable, you’re going to have that as oncologists to offer. For some people, that’s too much and that’s fine. As you’re trying to figure out what you want to do. You need to know who you are, what you’re capable of, what allows you to commit, and what allows you to tick.

I didn’t know that about myself but I’ve been able to present on that. Not many times that you experienced that. For most of our lives, we don’t have that many experiences before residency or before fellowship. We have these encounters with people in decent situations. I didn’t know that about myself, but what I tend to focus on is not the sad parts, but the good that we were able to do and the good that we can still do. Not for the patient that I can’t cure but for the next patient who longs with the things that work. Each patient inspires me. It’s a privilege for people to work.

What do you think the future outlook is like for your profession?

In the last few years, we’ve learned more than the previous few.

Is it like exponential growth?

Yes, it is. In terms of knowledge of not only the biology of cancer and there’s still so much that we don’t know but the way we can apply new medications or new techniques. I think that in the next five years, there’ll be a breakthrough that we can’t even conceive of. In 2015, we couldn’t imagine that we can take a tumor cell, a cancer cell and know its genetic makeup. Based on that genetic makeup, we predict which medications can be used to kill it. We didn’t know that. We always thought that was possible but we didn’t know.

Now, you can take a patient’s tumor and in two weeks, you would know what mutations were there, and what was wrong with the cells. Sometimes, you can find a medication for that type of tumor. That wasn’t readily available a few years ago. Some specialized places had it but it wasn’t readily available. Now, it’s fairly available. Those kinds of advances show that we’re learning a lot about the biology of these cancers as well as how to take care of them.

Do you think the cure rate will get better with time? Do you think there’s a ceiling that there are some cancers that your outlook is not going to be great?

That happens. Even though I talk about these exciting advances in cancer therapy in the last few years, the truth is that we have already hit the ceiling in pediatric oncology. This 80% cure rate was there a few years ago. That’s using the typical chemotherapy that we use these medications that we use. We’re discovering how to use newer medications that are not chemotherapy in the effort to cure these kids. I do expect that over the next years, we’ll learn more about these medications and be able to use them in a smarter sense so that there’ll be incremental improvements in cure rates. We’re talking about the overall 80% cure rate but if you’re talking about cancer like leukemia. You’re looking at 90% to 95%. There are certain things that you’re hitting a plateau, but certain types of cancers still need 50%.

It depends on the cancers and of course, the average is out. Alex, if someone wants to reach out to you, how could they reach out to you?

Email me at AChou@Montefiore.org. It’s my work email. Feel free to email me. I’m happy to talk about whatever.

I have a final segment here called Marn’s Lightning Round. Prepare yourself. Keep your answers short: yes, no or short answer. Let’s see how you do. Would you rather be able to speak every language in the world or be able to talk to animals?

Every language in the world.

On a scale of 1 to 10, how good are you at keeping secrets?

Ten. I’m super good at secrets.

Would you want to live forever?

No.

HCDM 37 | Pediatric Oncologist

Pediatric Oncologist: In the next five years, there will be a breakthrough that we can’t even conceive of now, just the way we couldn’t imagine that we can take a cancer cell and be able to know its genetic makeup five years ago.

 

If you could ask God one question, what would it be?

This is hard. Why would you love me so much?

What’s your favorite car?

Acura NSX in 2000. Not the current one, but the 2000-ish Acura NSX in red.

Velvet red seat too or black.

Black.

From 1 to 10, how hot do you like your shower water?

Eight.

What’s the most boring thing ever?

Listen to me talk.

I wouldn’t say that but I see what you’re saying. What’s the most delightful word you can think of?

Steak.

Your greatest achievement?

Having the guts to ask my wife.

What do you think people noticed most about you?

I’m quiet. I don’t talk. I talk to you. I’m not a talker.

You did some good talking. Alex, thanks for joining. I appreciate it.

Thank you.

It’s informative, really heartwarming to hear you’re helping these young kids. Thank you.

No problem.

Thank you for reading this week’s episode. I enjoyed talking with Alex and his career as a pediatric oncologist here in New York City. I appreciate how he helps not only the patient but families as they get through these difficult times. To learn more about this guest and other past guests, or if you’d like to reach out to me, visit HealthCareersWithDrMarn.com or HCWithDrMarn.com. I’ll catch you in the next episode.

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About Alexander J. Chou, MD

HCDM 37 | Pediatric OncologistAlexander J. Chou, MD, is a pediatric oncologist specializing in the treatment of pediatric sarcomas, rare cancers of the bone and soft tissues at Children’s Hospital at Montefiore. Dr. Chou, along with his colleagues, provides state-of-the-art therapies to patients with sarcomas in a comprehensive and multidisciplinary setting. Dr. Chou is the Clinical Director of the Pediatric Sarcoma Service at the Children’s Hospital at Montefiore and an Associate Professor of Pediatrics at the Albert Einstein College of Medicine.

Dr. Chou earned his Bachelor of Arts in Biology in 1994 at the University of Pennsylvania. In 1998, he received his Doctor of Medicine at Cornell University Medical College in New York City. Following this, he completed an internship and residency in Pediatrics at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City. In 2006, Dr. Chou completed his fellowship in Pediatric Hematology/Oncology at the Memorial Sloan Kettering Cancer Center and the New York-Presbyterian Hospital / Weill Cornell Medical Center.

Dr. Chou’s research focuses on identifying new and effective agents for patients with recurrent sarcomas. Dr. Chou collaborates with basic scientists and clinical researchers who are part of the Albert Einstein College of Medicine and Children’s Hospital at Montefiore to develop new treatments for pediatric sarcomas (osteosarcoma, Ewing sarcoma, synovial sarcoma and rhabdomyosarcoma). He is part of regional, national, and international cooperative group efforts specializing in the treatment of pediatric sarcomas. Many of his publications focus on osteosarcoma and its treatments, as well as other rare childhood sarcomas.

Dr. Chou is board certified in Pediatric Hematology/Oncology and General Pediatrics by the American Board of Pediatrics.