The Education of Morie Gertz
From Disciple to Sage
I’ve spent a lifetime making up my mind to be
More than a measure of what I thought others could see
~ Billy Joe Shaver, Old Five and Dimers Like Me
Morie Gertz almost failed one of the first tasks Robert Kyle assigned to him when he started out as a fellow in hematology and oncology at Rochester, Minnesota’s Mayo Clinic in 1979.
Gertz had impressive credentials, graduating from medical school and serving his residency with distinction before coming to Mayo. Nevertheless, Kyle, who is measured, studious, and deliberate, remembered his initial doubts. Gertz had an inbred Chicago confidence that didn’t seem to fit the Mayo image. Kyle thought he might be a bit too “brash.”
After Kyle asked Gertz “to review some cases, he came to me with a yellow tablet he had scrawled out by hand. And I said, ‘Well, Morie, a journal would never accept anything like that.’” As Kyle explained, a paper was “the doctor’s way of advertising intellectually or as a leader in the field.” He expected a typed, sourced, well-organized paper that could be submitted for publication. A week later, Kyle was flabbergasted and pleased by the high quality of the work he got back from Gertz. It removed whatever doubts he may have had.
The episode seemed to paraphrase Rick’s comment to Captain Renault in the final scene of the movie Casablanca. It was the beginning of a beautiful friendship, professional collaboration, and eventually they would be teaching each other. It was a relationship that bolstered Mayo’s considerable reputation and would change the lives of countless patients with myeloma, amyloidosis, and many other hematological diseases throughout the world.
To get a sense of who Morie Gertz is, start with his first name. Morie is not a contraction or nickname. It’s his given name. He has no middle name. When said out loud, the staccato-like syllables sound more at home in his childhood Chicago neighborhood than the improbable professional heights he ascended.
Gertz has a seemingly effortless gift of making the complicated comprehensible to both professional and lay audiences. He’s not shy about telling you what he really thinks, but he does it so disarmingly, not confrontational or overbearing. He’s enthusiastically informative in a way that both hides and reveals the innumerable hours he has spent treating patients and in the lab. Once seen and heard, audiences started to knowingly anticipate his presentations.
His Weeds in the Garden talk for patients and lay audiences is – not might be – the best, most informative summary about important concepts myeloma patients should know about their disease and treatment. Gertz masterfully explains myeloma and treatment with easy to understand metaphors. I first heard it at one of the first-ever International Myeloma Foundation (IMF) Patient & Family Seminars in 1998, shortly after becoming a public advocate for myeloma. Although I had been to The March earlier that year and started to represent the IMF shortly thereafter, I was really quite ignorant of the disease, describing it as “a cancer that was kind of like osteoporosis” the first time I advocated in Congress.[1]
Gertz didn’t talk down to the audience, most of whom probably hadn’t had much of any science since high school more than three, four, or more decades earlier. He avoided jargon, but since that’s unavoidable when trying to make cancer issues comprehensible, his explanations would avoid the mystery and confusion most felt. The talk has become a classic in the myeloma community as Gertz honed and updated it over the past three decades, essential for newly diagnosed patients and caregivers, eagerly anticipated by those who have experienced it.
The same is true of his professional meeting oral presentations, which are often filled to fire-code-allowable limits. Every scientific presentation begins with “disclosures” of research support or consulting fees from pharmaceutical and biotech companies.
Attendees to his presentations got downright giddy as he boldly declared he had none, showing a photograph of himself…fully nude except for a black rectangle to cover his most personal bits. It was always followed by a collective audience belly laugh, even if they knew what was coming. It never got old.
Beyond the laughs, however, attendees knew that they could expect insights about how research translated into treatment. Entertainment and substance, what more could they ask for?
“Kyle asked me to join his staff because, in 1981, he and Phillip Greipp were the only two myeloma doctors,” Gertz said, “the practice was growing. Bob was getting to be pretty famous at that time, although he wasn’t a legend as yet, but he was still pretty famous. And so he became less and less available as he was in the lab and they needed someone to help staff the myeloma clinic. At that time, the hematology staff of hematology was about fifteen, compared to now where it’s about seventy-five.”
While myeloma treatment had not appreciably increased overall survival, Mayo was seeing an increase in the “number of patients who were coming for second opinions.” First things first, however.
Kyle “was a big believer in having additional training outside of Mayo, just to have an understanding of what training was outside of Mayo,” Gertz said, “so he suggested that in addition to joining the staff that I spend a year at the Boston University Amyloidosis Treatment Center. So I did that from ’82 to ’83 to get a different perspective about amyloidosis management.”
The year in “Boston changed me because I recognized where my strengths were and where their strengths were.” Realizing, despite his “clinical exposure in hematology” that he “really hadn’t published that much.” He “met all these people who were writing the chapters in the books” realizing “I’m a better clinician than they are. These people are writing everything, but they’re seeing patients one month a year. Why are they writing it and not me?
“And I had a kind of epiphany and I said, ‘you know what? If we’re going to write about patient care, I should be writing because I see patients and they don’t. They’re in the lab and they can talk about cellular mechanisms,” but Gertz was in the trenches, so to speak, with all types of patients. “I decided I’m going to start writing about it.”
Gertz returned to Mayo “in ’83 and joined the transplant team. At that time, all we were doing was allogeneic transplant [for leukemia and lymphoma]. By ’86, it became increasingly obvious that autologous transplant for myeloma was an increasing issue, so Bob once again said, ‘Morie, we need a transplant program in myeloma, basically you’re it. You need to develop a transplant program in myeloma.’”
At that time, “Bart Barlogie was well underway with an autologous transplant program in Arkansas. I went down to Little Rock to spend some time with Sundar Jagannath, who taught me how autologous transplant was done.”
Upon returning to Mayo, Gertz got to work. “We had the infrastructure with a transplant unit and transplant nurses. What we needed was an expansion of our blood bank collection facilities, which are integral to transplantation including apheresis and storage. I did the first autologous transplant here for multiple myeloma, we’re now up to about 3,500 transplants.”
Other practical issues for a young doctor establishing a practice in rare diseases at one of the top medical facilities in the world confronted Gertz when he returned from Boston. “You were responsible for building your own practice.” This was daunting “because, the way Mayo operated, the hematology section was still almost all general medicine. When I came back, 85% of the patients I saw were in general medicine, about 15% in hematology.”
On the other hand, “because I saw so much general medicine, I became a pretty well-rounded internist. I learned a lot of nephrology, neurology, infectious disease, cardiology, and that ended up serving me well as I began to write and publish.” That, in turn, had a larger effect. “All of sudden, the referrals started and my practice began to grow and grow and grow so that it became 100% hematology.” Almost. “I have legacy general medical patients I still see who I’ve been caring for forty years.”
Ten years later, Gertz became head of one of two hematology sections. According to Kyle, “when you’re the head of a section or a chairman of a division your job is to help these younger people to develop.” In retrospect, it was one of the unique perks of Gertz’s career, one that make him the envy of virtually every myeloma specialist: “I had more one-on-one training with Bob than anybody.”
From 1995-2003, he became Chair of the Division of Hematology, after which he “became head of the personnel committee, that put me on the board of governors for three years.” Gertz served three years on Mayo’s officers and counselors of the staff[2] eventually serving as Mayo’s Chair of Medicine, “I reported monthly to our CEO, and the chairs of cardiology, gastroenterology, and infectious diseases reported to me.” As Chair, he supervised more than 700 doctors.
“At most academic medical centers, Chair of Medicine would practically be a full-time job,” Gertz explained. He credits the support of numerous colleagues which allowed him to continue treating patients and doing lab research. He finished that role about seven years ago and is now “a named professor of medicine[3] and a Distinguished Mayo Clinician” who spends about 80% of his time on patient care, 20% on research. Being able to continue to treat patients is “what I stayed here for.”
Being department Chair provided Gertz with opportunities to act on issues he had been learning about and observing for years. “When I joined the staff: white men only. There was no diversity at all.” In fact, “diversity and inclusion weren’t part of the terminology,” recalled Gertz, “but I have two daughters, and I said, ‘This is crazy. It’s just not enough. Our staff needs to reflect our patient population.’ You have to have some perspective about things that clearly are right, about patient focus and things that are archaic.” So I hired a lot of women and a lot of minorities, that’s for sure,” he asserted with conviction.
Two staff additions made before Gertz became chair were Angela Dispenzieri and Martha Lacy. “I made Martha my training program director and that started her on an executive training path. From there she went to practice chair to chair. Some of her first projects were guided by me.” Lacy later served as division chair and, as we will see below, had a personal connection as well.
There was an additional issue to address, one that turned out to fit perfectly with his concerns. “When general hematologists sent their patients to us for second opinions, after we sent them back, they’d say, ‘Well, you didn’t tell me anything I didn’t already know.’ And it became pretty obvious that if we were going to continue to attract patients, we had to know more than referring physicians did. Therefore, having only gifted hematologists was a flawed strategy.”
Being “smart or gifted” wasn’t enough. “We had to have all-disease-oriented groups, each with a specific focus – coagulation, myeloproliferative, lymphoma, myeloma, myelodysplastic, transplant and so on.” Recruitment of new doctors became more focused. We might need someone to do CLL or myeloma.” Kyle’s encouragement to go to Boston and Little Rock “really was a good idea that helped me a lot.”
Gertz “started pushing” young recruits, “to strongly consider going away for a year for additional training.” Of the people he hired in myeloma, Shaji Kumar “spent time with Ken Anderson [at Dana-Farber in Boston],” Rafael Fonseca was “sent to the National Institutes of Health (NIH),” Vincent Rajkumar “did a brief stint with Johns Hopkins statistics,” and “William Hogan, who became the director of our transplant program, spent a year in Seattle.”
Additionally, Mayo had a wealth of potential recruits already in their fellowship program, as Gertz had been. “I did a lot of recruitment internally because, have gone through our training program, I felt they already had a four-year job interview,” allowing Gertz to know “exactly the quantity you were getting, of which the primary is, are you good with patients? That was far more important.”
Morie and Marcia Gertz knew something about what was important since childhood. What was most important to them were family and people in general.
The extended Gertz family had roots in a tucked away part in rural Galicia, a place seemingly always up for geopolitical power grabs roughly comprising the present-day border region of Poland and Ukraine. Most of the Gertz clan fled the oncoming Nazis in early 1940s. Some went eastward, intending to take a circuitous route to Palestine. Others went southward to anywhere Nazis weren’t. Instead of Palestine, Gertz’s parents ended up in late 1940s in Chicago.
They had escaped the Holocaust – unlike many of their family and neighbors. Chicago provided refuge, but it wasn’t an easy transition. What anti-Semitism existed didn’t compare to that which they fled. A young Morie Gertz only knew Chicago and was American to the core, as his parents were also becoming in their working class neighborhood. Although neither of his parents went past eighth grade, they had high expectations for him. Surely the notion of their son becoming a noted Mayo Clinic expert must still have been unimaginable.
That didn’t deter, though. School came easily to Morie. It was still quite a distance, socially speaking, from the idea of having a medical practice on glitzy Michigan Avenue. First came undergraduate studies at prestigious Northwestern University in the tony town of Evanston, just north of Chicago on the shores of Lake Michigan, a place that must have seemed almost as far away as Galicia to his parents.
Marcia’s family’s history also took them to Chicago, but by a much different route. Her parents met near the end of World War II while being held prisoner at Dachau concentration camp. They were two of an estimated 32,000 who were liberated by American troops just days before the end of the war on April 29, 1945. They spent the next year in a DP (displaced persons) camp in Germany, one of many former concentration camps that continued to house survivors, some for as long as ten years.
They stayed together, married, and were able to make their way to Winnipeg, Canada, where Marcia was born. American restrictions on Jewish immigration made it too difficult to come to their first choice, family in Chicago, which they were able to reach after many bureaucratic delays by the early 1950s.
They had reached their promised land. Or so they thought. Marcia contracted and survived polio soon after, when the nation was desperate for a vaccine. The helpless terror of their child’s illness was surely something of a reminder of the terror they experienced in Dachau, something they never thought they would have to face again.
When they met in high school, Morie’s visible confidence matched like a puzzle piece with Marcia’s quiet reserve. They may have seemed an unlikely couple to casual observers, their devotion to each other hasn’t ebbed.
They raised two daughters and cemented Gertz’s priorities: family first, profession second. Morie and Marcia Gertz knew something about what was important.
An odd convergence of events upended the Gertz family in the early 2000s. His mother had been experiencing health issues that eventually led her to be seen by a hematologist. Although her son was a world recognized cancer expert, she had little understanding of what her son actually did.
When the physician was having difficulty explaining his diagnosis, he had trouble being understood by her. He left the room for a few minutes and came back showing her a medical text on myeloma, “Here’s the book your son wrote about your disease.”
She would soon be at Mayo for tests and was treated by Gertz’s colleague, Martha Lacy, until she passed away two years later.
Gertz was a young man with a plan in 1979. “My goal in life was not to be writing about myeloma, it was to be a gifted diagnostician. I wanted to get Mayo on my curriculum vitae and have a nice, lucrative Michigan Avenue practice as a premier hematologist in Chicago with Mayo Clinic training. No intention of staying in Rochester.”
Time at Mayo, however, led Gertz to want “to know how to diagnose and treat.” That much was clear. His experiences in Chicago, Boston, and Little Rock provided him with “exposure to multiple health care systems,” leading him to conclude there “was nothing like Mayo.” It “allowed me a practice to see patients from all over the world who came with really complex medical issues. And I really got to see some amazing patients.”
Gertz recalled his first days on the faculty, when patients would “walk through the door and say, ‘I’m really sorry, I couldn’t see Dr. Kyle, but you’ll do.’ Since he wasn’t available, I’m what they got.” It didn’t take long for patients to start asking for him.
Most satisfyingly, “You learn every time you send a patient to a cardiologist or gastroenterologist. I’m very, very happy at what I’m doing, which is why I’m still doing it and I think the patients like what I’m doing too, based on the feedback I get.” Being able to continue to treat patients is “why I stayed here.”
Forty-five years later, the Gertzes are firmly ensconced in Rochester; it’s hard to imagine them being anywhere else. But probably not for Marcia. Chicago still beckons.
Photos of Marcia and Morie Gertz courtesy of Morie Gertz.
[1] As Telly Savalas, aka Kojak, might have said, “You’ve come a long way, baby!”
[2] As President-Elect, President, and Past-President.
[3] The Roland Seidler Jr. Professor of the Art of Medicine.