April 9, 2010

VUMC Reporter Profile: Baseball, orthopaedics go hand in glove for Schwartz

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Herb Schwartz, M.D., is chair of Vanderbilt’s Department of Orthopaedic Surgery and Rehabilitation. (photo by Joe Howell)

VUMC Reporter Profile: Baseball, orthopaedics go hand in glove for Schwartz

Life is like baseball, if you ask Herb Schwartz. And he should know. He's had a lot of experience at both.

“There are a lot of lessons that can be learned from baseball,” he said. “Baseball nuances in many ways recapitulate life. That's because most of the time you fail. Hitting .300 gets you into the Hall of Fame, but that means seven times out of 10, you stink. Baseball teaches you how to deal with failure, that it's normal and you can still make a good thing of it. Success comes from perseverance.”

As an orthopaedic oncologist, Schwartz, chair of Vanderbilt’s Department of Orthopaedic Surgery and Rehabilitation, faces failure on a regular basis — the failure to cure a bone or soft tissue cancer as it takes over. Helping patients confront this failure, and work to overcome it, has made a philosopher out of an athlete.

“We see so much misery. People don't realize, myself included, what it is like to think you have cancer, to have cancer, to be treated for cancer, to die from cancer, to outlive your child who has cancer. It is a tremendous, life-changing event, yet there is no greater reward than to beat it,” he said.

“If there is a rule that I live by, it is that things can always get worse and we are very lucky for everything we have. Abiding by the rule helps level out the rollercoaster of emotions we all go through. You don't get too

Herb Schwartz, M.D., reviews charts at the  Vanderbilt Orthopaedic Institute in Medical Center East. (photo by Joe Howell)

Herb Schwartz, M.D., reviews charts at the Vanderbilt Orthopaedic Institute in Medical Center East. (photo by Joe Howell)


Change of plans

Growing up, Schwartz never knew he wanted to be a physician. He just wanted to play baseball. Although weather on the north side of Chicago wasn't always ideal, he would do anything to find a game.

“In the summers I used to take my bike and my mitt and pedal down to the lake,” he said. “We had nothing to do all summer. I wasn't going to read a book. So I would ride down and look for a game, anything with a ball and bat — fast pitch, hard pitch, underhand, overhand, whatever I could find. I would leave in the morning and come home late, a few bucks in my pocket that my mom and dad would give me.”

He played pitcher, then catcher, on his high school team, and then started looking for the next game after graduation. He went to many tryout camps, but money was tight, so Schwartz ended up on scholarship at the University of Illinois-Chicago and also began playing with the Midlothian White Sox, a semi-professional team from the south side of Chicago.

During summers, the team would play six games a week, and the players would receive meal or gas money. Many were released minor league

Schwartz talks with John Saunders, a longtime patient, and his wife, Rose. (photo by Joe Howell)

Schwartz talks with John Saunders, a longtime patient, and his wife, Rose. (photo by Joe Howell)

In college, Schwartz discovered an aptitude for science, which led him to apply to medical school.

That decision started a transformation in Herb Schwartz and set him down a path to become one of the few academic orthopaedic oncologists in the nation and, in April 2009, chair of Vanderbilt's Department of Orthopaedic Surgery and Rehabilitation.

“I became much more focused, more intellectual than physical. My accomplishments were not as tangible as they used to be; they became much more knowledge-based than hitting a baseball,” he said.

“Maybe another way to put it would be long-term goals rather than short-term goals. Also, less selfish goals. It was all about me, and then it became all about other people, really. In medicine, you put in lots of hours to help other people.”

Susan and Herb Schwartz go for a run in Percy Warner Park. (photo by Joe Howell)

Susan and Herb Schwartz go for a run in Percy Warner Park. (photo by Joe Howell)

Ronald Potkul, M.D., Schwartz's medical school roommate who is now professor of Gynecologic Oncology at Loyola University, described this transformation as “losing his polyester.”

“We were an odd couple — I was khakis and he was polyester,” Potkul explained. “His breakfast for the entire first year was Hostess cupcakes with a glass of milk while he read the baseball box scores. I am very surprised and very proud of all the work he has done. I never thought he would be the great researcher or chairman that he is.”

When deciding on a specialty in medical school at the University of Chicago, Schwartz thought he would try an orthopaedics rotation for the stereotypical reason — “the ex-jock thing” in his words — but the results were not what he expected.

“I hated it, and I got a D,” he said. “Orthopaedic surgery was boring. It was too repetitive, and sports medicine seemed less important.”

He tried cardiac and thoracic surgery for a while but was once again bored by the repetition. Then he met Michael Simon, M.D., “this great, energetic little bug, a gnat that would be flying all around, talking in all directions,” Schwartz said.

“He matched my sense of humor and my interest in sports. He was doing cancer surgery, which was important, and every day was a different patient, a different age. Kids, adults, women, men, arms, legs, spines, pelvises. Every day a different approach. Every day a different X-ray. It seemed to just fit.

“So then I had to go back and grovel to the group of orthopaedic surgeons who gave me a D the year before. But I did it. I accepted sports medicine and learned there's great stuff in orthopaedics. I tried to keep an open mind, but obviously I gravitated to oncology.


Battery mate

Baseball, it turns out, can also help you find love.

In his third year of residency, Schwartz and his wife, Susan, were set up on a blind date by her cousin, who had played baseball against Schwartz.

The pair hit it off immediately, although he did show up for the date two hours late when a case ran over.

“It took only a few seconds for me to drop any irritation I felt at Herb showing up so late,” Susan said. “We even joked about his hair, which was flattened from the surgical cap. He was funny, easygoing and thoughtful.

“On the second date, he followed up on things we talked about on the first. I was shocked that he was so tuned in and had listened and remembered. In fact, because we had both mentioned liking comedy, he took me out to dinner and to Second City.”

After five months of dating, Schwartz accepted a fellowship at the Mayo Clinic in Rochester, Minn., putting pressure on the couple to decide their next steps.

“I was ready to move on and wanted her to come with,” Schwartz said. “I was proud when I got married. I thought I upgraded. In my toast, I used a baseball quotation from Lou Gehrig. He was dying and made his last speech at Yankee Stadium, saying that he was the luckiest man on the face of the earth.”

They headed to Rochester the day after the wedding, and the following year, Schwartz accepted a position at Vanderbilt. The native Chicagoans were headed south.

Herb and Susan Schwartz share a laugh with daughter Dana following a Vanderbilt women’s soccer game. Dana is a freshman midfielder on the team. (photo by Joe Howell)

Herb and Susan Schwartz share a laugh with daughter Dana following a Vanderbilt women’s soccer game. Dana is a freshman midfielder on the team. (photo by Joe Howell)

“I didn't know if I would be successful, but I knew I wanted to try and learn for myself,” he said.

Janie Falkenberg, his first assistant, said the practice started as one little shelf of files but grew and grew as patients around the country sought his care.

“At the time, there were about 50 orthopaedic oncologists in the entire country,” she said. “I would always tell the patients they couldn't have a better doctor. If me or anyone in my family found themselves in the same position, I would travel any distance no matter how great for his expert care.”

Ginger Holt, M.D., his colleague in orthopaedic oncology, has taken over much of his patient load now that he is chair. She said patients still ask for him.

“His patients love him. But I let them know I'm smarter than he is, and I'm a better doctor, so they're OK with it,” she joked. “But seriously, they really trust him. They travel a long way to be seen, and they just keep coming back.”

Schwartz, ever humble, said this admiration stems from patients finally understanding their diagnosis.

“Most of our patients have already seen three or four different doctors, had oodles of tests. They have reports from the radiologist saying it could be anything from a broken toenail to cancer. So they appreciate when we tell them what we think it is,” he said.

Schwartz has to deliver bad news on a daily basis, but insists it's easier than you think.

“It's better from the patient perspective if you're direct, honest and simple. I used to spend what seemed like an hour explaining to someone this elaborate diagnosis, the fancy name, what's in store for them, the functional consequences, the risks, the benefits. And then I would ask, 'Do you have any questions?' and the family would say, 'Is this a cancer?'

“Now the first thing I say is 'This is cancer.' Direct, simple and let the

The Schwartz family, from left, Herb, Scott, Jessica, Dana and Susan, during a canoeing trip on the Harpeth River.

The Schwartz family, from left, Herb, Scott, Jessica, Dana and Susan, during a canoeing trip on the Harpeth River.

“The hardest thing for me personally, still, is seeing a child die. Or telling parents that their child will die,” he said.

“But the amazing thing is children are resilient. If the whole world could be filled with children, it would be a far, far better place. They're eternal optimists, they feel that they're indestructible, that tomorrow will always be.”


Just be there

While growing his practice, Schwartz also started what he considers his most important work — raising a family.

“He is a phenomenal father,” his wife, Susan said. “He has a remarkable combination of being tough and consistent, but naturally funny and playful.”

He and Susan have three children: Jessica, 22, Scott, 20, and Dana, 18. Like their father, they are all athletes competing at the college level.

Though Scott followed his dad in baseball, he said they were all encouraged to find their own interests.

“One of our parents' greatest strengths is that they pushed us but they absolutely did not force us into anything,” Scott said.

“I'm into music and baseball and my sisters do soccer and swimming. We're very different, and they let us do what we wanted.”

Jessica admits her father does have very high expectations, but she knows he is always on her side.

“This is how my family functions; we are a team,” she said. “We celebrate in each other's triumphs and band together to overcome defeat. As much as this sounds like I got it off an inspirational poster, it is in fact exactly how my family operates, which I realize is incredibly rare.”

Susan and the children agree that Schwartz is able to strike an amazing balance between work and home life.

“He doesn't let work get in the way of family,” Scott said. “He is so goofy and playful at home that you wouldn't know how intense his professional life is. Better than anyone I know, he doesn't take himself too seriously. He just knows the things that are important to him and puts all of his effort into them.”

Schwartz said his parenting motto has always been “being there.”

“During the day, at night, in scrubs … didn't matter. Just be there,” he said. “Sometimes, it was a logistical nightmare. Susan and I were outnumbered and we had to play zone defense instead of man-to-man.”

Susan says that unselfishness is his best quality.

“He is extremely driven and hardworking but refuses to call attention to himself. He never speaks of all that he does or how hard he works. He can put in a 12-to-14-hour day but immediately wants to know how my day was, if I have talked to the kids and what is new with them. He cannot focus on himself,” she said.

With all of his children away at college for the first time, Schwartz said he hates the empty nest, and he and Susan make every effort to travel to their games and meets.

“When I see him in the stands, I want to make him proud,” said Dana, who plays soccer for Vanderbilt. “He has made me into the athlete and hard worker that I am, so when I get on the field and play, and he's watching me, I just want to do something awesome to make him smile.”


New role

The empty nest, however, does have its benefits. It freed Schwartz to adopt what Ginger Holt calls his fourth child — the Department of Orthopaedic Surgery and Rehabilitation.

“He very much is a great father to his children, and now he is father to this program,” she said. “He really is a leader — experience, smarts, wisdom. But in the end, he's a great father and he looks out for us like his kids.”
Schwartz is still settling into the chairman role and getting used to a completely different way of thinking.

“As a surgeon, you think 'What am I doing next?' It's a binary world. Cut or don't cut. It's very goal oriented. There are hard endpoints for your day and your plans,” he said.

“A chairman's day is totally opposite. There's never an endpoint. You don't think about now or later today, you think about two years from now. You're worrying about many more people in the equation than you ever had before.”

Holt said Schwartz's greatest strength is leading by example.

“He never asks someone to do something he would not do. You can't complain about what he asks you do to because he has either done it or would do it. He's the first to volunteer for things like taking call,” she said.

Aside from battling his new Blackberry, his greatest challenge seems to be his mouth.

“His jokes are terrible, and he's a terribly, sometimes painfully, honest person,” Holt said.

“I think that comes from being a Midwesterner. Some of the Southern politeness and passive-aggressive behavior isn't there. He is as direct as it gets.”

“In my new role,” Schwartz said, “I have become more refined and craft my words more carefully on a regular basis. The unabashed locker room kind of stuff probably connects back to my youth playing baseball. Maybe it's Midwestern. Maybe it's just being honest, not being politically correct all the time.”

Or perhaps it's a way to face the harsh reality that failure happens regularly.

“It's tough dealing with death and dying all the time, and I don't think you ever get used to it,” he said. “As I get older and look back, I think this job has provided a very good perspective on life. You realize how lucky you are. It highlights what's important in life and where you should put your time and effort.”

One of Schwartz's signature phrases is “What's it all about?” And Janie Falkenberg, his first assistant, says he has the secret.

“Whether he knows it or not, he does know what it is all about,” she said.
“It's about being true to yourself and being responsible for the children you brought into this world, the marriage you created and the profession you chose. He does know what it is all about.”