The Berlin Wall fell thirty-five years ago this past Saturday, November 9. For Suzanne Lentzsch, then a medical student in East Berlin, the events of November 9, 1989 not only shook the world, they were just one chapter of on an improbable odyssey leading her to become a world-recognized myeloma and amyloidosis specialist at New York’s Columbia University.
When she started her final year of medical school – which, in East Germany, meant spending a year working in a hospital – on September 1, 1989, what happened ten weeks later was inconceivable. But clues were emerging. In retrospect, one of the strongest came when she met the division chief for internal medicine of the hospital to which she was assigned to get practical experience in internal medicine, in Oranienburg, a suburb just north of Berlin. She remembers it as if it were yesterday.
“Dr. Lentzsch – he already called me a doctor, despite not being one yet – I have good news and bad news. The good news: you will work relatively independently, even though you are still a med student. The bad news: we’re the only ones who are left on the internal medicine floor. All the other doctors are in West Germany.” One, he hoped, was expected to come back from vacation. “But for the next two weeks,” he continued, “it’s just you and me.”
The story of how she got there and what happened after is one of the more memorable chapters in myeloma history.
When the Berlin Wall went up on the night of August 13, 1961, it created more than a physical barrier encircling West Berlin. The Wall and the so-called Todesstreifen (death strip) between East and West Germany solidified the post-World War II Iron Curtain,[1] preventing any substantive travel or contact for people who wanted to go from East to West Germany. They were created to stem the severe worker shortages and “brain drain” of people leaving the East for better opportunities in the West, especially people like Lentzsch’s parents.
They were on the wrong side of new partition on August 13, just two of millions of Germans unexpectantly caught up in world events beyond their control. The young couple had two children; their sister Suzanne would be born a couple years later. Her father, an electrical engineer working in West Berlin who lived in East Berlin, “had a choice to jump over the barbed wire” in the early hours of the construction of the Wall, but with the obligations of a family, he decided to stay in East Berlin. Perhaps his earlier life experiences influenced his choices.
“He was drafted when he was seventeen,” to serve in the German air force in early World War II. He was shot down in North Africa, and “spent five years in a British prisoner of war camp in Egypt,” Lentzsch said, although “he never talked about the war. Most of what I know was found in files after he died.” After returning to Germany, although he was unable to graduate from high school due to his military service, he took exams that led to college, her father took continuing education courses – he was not able to graduate from high school due to his military service – to become an electrical engineer and a college[2] teacher.
In communist East Germany that type of position didn’t correspond to the same income or status as it would have in the West. Even adding the position of her mother, who became a head accountant in a factory after continuing her education that was first limited to eight grades because of the war. Lentzsch said her family often had to rely on help with food and finances from her aunt in West Berlin, her father’s sister, who was a cleaning lady, although, one would think, they should have been expected to be better off.
East Germany’s state-controlled economy limited the amount and type of goods that were made available to its citizens. Lentzsch recalled a story her mother told one day from work. A coworker entered the office, exclaiming, “they have bananas at the shop!” Her mother, as the boss, told her to take another coworker with her to buy some. “So they spent three hours in a line to buy two bananas for their colleagues in the department.” In remembering that episode, Lentzsch recited a common East German saying as she grew up: “Erst kommt das fressen”: first comes the eating. “It was humiliating, it was bad, it was horrible.”
Lentzsch was born and grew up in Oranienburg, she was the first in her family to graduate from high school and medical school. Political circumstances beyond her control didn’t make her educational progression as clearcut as that, though.
Two of her mother’s three sisters were in the West, one in West Germany and another in Montreal, Canada; her father’s sister lived in West Germany. Having close familial contacts in the West made her family fundamentally suspicious to East German authorities, “politically, I didn’t ‘fit into the pot.’ Despite finishing first in my high school graduating class,” the only grade below an equivalent of an A was in physical education.
Hoping to attend medical school, Lentzsch “was rejected” because her principal, who had to approve her application, chose the latter of three possible recommendations: well qualified, qualified, or not qualified. It was obviously a political decision, one having nothing to do with academic achievement. She didn’t need to be told why. Neither she nor any members of her family were members of the SED, the ruling political party – the only party – in East Germany.
Luckily, one of Lentzsch’s best friends had a mother who was a dean of the economics department at Berlin’s Humboldt University, where she hoped to study. A meeting was arranged. Lentzsch recalls it ending with a strong Berlin-accented admonition: “‘Suzi, don’t let it cloud your head! We’ll get it worked out!’[3] She was a dean, that meant she was higher up than my principal. She talked to her friend, who was the dean of medicine (at Humboldt). He recommended an appeal of the decision.” It was successful but with a somewhat bitter caveat, “all spots are filled, but we can assure you a spot in 1984,” a wait of two years.
When her high school teachers and principal found out, “they couldn’t believe it, and one teacher told me, ‘I know why you were admitted,’ they assumed I worked the Stasi,[4] ‘that’s why you got in.’” They couldn’t imagine that Lentzsch had “higher connections to the dean than they did. It was pure luck.” The entire situation is an example of the “damned if you do, damned if you don’t” hypocrisy upon which East German society was based.
Fortunately for Lentzsch, she secured a position as a nurses’ aide in East Berlin’s Academy of Science Robert Rössle Klinik, the top cancer facility in East Germany, in large part because the husband of the dean who secured a medical school position for her worked there. It was the nation’s only clinical and basic research facility dedicated to cancer care.
“I think I would have been a pretty good cardiologist, but working there for two years focused my interest on cancer and provided me with many connections. You could say it was the ‘MSK (Memorial Sloan Kettering) of East Germany.’ They had the first (and only) CT scanner in the country. So that was good because it really gave me relations to researchers, to people who had PhDs in basic research, it was a completely different environment.”
Two years later, Lentzsch finally began medical school at Humboldt University, again thanking her “luck” of not being sent somewhere else in East Germany. Humboldt University was affiliated with Berlin’s Charité Hospital, which is still among Germany’s most respected hospitals. By September 1989, she was back in her hometown, in Oranienburg, in the hospital where she got her good news/bad news as she began her final year in medical school.
The reasons why the other doctors at the hospital were gone had both long and immediate histories, requiring us to take a detour from Lentzsch’s personal story to understand.
Germany was divided into two nations in 1949 based on the post-World War II partitions governed by the allied forces of the United States, the United Kingdom, and France, which made up the Federal Republic of Germany (West Germany), and the Soviet Union, which became the German Democratic Republic (East Germany). Berlin was partitioned much the same but was wholly encompassed by East Germany. West German relations with the East were governed by Hallstein Doctrine, which denied the legitimacy of East Germany and claimed its own. No diplomatic relations between the two nations existed.
By 1974, West German Chancellor Willy Brandt’s Ostpolitik, a policy of engagement with the East, created the first cracks in the Iron Curtain, allowing West Germans to visit relatives in the East and tourists to buy day passes to go into East Berlin. The fees became a great source of income for the East German government.
But for East Germans, travel to the West was mostly limited to very few individuals who could briefly visit with very sick family members. The rest of their families were not allowed to travel, becoming de facto hostages to ensure the return of those allowed to visit the West.
Lentzsch recalled visits to East Berlin’s Charité Hospital[5] when she was in medical school, looking out to West Berlin, “you could see the cars driving, the people walking along the street, and I aways thought, ‘oh my goodness, they are so close, but they are farther away than the moon.’ It would be death; the possibility to go to the moon with the Russians was higher than to shake hands with the people across the street.”
The first significant rip in the Iron Curtain occurred less than six months before Lentzsch got her good news/bad news welcome to the Oranienburg hospital. The Hungarian government cut of the electricity of the fences on the Austrian border, abandoning its guard towers. When the news trickled through to East Germany – through the access to West German television news for those who lived near the border and in the vicinity of Berlin[6] – a number of East Germans quietly booked “vacations” to Hungary. It was one of the few places outside of the country they could visit.[7]
By early August, East Germans were walking across the border to Austria, with the first train of escapees leaving Vienna for Frankfurt on August 8, 1989. Over the next few months, East Germans who could not make it to the border began seeking asylum, living on the neutral grounds of western nations’ embassies in Hungary and Czechoslovakia before being loaded on trains to West Germany.
The justification for building the Berlin Wall was being overcome twenty-six years later. Many East German doctors joined the exodus. Since their degrees were recognized by the West German government, they were eligible to get work within two weeks of arrival, which explained why it was “bad news” for existing hospitals in East Germany.
For Lentzsch, as enticing as it may have seemed, leaving for the West at that time was not a consideration. She was close to graduating and didn’t want to have to start medical school all over again in the West – medical degrees were accepted, incomplete medical education was not. Plus, she could sense things were changing, but like everyone else at the time, had no idea how quickly they would.
It was much like being thrown in water to learn how to swim, only in this case, it was the lives and welfare of her patients that she had to “keep afloat,” which was as intimidating as it sounds. “I was doing rounds with Schwester Maria,[8] she was the head nurse on the floor for thirty years, and I was still a med student. We went to do rounds, and the patient was in front of me,” Lentzsch remembers, “and I had no clue, and Schwester Maria was behind me and said, ‘oh, the patient is on diuretics, what if you check on potassium?’ ‘Yes, we should check potassium,’ I said. It was quite an experience. It was amazing, and that’s why I have high respect for all nurses. So that was my start in internal medicine.”
As Lentzsch gained experience, she “had to cover the night shifts. And that was not easy, because you are ‘alone’ in the hospital, I was the only doctor there. I was scared to death. I also had to cover the delivery floor and had to conduct my first episiotomy with a midwife.” Her first night shift was on September 30, 1989, which she remembers so clearly because it the night when West German Vice Chancellor Foreign Minister[9] Hans-Dietrich Genscher announced, from balcony of the West German embassy in Prague, that hundreds of East Germans who had amassed on the grounds were going to be transported to West Germany.[10] The exodus of East Germans through neighboring Iron Curtain nations had become a human flood.
It is important to remember that being at a medical school in East Germany, Lentzsch was subject to its rules, “You could say what direction you wanted to go (surgery or internal medicine, for example), but you could not say where.” First, she was to be assigned to a hospital in Görlitz, a city southeast of Berlin on the Polish border, for her residency, “and I refused.” It wasn’t the first time she balked. When in medical school, she almost ended up spending time in Siberia, as a doctor at the oil pipelines, “but on the day of my scheduled flight, I called in sick. I almost got fired a few times, but the dean who helped me get into medical schools was something of a guardian angel.”
Luckily for Lentzsch, however, “before they could punish me more, everything fell apart” in East Germany. Instead, she “got a spot for residency and fellowship at the same institution where I was a nurses’ aide: the Robert Rössle Klinik. It was an improbable homecoming. Moreover, “it was being transformed into sort of a German National Institutes of Health campus.”[11]
Many of the professors working at the Rössle Klinik “had connections to the Stasi, including my boss, so a new wave of professors from West Germany came over. My new bosses came from Heidelberg,[12] including my soon-to-be husband, Markus Mapara. They came over and created whole new structures, they taught us how to write grants and organized seminars to teach us English. They opened up a completely new world. Suddenly going to the annual American Society of Hematology (ASH) meeting, going to congresses, that was within reach. Suddenly the world opened up.”
With the changes came new funding. Lentzsch recalled, from her nurses’ aide days some of the measures taken out of desperation. Adriamycin, a common chemotherapeutic agent used at the time – in myeloma the A in VAD – was so expensive back then, “the scientists developed a method to reuse Adriamycin from the urine of patients; they collected the urine – the metabolites were still useable, the same was true of methotrexate – to distill, extract, and reuse it.”
The early 1990s were filled with whirlwinds of professional activity Lentzsch could never have imagined just a few years earlier. In 1993 she had an abstract accepted for oral presentation in Stockholm, Sweden, which was to be delivered in English. “I wrote the abstract in German and a colleague translated it for me,” she recollected, “I learned the presentation by heart, I was so nervous, but before me was a Chinese presenter with limited English skills, and that saved my life. And I thought, ‘OK, your English will be better, and I gave my presentation, but I couldn’t answer the questions, because I didn’t understand.’ It was a new skillset! Not only English, but we had to adjust to new medications, the names were different, even between East and West Germany. But I was young, and young people can learn.”
By 1998, Mapara and Lentzsch took a two-year sabbatical; he applied for a fellowship in Boston, and she was accepted to work in Kenneth Anderson’s lab. She had developed an interest in angiogenesis, which at that time, especially with Judah Folkman’s theories in anti-angiogenesis becoming more popular – restricting blood flow and nourishment to tumors – and becoming the justification to use of thalidomide in myeloma. She sent an email to Anderson, “that was my first email, I guess, and said I would come with a grant from the Mildred-Scheel-Stiftung.”[13] Anderson replied that he would be happy to host her. Mapara went to work with Megan Sykes on immunology at Massachusetts General Hospital. The latter began a collaboration that would change their lives again years later, as we will soon learn.
Lentzsch, recalled that the opportunity in Boston with “Dr. Anderson developed my interest in myeloma. He inspired me.” Working under Anderson, she “developed a very nice animal model combining irradiated mice with a human myeloma cell line that's still used.” She also had two abstracts and an oral presentation at ASH, wrote a paper with the Folkman Laboratory, and remembered how open and encouraging Anderson was throughout her stay.
Unfortunately, the enthusiasm and good will didn’t last for her or Mapara after returning to Berlin after two years. Their boss made Lentzsch “wait for four weeks before he gave me an audience” and made it clear that she should not expect any promotion, despite her experience. The next three years were unhappy, professionally speaking, which led them to seek opportunities in the United States. Both interviewed and were offered jobs at the University of Colorado at Denver, but before signing, fate intervened again.
Lentzsch was attending the 2003 International Myeloma Workshop (IMW)[14] in Salamanca, Spain. At the lunch break she bumped into David Roodman, a myeloma and bone specialist at the University of Texas in San Antonio and colleague of Greg Mundy with whom she had collaborated on an earlier research project. As they were chatting, Lentzsch mentioned that she and Mapara were on the verge of accepting positions in Denver. Roodman perked up. He was about to become the head of myeloma at the University of Pittsburgh, beginning a two hour conversation.
“And I got up, called my husband,” Lentzsch recalled, saying, “we have an offer to go to Pittsburgh!” Within a few months they flew to Pittsburgh. After being picked up by a limousine, departing the airport, they saw a billboard with the message: Welcome Dr. Lentzsch and Dr. Mapara. It’s no wonder they began working there on July 1, 2004. “Fast forward,” continued Lentzsch, “it was the best decision we could have made. It was a wonderful city, we had to adjust to a new system, but I could do research, my clinic was going well, and we stayed for eight years.”
When Roodman moved to Indiana University in Indianapolis, Mapara got an offer from Megan Sykes, with whom he had worked when they were on a fellowship in Boston. She was moving from Dana-Farber to Columbia University in New York and offered the director of bone marrow transplantation position to Mapara. Since Columbia had no myeloma specialists, they offered a new position to Lentzsch.
“My postdoc researchers, lab, refrigerator, and centrifuges came with me, but I didn’t have any positions to fund in my startup package, so I was alone in the clinic starting a myeloma program just by myself.” Working with Anderson had instilled a love for translational research; she wanted to split time between research and clinical patient care.
Now in her twelfth year at Columbia, Lentzsch built up a small, but dedicated team. “I think the doctors we have now, Divaya Bhutani and Rajshekar Chakraborty, are really outstanding, I would send my mother to them. If you call us today and want to see us next week, we will see you next week, no waiting time. Cancer cannot wait. If I’m diagnosed with cancer, I want to see the doctor tomorrow. So I’m happy with the size of things, we can communicate easily. I’m very happy with my team.”
Lentzsch has come a long way from Oranienburg, from being wrongly suspected of being too close to the West, or even having connections to the Stasi. She remembers the pressure and emotions that came along with the collapse of the world she grew up in, of adjusting to new challenges. Now she and her husband are leaders at a prestigious Ivy League medical center, respected by their peers and patients alike.
“When I look back on my life, I think I’m the luckiest person, I’m so grateful,” Lentzsch summed up, “each morning I wake up and say, OK, enjoy the day, you don’t how long it lasts.”
[1] Although Winston Churchill coined the term “Iron Curtain” on March 5, 1946, to describe the post-World War II ideological and political partition between the territories controlled by the Soviet Union and the Allied nations that extended “From Stettin in the Baltic, to Trieste in the Adriatic,” it wasn’t until August 13, 1963, with the construction of the Berlin Wall, that its physical dimensions were set. Interestingly, Churchill’s warning did not include what would later become East Germany, the Soviet sector of Germany. At the time, the idea of two German states was not a consideration.
West Berlin, consisting of three sectors controlled by the U.S., British, and French armed forces, was encircled, first with barbed wire, then with barriers of bricks and mortar, and finally with a sophisticated barrier that included a high wall behind which was a so-called “death strip” consisting of more barbed wire, automatic machine guns set off by motion detectors, manned watch towers set at distances in sight of at least one on each side, and patrols of armed soldiers with guard dogs. Similar barriers, but without a wall like that in Berlin, were placed all along the East and West German border, and continued to extend southward between the former Czechoslovakia and West Germany and Austria, between Hungary and Austria, and other nations between East and West all the way to the Black Sea.
[2] He taught at a Hochschule, which in English translates literally as high school. But in Germany, a Hochschule is closer to what Americans call a college which can confer something equivalent to a bachelor’s degree, but not a doctorate, which is earned at a university. Complicating the picture somewhat, a Hochschule could also be something akin to a graduate school in that it focuses intensively on a subject, leading to a master’s degree-like level of education.
[3] „Suzi, mach dir da kein Kopp! Det kriegen wir hin!“
[4] The East German secret police, the Ministerium für Staatssicherheit, the Ministry for State Security. It was estimated that the Stasi, employed as many as 274,000 people in the 49 year history of East Germany’s existence and that as many 174,000, 2.5% of the population, were unofficial coworkers spying and reporting on their neighbors.
[5] Charité’s reputation as one of the top hospitals in Europe goes back to the late 1800s when Rudolf Virchow, the father of pathology, established its reputation. The new Charité hospital building was under construction when the Berlin Wall came into existence. It was designed by Arthur Davis, an architect from New Orleans who also designed the city’s Superdome, was in Berlin in August and made his last visit to supervise construction on August 12, 1961. One wall of the new hospital was actually a part of the Berlin Wall itself. Davis’s son, Quint, is the founder and still director of the world famous New Orleans Jazz & Heritage Festival.
[6] Color televisions sold in East Germany were equipped with devices preventing reception of West German television, so many East Germans held on to their old black-and-whites in order to receive programming from the West in private. Most who lived near the Polish-East German border were too far away to receive signals.
[7] It was also possible to book state-run cruises leaving Dubrovnik, Yugoslavia, but the passengers, who could see shorelines of places like Italy, Gibraltar, France and England from the English Channel, Denmark, and Sweden, would not be allowed to embark the ship until it arrive in Rostock, East Germany.
[8] Nurses are called Krankenschwestern in German, which literally translates into English as “illness sisters.” They are addressed individually as Schwester, or sister.
[9] The equivalent of being an American vice president and secretary of state wrapped into one position.
[10] Lentzsch’s brother was among those who escaped via Hungary. He returned to his wife with 500 Marks given to him by his aunt who encouraged him to return after the Berlin Wall was gone.
[11] In 1992, the Rössle Klinik was renamed and expanded to become the Max Delbrück Center, which is one of the top comprehensive cancer centers in Germany and Europe.
[12] Heidelberg was long considered – and still is – the most prestigious address for medical sciences in Germany. Hartmut Goldschmidt, also originally from East Germany and working at Berlin Charité as the nation came to an end, established its world-renowned myeloma department in the mid-1990s.
[13] Mildred Scheel, a cancer physician, was the wife of former West German President Walther Scheel and founded Deutsche Krebshilfe (German Cancer Aid is the largest cancer charity in the nation, much like the American Cancer Society here) in 1975. She died of breast cancer in 1985.
[14] Now the annual meeting of the International Myeloma Society (IMS). IMW meetings were held biannually.