Dr. Maie St. John, MD, PhD, University of California - Los Angeles

 

Dr. Maie St. John, MD, PhD

Professor & Chair, Department of Head and Neck Surgery,

Thomas C. Calcaterra, M.D., Chair in Head and Neck Surgery,

Co-Director, UCLA Head and Neck Cancer Program,

University of California - Los Angeles

 

 

Dr. St. John is a world-renowned surgeon-scientist focused on head and neck cancer. She received her Bachelors degree from Stanford, and M.D. and Ph.D. degrees from Yale. She completed her residency and postdoctoral training at UCLA. Dr. St. John’s clinical expertise is in intraoperative tumor margin delineation in the resection of head and neck cancers to allow for precision surgery. Her efforts have helped in the development of strong interdepartmental research programs in Head & Neck Surgery and Bioengineering. This work has led to clinical trials and patent applications, and has been consistently funded by the NIH, charitable foundations, and industry. She has served in multiple leadership positions with in the American Head and Neck Society, the Triological Society, the American Academy of Otolaryngology-Head & Neck Surgery, and the American College of Surgeons, among others.

 

Dr St. John why did you choose to specialize in otolaryngology and why head and neck cancer in particular?

My story really begins when I was a young girl. I would spend summers with my grandfather who was a small-town doctor.  He would carry me on his shoulders and we would visit patients together.  One evening we saw a young patient with a large ulcerative growth on her neck.  I remember my grandfather saying this was “cancer,” and that she probably was not going to live for a long time. I remember she also had a young child, and I thought to myself, I didn't know what cancer was, but I knew that what I wanted more than anything in the world at that time was to make sure that cancer could be cured.  And so, from a young age, I was very driven to be a cancer doctor. I knew from my youngest years that I wanted to do that, and I worked diligently towards that goal. I was very fortunate to attend Stanford, and while I was at Stanford, I did research with George Hahn, who was one of the leaders and very bright minds in heat shock proteins and cancer. I did my research time with him, and he was an amazing mentor. I recall him asking: “Why don't you stay on as my final PhD student?”  He encouraged me to apply for MD-PhD programs. As a result of his guidance and mentorship, I ended up getting the opportunity to go to Yale as part of the MSTP program and he recommended that I head to the East Coast to get my training because he said, “If you want to come back to California, it's better to variegate your background a bit and go to the East Coast”.

So I went to Yale, and then shortly thereafter I got married to my college sweetheart. My husband went to Yale to do his JD and we both enjoyed our time at Yale immensely. After my first two years of medical school, I entered my PhD years and I was very fortunate to work with Tian Xu, who was a Howard Hughes investigator. He was pioneering Drosophila as a genetic model to identify the role of oncogenes and tumor suppressor genes (especially important if there was an embryonic lethal tumor suppressor phenotype). We were using the FLP/FRT system, (similar to Cre/loxp system) and the Drosophila model to create conditional mutants and to create and understand a variety of mutations. Using this system, we were able to identify novel new tumor suppressor genes. When I joined the Xu lab, I wanted to learn not only cancer biology but also the genetics behind preclinical models. One day Dr Xu said to me: “Well, you're an MD-PhD student, let's move into a mouse model”. So, I was able to work at Cold Spring Harbor Laboratories and learn all about making knockout mice. And I made a series of three knockout mice during my PhD.  While in the lab, I realized that between injecting genetic modifications into drosophila eggs and operating on mice and transplanting different ovaries as needed, that I really liked to combine my love for cancer with surgery.

Prior to joining the lab during my MD-PhD years, we had an opportunity to rotate through internal medicine, so then we could work in a free clinic one night a week and keep our clinical skills active and relevant. When I did internal medicine, it was a really difficult time for me.  I became somewhat saddened because I had spent my whole life planning for a career in medicine, but I didn't care for the cadence of internal medicine. One night, I called my father and I said “Dad, I spent my whole life focusing on and preparing for this. And now I find that I don't really care for it”. And my dad said, “Do me a favor, just finish, then we'll discuss it”. Given the timing,  I was very fortunate to go into the lab and discover that I really liked using my hands and liked doing surgery and wanted to combine surgery and cancer.

Once I defended my PhD, I rotated on surgical oncology. Dr. Ronnie Rosenthal, was Chief of the Division and a wonderful mentor., She said to me “you know, in addition to surgical oncology, you should also try head and neck surgery”. So that was my first foray into head and neck. I hadn't really thought about it. I didn't know much about it. And I went into the operating room that first day with a gentleman named Dr. Clarence Sasaki, (who was the former chair at Yale prior to Dr. Yarborough and Dr. Judson). Dr Sasaki had an immense effect on my life. He was gifted and brilliant.  I consider him one of my lifelong mentors. Dr Sasaki had invited me to be the inaugural speaker at the annual Sasaki Endowed lectureship in 2019. So, you can only imagine what that meant to me.

 

This has been an incredible story. Really, really exciting. Sounds a little bit like a roller-coaster, especially the part with an Internal Medicine and the disappointment you got. Is there something that you don't like about the specialty and the subspecialty in particular?

You know, a lot of people ask me, “Isn't it difficult to take care of cancer patients?”. But one thing I learned from Dr. Sasaki is that if you take care of cancer, sometimes you win and sometimes you lose. But if you take care of the patient, you always win.

 

That's really inspiring to hear. Thank you for sharing that!

I think a lot of times, too, people will say, “oh, my goodness, I have to go to clinic this morning and it will be so busy…”. But I can tell you that as a cancer surgeon, I am very fortunate in that I have people of every background of every age, of every walk of life, of every identity, of every diverse kind of variable you can imagine praying for me every day in every language all around the globe.  I am so blessed as I find myself to be in a very privileged position to try to help people in any way I can.

 

I see. Now, I understand that you have multiple roles: you are the Department Chair, you are a leader in the field of Academic Otolaryngology, you're a surgeon and you’re a researcher. So my question is, how do you balance all these and essentially, how do you find the balance between the lab/research and the clinic? And how has that balance shifted, if any at all, now that you also have multiple leadership roles?

 

A lot of times people ask me “Dr. St John, how do you get so many things done?”. I can tell you that the bottom line is I'm really “living the dream”, right? These are the things I had dreamt of doing with my life, and now I'm privileged enough to have the opportunity to do these things with my life. My mind is much like the New York train station. It tells you which train is leaving, on which platform, on which time, and they keep changing every two minutes. That’s what I'm doing. I have learned to be present in each task then, I can easily just jump into the next thing I'm doing. I keep dynamic lists and I have a kind of organized structure to my weeks. But I think the important thing to keep in mind is that one must practice adaptability, resilience, and the capacity to just switch and do what's necessary and what's needed. You know, the operating room is a bit like my sanctuary, frankly, because when I'm in there, I am only focused on one thing.

I'm fortunate to be very passionate about the different things. I'm very passionate about helping people, whether that's helping patients or whether that is providing and creating opportunity for trainees and colleagues, and people who I work with globally. It brings me great pride to get to my students and say, “Hey, there's going to be a student poster day. Let's make sure we present and let's make sure you're out there”. All of that really drives me. I'm very fortunate to wake up each day with a lot of ideas in my mind, and to have an amazing team that can enhance these ideas and make the vision a reality. I think we try to be a team that is inspiring. I try to lead through inspiration and service, and I think I've just been so fortunate to have so many people on my team that are driven in the same way. And I think the more selfless what you do is, the better the outcome.

 

That's very interesting. Particularly the analogy you made with with the New York train station. MD-PhD surgeon-scientists in the field are a rare breed. But through the Blog I had the opportunity to interview a couple of those, including Drs Ferris and Teknos. And of course, I have had the opportunity to interact a lot with my PI Dr. Yarbrough. And one pattern that I think I see in all of you is that you like switching, you are very capable of switching from one mode to the other. From the surgeon mode to the scientist mode. And you it sounds like you kind of enjoy this constant transition between the two.

 

You know, I think one of the things to think about is that if you're only focused on one thing in your life, then you're very, very focused on “is it going well or could it be going better?”. Whereas if you have a lot of things going on, you can't let one thing bring you down because there's always something else going in another great direction.

 

Yes. Yes. That is that is so true! Now, for my next question, I'm going to move to a different to a different subject. You're the Chair of one of the leading Otolaryngology Departments in the country. And I'm sure you have you've had a lot of experience with applicants on multiple levels: Resident Applications, Fellowship and even Faculty. So, what in your opinion, makes a strong applicant?

I'd be curious to hear some of the things that might stand out in your eyes, and on the other hand, red flags, things that, you know are a red flag for you, either in an application or during an interview.

 

People who are interviewing for any position are interviewing to be a member of our team. For me, the team is comprised of every single person on the team, because we all support and affect patient care. I think really what we look for is integrity. And a very clear concept that no job is too big or too small. I think we live in a culture where a lot of people want to present themselves in a certain way. But what we are looking for is “who are you?”. What makes you tick and what do you want to do? What are you motivated by? Because I think if you're motivated to help other people, that is someone who's really going to shine as a member of the team.

 

 

I don't know if you have time for one more question.

 

Yes, of course!

 

This one is about your legacy, really. So, I know you have had lots of academic experiences. You mentioned centers like Yale or Cold Spring Harbor. And obviously you have already made major contributions in the field in so many levels: from being one of the most important, I think female academic figures in the field -which is honestly very inspiring- to your scientific contributions and your clinical work. But out of all this, what would you like to be remembered for?

 

We live in an age where a great del of the time a surgeon or a physician is being taken up by computers and tasks that really don't involve human connection. And that human connection, is why we went into medicine in the first place. So, it's very, very important to always remember that regardless of whether or not the tumor is resectable or curable, you can always help the patient. For me, the legacy is getting to know your patients, getting to care for them like family, whatever that entails. Listening to them, respecting them, and respecting everyone on your team. Because our goal here is to shape a better future for everyone involved, whether it's my trainees, whether it's my faculty, and of course at the center is the patient. I really think what I would say is: if you are really focusing on the patient, everything else takes care of itself”.

 

You've given some very powerful, very inspirational messages through this interview. And definitely a lot lots of food for thought. I really appreciate that and I hope the readership will do the same!