Pulling Back the Curtain: Caitlin Costello, MD

Caitlin Costello, MD
Hematologist/medical oncologist and associate professor of medicine at University of California San Diego

In this edition, Caitlin Costello, MD, talks about her winding path to a myeloma specialty, and raising four daughters along the way.

Where did you grow up? What was your childhood like?

I’m a born and bred San Diegan. I’m the oldest of three and my brothers are 17 months and nine years younger than me, respectively. I attended a Catholic high school and spent most of my free time in a gymnastics gym or on a soccer field.

I was fortunate enough to be recruited to play Division 1 soccer at Harvard University and pursue my undergraduate degree. My plan was to spend four years in Boston and find my way back to the West coast.

Dr. Costello with her husband and their four daughters.

Did you always know you wanted to go into medicine?

Medical school was always a goal. As far as my cardiologist father was concerned, I was going to take over the family business. As far back as I can remember, that was the plan. In elementary school, I remember bringing in a cow heart to dissect and to analyze in science class.

Did you always know you wanted to go into medicine?

Medical school was always a goal. As far as my cardiologist father was concerned, I was going to take over the family business. As far back as I can remember, that was the plan. In elementary school, I remember bringing in a cow heart to dissect and to analyze in science class.

In college, I majored in biology to pursue a pre-med degree. Both my class load and soccer were significant time commitments, but it was wonderful. I was surrounded by extremely motivated people – people who were going to change the world. It’s inspiring to be around people who push you to compete and become something bigger than you could have imagined.

Walk us through your career. What drew you to hematology, and then myeloma and transplant specifically?

Although I planned to return to the West coast at the end of college, once you end up in Boston, it’s hard to leave. It’s such an amazing city. I was fortunate to be able to attend Tufts Medical School and spend another four years in Boston.

During the summer after my first year of medical school, I worked as a phlebotomist at a hematology/oncology clinic. After that summer, I had essentially crossed oncology off my list of potential specialty aspirations because, as a young medical student, I wasn’t sure I could cope with the burden of grief that accompanies the field of oncology. While I did find many patient relationships to be rewarding, I felt overwhelmed by the suffering I witnessed and couldn’t see myself doing it as a career.

I also explored obstetrics as a potential career path. Delivering babies can be exhilarating and celebratory – almost the opposite from a life in oncology. After some thought, I steered myself again in another direction. Maybe it was lifestyle – maybe my incredible obstetrics colleagues had more stamina or endurance than I did – but I crossed that off the list as well.

I couldn’t see myself as a pediatrician or surgeon, so at that point, my plan was to go into internal medicine. It seemed like a good route for me because it kept my options open for adult medicine while I figured out which subspecialty was right for me.

During my internal medicine residency at Weill Cornell Medical College, despite asking to not do much oncology because I was convinced it wasn’t for me, somehow, I kept getting assigned to the oncology wards, specifically malignant hematology. At some point, it occurred to me that maybe I hadn’t given it a fair chance. I found myself emotionally invested in patients and intellectually stimulated by all the scientific progress in the field.

Suddenly, the grief I initially felt became more meaningful. I developed rewarding relationships with patients who trusted me and took a leap of faith with me. With my support system within the community of malignant hematologists, I discovered the specialty was more fulfilling than I could have ever imagined. I did not plan to go into multiple myeloma specifically. In fact, I loved acute leukemias and spent most of my time during my later years of internal medicine residency negotiating with co-residents to see if I could trade for their rotations at Cornell, or across the street at Memorial Sloan Kettering, so I could get more experience on the leukemia wards.

Thanks to my wonderful mentors at Cornell and Sloan Kettering, my first impression with oncology proved to be wrong. I realized that this field would provide that human touch and patient relationship I hoped for, as well as that intellectual stimulation where I could think and dream about treatments and potentially cures.

In fellowship, I finally had the opportunity to make my way back across the country to the “Best Coast.” I have been embraced by my UC San Diego family ever since. Coming into fellowship, I hadn’t had much transplant experience. Fortunately, UC San Diego is a medium-sized program with an umbrella approach to the management of malignant hematology. Our division manages patients with any hematologic malignancy from diagnosis through treatment and follows patients through transplant and post-transplant care. Much of my fellowship was spent learning the management of hematologic malignancies and stem cell transplant. Again, I discovered such a rewarding opportunity to participate in the care of patients who have been confronted with a major illness requiring extensive, often life-threatening treatments. Of course, we still all too often face grief, but ultimately patients rely on us to make a difference in their journey with cancer. That relationship gives me the energy that I need to get up in the morning and try to make a difference.

When I finished my fellowship, I was triple–board-certified in medicine, hematology, and oncology, and accepted an offer to join the faculty at UC San Diego in the Blood and Marrow Transplant Division.

At that time, there was no single person specializing in multiple myeloma at UC San Diego, and my division chief was looking for someone to develop a myeloma program. I was grateful for the opportunity. In hindsight, multiple myeloma wasn’t originally my passion, but it has become exactly that. Sometimes you don’t know what you’re looking for until it finds you.

Looking back on your career so far, what is your greatest accomplishment?

Personally, my greatest accomplishment is my family. I am a proud mother of four daughters ages 2, 5, 7, and 9. They continue to teach me the meaning of patience, and I’m sure they will teach me about karma when they all hit their teenage years.

I want to show my daughters how mom doesn’t have to work, mom gets to work and help people and do these amazing things that I know they will have the opportunity to do someday as well. I’m trying to impress upon these young growing women that the world is theirs to change.

On the career side, my greatest accomplishment is finally feeling like I have a seat at the table. The myeloma expert community is a tight-knit family that in the last couple of years has welcomed me, allowed me to have a voice, and valued my input. I’m proud that investigator-initiated trials of my own design are supported and that I can offer ideas that I hope will someday make a difference in the myeloma world.

Dr. Costello with her family on a recent trip to the beach (at top) and a biking adventure.

Were there any specific mentors who impacted your career?

My division chief has been a wonderful mentor here at UC San Diego. Outside of my institution, within the myeloma world, my biggest fan is the one and only Joseph R. Mikhael, MD, MEd, who has decided that as part of his career, he is going to be a mentor to as many people as he can possibly support. When I was a first-year faculty member, a mutual friend introduced us and, since then, he has made it his mission to help me succeed in the greater myeloma community – locally, regionally, nationally, and even internationally.

What advice would you pass on to early-career hematologists?

Find multiple mentors – both within and outside of your institution. It’s easy to get entangled in the local challenges that occur within every institution. You need someone with an outside perspective and a greater vision of you, your future, and your potential. Find someone with knowledge of what the landscape is like in your disease of interest specifically. Since I didn’t have anyone who was myeloma-oriented here at UC San Diego, I had to branch out and find other people who could provide that perspective.

I also think it is important to have a couple different kinds of mentors. For instance, in addition to the academic mentor to help establish your career in research and publishing, find personal mentors to help you understand work-life balance. “Doing it all” isn’t realistic, and it helps to have someone to bounce ideas off of and help you figure out what’s right for you and your personal goals. A personal mentor can help you answer the question, “What do you want to do that will fulfill you and not just check the boxes that your institution is requiring of you?” As an apologetic rule-follower, I always feel like I need to do everything I’m told, but when it comes down to it, as an early-career faculty, it’s important to take time to explore your options and then focus on the things that bring you the most satisfaction and passion.

Tell us about your life outside of medicine – what are your hobbies? What do you do in the off-hours?

Life outside of medicine? I would love to say I have one. You’ll catch me on the soccer field cheering on a daughter, crafting some goodies for the nursing staff or schoolteachers, or upside down at yoga. Someday, once I’m done rearing all these tiny humans who live in my house, I’d love to be able to just spend some time stirring up trouble with my husband of 13 years.

What is one thing most people would be surprised to learn about you?

During my time as captain of the Harvard soccer team, we were Ivy League champions and ranked number seven in the country. I’m very proud of that. Go Crimson!