What got you interested in medicine initially?
My father was a family practice doctor in a rural area of Tanzania, which is where I grew up. I was interested in medicine since I was eight. My dad used to do home visits, and I would go with him, and that was the model of a doctor that I wanted to be. He knew all his patients—not just their medical issues, but their family, their life. That's what I thought I would be when I went to medical school.
How did you get interested in research?
At the beginning of medical school, we had to do electives, like follow a clinician around once a week or a variety of other things. I got my very last choice, which was to follow a researcher around once a week, and I got assigned to a biochemist who did basic biology of how DNA folds and processes. He was a phenomenal teacher, and what he was doing caught my attention. I spent the summer between that first and second year doing research in his lab. It was so cool, and I could see how it applied to what we were learning in med school. That’s when I applied for the MD-PhD program.
What brought you to oncology specifically?
I was doing an emergency room rotation as a medical student, and a 14-year-old girl walked in with bruises all over her legs. She told me, “I'm on a soccer team, and we had three games yesterday. I got kicked a lot, and these bruises really hurt. I need something, because I have a big dance recital later today.”
I'm examining her, and I'm thinking, “These bruises don't look like just bruises from being kicked. There's more to it.” We did some labs, and it turned out she had an aggressive type of leukemia. She got very sick and ended up in the ICU, and my next rotation was the ICU, so I took care of her for a month in the ICU, and I developed a relationship with her and her parents, and I realized that this was my calling. It was like, “This is what I'm going to do with my life.” The cancer biology was fascinating, but the relationships and the oncology and the care was just something that spoke to me. And because she was a pediatric patient, I realized that's what I wanted to do: I wanted to help take care of kids with cancer.
How did you get interested in treating brain tumors?
I did my pediatric residency on the oncology ward at Iowa, and there were a bunch of children with different brain tumors, but they were all getting very similar chemotherapy. I said to the attending physician, “This is weird. They have different tumors and different pathology, but we're treating them the same way. How does this work?” She said it was because we don't understand the biology of brain tumors. We've studied leukemia, so we know what the mutations are, but research on brain tumors was 20 years behind. I said, “OK, this is really important. We treat them all the same way, because we don't know any better. There's got to be a better way.”
You split your time between clinical work with patients and doing research in the lab—what is that division like? Does one inform the other?
I love the fact that I can do both. I love the fact that when I'm thinking about research, it triggers ideas about clinical care. And I love the fact that when I see patients, particularly patients with really rare tumors, it gives me ideas about things to do in the lab. When you say, “I wish I had something better to offer this family or this patient,” that drives you a little more in the lab to say, “We need to work harder. We need to do more. We need to think outside the box, because whatever we've been doing for the last 30 years isn't working.”
How have you seen understanding of and treatment for brain tumors improve in the time you have been doing this work?
The care for many types of brain tumors has improved significantly. One of the tumors that I work with is medulloblastoma, which in 2000 had about a 30% survival overall. We didn't know much about it. That's just when omics technologies were coming online, and I was part of a couple of national consortia through the late 2000s and early 2010s that looked at the omics of these patients to understand why they respond differently. We now have subtypes of medulloblastoma that have 80%-plus survival. We made a difference.
