Laurie Kirstein

Dr Laurie Kirstein came full circle when she decided to go into medicine, returning to study at the same campus where she was born. As a surgical oncologist Dr Kirstein treats breast cancer not only with modern medicine but also by taking into account each woman as a whole person. In her work and life, she embodies her favorite motto; treat others as you would like to be treated …

How old were you? 
Around 16 or 17 years old. I continued that job throughout college, as well. I studied sociology. When I graduated college, I got a full-time job there, answering hotlines, admitted patients, and seeing if people needed referrals. My stepmom was also a psychiatrist. I really liked the work, especially the research aspect of it. When a job opened up at Memorial Sloan Kettering, where my stepmother had trained, I applied. I worked on a program called The Network Project. It was an education project teaching healthcare professionals how to manage cancer and AIDS pain. I was the administrator, and so I would set up observations for different healthcare professionals, and I also created a library of resources for physicians, nurses, and social workers. It was working there that made me want to go to medical school.

I went to pre-med at Columbia University, and worked both full and part time still at the Department of Psychiatry. When I went to medical school, I went to SUNY Downstate. I lived in the dorm where I was born.

That’s crazy! What was medical school like? 
Medical school was great. I loved it. I think because I was a little bit older when I started, I had an appreciation for things. I have a very good perspective on life, and I have a lot of gratitude for what I've done and what I have. I’ve never taken the traditional road—it’s always taken me a little longer to get there [Laughs], but by the time I got to medical school I was ready and sitting in the front row!

I really don’t think it’s a bad thing to take a year or two off between college and medical school. It gave me a different perspective, and also allowed me to deal with patients a little differently because I was a bit more mature. You come at things with a bit more life experience, which makes it easier to relate and talk to patients going through a major turning point in their lives.

How did you come to work in breast surgical oncology?
In terms of choosing a speciality, I struggled with that. I was leaning towards surgery, but there are so many different paths. Surgery in general can be a very tough life. You are working with people who are very sick, patients can die, and you are on call in the middle of the night. I didn’t want to do that for the rest of my life. I loved kids, so thought maybe I would do pediatrics, but ultimately I was in love with surgery. I loved the operating room, and being able to intervene in a patient's illness and do something for them. But I also wanted a specialty where I could get to know my patients and that they would stay alive, because I like them! Because of all those things, I gravitated naturally towards oncology. I really love working with women, and the thought of helping other women was really important to me. I always tell my kids that I’m helping other mommies.

Also, the field of breast cancer is so dynamic. It’s constantly changing. There are always updates and new research. So that was very appealing to me, as well. I always wanted to have an academic career, as well as practicing and treating people.  

How many years did you study before practicing medicine? 
When I decided to go to pre-med, it was 14 years until I became a doctor.

That’s a lot of years!
You know, that time is going to pass anyway, so you might as well do what you like so that when the years have passed you’re at a place you want to be. I may have started a little later, but I got there in the end!

Were your parents surprised when you went into medicine? 
“Surprised” is probably the best word. [Laughs] I was a bit of a late bloomer, and not really very committed to things growing up. There wasn’t a lot of follow-through. I also wasn’t great at science in school. My dad was probably more surprised than my stepmom; she was always very supportive of me, no matter what I wanted to do. She would say, “The biggest failure in life is not trying.” I know that they are proud of me, though.

How would you explain your job to someone who knows nothing about it? 
Generally, I will see patients two days a week and operate two days a week. I’ll do outpatient surgery on one of those days and then inpatient surgery on the other. Memorial Sloan Kettering recently opened a branch in Monmouth, New Jersey, so I’ll be doing a lot of my outpatient surgeries out there, and my inpatient in the city. All mastectomy work is done here. Then I have one academic day a week, which is when I can work on my research and catch up on other things.  

What are you researching? 
So, my background has always been education. I was a fellowship director, meaning I organized the training for surgeons. I’ve always been interested in communications and teaching. My research, not surprisingly, is in that area.

There are many women these days who, after they’re diagnosed with breast cancer, are removing both of their breasts. For some women this is completely medically appropriate, like Angelina Jolie, who carries the gene for breast cancer. But then there are other women who are considered “average risk,” meaning they don't carry a gene and the risk of getting another breast cancer over the course of their life is very low, but they are still choosing to take out both their breasts even when they have other options. Some of it is really driven by fear, and a sort of hysteria in the media. For some women it's the right decision, but I want to make sure that women who go down that path are well informed, and set their expectations for what the surgery can do. For example, it doesn't change your need for chemotherapy. I also want to set expectations for what they will look like, and how they may feel. Breasts can be very important to women in terms of body image and sexuality.  My project is the creation of a web-based decision aid for women who are diagnosed with breast cancer, who are average risk and who are thinking about taking out both of their breasts. It addresses issues like risks of cancer recurrence, body image, psychological factors…. It’s interactive and at the end it will give you a printout that you can take to your doctor with questions. It’s something women can look at as much as they want when making this decision.

That's an amazing tool to have.
It's been great. I’m also working on analyzing some data for a grant submission. It’s about pain management after mastectomy, but for women who are not getting reconstruction. We currently have a standard post-op pain protocol, which is the pain medication given when the patient wakes up from surgery. Often, when a patient first wakes up from surgery, their level of pain is very, very high. They get some narcotic medications over the first six hours they are awake and then they start to feel better. But we are looking at the data, trying to stop that pain before they wake up.

So they don’t experience that trauma first thing after waking up. 
Exactly. People remember that pain. We want to apply something in the operating room, a pain-management intervention. Remembering pain is awful, nobody wants that.

So you’re applying for a grant to research this? 
We’re looking to fund it. There is a lot of chronic pain after mastectomy that people don't talk about or don't realize. There is a theory that if you stop the pain right after surgery, you may impact this long-term pain. We’re doing a pilot program now to see if we can get to a bigger program.  

Do you think being a woman working in this field gives you a different level of insight? 
Absolutely. Breast cancer and working with women in general is very psychologically minded. There is a layer of emotional aspects and ramifications of this illness beyond the medical. I think that’s one reason this field is particularly suited to me. It allows me to get to know my patients. Surgeons sometimes don’t have the best, kindest reputations. With my work and my research, I really care about the whole person and also their family. You want to get your patient to the other side as smoothly and as easily as possible, but that’s not going to happen if you only address the breast cancer. A woman dealing with breast cancer can have a family, partner, kids—she leaves your office and you don’t know what she’s then dealing with at home or in her life. My team and I try our best to address all those possible issues, whether it's with social work or referral to psychiatry or pain management.

Approaching your work this way, can you see the difference in your patients? 
I mean, patients do thank you. It’s not that I’m asking for that, though. I always tell them the best thank you is just live a happy life. One of the best compliments, though, is when a past patient sends you their friends or family. It’s an acknowledgment of the trust you have. It’s about communication and an open dialogue.

That’s really inspiring. I see you have children, so how do you manage your practice and also your family? 
So my “outside of work” world is a bit of a story.  I met my husband on Match.com when I was a resident and he was a lawyer. We both worked really, really hard and we hit it off. We got married about a year and a half later, and then he got very badly injured. He’s had about 18 back surgeries over the course of the last few years and is now permanently disabled. He doesn't have great function in his left leg and there are some neurological problems. He was a corporate lawyer, trained at Harvard. He’s incredibly bright, and was at the top of his class, but he’s had to come to terms with not being able to work anymore. Once we worked through that, we decided to have kids. We knew that he would be able to spend that time with them, and it would also give him a new purpose. We tried for a few years, but eventually I got pregnant and we had twins. We have a girl and boy, who turned three a couple of months ago.  

That's amazing.
Yeah, they are awesome. So my husband stays home with the children. He still has to do a lot of physical therapy, but we’ve bought equipment for our apartment so he can do that at home for a few hours every day.

That’s a lot.
It's his job to keep himself healthy, so he does physical therapy while the kids are at preschool. He is great because he teaches our kids so much. I give him full credit for teaching them “please” and “thank you” and things like that. He does incredible research into books for them. He’s a fabulous dad.  

In terms of my work/life balance, we had the twins when I was already attending for a few years, so it was a little more manageable. One of the nice things about being a breast surgeon is that you don’t have too many emergency surgeries. You can plan your surgeries and schedule, so if there is an important family appointment then I can make that happen.

There can be more emergencies with kids than with my patients! I had both my kids end up in the emergency room a few weeks ago. I was scheduled for surgery, so I called one of my colleagues who was able to take my case for the day. I can get help when I need it.

Do I find enough time, though? There is never enough time! That being said, I don't think I could be a full-time mommy. I love, love, love my kids, but I just need to get out of the house and do something else. But, on the other hand, there is never enough time to be with my kids. It’s tough.

What is it like having kids in Manhattan? 
There are the most incredible opportunities for children in New York. It's expensive, though, I will say that! That’s probably the most difficult part of having children here.

But the things they can experience are amazing. My kids take a class called Hello, Met! at the Metropolitan Museum of Art. They go there on Monday afternoons to look at different art works, and learn about color and art history. They go to another place called an “art farm” where they pet live animals and do art!

I want to go to art farm!
They have an animal theme every week. For example, if the theme is birds, they’ll bring in a live parrot and then the kids learn about the bird, sing some songs, and do an art project about it.  

So the reason I bring this up is that there are these opportunities in New York City that you just really can't get in the suburbs, and as much as there are other benefits to the suburbs, certainly the exposure to this kind of stuff is amazing. When the decorations were up for Christmas, we took them to see Rockefeller Center, we showed them Saks Fifth Avenue and the crowds….

What's the best piece of advice you could give?
I try to live life without regrets. So I try to really think about my decisions before I make them and really act in a way that I know I won’t regret later on. But if I do, then I apologize.

The other piece of advice is to treat others as you want to be treated. That goes for everybody that you come across in life. Never stoop to other people’s levels.  

One more! Whatever you love, chose to do that and then you will be successful. Don't do something because you think you should, do something because you want to. If you want to do it, then you will be happy and successful.

Also, family is so important.  As much as I love what I do, I’ll never look back and say, “I wish I worked more.” When you can, spend time with your family. It can be hard to listen to my own advice as a working mother; you definitely have to compromise in different ways. I do have mommy guilt. I have mommy guilt when I leave in the morning and I have mommy guilt if I have to do something for myself. You do things the best way that you can to make your life work in all areas: home, family, and work. If one thing falls to the wayside then I step back in and make a change. You can always change in life. Nothing is permanent.

That’s both very scary and very freeing. 
Exactly. Change is hard. We were living just out of the city when I got recruited to work here. We had built a home, and I had picked out every single part of it. It was wonderful, but I didn’t want to say no to this job opportunity that would allow me to work with amazing mentors and further my research. So my amazing husband said, “Well, we’ll just have to sell the house.”  

What does New York mean to you? 
New York is where I grew up. New York is my family.  

Photography by Stephanie Geddes ©