Wayne Frederick on the legacy of LaSalle Leffall, Jr.

The Cancer History Project Guest Editor Robert Winn focused on the legacy of LaSalle Leffall, a Howard University surgical oncologist.

Winn is the director of VCU Massey Cancer Center. He and John H. Stewart, director of Louisiana State University-Louisiana Children’s Medical Center Health Cancer Center spoke with Wayne  A.I. Frederick, president of Howard University.

Stewart and Frederick were mentored by Leffall.

Leffall’s obituary appears here. A video of this conversation is available above. This conversation is also available as a podcast: 

Wayne Frederick: Sure. You know, I think of two things that come to mind. One is Dr. Leffall’s impact on training. If you look at the time he spent at Howard, he was on faculty for an excess of 60 years (The Cancer Letter, May 31, 2019).

During that time between students, residents, and the number of lives that he changed in terms of career trajectory, not just getting people interested in surgery, but getting people interested in surgical oncology and then outside of surgical oncology, I would also say he influenced a lot of other medical students who take care of cancer patients.

In some cases, it’s in an ancillary fashion, but they still use a lot of his teachings and philosophies around obsessing about the patient, making the patient the center of our affection and providing hope, which he defined as “the anticipation of tomorrow.” So, I think that’s a significant influence.

The second influence was when he became President of the American Cancer Society as the first African American to do so. At that time, he had a very heady agenda to focus on closing and highlighting the disparities that African Americans and other underrepresented minorities were experiencing in terms of outcomes. I think that was a bold initiative in 1970 to put that on the table.

It definitely was the right initiative. And, it was the initiative that I would say also led to lots of changes that would come down through the years. So, I think that the impact of his bold agenda then was important, so much so that I have a bust in my office that the American Cancer Society gave him at the end of his tenure, because I do feel that that was one of his most pivotal contributions. He gave me that before his passing to ask me to keep it as well.

WF: You know, as a Dr. Drew Professor here at Howard, both of those men are tied to a lot of what I think of in terms of philosophy, equanimity under duress. I think I probably use it every day in terms of saying it to someone else.

I’m on the board of directors of several public companies. I say to the CEOs all the time that one of the lessons in surgery is equanimity under duress, and what it means is that when stuff is going wrong, everything is all over the place, you have to get quieter.

The way I explain the experience to the medical students is that when the patient is bleeding, I don’t get to two instruments across the room and yell and scream and stomp my feet. As a matter of fact, if anything, the only thing that I get to do is to become more focused.

My description of that is that almost everything around me slows down. It gets quiet, and you get to focus in on it. And in my capacity as university president, that happens all the time, every crisis—when everybody wants to respond and have a knee-jerk reaction to catch the latest news cycle.

So, I tell the team the same thing. We need to slow ourselves down, make sure we are really dealing with the right problem, and not just putting a band-aid on a wound that’s probably three times the size of the band-aid.

I think it’s a very important adage that he left us. And one that certainly has served me very well.

WF: In many ways, I would say he became a father to me. I didn’t anticipate having such a close personal relationship, but that’s what occurred, as I lost my own dad at that time. Dr. Leffall, in many ways, I think, went above and beyond just being a mentor. That shaped me in terms of my own experience being a father and my relationships with my 17-year-old son and my 15-year-old daughter. So much of this comes from that same attention to detail he put into my relationship.

We never started any conversation without him asking me how I was doing. How’s the family doing, et cetera. It doesn’t matter what the topic of the discussion was. The gravity of what you had been through, discussions always started that way.

And a few weeks ago, I had the opportunity—probably two months ago now—to take my two kids to the operating room to watch me operate.

And if I do nothing else in my career, that certainly was a zenith to have them see me in what I think is the most sacred space that I’ve been able to enter and to see them behind their masks get the same rush of adrenaline that I got the first time I was in that space was an incredible feeling.

My son came up to me after and said, “I just, I don’t, I can’t explain it, but I just felt like this rush of excitement when you made that incision.” You know, that’s not what you’re expecting your kids to think or say.

I’m just hoping they didn’t faint. And the fact that my son got that sense of exhilaration says a lot.

The other thing about Dr. Leffall’s influence on me was that he led by example. I still operate to this day, and I’m probably the only university president in America who does that now. I don’t do it because I can, I do it because I must. So, the ability to pass on what I’ve learned to another generation is important. That’s why he did it, to lead by example.

That’s important—when you lead a faculty as diverse as this one, it must be clear that you have to lead from the front and lead by example.

This evening I’ll teach a course in the School of Education. When I say teach a course, I’m not a guest lecturer; it’s my course for the whole semester. And so, I carry my own load to make sure that everybody has. I think that was one of the things that he left with me on a personal note that you have to lead by example.

The other very personal things in terms of how he carried himself and little things that he would do—I like to call them the secrets of the trade that I still do to this day.

They bode well for navigating life in general. I think that those are some things that I also appreciate that my close relationship with him allowed me to live in.

WF: I think the two things that he was telling us about all along that to this day apply—one was the Charles Drew quote that you use daily, excellence of performance to transcend all artificial barriers created by man.

His point there was not that we ignore the oppression and the things that must be changed, but that while we do that, we also must be excellent.

So, as we occupy the spaces that we rightfully should be in, people cannot question us being there when we get there, such that we don’t get there and then start thinking of preparing ourselves appropriately. But we perform in an excellent way such that when we are there, the only thing people can say is, geez, why did we keep them out of here for so long? Whether they acknowledge it in word or in deed, they will acknowledge it.

I think that he would still do that. The other thing that he would say is that we must amplify each other’s humanity. Ultimately, at the end of the day, that is what a lot of these things are about.

Not just respecting or acknowledging each other’s humanity, but amplifying each other’s humanity. And that’s a big difference. I think he made a point about that, the dignity with which he spoke about treating patients and affording them the fullness of their humanity.

That is that we should be amplifying each other’s humanity, not just simply acknowledging it. That means that you have to go the extra step, not just to provide opportunity but also to make sure the support systems are there.

As you said, as you take down systemic racism, you’ve got to replace it with something else. We have to replace it with as good of infrastructure and support for the people who’ve been oppressed. I think that that’s what he would have been advocating for us to be focused on.

WF: I think two stories put it onto perspective, especially that issue about people amplifying his humanity. First, he graduated from Florida A&M College at the age of 18, and, like most African-American students at that time, he didn’t take standardized tests well, so he did not get into any of the medical schools that he could apply to.

At that time, I believe there were only two medical schools he could apply to. They were Meharry and Howard; he didn’t get into either one. That resulted in his university president, President William H. Gray, petitioning Mordecai Wyatt Johnson to admit him and a fellow student into Howard’s Medical School. The other student had straight A’s as well.

Sure enough, the dean of the medical school admitted both of them, and he would go on to graduate number one in his class. So, he often talked about the grace that his university president gave him by making a personal petition on his behalf to get him into medical school.

Something else—while he was in medical school, his dad would die unexpectedly. While he was waiting tables in the northeast during the summer, he came across a gentleman with whom he had developed a relationship while being there a couple of summers.

So, he would write that gentleman a letter at the beginning of the semester explaining to him that his father died and that he would like to borrow money for tuition; I think at that time it was $500.

The guy would write back with a check because he was so impressed with Dr. Leffall waiting tables and told him, you don’t have to pay me back; pay it forward. He would always recall that story. That added to his sense of generosity and his philanthropy. 

Then, on the issue of Dr. Walter Lawrence—again, talking not just about equanimity under duress, but also, I would say, putting yourself in an uncomfortable position. As he told it to me, the story is that Dr. Walter Lawrence advocated for him to be admitted to the Southern Surgical.

They would refuse to admit him, and Walter Lawrence got up in that meeting and said, if Dr. Leffall is not qualified to be a part of this organization, then I’m not qualified to be a part of this organization.

I believe in the history of the Southern Surgical, he is the only person who ever withdrew from the Southern Surgical because of the way their bylaws were written. I believe Walter Lawrence would go to his grave, never being a general member of that body.

I think they re-admitted him as an honorary member at some point in his career. So, when Dr. Leffall spoke of what Walter Lawrence did on his behalf, in terms of his advocacy for him, he spoke about the fact that other people will amplify your humanity, will be more than just allies.

I think Walter Lawrence’s example is precisely that he didn’t just advocate for Dr. Leffall. He made a personal career sacrifice among colleagues who could impact his career when he was vulnerable but felt right. And so, he had a great deal of respect for Walter Lawrence for doing that.

WF: I agree. I think the other thing I would mention is that Dr. Leffall was always quick to highlight people like Dr. Lawrence, which I believe is another personality trait that he had. That was great because he always believed in lifting others, you lift up yourself as well. People like that don’t often get the recognition they deserve for taking those types of stances, that if more people in our society did, we would probably have a much more complete union.

WF: Yeah. He would be very sensitive about the disparities that exist, that we aren’t closing those gaps quickly enough. I think today in particular, he’d be even more acutely concerned that after the pandemic, as we’ve had a decrease in screening, as we’ve shut down access even further, the most vulnerable are going to come out of this in a much worse position.

Some of the gains that we’ve made on life expectancy are going to slip away. So, he would sound the alarm that we needed to start investing in those and ensuring that we were training the next generation, who would be willing to care for folks in those communities.

I think in the next five years, outcomes in African Americans could be disastrous, as a result of the pandemic and its impact—everything from the economic impact to the fact that we decreased screening in those neighborhoods, et cetera. Five years from now, we could be in a very difficult place when we look up.

WF: No, thanks for doing this. I appreciate it. Thank you for thinking of me. Appreciate it very much.

WF: The one thing that I cherish is that he was so proud of that fact, that as he would say, I trained a university president.

WF: That’s a great question. I’m going to mention something that I’ve probably never mentioned publicly. Long before we did timeout, and it was written about and adopted and tested, he did timeout.

I’m sure John may remember this, but if you went to the operating room with him to do a breast case, even as a student, he would ask the patient in front of you, “Which breast are we operating on today, Ms. Smith?” She would say left, and he would even have her raise her left arm.

Then, he would look around the room and say, which breast are we operating on? He would put the films up and look at them. And before we started, he would make everybody stop and acknowledge that we were operating on the left breast. And years later, when the timeout came about, I would chuckle to myself that he could have called it the “Leffall timeout.”

But I mentioned that again because I think he was such an intelligent, methodical human being in terms of what he did. The impact that he had was the issue of always being prepared, about always giving yourself, always being excellent in every single moment that there was an opportunity to necessarily let your guard down, when it came to providing the best, because somebody’s life mattered. I think that the humanity and dignity with which he wanted those patients treated was the biggest impact.

Like I said, it doesn’t matter what field you went into, as long as you were a medical student. Everything from turning in your case report, then having him correct the spelling—I turned in my case report and got one point taken off because I missed out that F in Leffall on the cover sheet.

I was amazed that he paid that much attention. I think I still have that paper at home. We used to tell him that story repeatedly. He was a very humble man, too.

John’s classmate—I think he may have been a year after you, Marc Rankin—at a party at the Espy’s house, fell into the pool when he was around five or six. The bigger kids jumped in the pool and started to drown him. Dr. Leffall, in a three-piece suit, jumped in and pulled them out.

Marc Rankin told me that story. I got goosebumps. I couldn’t wait for my Monday morning meeting with Dr. Leffall. I ran in there, and I said, “Listen, I saw Marc Rankin this weekend, and he told me this story.”

So, I told him the whole story, and the whole time, he’s looking at me totally deadpan. As soon as I was done, he said, “Yup, that’s exactly what happened, there’s no yeast in that story. So, how are you and your family doing?”

He just moved on, didn’t add a single word to the story. He didn’t tell me how much the suit cost, nothing—the average human being would have described the shoes they were wearing.

To me, that just spoke volumes about who he was.

WF: As I think back on the field of cancer disparities, I think he had a significant impact both in direct ways in terms of how he treated patients and the things he wrote about. Also, when you look at some of the major things, such as appearing on primetime TV to talk about colonoscopy and its impact on colorectal cancer—to see a black man as an expert in the field in that day and age highlighted many things about cancer care. It also stressed that there weren’t enough African-Americans involved in cancer care.

It highlighted that he was one of the most talented in the country at providing care for those patients. And, it highlighted the issue at hand. I mean, his words about the issue about screening—that wasn’t the typical thing that somebody would do that would impact the field, but I think it had a massive impact in terms of how the country viewed an issue like that. Colorectal cancer got a lot of attention around that issue as well.

WF: You guys take care, stay safe. All right. Take care.

Editor’s note:

By Paul Goldberg

In this issue, The Cancer Letter features the first installment of extraordinary work by Rob Winn, our guest editor for February, Black History Month.

Winn has agreed to step in as guest editor of both The Cancer Letter and the Cancer History Project for the duration of February. An editor is a visionary and a convener, and in the upcoming issues you will see Winn turn up eye-opening historical material.

Winn is director and Lipman Chair in Oncology at VCU Massey Cancer Center, senior associate dean for cancer innovation and professor of pulmonary disease and critical care medicine at VCU School of Medicine. Winn’s vision as a member of the editorial board of the Cancer History Project has been important in guiding our efforts to capture history.

Last February, my co-editor at the Cancer History Project, Otis Brawley, and I, invited Winn to serve as the guest editor of the Cancer History Project for February 2021. Last year’s Black History Month coverage is highlighted here.

In August 2020, Winn and I jointly interviewed Walter Lawrence, a civil rights hero and the founding director of the cancer center Winn now runs. That interview was a soft opening of the Cancer History Project. Prior to that, Winn’s personal account of police brutality—“I could have been George Floyd”—brought home the point that even a Black physician is not protected from this deadly form of racism.

This year, Winn has agreed to serve as guest editor again. There is, however, a difference: this month, he will also serve as the guest editor of The Cancer Letter.

Guest editorship is not something you see often. To broaden our coverage, both historical and current, Brawley and I have invited several thought leaders in the field to serve as guest editors for periods as brief as a week or as long as a month.

The purpose of the Cancer History Project is to provide a deeper understanding of events occurring around us today. Therefore, it makes sense to combine the guest editorships of the Cancer History Project and The Cancer Letter.

The most important aspect of the job of an editor is to convene and bring to full view stories that would ordinarily remain unseen.

The contribution of Black doctors and scientists to the development of today’s oncology is a clear example of a part of history that merits a focused, hypothesis-driven examination.