Pulling Back the Curtain: Saad Z. Usmani, MD

Saad Z. Usmani, MD
Director of Plasma Cell Disorders Program, Director of Clinical Research in Hematologic Malignancies, Levine Cancer Institute

In this edition, Saad Z. Usmani, MD, talks about the art of emotional intelligence and trekking to Mount Everest base camp with his patients.

Hear more from our interview with Dr. Usmani in Sound Bites.

Tell us about your childhood. Where did you grow up?

My earliest memories are in Karachi, Pakistan. When the British left the Indian subcontinent in 1947, dividing it into Pakistan and India, Karachi – previously a sleepy seaside town – suddenly became the capital. Within a couple of decades, its population increased from around 100,000 to 7 million. Now it’s a sprawling metropolitan city.

I grew up in the 1980s and for the first eight or nine years of my life, we lived in a joint family home. My father had eight siblings, and each family had one room of the house. My parents and siblings and I shared a room, and the same was true for my uncles and their wives and kids. Eventually, everyone’s careers took them elsewhere in Pakistan and across the globe, and, as my father gained success in the corporate world, we moved to different cities. I graduated from high school and attended Allama Iqbal Medical College in Lahore, the second-largest city in Pakistan.

Did you always want to go into medicine?

When I was growing up, the general cultural belief in Pakistan was that a child had to become a doctor or engineer or work in business administration or accounting to be considered “successful.” From an early age, my parents pushed me toward medicine.

During high school, I focused on earning a reasonable enough grade to stay out of trouble with my parents, and I did well in the sciences, but I was more passionate about cricket. I wanted to be a professional cricketer, but, in Pakistan, one starts medical school right after high school. When I was admitted to medical school, my parents had a chat with me about goals and expectations, and I had to set my cricket aspirations aside. I did continue to play at the college level and captained the team.

What else could you have imagined yourself doing for a career?

I went to high school in the mid-1990s – the golden age of grunge – so my other dream job was to become the front man of a grunge band, like Nirvana, Pearl Jam, or Alice in Chains.

Once you started your medical training, how did you come to focus on hematology?

I was first exposed to hematology during clinical rotations in my fourth year of medical school.

Zeba Aziz, MD, my professor and the head of the oncology department at Jinnah Hospital in Lahore, was an early influence in pushing me toward oncology. Still, it wasn’t until my early residency years that I started to differentiate into malignant hematology.

Another landmark event happened during my time in medical school: I met my wife. She’s a transplant infectious disease physician and works at Levine Cancer Institute, too, in the office right across from mine.

Have you always worked together?

We have – we went to medical school together, got married a few months before coming to the U.S., and then went through all our training together. We completed our internship, residency, and fellowship training at the same institutions, and then went on to our first faculty appointments at the same institution. So, we’ve known each other more than half of our lives, and we’ve learned that we work pretty well together.

Do you have any children?

We have three kids: This summer, our older daughter turns 15, our younger daughter turns 12, and our son turns 7.

Dr. Usmani, his wife, and their three children after he finished the 2019 Boston Marathon.

Given that you and your wife are both doctors, have any of your children expressed interest in going into medicine one day?

Career-wise, our only expectation for our children is to excel in the field they choose. We’ve never pushed them toward medicine, nor dissuaded them from it, but our older daughter has started to show some interest. We do push them to excel academically, but they get to chart their own paths. If you are passionate, then a job doesn’t feel like a job – you enjoy the work.

Speaking of the younger generation, are there any pieces of advice you received from your mentors that you would pass on to early-career hematologists and oncologists?

My best advice to junior investigators is if someone lends you a hand, take it. I’ve had many mentors, both direct and indirect, throughout my career. During my fellowship at the University of Connecticut, I started to realize my potential under the mentorship of the fellowship director Robert Bona, MD, and my lab mentor, Zihai Li MD, PhD. These two gentlemen helped me learn something that is not formally taught – the art of emotional intelligence.

Bart Barlogie, MD, who recruited me for my first faculty position at the University of Arkansas Myeloma Institute, was a free thinker and taught me how to approach hematologic diseases from a translational research standpoint. During my time as his mentee, I also learned a lot about what to do and not to do as a leader.

I advise mentees to be mindful of opportunities to learn good habits by observing your mentors. Continuously improve. Become emotionally intelligent. Pick a problem and then find like-minded people who will work with you toward a solution.

I’ve been lucky because the myeloma research community is very collaborative. Senior investigators (like Robert Orlowski, MD, PhD, Vincent Rajkumar, MD, and Sagar Lonial, MD, just to name a few) have supported me throughout my career and continue to do so. I also have great role models now at Levine Cancer Institute (Derek Raghavan, MD, PhD, Edward Copelan, MD, Belinda Avalos, MD, and Ed Kim, MD) who have helped me grow as a person. I pay it forward by supporting junior faculty and fellows at my own institution and beyond. If someone from another institution reaches out to me for academic advice, I try to make time to help that person. I am frequently approached by international medical graduates coming to the U.S. to seek residency and fellowship training, and I try to support them as much as I can during that transition. When my wife and I were in their position, we struggled without folks to lean on, so it’s something that I always keep in mind.

My medical school has an active alumni association in North America, which I have been involved with for several years. By staying in touch with the school, I’ve been able to connect with people who, like I did, aspire to become clinical scientists but don’t have the resources or opportunities to do so in their home countries. I also return to my alma mater to contribute and teach at least once a year.

You mentioned learning the art of emotional intelligence. How has that helped you connect with patients?

Interacting with patients is the most fruitful part of being a hematologist. I love helping to make a difference in people’s lives. We see our patients at their most vulnerable; a diagnosis of blood cancer dramatically changes the trajectories of their lives and their family’s lives. As a clinician, you need be empathetic to their situations and treat them holistically.

As an immigrant, I’ve always believed I need to work hard to prove myself to my peers and colleagues and succeed in this field. It’s easy to remain in this work-driven mindset and forget the main reason why I’m doing it – my family. Balancing work and family can be difficult for people from my cultural background and for people who are passionate about moving the needle for a specific disease. This is an important lesson I learned from one of my mentors. He’s perhaps the best patient advocate that I’ve ever met, and I’ve learned so much from him, but in his search for a cure for myeloma, his personal life was affected. When I became the chief of the Plasma Cell Disorders Program at Levine, I promised myself that I would be dedicated to my patients but try to leave work at work and be present during the time I have with my family.

What has helped you achieve balance and shift your mindset?

A few years ago, I was struggling to find time for myself and my family, and around the same time, the Multiple Myeloma Research Foundation (MMRF) was looking for participants for its “Moving Mountains for Multiple Myeloma” initiative, which hosts endurance events to raise funds and awareness for myeloma research. I reached out to MMRF to enquire about opportunities and the team asked me if I wanted to go on the trek to Mount Everest basecamp. A few weeks later, I just happened to mention it in passing to my patient, Kirk Wilkerson, who was on a clinical trial. Like me, he said, “Sure, I’ll do it.”

But, at that time, we didn’t fully understand what it entailed. The reality sank in later, when we started to think about everything we needed to do to prepare. As we shared the news with our wives and saw the looks of horror on their faces, we thought, “What have we done?” Since we had already signed up, we trained for it. The training was roughly 14 months, and we arrived in Nepal on March 2, 2018, with a team of 18 individuals that included myeloma patients, caregivers, and clinicians (I’d like to give a shoutout to Joel Topf, MD, Jeff Zonder, MD, and Silva Pregja). Our team raised close to $450,000.

Dr. Usmani (at left) and Kirk Wilkerson, his patient, on their trek to Mount Everest basecamp.

I had no idea how hard the climb would be, and it changed my perspective on life. Out there in the wilderness, you’re in the elements and all you’re worried about is how you will catch your next breath. That’s how many of the myeloma patients I’ve seen feel: “How do I take this next step? How do I keep on going on this journey?” So, the trip was quite symbolic. When I returned from Nepal, I took a different approach to living because I understood what my patients with myeloma and their caregivers had endured. I could certainly find time for myself and for spontaneous trips with my family. It was an eye-opening journey for both me and Kirk.

After the Mount Everest trek, what made you decide to run a marathon?

It was a bit of a coincidence: During one of the toughest days on the Everest trek, I told Kirk and another patient with us, Mark Herkert, that I would like to run a marathon with them. Mark agreed, and Kirk responded again with, “Sure, I’ll do it.” It was just said in passing, but then, a few months after the Everest trek, when the euphoria was winding down, MMRF presented another fundraising opportunity: running the Boston Marathon. When I signed up for it, I found that Kirk and Mark had, as well.

What was training for the marathon like, and how did it compare with Mount Everest?

Even though I did okay on the Everest trek from a physical endurance standpoint, I didn’t think I’d trained as hard as I could have, so I was more thoughtful and committed in my training for the Boston Marathon. I ran a couple of half-marathons to prepare, trying to predict the type of the gear, nutrition, and hydration I’d need for the big event. Our goal was never to set records, we just wanted to finish the marathon together to symbolize the journey that a patient with myeloma and his or her doctor take together. We were able to accomplish that.

Dr. Usmani and Kirk Wilkerson running the last mile of the Boston Marathon with Dr. Usmani's son.

The most wonderful part of the day was that our families were there at the finish line. In fact, the Boston Police let my then six-year-old son run the last mile with us. (That did not go over well with my daughters, who were a little jealous, but that’s another story … )

Do you have any plans for future endurance events?

We’re still basking in the glory of having run the Boston Marathon together, but running an ultramarathon would probably be our next move. I’m hooked on running now. I will be running in the Chicago Marathon in October, but that’s just for my own personal edification. I’m a goal-oriented guy, so I need that next goal to focus on.