James Cassady, MD, FASTRO

 
Baldassarre Stea:  All right.  Bob, we’ll start with your biographical information - where you were born, your parents, where did you grow up?

James Cassady:  I grew up in Los Angeles, California. My dad was a general practitioner. He was the first person in his family to go to college, and then medical school. My mom was a registered nurse.  I have one brother who is a now retired neonatal pediatrician. I think the most significant event in my early youth was that I had rheumatic fever. Because of all the penicillin in the country going to the war effort, I was treated with streptomycin and spent a year in bed. My cardiologist was a Lewis Dexter pupil, and that influenced my choice of medical school.  But it also influenced that I was able to skip 2.5 grades because my folks arranged for a tutor when I was in bed for a year.  So I was able to be somewhat younger than my peers’ grade level in terms of school.

Baldassarre Stea:  You were ahead of your peers, so to speak.

James Cassady:  Yes.  I went to a public high school, Susan Miller Dorsey High School in L.A., which I thought was excellent because it was a very diverse high school at that point. Then I went to the University of Southern California where I majored in Zoology. But the most important courses I took at Southern Cal were the History of Rome, the History of Greece, and Dr. Frank Baxter's course in Shakespeare which were much more important than any of the other courses that I took.

Baldassarre Stea:  How come zoology?  Not chemistry or biochemistry, the standard thing?  What led you to zoology?

James Cassady:  Nothing in particular other than it was a reasonable major to take and it allowed me to do some of the other courses that I really wanted to take.

Theodore Phillips:  You were determined to go to medical school at that point.

James Cassady:  Not really at that point. Well, in college, yes. But the event that made me decide for medicine -- I had two choices in my mind that I wanted to be. One was an archeologist, and one was a physician. Obviously with a physician relative and a brother who was headed in that direction in the family, that was an influence. But when I was 16, I had just finished high school and had not made a decision on what I wanted to do, I took a trip, initially a back pack trip to Europe courtesy of my folks, but I took an extension to that trip. I was on the last plane to leave Rome and landed in Egypt before Nasser closed the Suez Canal.  That was a little bit scary for a 16-year-old --

Baldassarre Stea:  Sixteen years old, yeah.
 
James Cassady:  -- seeing troop trucks after troop trucks filled with rifle bearing soldiers heading the opposite way. I was heading back into the center of Cairo.  But I think probably the most significant event was that I took a night train, which left about 4:00 from Cairo, to Luxor as part of my interest in archeology.  On the way down, the train stopped at multiple stops.  At every stop I saw up to 30 or 40 kids, children who had trachoma and who were either blind in one eye or both and this is in a time —

Baldassarre Stea:  From swimming in the Nile River? Where did they get this from?

James Cassady:  Mostly swimming, but also just local transmission.  This was the time when Egypt was getting tons of money from both the U.S. and Russia.  Seeing all these kids who had a totally preventable but catastrophic illness, I felt that there was still a place for a physician.

Baldassarre Stea:  Wow.  So that was influential in determining your future career.

James Cassady:  Yes.

Baldassarre Stea:  So then you come back to the U.S. and you applied to the medical school, right?

James Cassady:  Right.
 
Baldassarre Stea:  You had to take the MCAT like everybody else, right?

James Cassady:  Yes.
 
Baldassarre Stea:  So how did you choose the medical school?

James Cassady:  Well, as I said, my cardiologist -- I had applied and been accepted at Stanford and Southern Cal, but my cardiologist said why don’t you go to Harvard because it’s a good school.  So I applied to Harvard and got accepted.  He wrote a nice letter for me because he sort of followed my course after taking care of me for rheumatic fever.  That was a good decision on my part.

Baldassarre Stea:  Which then led to your medical degree from Harvard.  Then, after that, where did you do your internship and residency? After finishing medical school, what was your inclination at that point?

James Cassady:  My inclination was to be a surgeon, and so I took a straight surgical residency or internship I should say at King County Hospital in Seattle which is now Harborview Hospital.   It was an excellent internship because I was able to take two months of Medicine in addition to surgical subspecialties.  I also was able to take two months of Emergency Department and that was very helpful.   I decided at that point that I really didn’t want to be a surgeon.

When I was at Harvard, and this is an aside, one of my literary heroes growing up was Sherlock Holmes. Most people in my class took Richard Schatzki’s course in diagnostic radiology. By the time I applied for diagnostic radiology, Dr. Schatzki’s course was filled up and so I took Dr. EBD Neuhauser’s course in pediatric radiology.  Dr. Neuhauser is the closest person to Sherlock Holmes in real life I’ve ever known or experienced.  He was extraordinary.  His only possible peer in that regard was John Kirkpatrick who succeeded him at Children’s.  But Dr. Neuhauser was a, I don’t know if he recognized this or not, but he was a major influence because I (a) really liked taking care of children and (b) I was really impressed with the field of Radiology - what it could do, et cetera. 

So after my internship I decided I wanted to do Radiology, in particular Pediatric Radiology.  But Children’s at Harvard was a fellowship rather than being part of the regular residency, at least at that point.  I had known that Walter Berdon and Dave Baker who had been extolled by Dr. Neuhauser and others were part of the regular residency curriculum, if you will, at Columbia.  So I went to Columbia for my General Radiology Residency. This was right at the time when Radiology and Radiation Therapy was separating between straight diagnostic and straight Therapy.

Theodore Phillips:  What year was that, Bob?

James Cassady:  That was 1965.  So after about 15 or 16 months of diagnostic, which was superb, I came in contact with Bob Sagerman. Bob was a very, very, very significant influence on me and my career.  Anyway, Bob asked me and a couple of my fellow residents to do some reviews and prepare talks for the New York Roentgen Ray Society on pediatric topics.  I happened to choose rhabdomyosarcoma and Jim Lingley who was one of my friends/classmates and fellow residents, who is now a retired neuroradiologist, chose neuroblastoma. Bernie Schneider chose Wilms’ tumor.

I looked through many, many charts because at that point the Ophthalmologic Institute at Columbia was part of the Department, and focused on 10 or 12 kids who had orbital rhabdomyosarcoma.  A surprising number of those children had been treated with primary radiation therapy because they were deemed unresectable, and they were cured.  So ultimately Bob and I presented that paper, which I think was one of the cardinal papers in changing treatment of childhood rhabdomyosarcoma and the value of radiation therapy in its treatment.

Theodore Phillips:  That was a famous paper.  That really changed what we believe at that time.  That was the era that -- you guys are the people that first that had made that known all over the world.

Baldassarre Stea:  So that was the introduction to the field of radiation oncology, so to speak.

James Cassady: Absolutely.

Baldassarre Stea:  Yeah.

James Cassady: Then Bob and I and Bob Ellsworth, who is the Head of Ophthalmology at that time, we reviewed about 230 children with retinoblastoma. Bob Sagerman and I presented that paper.

So I was sort of on the track of being very interested in childhood cancer treatment.  At that point, I was in the Public Health Service, the Berry Plan.  After I finished my general residency which was a three year residency - of which a couple of months were in nuclear medicine and I think 11 months in therapy and the rest in diagnostic radiology including neuroradiology - I did two years at what was then the National Center for Radiologic Health.  I became part of the Bureau of Radiological Health looking at everything, from radiation from color television tubes to radioactive iodine.  I did that for two years with Debby and I living in Bethesda, but also taking opportunity to visit NIH and do some locums in radiology atPrince George’s County Hospital.  But Bob Sagerman had been instrumental in saying, Bob, you have to take some training with Dr. Kaplan and Dr. Bagshaw.

Baldassarre Stea:  At Stanford.
 
James Cassady:  At Stanford.  So after my two years of service commitment, my wife and I moved to Stanford.  I spent two years in the Department at Stanford.

Baldassarre Stea:  You were like a super resident?
 
James Cassady:  I think I was an acting assistant professor, a fellow, or whatever.

Baldassarre Stea:  Assistant professor, okay.
 
 Theodore Phillips:  I heard you were sort of faculty.

James Cassady:  Yeah, I had a junior faculty appointment.
 
But in reality I felt like I was a resident with people as well. My fellow residents were Sarah Donaldson, Don Goffinet, Bob Stewart who had just finished as had Eli Glatstein.  So it was really a super group of people, I think that training was excellent and very significant, not only because of the skill and excellence of Dr. Bagshaw and Dr. Kaplan but also just the other people that I was around.  It was very informative, I think.  Everybody on that track had to spend time in the clinical research center which was a radiation therapy department in the hospital where we had inpatients.

I remember that I was the only person who had 110 percent occupancy of the ward during my whole period of time on the Research ward.   But during that time Sam Hellman was a visiting professor at Stanford.  I’d been offered jobs by Bob Stewart at Utah and Jerry Hanks and Simon Kramer, but Sam said how would you like to be the Division head at Children’s Hospital in Boston.  That was the golden plum job that I could think of and so I said absolutely, yes, Sam.

Baldassarre Stea:  This is now 1969.

James Cassady:  1971.

Baldassarre Stea: ‘71?

James Cassady:  1971.

Baldassarre Stea:  What were some of the developments that you were put in charge of when you arrived there?

James Cassady:  Well, at that point Dave Nathan, who was the senior hematologist/oncologist at Children’s, was at some odds with Dr. Farber. Dr. Farber was a proponent of one-drug-at-a-time for childhood leukemia so that when a child developed resistance to drug A, then he or she would go on to drug B and C.  A few years before that the folks at St. Jude had come up with multidrug treatment and had striking and long term results, and had included in one of their trials cranial radiation since in the early, early trials primary CNS relapse was a major cause of failure in the treatment.  Omar Hustu and the folks at St Jude showed that cranial radiation could not only eliminate the primary CNS failure, but more importantly some of those children were longterm or relatively longterm and now very longterm survivors and probable cures.

So David started a program that he offered through Steve Sallan, the absolutely superb pediatric hematologist/oncologist who became head of childhood medical oncology at Harvard. Either to go to Dr. Farber and have one drug at a time or to go on to the multidrug regimen.  In that case, it was an Adriamycin-based primary regimen with cranial radiation.  So I was involved with the first patients in that study.

Theodore Phillips: Were they randomized? Which doctor did they go to?

James Cassady:  No, they didn’t randomize.  No, it was up to the parents.

Baldassarre Stea: The beginning of this relationship which you –- I remember for the past ten years you keep mentioning the same name. This must be a strong relationship.

James Cassady:  With Steve?

Baldassarre Stea:  With Steve, yeah.
 
James Cassady:  Oh, absolutely.  Steve is just a brilliant person and Doctor.

Baldassarre Stea:  He must have also been formative in your early career then.

James Cassady: We were sort of coequal in terms of both   age and interest.  Again the pediatric hematology fellows and junior faculty at the Farber were excellent.  They were wonderful collaborators. My office happened to be right next door to Diagnostic Radiology which was a great advantage because when I would get a case, I would immediately be able to go over and tap into the expertise of Dr. Kirkpatrick who was then the head of Radiology, or Roy Strand in neuroradiology, and people like Thorne Griscom and Bob Lebowitz.  So I really had superb back up.

The other thing that was really a great advantage was I had was what I think is if not the best, certainly ranking with thebest pediatric surgeons in the world - Bob Filler.  Bob had the best judgment of any surgeon I have ever seen in terms of when to and when not to operate.  So that was a great advantage for a young, not dry behind the ears yet, person.

Baldassarre Stea:  So that’s when you started to publish all the pediatric oncology topics that you have become famous for, including Wilms’ Tumor and all that.  What else was going on at that point ? well, you worked hard.   Was there any role in TBI (Total Body Irradiation)?

James Cassady:  Absolutely.  Because we were just starting marrow transplants and so in Volume I, Number I of the Red Journal was an article on low dose radiation as a way to abrogate GI toxicity by low dose rate treatment.  That was a paper we wrote.  But we were treating children with a variety of unusual malignant conditions. In addition to malignancy, we treated a child who had Wiscott-Aldrich syndrome.  Anyway, but the treatment and the equipment were relatively primitive because basically you would sit with the child being treated or patient being treated for roughly three hours and the dosimetry was, as you can imagine, not great.  We used the old horizontal treatment.

After that, Wendell Lutz and Bengt Bjarngard were instrumental in developing the dual-headed linear accelerator treatment.  It was much more homogenous with dose distributions and was just a better way of treating.  Similarly, at that timeour neurosurgeons - particularly Ken Winston who was a neurosurgeon at Children’s - were not happy because some of the children were being taken to Sweden to be treated for brain tumors by stereotactic radiation therapy using a multi-source cobalt unit.

So Ken, along with Sam Hellman, recruited Wendell – and I was in that group - to develop a LINAC-based stereotactic radiation therapy device. Actually I think we probably delivered the first LINAC-based stereotactic treatments in the country. So that was another significant event.  Again I think Dr. Hellman is in my highest, highest regard because he had an absolutely superb Department with wonderful people who were collaborative and who were brilliant.  People like RalphWeichselbaum, John Chaffee, Marty Levine and others such as Leslie Botnick and Chris Rose. It was just a super department for young faculty.

Baldassarre Stea:  And you were there for approximately 12 years?

James Cassady:  It’s 13.5 years.

Baldassarre Stea:  And you became like the national face of pediatric oncology at that point.  I mean I remember that.  That was at the beginning of my career.  You were the pediatric oncologist par excellence.  And then what was your next career move after that?

James Cassady:  Well, Dr. Hellman decided to be the Physician in chief at Sloan Kettering and left.

Baldassarre Stea:  Physician in chief.
 
James Cassady:  Physician in chief, right.  And things became a little unstable at the Joint Center because we weren't quite certain what was going to happen. I had also decided that if I was ever to become a chief-this was the time. I came out to look at the Arizona job and, just on the side, I asked Debbie, my wife, if she would like to live in Arizona —in Tucson, Arizona.  She said, where's Tucson?  She being an Easterner at that point.  But the Department at that point had what I thought was great potential in the sense that it had a really, really superb basic science. It had excellent physics with Jeff Williamson and others such as Tom Cetas.

It lacked a business sense because the department had lost lots and lots of dollars which was to me a little shocking in a radiation oncology department.  And so I thought that the financial situation could be put to rights pretty easily.  It also didn’t have a lot of clinical or training excellence at that point and I thought that could be ameliorated because I thought those were some of the strengths that I might be able to bring to the program.  So I recruited some guy by the name of Dino Stea to the department, which was one of my most brilliant moves.  I think we developed a really excellent residency program.  When the ASTRO fellowship awards were first pioneered, we had one of the first and continued to secure one each year thereafter.

Baldassarre Stea:  And, yeah, an ASTRO president now. James Cassady: And now we have an ASTRO president. 

James Cassady:  And now we have an ASTRO president.

Baldassarre Stea: That's Paul Harari.

James Cassady: And three department heads.

Baldassarre Stea: Three departments with John Buatti and -- who else?

James Cassady: Rich Wilder.

Baldassarre Stea: Rich Wilder, yes. Good, good. So what was the highlight of your tenure here in Arizona.
 
James Cassady:  I think seeing the training program gain real National stature and excellence.  I think similarly we were fortunately able to recruit Wendell to come in physics and I think we developed an excellent physics program in turn.  We had some new equipment so, again, it became an excellent department.

Theodore Phillips:  When you became interested in hyperthermia, how did that developed?  Who was the person behind that?  How did you become so good?

James Cassady:  The program had had a lot of interest in hyperthermia prior to my arrival.  Really we had an NCI Program Project grant.  Because it was a NCI Cancer Center and we had a program grant in hyperthermia.   I think a lot of that credit goes to the people who preceded me here, but also Thomas Cetas and and Gene Gerner.  Again, as I mentioned earlier, I think we had the best - in my opinion - basic science in the whole of the university and Tim Bowden was the best of the best.

Baldassarre Stea:  Gene Gerner and the rest. 

James Cassady:  Right.  So I think they supplied a lot of kind of fervor, (almost a pun) if you will, to the program.

Theodore Phillips:  Within the proximity of the university or the cancer center, or both of them? I mean this grant for hypothermia.

James Cassady:  We were all in the  same department.  That was, I think, a real strength because we basically were on the same track.  We saw things similarly.

Baldassarre Stea:  Then you had Kullervo Huynynen in that. Bear in mind, he’s still active in the field of hyperthermia.

James Cassady:  Right, at the Brigham now.

Baldassarre Stea: Yeah. So to conclude your employment history, then after vacating the great state of Arizona, then what happened?

James Cassady:  Well, I won't go into why I left there --

Baldassare Stea:  No, no.

James Cassady:  -- which relates to my opinion of Deans which I share with my brother.  But I had two opportunities.  One, to chair the program at the University of Colorado where I was offered. Ken Winston who had moved from Children’s to Colorado  wanted me to come .  But I felt that Colorado would be pretty much doing the same thing as I had done at Arizona.  On the other hand, the then CEO at Lahey, the Lahey Clinic in Boston, had formed an affiliation with Dartmouth.  And if you remember, Kullervo had come from Dartmouth where he got his engineering training.

Dartmouth has excellent basic science, excellent engineering, and needed help in clinical radiation oncology. Lahey had a huge group of superb physicians. I thought that that marriage had real potential to form something like the Joint Center wherein you could have multiple departments through New Hampshire and Massachusetts and maybe Vermont.

Unfortunately egos got in the way, like they often do, with the merger.  Dartmouth and Lahey went their separate ways.  However, Lahey was an excellent place to work.  I had excellent colleagues to work with.  For a period of time we had Tufts medical students and Tufts residents , rotating through the Department.  So basically I  spent almost 16+ years at Lahey.  I retired full time in 2011 from the Lahey Clinic.

Baldassarre Stea:  We glossed over some of the controversies that were going on during your career.  Is there anything else, a major controversy that impacted your practice or your career?

James Cassady:  I think obviously over the course of my medical life there have been amazing changes, from total incurability of childhood leukemia to now a cure in 90-plus percent or thereabout of kids with leukemia.  I think the place of cranial radiation has evolved to where it is much less of a significant factor.  I think the change in radiation therapy from the original total nodal irradiation approach for Hodgkin’s disease has changed.  I think the whole development of brachytherapy in treatment of prostate cancer and recently the hypofractionation for both breast and prostate are some developments that have changed and changed practice in treatment.

When you looked at, for instance, the original patients at the Joint Center treated for breast with initially external beam and after that,an implant to external beam with electron boost, et cetera, to what today we are doing for primary breast treatment, I think there have been legions of changes.

Baldassarre Stea:  Yeah.  Then you already mentioned you were instrumental with Wendell in total skin treatment for mycosis fungoides.You also were a pioneer of LINAC based stereotactic RT. You also started that program at Arizona.  That’s when it probably grew or mushroomed into a huge industry at that point. In the meantime, you were doing work for the organization – ASTRO. You were ASTRO president and then --

James Cassady:  I was never an ASTRO president.  I lost the election to Lester Peters.  I was heavily involved in education. I was a chairman of Education and in charge with the Refresher Course Committee for maybe 10 or15 years.  For the RTOG, I was asked to be a reviewer of the RTOG grant prior to it being submitted on a couple of occasions at least.

One of my most brilliant classmates and best friends is John Mendelsohn.  John is now the retired CEO of MD Anderson. Thanks to John, I started out on NCI Review Committees with the NIH and migrated from working with multiple review committees to being on Study Sections.  I ended up working with I think three Study Sections and those were very educational, informative and rewarding in “keeping up”.

Baldassarre Stea:  Time consuming. 

James Cassady:  -- time consuming.

Baldassarre Stea:  Do you still find time to do all of those and written Boards for the ABR as well? 

James Cassady:  For about 20 years I was the primary ABR pediatric board examiner in Louisville, Kentucky.

I think in terms of things that I'm most happy about and I value most, I was asked to be on the External Scientific Review Committee for St. Jude Medical Center or St. Jude Hospital.  I went at a challenging time.  There had been some difficulty and our Committee felt that there was a need for change.  St. Jude which has, I think, the most incredible Citizen Trustee Board and support staff of any Institution (ALSAC). They recruit zillions of dollars, as well as exert excellent oversight but not manipulation if you will.    So the right kind of people  agreed with our opinion and I was involved partly in the selection of Dr. Simone who is, I think, one of the giants in the whole field of medicine.

Baldassarre Stea:  Another great time to come in.
 
James Cassady:  That's right.  I think I was a little bit helpful in getting the institution to recruit and get Larry Kun , a great person and doctor.  So I view my time at St. Jude -- I was probably chairman of the SAB for five or six years as one of the things I’m proudest of.

Theodore Phillips:  I have one other question, Bob. You were heavily involved with manpower studies with ASTRO.

James Cassady:  Yes.
 
Theodore Phillips:  Really what do you feel now about the manpower situation for radiation oncologists and therapists?

James Cassady:  I thought at the time that the field was undermanned, that we needed more radiation oncologists.  I think that was demonstrable at the time.  Now I'm really not cognizant of the field. I know that as a general profession, medicine is clearly undermanned.  I think we need many more primary care doctors in the country than we have, especially in rural and underserved areas.  I think we're going through tremendous changes. I think it's really hard to predict what's going to happen.  As you know, we have a tremendously growing aging population -- there’s more 65 and older people and there’s going to be, irrespective of improvements that have been made in treatment, there’s going to be a need for radiation oncologists which will probably grow in the next couple of decades anyway.  What will happen with the population thereafter is the real question and whether we will have then a bolus of 50-year-old radiation oncologists who have now finished training,is a big question.  Not because I have any idea that radiation therapy is going to be less important in cancer treatment in the future than it is now - I think it's going to be more important - but because of just population demographics and therapeutic changes.

Baldassarre Stea:  What technological advances do you envision for the field of radiation oncology?

James Cassady: I think some of the stuff that Ralph Weichselbaum is working on with immune treatment, of targeted immune treatment with radioactive isotopes, identification of minimal residual disease, I think boosts with radiation to former sites of disease.  I think all of those approaches are going to be important in the future.

Theodore Phillips:  Nodal metastases treatment?

James Cassady: Nodal metastases treatment similar to Hodglkin's. 
 

Baldassarre Stea:  I  know your positive outlook towards the future.     What advice would you give to a young resident?

James Cassady:  Well, first, here I guess I'm a little bit – I won't say at odds but I think I have a different vantage point or viewpoint than a lot of people in academic medicine. Here, I am truly, as I have said multiple times, a dinosaur.  I think the most important job for a physician is to be an excellent physician and to take good care of their patients.  I think that ought to supplant all other things.  A young man or young lady going into medicine, they have to be good doctors.  I think in my experience, one of the most important training experiences that I had was when I was a high school senior and for the four years I went to college, I worked at a service station (gas station).  I think learning to deal with people; understand people, learning to get along with people; learning to cohabit, if you will, with people was absolutely invaluable on how to approach patients and how to be a good doctor.  Often, you can learn more about what’s really bothering people by listening to what they aren’t saying.   So in my opinion that’s number one. 

Baldassarre Stea:  That’s a good word of wisdom.  But we have to talk about your family as well.  I know you care about your family.

James Cassady:  I am blessed with a fabulous wife.  Deborah and I have been married, come July of this year, 55 years. None of my successes would have happened without her support and wisdom.

Baldassarre Stea:  Wow.  Congratulations.

James Cassady:  She has been tremendously supportive.  She's brilliant.  She is a very excellent advisor  when I need correcting.  We have two children and 4 grandchildren.  Rob, my son. And Kristen, my daughter.      Kristen is two years older than Rob.  Kristen is a trained neonatal nurse who is now a full-time mom.    Her husband, Basil, is a neurology and neurosurgery nurse at the Beth Israel in Boston.   They have two children - no longer children but young adults.  One of whom is a Junior at Colorado State U and interested in veterinary medicine.  One of whom is a graduate of University of New England, interested also in animal behavior.

Our son, Rob, is a teacher of high school science.  His wife is similarly a brilliant woman and role model who teaches physics in the Jefferson County Schools in Colorado. They have two children.  One, Dylan, is a graduate in Mechanical Engineering at Colorado U.  And Anna, who was adopted from South Korea, is a Junior in high school.

Theodore Phillips:  Both of your kids are now in Colorado? 

James Cassady: Kristin and Basil and Katie are in New Hampshire Three of our grandchildren are in Colorado as are Rob and Julie.  Rob, our son, has kept his parents somewhat on tenterhooks.  As an outstanding mountain climber, he had climbed some major peaks including Everest to the occasional concern of his parents.  So the parents have a different view.  In terms of my hobbies, et cetera, I’d say that I've always been interested in glass—originally stained glass and now lamp working glass.  I make glass beads some of which were on a red journal cover. I'm very interested in music, and in my retirement I'm playing the violin which I played when I was young and in high school and college.

Theodore Phillips:  Played the what? 

James Cassady:  Violin when I was a youngster. And I have taken up again in my retirement.

Theodore Phillips:  Great.  Do you have any last words of wisdom or any sayings that you'd like to quote?

James Cassady:  I guess the quote from the Rolling Stones that I used at my plenary talk that I gave at ASTRO: We don’t always get what we want, but we often get what we need.  It’s a good quote there.

Theodore Phillips:  Very good. Did you do any sabbaticals? I know you’ve worked at multiple places but anywhere where you were on sabbatical?

James Cassady:  I was fortunate in my Arizona time to be able to spend three or four months on sabbatical.  When I was at Stanford, Clive Harmer and Margaret Spittle who were then married, were fellows at Stanford with me. Clive became Head of the Royal Marsden, and Margaret became Head of the Westminster Hospital in London.  So Debbie and I went to London for three months and I visited the hospitals, toured London, and got to know a little of the music scene in London.  But I also worked quite a bit on my textbook, The Pediatric Radiation Oncology textbook, chapters I wrote in that book.  I spent a wonderful month with a friend of Eli’s and Dino in Lyon, France.