By KAREN NEOH
“It is the choices you make in response to the challenges presented to you during your life that determine your own course. When you make ‘divergent’ choices you end up with a unique journey.”
A leading expert in the medical and surgical treatment of obesity and obesity-related diseases, Robin Blackstone, MD, has performed more than 5,000 bariatric surgeries in the 13 years since she established the Scottsdale Bariatric Centre.
After a study tour in China and spending time with Blackstone in her home base of Arizona, the United States, I felt that she had a story to tell.
Hello again Robin! Do share with us more about yourself.
I am a third generation Arizona native, and spent much of my childhood living inside the Grand Canyon National Park.
I was a very active and athletic person, riding bicycles, building tree forts and learning to hike and backpack.
The school I attended, Grand Canyon Public School, was unique in the sense that it was the only public school inside a national park in the United States.
During the summer we had almost a million people visiting The Grand Canyon, and I was privileged to get to know people from many countries.
I held my first job at the age of 14, working at Verkamp’s Curios, a store that sold native American rugs and jewellery. I worked long hours during those summers and gained valuable training in the art of talking to people.
I was then interviewed and accepted into the Rotary foreign exchange programme. Out of the three people accepted, I chose to go to Japan.
When I was 15, I said goodbye to my family and flew by myself to Japan where I had one of the most critical experiences of my young life. Being so young allowed me to accept the culture with an open heart and mind.
At the end of my summer, I was asked to speak about my many experiences. I prepared my talk, got it translated into Japanese, and memorised it.
However, when I got to the luncheon, I had a shock. Whilst at home our Rotary Club had about 20 to 25 members, in Fugisawa, Japan, there were hundreds of men!
Still, feeling that my presentation somehow represented my country, family and honour, I summoned my courage and gave my talk from memory. It was my first public presentation, and I earned a standing ovation.
(Picture above: At the Fete de la Fleur in Bordeaux France with a friend.)
Did you always want to be a surgeon?
In some ways my course of being a physician and surgeon was set very early. When I was five years old I noted down in my school record grade book that I wanted to be a doctor.
However, the process of becoming a physician was complex. When I was in high school and college, there was no Internet. Our research was done with the Encyclopedia Britannica.
Moreover, the Grand Canyon National Park is located in a very rural area. There were few outlets for the intellectually curious – other than reading, which I did constantly.
In college I liked science but was equally attracted to business courses and humanities. I worked during my four years in college and graduated from the University of Arizona with a degree in Philosophy.
I chose Philosophy because I loved the subject matter and could choose what I wanted, since I was paying my own way.
During the last few years of college I worked in the laboratory of David Alberts, MD, who was an internist specialised in cancer research. He became my first mentor.
I applied to medical school but was turned down. In retrospect, I wasn’t ready for the responsibility of becoming a physician at that time.
But you didn’t give up! What did you do next?
Not taking no as an answer
I married after graduation and worked in the insurance field for a few years. It was really my intellectual curiosity that led me back to medicine.
I researched the best way to get into medical school, and found a professor at Houston Baptist University, Joyce Fan, PhD. She was somewhat renowned in helping motivated students get into medical school.
When I visited her with my university transcripts, she just looked at me and said, “I don’t know if you can do this.” I asked her what to do and she said, “Take my Organic Chemistry course over the summer.”
Needless to say, “O Chem” was a formidable challenge. Nevertheless, I needed to prove that I could do the necessary work and had the backbone to stick with the programme, and so I signed up.
Out of the 1,000 points available in the two courses (Organic Chemistry I and II), I scored 999 and had the highest score in the class.
When I went back to Dr Fan, she said, “Let’s see what you need to do to get into medical school.”
On another note, my family played a very important role in my success. However, tradeoffs will have to be made, as no matter what the commitment, you have to be able to focus on both work and life.
Whatever the situation you find yourself in, you just have to work through it. You really have to do what is right for everyone, which includes yourself.
Personal lives are always a part of every work life. Finding the balance and your passion, whether it is your family or your work, is the key.
When I began my transition into medicine, there were only few faculty, if any, who were women. There were strong opinions against women going into some fields of medicine, particularly surgery.
Although these issues were present, I never considered not pursuing what I was passionate about, and because of that attitude, the barriers seemed less insurmountable.
However, the choice to pursue your own vision for your life can be lonely. It is far easier to keep your head down and remain “part of the group”.
In 1991, the third year of my residency, there were 17,757 active general surgeons in practice in the United States, of which only 5.9% were women.
There were no women faculty at my institution. The two other women who had started with me as residents had dropped out.
During the first part of my career I did general surgery cases, many using a laparoscopic approach that was fairly “new”.
Gradually I became an expert in providing surgical treatment of breast cancer and other types of cancer, as well as doing complex operations using minimal access techniques.
One day, some colleagues asked if I could help them learn a laparoscopic gastric bypass and a whole new field that I had been barely aware of came into focus for me.
A large part of the appeal was the difficulty of the procedures from a technical standpoint, but also the amount of discrimination and prejudice against big people.
People with obesity and related diseases like diabetes and heart disease could not access treatments that would save their lives.
I was so motivated by this lack of access to care that I began participating in activities that could widen access at state and national levels.
This eventually led me to leadership positions within our national surgical society.
Since 2001, I have dedicated my research and practice of medicine to the care of patients who suffer from obesity.
It has been tremendously rewarding. My team and I have operated on over 5,000 individuals and established a medical model of care that has been replicated in many other places.
First of firsts
The American Society for Metabolic and Bariatric Surgery or ASMBS is a 30-year-old organisation dedicated to the field of surgical care of the obese patients. I was the first woman to be voted president.
This platform of presidency allowed me to organise the society in a more modern structure, introduce the science of metabolism, organise the quality efforts across the country into a single programme with a focus on standards, and help establish a data registry.
I worked tirelessly on behalf of our membership and I gained an understanding of how to organise and lead a complex, not-for-profit organisation. I was supported by an amazing and talented staff and colleagues in these efforts.
You have a very dedicated team – could you share with us how you have kept such a cohesive and effective team together?
I am extremely fortunate to have very dedicated people around me who see the same vision that I do.
What I believe is that there are no bad jobs, but sometimes people do not see their contribution to the whole project in the right light.
When I was working my way through college as a waitress, I tried to be the best waitress I could be.
In doing that, I do not allow the environment or situation to define me; I define myself within that space.
Most of my colleagues are so talented and have such deep experience that they could work elsewhere for more money, yet they stay, because of our shared vision of caring for people and for the research we are doing.
These individuals are highly valued and motivated to go above and beyond to implement that vision.
I think that as a leader you have to be fair and kind, to care about the lives of the people you serve with and hold them accountable for their own decisions and actions.
Back to school
I see myself as a lifetime learner. At times, I study French and opera, and at other times, cooking and wine.
I always commit to what I do with a thirst for knowledge and I love learning little stories of the history that makes the subject more magical.
This helps me remember the details about it. These stories are all around us wherever our lives are and teach us so much.
Recently I had the opportunity to go to Santa Fe, New Mexico to see the opera Carmen. Typical of me, I wanted more information on the opera theatre, which is open to the air and looks out over the New Mexico desert.
The next morning after the opera I went back to the theatre, and took an hour tour of the backstage area. It turned out that the opera was the vision of a young man who wanted to establish an apprentice programme for young people so that we would not lose these talented people to Europe.
He built the first theatre of redwood and it opened in 1956 with Madame Butterfly. In 1967, a few days into the season, the entire theatre burnt to the ground over night.
He and the troupe performing that summer continued to perform every single opera of the season, using a high school’s gymnasium.
Many of the performers did not have costumes or any sets, but the operas were performed anyway, until the new opera house had been built.
This illustrates one of the most important principles that I live by: it is not that I was born to humble parents and grew up in a small village, but what I did with my hands to change my destiny.
I continue to explore what I can do to help the world. My recent study at Harvard is focused on the intersection between public policy, public health and the business of healthcare.
I believe that these three components of health are not integrated in the correct way and I am searching everywhere for the information I need to try and formulate some plan that could provide a platform for this integration.
I believe that we will be facing serious health issues moving forward due to the level of obesity and related diseases in the world (Type 2 diabetes and heart disease).
I want to try and find a reasonable, scalable and implementable population management plan to address it.
Blackstone’s message to the young people of Malaysia
Each of us travels a different path to enlightenment. None are easy and only few who excel and try to change the world are given the resources they need.
Instead, those individuals who want to change their lives apply hard work and become accountable for the outcome of their own life.
You are unique in the whole world. Your path is unique. The decisions that you make add up to the sum of your journey.
Take some time to think about your own vision for your life, and move toward it in every decision you make. Be divergent.
True to herself
Of all Robin’s accomplishments, I will never forget the day I watched her talk to a patient in China who happened to be there when we arrived, and who was very anxious about his condition.
Though he understood no English, the manner and tone she used instilled so much faith in him that he calmed down even before the interpreter helped him understand all that she said.
A true healer. A true leader. Dr Robin Blackstone.