George, tell us about where you grew up. What was your childhood was like?
George: My younger brother and I grew up in the Bronx. My parents were from Poland and immigrated to the U.S. in 1950. They were both Holocaust survivors – my mother was in the Lodz ghetto and my father was in the Warsaw ghetto uprising. They met on a train after they were liberated from concentration camps, but while the war was still going on.
Education was very important to my parents – had they not suffered through World War II, they would both have gone on to higher education. My father was a machinist and eventually became the owner of a supermarket. My mother was only 16 at the end of the war, and she had plans to earn her high school degree and start college in Munich for architecture. However, those plans were put on hold when she and my father moved to the U.S. When she was 41-years-old, when I was enrolled in college, my mother said, “If he can do it, so can I.” And she did. She went to the local community college for two years and then transferred to Fairleigh Dickinson University and earned a Bachelor of Social Work degree. Next, she earned a Master of Social Work degree from New York University. She eventually accepted her first job as a social worker at age 51.
What drew you to medicine?
George: I never specifically wanted to be a doctor. In college, I ended up taking science courses just because I found them interesting. That interest grew, and I ended up getting a part-time job in one of the chemistry laboratories at my college. I was taught how to build and fix lasers used in basic chemistry experiments, stimulating molecules to see how they interacted with other molecules.
Rebecca and George at Robert Wood
Johnson Medical Center in 1986.
In my senior year, I still didn’t know if I wanted to go to medical school or not. I applied to several MD/PhD programs, got into several of them, and ended up instead going to the MD program that all my friends were going to.
As a third-year medical student at Columbia University, I took an elective with a very well-known hematologist, Hymie Nossel, MBChB, DPhil, who did a lot of the pioneering work on fibrinogen. I worked in his lab for several months, which really piqued my interest in hematology. Then, I matched in internal medicine residency at the University of Chicago, which was great, but three days later I met my would-be wife, who was a third-year medical student in New York. We were in a long-distance relationship until we decided to get married two-and-a-half years later. I was a fellow at the National Institutes of Health at the time, and she was doing her residency at Boston Children’s Hospital. I moved up to Boston and completed my fellowship at Dana-Farber Cancer Institute.
Rebecca was born when I was an attending in hematology/oncology at Beth Israel Deaconess Medical Center (BIDMC), the same hospital where she spent several years in residency and fellowship. Several of her professors were people I worked with back in the 1980s.
Rebecca Karp Leaf, MD, with her father
George Karp, MD, at Beth Israel
Deaconess Medical Center.
Rebecca, do you remember medicine being a large part of your life growing up?
Rebecca: I have been surrounded by medicine and discussions about patients for as long as I can remember. My dad had his own lab for a while at Robert Wood Johnson Medical School, and he would bring home stuff for me and my siblings to play with. We loved to put dry ice in Styrofoam containers at the end of the driveway, add water and food coloring, and make colorful smoke.
George: I have to emphasize that we never, in any way, encouraged Rebecca to become a doctor, but she did see both me and my wife enjoying our work as doctors. We were happy in our professions and I think that really made an impression on her.
Rebecca: I remember always being so proud of my parents growing up. After services at our synagogue on Saturday mornings, my dad would spend another hour talking to patients or family members about their care. I felt that he had an important role in our community and that people depended on him—I continue to be in in awe of how generous he is with his time.
As a teenager, I became an EMT on the rescue squad in our town. I think that experience, more than anything, inspired me to go into medicine. On the squad, every person shared the same goal: helping a patient to get timely care. I loved the community I found in the rescue squad, and I have found a similarly strong community amongst my fellow physicians.
George: When I was seeing patients full-time in the 1990s, our busy office had a lot of very sick patients and, from time to time, Rebecca’s rescue squad would come pick up my patients and bring them to the emergency room.
You mentioned both working at BIDMC. How else do your careers overlap?
Rebecca: We trained and worked in many of the same places and with many of the same people. When I was an internal medicine resident at BIDMC, I started doing electives in hematology with my subsequent mentor, Kenneth Bauer, MD. Ken was actually my father’s resident at the University of Chicago, and they also worked in the same lab in Boston. Even though I’m at a different institution now, I still call Ken with difficult coagulation questions.
George: And, when Rebecca moved to Mass General, she began working under David Kuter, MD, DPhil, the director of clinical hematology, who worked with me in the lab of my mentor, Robert Rosenberg, MD, at Dana Farber. I met Dave in 1982 and, through Rebecca, we have been able to reconnect and renew our friendship.
Rebecca: Dave likes to remind everyone that he knew me as an infant.
Given the obvious overlap in your careers, do you often discuss patients together?
George: Quite a bit.
Rebecca: Oh yes, I call him all the time. And if we can’t figure out a problem, we can call Ken Bauer or Dave Kuter for advice. When I first started as an attending, I must have called my father two or three times a day to ask him about patients. Perhaps that was a bit overkill!
We also try to go to the American Society of Hematology (ASH) annual meeting together where we usually attend the same sessions. When I was a child, the whole family would go to the ASH annual meeting when it was in Orlando, and I still equate the annual meetings with Mickey Mouse.
Rebecca, why do you think you chose to go into hematology?
Rebecca: I was drawn to hematology for a variety of reasons. First, I have had some incredible mentors who truly inspired me, including Drs. Bauer and Kuter, as well as Reed E. Drews, MD, associate professor at Harvard Medical School. Second, I’ve always enjoyed the cerebral aspect of hematology. For instance, coagulation is like a puzzle that, when you find a missing piece, all makes sense. Finally, when I was in medical school, I remember finding blood smears and bone marrow biopsies so beautiful to look at under the microscope. I’ve never lost that sense of wonder when looking at a smear—especially if it helps you solve a case.
I have also found a small niche taking care of pregnant women with hematologic issues. I love thinking about the pathophysiology of both mother and baby and working closely with the obstetricians.
George: That is another interesting overlap between our careers. I also have a strong interest in hematologic and oncologic problems in pregnancy. That all stems from caring for a 29-year-old woman when I was fellow who developed acute lymphocytic leukemia (ALL) when she was 21 weeks pregnant. At the time, in 1979, the standard recommendation was termination of the pregnancy and intensive chemotherapy. The patient insisted on continuing the pregnancy, received standard treatment for ALL, and delivered a healthy baby at 36 weeks.
Throughout my career, I’ve sort of established a niche for myself as someone who deals with the hematologic, and rarely oncologic, problems of pregnant people. Now, Rebecca and I talk to each other and share advice when we see difficult hematology situations in pregnancy. I depended on her more as she became more experienced. I would not hesitate to say to patients, “You know what? My daughter does the same thing up in Boston and here’s what she recommends.”
What is the best advice you’ve ever received from a mentor, and, George, what advice do you share with early-career hematologists/oncologists?
George: Try to figure out relatively early on if you want to be a scientist or a clinician, then focus your time on what most interests you. Personally, I felt as though I could not devote myself fully to both the lab and to my patients. I needed to decide how I wanted to spend my time. I ended up giving up my lab in the 1990s when my third child was born. It was a tough decision, and I still miss the investigative aspect of hematology – the act of taking an idea from bench to bedside – but I also had a terrifically rewarding career as a hematologist/oncologist in practice with an academically-minded group of partners. I would advise anyone just starting out in training to pick their true passion in hematology, with the goal of not feeling torn between too many commitments.
Rebecca: When I was just out of training, my dad gave me some of the best advice I’ve ever received: There is often no right or easy answer for the complex patients we see, so get comfortable with uncertainty. When I first started out as an attending, I would call him and ask for a definitive answer: “should I start anticoagulation? What dose? For how long?” But, in reality, so much of hematology – so much of medicine – is an art, requiring nuance and subtlety and experience. And it’s important to ask for other opinions when you need advice.
George: By the time Rebecca finished her training and was asking all these questions, I had years of experience dealing with uncertainty, so I was able to say, “Listen, there is no right answer. This is the way I do it. It usually worked, but sometimes it didn’t work.” It sounds like that was helpful to her and it also gave me insight into some of the ongoing questions in hematology. It has been a wonderfully collaborative relationship.
Rebecca: My dad is my biggest role model and mentor – not only for how to be a physician, but also for how to act as a human being on this planet. He’s absolutely brilliant, both as a clinician and as a scientist, and it’s unfortunate that he had to give up his lab career in the 1990s. But he is also the most compassionate, ethical person I have ever met. He consistently sees the best in people, giving everyone the “benefit of the doubt” even in the most trying of circumstances. The Talmud says that the “highest form of wisdom is kindness,” and I truly believe that my father embodies this sentiment.
George Karp, MD, (second from left)
and his wife, with their daughter Rebecca
Karp Leaf, MD, her husband, and their
two children.
What do you talk about when you aren’t talking about hematology? What do you enjoy doing as a family?
George: Well, right now, the main thing is babysitting. Rebecca has a 3-year-old and a 1-year-old. I recently retired, and my wife and I have moved to Boston and live in an apartment three blocks from Rebecca. We love nothing more than going over there to see the grandkids. Then, when the kids are asleep, Rebecca and I can still sit on the couch and say, “OK. Let me tell you about this interesting patient.” Rebecca’s husband, David, is a nephrologist at Brigham and Women’s Hospital and one of his interests is iron and kidney disease. I really enjoy reading David’s grants and discussing research ideas with him.
Rebecca: I spend my time chasing after my children, Emma and Teddy, and our large Siberian cat, Winston. I also love to run along the Charles River. Our family enjoys going to museums, farms, and historical sites on the weekends.
Rebecca, what do you think the odds are that one of your children will go into medicine, if not hematology specifically?
Rebecca: Whatever they want to do is totally fine. But I hope they see that both my husband and I are really happy in and fulfilled by our careers and the community we have made. I truly love what I do.
George: I tried to impress on all our children that I never cared what field they went into, as long as they were happy doing it. You have to get up in the morning and say, “I’m looking forward to going to work.” And if you can’t find that, then you should look for something else.
Rebecca: Fortunately, my dad and I both found a career where we feel that way.
