In this edition, Uma Borate, MD, speaks about growing up in a household with extended family, including her "living legend" grandmother, and trying to re-create that experience for her own daughters.
Where did you grow up and what was your childhood like?
I grew up in a city called Pune in southwest India. I had a wonderful childhood in a home full of extended family. I lived with my parents and brother, as well as my uncle and grandparents. My uncles, aunts, and cousins were frequent visitors. My parents were two busy working physicians – my mother is an internist, and my father is an orthopaedic surgeon – so I was raised by this extended family, especially my grandparents. I also was fortunate to go to a wonderful school and met lifelong friends there, many of whom I am still in touch with. Having so many friends and family around helped me develop a sense of self and identity early on.
Growing up in a multigenerational household provided such a variety of perspectives and experiences to learn from, but, looking back, I didn't fully appreciate how unique that was. It has probably helped me relate more to my patients because they have a wide range of ages and life experiences as well.
Did your parents inspire you to go into medicine?
I feel like medicine is the family business. My grandmother was a physician – one of the few female physicians at that time in India. Her life story is extraordinary, and I did not realize that I was growing up with a living legend.
My grandmother was one of 11 children and, as with most women of that era, her destiny was to get married, raise her children, and be a good homemaker. But her mother – my great-grandmother – recognized her daughter's extraordinary intelligence and thwarted my great-grandfather's attempt to marry her off. Whenever prospective grooms came to visit, my grandmother was mysteriously absent!
Her teachers also recognized her intelligence and petitioned my great-grandfather to allow her to continue her education. Medical school in Mumbai was the only option then, but only one student from her province was allowed to attend. My grandmother qualified for that seat and went to Mumbai alone, which was very unconventional for that era. She majored in obstetrics and gynecology, later entered academic medicine, and eventually became the first head of the department of obstetrics and gynecology at Lokmanya Tilak Municipal Medical College in Mumbai until her retirement. She continued her legacy of advocating for women's health through her work at the nonprofit organization, Family Planning Association of India, which she did well into her 70s.
My mother followed in her footsteps and I did the same. I wanted to be a physician at a very young age because of them. I probably also subconsciously understood that becoming a physician was a straightforward way for a woman to get a higher education, command respect in society, and achieve financial independence, all while helping people every day. I saw that firsthand with my grandmother and my mother; it made sense to follow that path.
Did you ever consider straying from the "family business?"
I briefly considered being a forest ranger, after visiting several national parks throughout India with a variety of camps that my parents enrolled me in growing up. Again, it was unique for children, especially girls, to have these opportunities. I credit my parents with giving me experiences like these that broadened my worldview and contributed to that early sense of identity and independence.
On one of those trips, surrounded by the natural beauty at these parks, I remember thinking, "This is a great career – I could live in a jungle and see tigers every day." Obviously, that did not materialize.
Once you decided to pursue medicine, what drew you to hematology, and specifically your focus in myeloid malignancies?
I left my parents' home for the first time after medical school, when I came to the U.S. I did my residency at the Albert Einstein Medical Center in Philadelphia. That is when I started falling in love with the field of oncology. I saw the unique relationship that oncologists developed with their patients – we were united as a team in trying to stay one step ahead of their cancer, as it was figuring out ways to elude every therapy we tried. Myeloid malignancies, and acute leukemias in particular, illustrated that biological battle more dramatically than any cancer. There is a sense of urgency to save patients' lives, but we continue to follow them along their treatment trajectory to determine how we can maximize their quality of life while offering them potentially curative treatment. I took care of very sick patients and seeing them get better after a tough hospital stay felt like a victory for our team. Even when the outcomes were not good, we continued our teamwork to minimize pain and suffering and maximize our patients' quality of life.
I knew then that I wanted to be part of a profession where you could build these unique relationships. In myeloid malignancies, we have made tremendous strides in employing newer diagnostic techniques to develop targeted therapies, minimizing side effects, and outsmarting the cancer by exploiting its vulnerabilities.
Were there any specific individuals there, or at other institutions, who helped shape your career?
After that initial exposure to oncology during residency, I explored the field even more in extra rotations and electives before applying for a hematology/oncology fellowship at the University of Alabama at Birmingham (UAB). I have had wonderful teachers and faculty mentors who fostered my love for this profession, especially on the leukemia service where I saw patients with aggressive myeloid malignancies.
During my fellowship, I worked with James Foran, MD, who was a wonderful clinician and my fellowship director when I joined UAB. I spent a lot of time with him in clinic, where I saw his efforts to keep patients front and center in every recommendation he made. Thinking about managing a patient's disease, he would famously say, "Do the right thing." Lisle Nabell, MD, our interim division director, was a wonderful role model of a female oncologist in academia who embodied what it takes to pursue your passion while staying true to yourself. After joining the UAB faculty, I was fortunate to work with Harry Erba, MD, PhD, another outstanding leukemia physician with a patient-centered philosophy and an exceptional teacher for fellows and junior faculty.
Next, I joined Oregon Health & Science University and had the opportunity to work with Brian Druker, MD, whose discovery of imatinib for chronic myeloid leukemia (CML) led the way for precision oncology in myeloid malignancies. Working with Dr. Druker was inspirational – seeing his passion and leadership for translational research as the director of a comprehensive cancer center and the incredible impact his work has had on the lives of our CML patients.
I learned a lot from these mentors but, most of all, I continue to learn and be inspired by my colleagues and trainees. Most of my colleagues are women, so we all share the experiences of coming into our careers while we are also coming into ourselves in our personal lives. We support and promote each other, while sharing and connecting over many of the same highs and lows, challenges and triumphs of our personal and professional lives.
Do you have any advice for early-career hematologists?
Build your network and support system early on and maintain those relationships through networking at meetings. As an early-career academic, it is easy to develop imposter syndrome, but know that everyone is finding their way and your voice is important. Speak up and amplify others who may be in the same boat. Don't be afraid to say "yes" to opportunities; it gives you a seat at the table and a chance to influence the conversation. Conversely, don't be afraid to say "no" if you are overextended to protect your sanity and maintain the elusive work-life balance. I am notoriously bad at this – I have a hard time saying no to anyone (except for my children, as they constantly remind me).
Did you also talk with your mother about her own experiences as an early-career physician? Was that helpful for you?
Absolutely, she made it a point to share many of the challenges she went through, starting when I was young and considering medicine as a career. She knew that I might choose the same path and she wanted me to be aware of what kind of challenges might present – like, deciding when to have your children or balancing your career with your family. These are all age-old questions that we continue to grapple with – even more so during the COVID-19 pandemic – but it is helpful to hear everyone's experiences and know you are not alone in these struggles.
What do you see as your greatest accomplishment in your career so far?
I am proud to have the opportunity to work with scientists in the lab, as well as various industry or pharmaceutical partners to bring novel clinical trials from the bench to the bedside. As a clinician, I can take what has been learned in the lab and go to a variety of partners and collaborators to advocate for my patients and how they would be best served by the investigational therapies or novel combinations. The clinical expertise that our team has built up makes running these complex trials every day a joy and a privilege. I am always amazed at how many of our patients want to be part of these clinical trials, fully knowing that they may be helping others that come after them more than themselves. I see the best of humanity and teamwork at my job, and that is by far the biggest accomplishment of my career.
Can you tell us about your family and your life outside of medicine?
My husband and I have two little girls, eight and five – they're not so little anymore – and a geriatric Doberman. I met my husband 10 years ago. He is an IT professional and we met in a modern way: an online dating site. I tried online dating because I was a busy trainee at the time, and it felt like the least time-consuming way to meet people!
Our first date in person lasted 10 hours. Within a few months, we were engaged and within a year, we were married. Now we have two beautiful girls. He is my biggest champion and advocate, supporting me through multiple moves and shouldering a large portion of the household responsibilities so I can dedicate time to my career. My children are also my cheerleaders – they constantly tell me how proud they are of me. That is priceless.
What do you enjoy doing as a family?
We are all outdoorsy. We bike, hike, and, of course, spend time at our children's activities. Our daughters play multiple sports – soccer, swimming, gymnastics, Bollywood dance classes, and more. So, my No. 1 extracurricular activity right now is spending time at their activities and being a very proud mother. Being around them gives me so such joy and keeps me grounded, which is crucial to avoid burnout in my line of work.
The past year has limited travel, but do you take trips back to India?
Yes, we have been fairly consistent in traveling to India at least once every couple of years to see family, and so that my daughters can reconnect with their grandparents and other extended family. I am lucky to have much of the family I grew up with in India now living relatively close to us in the U.S. My cousins have their own kids now, so we meet up every week. To the best of my ability, I've tried to re-create my childhood experiences of growing up in a big, extended family for my children.
What is one thing that most people would be surprised to learn about you?
I am fascinated with languages. I can speak three languages fluently, but always wished I could learn more. I watch international shows on Netflix and other streaming services in their original languages – Turkish, Korean, Spanish, Russian, pretty much every language I can possibly listen to. I love gaining insights into different cultures, how people live, how they talk… I'm astonished by how many words I know in Korean (although native Korean speakers may think differently).