Mark Lewis, MD, discusses career motivation, Twitter and oncology’s emotional ‘yin-yang’
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Mark A. Lewis, MD, has two special drawers in his office desk — one with notes of appreciation he has received from patients over the years and the other with his patients’ obituaries.
“I never throw away a note or card I receive from a patient. When I need some emotional ballast, I look in the note drawer,” Lewis told Healio. “When I need to be reminded of how sobering this is, I look in the obituary drawer, and I remember my patients who have passed on. So, for me, those two drawers are the yin and yang of the emotional side of oncology.”
Lewis, director of gastrointestinal oncology at Intermountain Healthcare in Utah and inaugural Healio Social Media Influencer honoree, witnessed the emotional ups and downs of oncology long before it became his vocation.
His first encounter with the disease that would define his career came at age 8 years, when his father was diagnosed with thymic cancer. Later, his own battle with an inherited cancer syndrome, which was passed along to his son, would give him firsthand experience of the disease and a deeper empathy for his patients.
Lewis spoke with Healio about what motivates him to get up and go to work every day, the “nice problem” of keeping up with rapid oncologic advancements, and his life when he’s not working to cure cancer.
Healio: What inspired you to become an oncologist?
Lewis: When I was 8 years old, my father was diagnosed with cancer and he died when I was 14. I am very, very glad I had those years with him, but of course, I wish I had more. After he died, his oncologist took me under his wing and I got to work in his clinic every summer in high school and college. My father’s oncologist was a wonderful man. He really cared about the person — he never reduced my father to a diagnosis. He had these marginalia — these comments he would write about his patients — and they weren’t just about smoking status or lifestyle habits. They were more like the little grace notes of someone’s identity. He always looked at the whole person. By following him like an apprentice, I learned that short of psychiatry, oncology is possibly the specialty where you become closest to your patients.
Healio: What motivates you to get up and go to work every day?
Lewis: You mean, besides coffee?
I know it’s cliché, but it’s the patients. I am astonished by how gracious they are in the face of adversity — they are literally some of the kindest people I have ever encountered. They might not have the longest lives that I would like to witness, but many are quite intentional in how they spend their time. That reminds me that time is precious for all of us.
Healio: If you hadn’t pursued oncology, what career path might you have followed?
Lewis: My father was a Presbyterian minister and his father was a minister. I’m an only child, and so I am interrupting a generational chain of pastors. So, I like to think that if I hadn’t gone into oncology, I would have gone into the ministry. Medicine is very secular, but there are times when the work I do feels a lot like pastoral care. To be honest, with some of the GI cancers I treat, we have very few lines of therapy. So, in the latter stages, you either have someone on a clinical trial or you’re just trying your best to usher them peacefully into the end of life. I remember watching my dad minister to his congregation, and I realized there are many parallels between that world and this one.
Healio: What is the last book you enjoyed, and why?
Lewis: I’m currently reading Song of the Cell by Siddhartha Mukherjee, MD. He is far and away the greatest physician-author currently writing. I met him when I was in fellowship, and that’s when he wrote The Emperor of All Maladies, which I think is the best book about cancer ever written. My wife likes to kid me that I go to work all day and think about cell biology, and then I come home and my recreational reading is about the same subject. I just love it, though. He is such a gifted, lyrical writer.
Healio: What is your “can’t miss” TV show?
Lewis: I really enjoy “The Bear” on Hulu. I have a very close friend who is a chef in Chicago in some of the fine dining establishments mentioned on the show. Over the years, he and I have talked about some of the similarities between medicine and the restaurant world. We have a craft, and we learn it in a very hierarchical fashion. The way they set up the brigade in the kitchen reminds me a lot of how a medical team is structured, from medical student, to intern, to resident, fellow and attending.
Healio: What are some of the biggest challenges you face in your career, and how do you overcome them?
Lewis: We have a really nice problem in oncology, which is the pace of progress. It’s interesting — just last week I recertified my board exam, so now I’ve been in practice for a decade. When I looked at the syllabus I studied for my first board exam, I saw it’s almost all obsolete now. Everything has gotten better. Most fields have treatments that we didn’t have 10 years ago. When I look back at my fellowship, it wasn’t even really about this regimen or that study. It was mostly about how we take care of our patients with cancer. Those principles are the bedrock, but the science changes all the time. So, I try to keep up with the ever-evolving literature, and one of the ways I do that is through Twitter.
Healio: How is Twitter valuable to you in keeping up, as well as in connecting with your large following of physicians and laypeople?
Lewis: I was forced, almost, to join Twitter by my chairman when I got out of fellowship. My first faculty position was at MD Anderson Cancer Center. On day 1, I thought my chair would quiz me about prescribing chemotherapy, but instead, before I left his office, he said, “Mark, you need to sign up for Twitter.” I thought, “Gosh, this is odd.” He said, “The good stuff will bubble to the top. If you let your peers crowdsource for you what they think is important, then Twitter will become a wonderful tool.”
Obviously, the past 2 or 3 years have been a very interesting time for discussions around science and medicine, and my employer, Intermountain, is very progressive in its stance on social media. It allows caregivers to have a presence, with appropriate professional boundaries. So, I like the directness of it. There’s also a beautiful feedback loop — it’s driven patients to my practice. I deal with some of the rarer tumors, and I’m told when people Google these terms, my name or one of my tweets about these tumors will come up, and then patients come to my clinic. The more of those patients I see, the more I can cultivate expertise in these rare tumors, and it kind of feeds back. It’s interesting — in the last decade, I’ve seen social media go from being seen as something frivolous to something you can do as a doctor. Frankly, I would now argue it’s almost mandatory if you want to keep up.
Healio: What do you enjoy doing when you’re not at work?
Lewis: I’m Scottish originally, and so I love soccer. I am absolutely thrilled about the World Cup. During non-World Cup years, I follow the English Premier League — Manchester United is my team. I also enjoy just spending time with my family. My wife is a pediatrician and we like to go skiing together. When we moved to Utah, we deliberately chose a home that’s not too far from the ski slopes.
Healio: What is your favorite travel destination, and why?
Lewis: In Scotland, there’s an island called Islay that half of my family comes from. It is my favorite place in the world. It’s peaceful, it’s green, the people are amazing and I’m proud to have roots there.
Healio: What do you think will be the next big breakthrough in oncology, or in your particular subspecialty?
Lewis: We are currently living through a revolution in oncology — immunotherapy. When I first started my training, we had chemotherapy, radiation and surgery. You either poisoned the cancer, you burned it out or you cut it out. Now, being able to harness people’s immune systems against their cancers and have their bodies recognize it as something foreign — that’s amazing, I think we are just in the infancy of figuring that out.
I gave my first immunotherapy dose to a patient in 2011. They had metastatic melanoma and they had a complete response. It was just mind-blowing. It’s pretty much the closest thing I’ve ever seen to a miracle. The other thing that is coming, or is here already, is customization of care. There really shouldn’t be any “one-size-fits-all” chemotherapy. We’re figuring out the right amount — not too much or too little, just right.
Healio: How has your personal experience with cancer enabled you to empathize with your patients?
Lewis: A couple of years ago I had a pulmonary embolism. In medical school, you read about this sense of impending doom that is one of the sentinel signs of a PE. Until I felt it, until I had that visceral experience, I didn’t really know what that meant. Until you actually feel something, your understanding of it is different. You can sympathize with almost anybody, but to empathize, I think, means you are identifying with something they are going through that you’ve also been through. I’m not noble — I didn’t choose to have cancer. I didn’t want to have half of my pancreas removed. Yet I have to say, being candid about all of that has had interesting results. My colleagues, especially older ones, have said, “Oh, that’s career suicide — you’re admitting a weakness.” If anything, though, I think it has made me a better doctor.
I’m quick to tell my patients that I haven’t had chemotherapy, I haven’t had radiation — I’ve actually had very few of the treatments that I prescribe. On the other hand, I do get the apprehension — I call it the tinnitus of terror. When you first hear the word “cancer,” everything else just becomes this low drone. I get that.
Healio: What is the best advice you’ve ever received?
Lewis: My father wrote a book while he was dying, and in it he stated that “crisis is the opportunity, however brief or lengthy, to discard the trivial and the shallow and to fill every moment with meaning, intensity and value.” That’s such an important quote to me that one of my partners here got me a mug that has those words inscribed on it: “meaning, intensity and value.”
Healio: What advice would you give to someone just starting out in oncology?
Lewis: I would tell them to be hopeful.
We’re constantly walking a fine line between hope and hype in oncology, and we never want to overpromise and underdeliver to our patients. On the other hand, it’s remarkable how much better things are getting, and how quickly they are advancing. I think in the future, we will probably look back on chemotherapy and think, “What were we doing?” Yet it’s the best we’ve known to do to this point. I hope I am still early in my career, and that I get to do this for a few more decades. Thinking about how much better things have gotten just in my time and practice really, really excites me. It should excite anyone entering the field.
For more information:
Mark A. Lewis, MD, can be reached at Intermountain Health, 5171 Cottonwood St., Bldg. 1, Suite 610, Murray, UT 84107; email: mark.lewis2@imail.org; Twitter @marklewismd.
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