In this edition, Brian J. Bolwell, MD, talks about the pediatric leukemia patient who spurred his interest in hematology, early days in the Cleveland Clinic's bone marrow transplant service, and his penchant for books about leadership.
In Sound Bites, hear more from our interview with Dr. Bolwell.
Where did you grow up?
I grew up in Chattanooga, Tennessee. It was a good childhood; we lived on a mountain and always had a lot of pets. The other side of the mountain was teeming with rattlesnakes, though, so I have a deep-seated fear of snakes.
What did you want to be when you grew up?
When I was younger, I played baseball, and I suppose I wanted to be a pitcher, but I flamed out pretty quickly. My first game was the highlight of my Little League career: I only gave up one run, the game was tied through regular play, and I won it in extra innings. From there, it went downhill.
Later, I became interested in theater, so, if I could imagine myself in another career, I might want to be an actor. I performed in a bit of everything – Shakespeare plays, comedies, musicals – and I was part of the Glee Club in high school. I'm not sure I'm a good enough actor to do it for a career, but I'm sure it would be fun.
What was your first job?
When I came to Case Western Reserve University for medical school, I worked in the mailroom of a law office. It was before we had email or even faxes, so I sorted mail and made deliveries to businesses in downtown Cleveland. I made very little money, but I did get to know the area quite well!
Once you started down the path of becoming a doctor, what experiences brought you to specialize in hematology?
The first patient I ever saw as a medical student at Case Western Reserve University had a significant impact on me. I was on a pediatric rotation, and the residents assigned me to see a 4-year-old girl with acute leukemia who didn't have long to live. There wasn't much we could do for [the child], but I realized one thing I could offer [to her and her family]: I could listen. I spent a lot of time with the patient's mother and got to know her well. Many nights on call I would take long walks with her through the hospital and just absorb everything she had to say about the horror of the situation. This experience affected me profoundly, and I wound up becoming interested in leukemia. During my residency I did most of my electives in hematology, either clinically or in the lab. Then, I went to the Hospital of the University of Pennsylvania for my hematology/oncology fellowship and specialized in leukemia.
When I came to Cleveland Clinic 30 years ago, the timing was serendipitous. In my first two years, everybody in the bone marrow (BM) transplant service left, so I was basically told – at an extremely young age – that I was the leader of the program. However, it wasn't much of a program at the time; we performed about 15 transplants per year. That was my first leadership opportunity, and, fortunately, we were able to take a small program and build it into something quite special. For the first 20 to 25 years of my career, I led our BM transplant program. The good news is that our present director, Navneet Majhail, MD, is much better than I was, so the program is now thriving.
Have you had any major disappointments in your career? If so, how have you handled them?
I've been part of the C-suite at Cleveland Clinic on a couple of occasions, and I've been asked to depart the C-suite. It certainly didn't feel good, but I think whenever something happens that may not be in your favor, it's an opportunity for self-reflection. Hardships are opportunities – that's how you've got to take it.
And sometimes setbacks are okay. When you take a principled stand or make a decision that ruffles feathers, you don't always win; but you can still hold your head high because you know you did the right thing.
Were there any specific people who mentored you along your career path?
In all honesty, I haven't had a ton of mentorship. Much of what I know about being a leader I learned from participating in a formal executive coaching exercise about 12 years ago. That's when things started to change for me, and I became keenly interested in the concept and study of leadership. I've probably read more than 70 books on leadership – it's a fascinating topic to me.
What makes a good leader?
There are a few qualities that come to mind. First, be ready to freely admit that you don't know everything. There is always room for improvement in how you interact with people, how you lead, and how you conduct yourself. Many of the books I've read suggest that leadership and character development are one and the same, and I tend to believe that you can keep getting better if you're motivated. I suppose that having an eye for self-improvement is a double-edged sword, but, in general, I think it's a good thing.
Second, learn to accept a certain amount of chaos. When you're managing hundreds of people in a field like hematology that changes so rapidly, and when health care itself is changing so rapidly, stuff happens. You're going to have to stop what you're doing and deal with the unexpected. Some people have a hard time with that. When you're in an administrative position like mine, you have to expect the unexpected.
Lastly, have courage in your beliefs. Even if you know that you hold an unpopular position, and even if people who have more authority than you don't agree with you, have the resolve to stand up and say, "This is what I believe in. This is what we're going to do."
What advice do you have for early-career hematologists and oncologists?
It's okay to admit you don't know everything, and it's okay to ask for help. Also, be nice to folks who are there to help you. I think it's important to treat everybody who works around you with respect. That means not just physicians, but also nurses, secretaries, and the people who clean the floors.
How has the field of hematology/oncology changed since you began your career?
I'm still thrilled and honored to be in this field. The science of hematology is utterly fascinating, but the diseases are terrible. So many wonderful people across the world are nobly trying to help patients afflicted with these diseases in every way possible.
Today, there is so much interest in immunotherapies and gene therapies for cancer, and people involved in hematology have always been thought leaders in this space. I think the promises of genomics and chimeric antigen receptor T-cell therapy have come to bear in hematologic malignancies. And much of the knowledge we've gained about genetics and genomics of acute leukemia has set the stage for what we know now about other types of cancer.
It's funny – although these therapies have emerged and become a major focus of cancer research recently, those of us who have been doing allogeneic BM transplantation have basically been practicing immunologic therapy for decades. Everything has come full circle.
“Have courage in your beliefs. …
[A good leader has] the resolve
to stand up and say, ‘This is what
I believe in. This is what we're
going to do.'”
In a typical day, what is your rose and what is your thorn?
The best part of my day is the beginning. Almost every morning, the first thing I do after I wake up is some type of cardio exercise – an elliptical machine, a bike – and listen to music. At work, the best part is when goals are achieved, either by a patient, someone on my team, or myself. As an example, one of our goals at the institute is to reduce the time it takes new patients to get their initial therapy.
If we can cut that down by a few days, it's an accomplishment our whole team can be proud of. When any member of the cancer center's team succeeds, it's important for me as a leader to sit in the back row and give him or her all the credit.
The worst parts generally fall into two categories: trying to manage folks who aren't behaving well and handling budgetary issues, which can be a challenge. I'll just leave it at that.
It's hard to find too many things to complain about in this job. My biggest pet peeve is folks who are entitled. At our institute, we see so many courageous people who are facing some horrific illnesses and doing so with class, grace, and courage. Anybody, regardless of where you were born or your socioeconomic status, can get these diseases. There are so many wonderful things that are available to us if we have our health. Sweating the small things just doesn't make sense to me.
Outside of work, what do you do for fun? Do you have time for any hobbies?
I like spending time with my kids; I have two sons and one daughter.
My sons are skilled golfers. They played competitively in college. Even though I'm not nearly as good as they are, it's fun to play with them. My daughter is getting her degree in clinical psychology in Los Angeles; I enjoy hanging out with her when I can.
I'm a Cleveland Cavaliers fan, so we have season tickets and watch them play quite often.
Other than that, I like reading mystery novels and books about leadership – which are two very different topics. And, of course, I still love going to the theater.
What's one thing people might not know about you?
I'll give you two: I'm still a huge University of Tennessee football fan, and I really like Britney Spears' music – it's great to work out to!