Yasgur’s Farm to Montefiore with Dr. Robert Marion

by Paul Kezmarsky

Congratulations on the publication of your latest book Genetic Rounds. What was your experience like writing this book? Why did you think it was important to tell these stories?
I wrote the essays that make up Genetic Rounds over the course of the past 20 years. I usually write for selfish reasons: to try to figure out why I’ve reacted to events the way I do. It’s a kind of psychotherapy: for instance, in the essay “Failing AC”, I come to understand why I didn’t tell the woman who’d come for prenatal counseling who was so upset at seeing my patient with Pfeiffer syndrome in the waiting room that that young man was a person, like anyone else, and not a monster, as she had come to believe. I found early in my career that although I may not understand my motivation for the things I do and say as I’m doing and saying them, writing about the events helps me get to the deep dark recesses of my soul.

My reason for collecting these essays in a book was to show what’s happened in the field of genetics over the past 20 years.We’ve come such a long way in such a short time. I always say that when I was in medical school, deciding on a career path, I chose genetics because it was a small insignificant subspecialty of pediatrics (and I was looking for something small and insignificant). Today, pediatrics, in fact all of medicine, is nothing but a small, insignificant part of genetics and genomics! We are everywhere! And the essays in Genetic Rounds illustrate how far we’ve come.

What book are you currently reading?
I’m currently reading two books, kind of from the sublime to the ridiculous. I’m reading a novel called The Emigrants, by W.G. Sebald, an incredible Bavarian writer who is reminiscent of Kafka (that’s the sublime part); for the ridiculous, I’ma lso reading Taking Woodstock, by Elliot Tiber and Tom Monte, on which the recent film by Ang Lee was based. I was one of the 400,000 or so people sitting in the mud at Max Yasgur’s farm in August of 1969, and reading about the events that led up to those days of infamy are allowing me to revisit my teenage self.

Where did you grow up?
I was born in the Bronx, about five miles from where I currently work. At age 4, when the Tappan Zee Bridge opened, my family moved to Spring Valley,New York, across the Hudson in Rockland County. I spent my formative years in Spring Valley. After college, I returned to the Bronx to attend medical school at Einstein, and never really left. I’ve now been at Einstein for 35 years!

Where is your favorite place you have traveled?
Two places: Paris and the Dingle Peninsula on the West Coast of Ireland. Paris is a fantastically beautiful city; but it is a city, which is both good and bad. The Dingle Peninsula, especially the area around Slea Head and the Blasket Islands is a fantastically beautiful landscape, and is an anti-city, completely devoid of people. It’s a great place to relax and watch and listen to the ocean lap upon the shore.

What is a hobby that you enjoy in your spare time?
Sad to say, these days, I don’t have a lot of spare time. Between my job as a geneticist at Montefiore, my job as director of a large program serving individuals with developmental disabilities at Einstein, being Chair of Einstein’s Admissions Committee and my writing, I don’t have much time for anything else. I do love watching baseball, though. Not surprisingly, since I’m a Bronx boy, I’m a life-long Yankees fan.

What is your favorite movie?
This is a really tough question. I don’t think I can choose just one. I’ve always loved the Marx Brothers; my favorite film of theirs is A Night at the Opera. I love Field of Dreams. And pretty much anything with Bill Murray.

What do you enjoy most about being a pediatric geneticist?
A few things. First, the thrill of being able to “solve the puzzle,” of putting together all the seemingly disparate pieces of the patient’s history and physical exam and coming up with a single unifying diagnosis that explains everything. Even after 25 years of doing this, I still get that same thrill, that same feeling in my chest, that same catch in my breathing when everything suddenly falls into place. Second, since I’ve been doing this for so many years now, it’s wonderful to be able to follow kids and their families,watch them grow up and reach important milestones in their lives. Many of my patients become like members of my family (and they view me in the same way); watching them graduate from elementary school, middle school and high school, attending their confirmations and Bar and Bat Mitzvahs, attending funerals (as in the essay “Scotty’s Funeral” in Genetic Rounds). I really feel so fortunate to be able to play this role to people. And finally, because the field has advanced so rapidly in the past 20 years, I love the fact that more and more,we’re able to do things to treat and cure the patients. The essay “Three Pictures” in the book really explains this feeling in detail.

How has the field evolved/changed since you began your career?
Really, as I said above, there are so many things we can do today that we could not do 25 years ago. Back in the 1980s, our diagnostic arsenal consisted of metaphase chromosome analysis and some basic metabolic tests. I’ve been fortunate to live through the development of high resolution (prophase) chromosome analysis, FISH, direct DNA analysis and now microarray comparative genomic hybridization. And sometime within the next ten years, I look forward to the day that I can send off a tube of blood for full genome sequencing. As a result of the technological advances,we’re able to treat a growing number of conditions, and to begin to offer real personalized medicine to more and more families. And this will only continue in the future. When genomic medicine is fully realized, all of medicine will change from a field in which we wait for people to develop symptoms and signs and treat those, to one in which we know that the individual is susceptible to developing those conditions, and will take steps to prevent the symptoms and signs from ever appearing. That’s really the promise of genomic medicine.

If you had not become a geneticist, what career would you have pursued?
This is easy. I would have been a drummer in a rock band (and probably retired by now). My dreams of becoming a drummer were shattered in high school when, after being the school’s premier percussionist for two years, a drumming wonder child entered my school. Richard Cutler was so much better than I could ever have dreamed of being, that he quickly taught me that I needed to find some other career to pursue. So, I owe my career to Richie, wherever he may be.

What advice would you give to students preparing for a career in genetic counseling?
The world is your oyster. Although the job market may be tight right now, the future has so much promise, and genomics continues to grow and take over all specialties. There will be a growing need for people to interpret the results from the lab for the patient. The genetic counselor will have to be the person to take on this challenge.
By the way, the time may soon be here for the field’s name to change from “Genetic Counseling” to “Genomic Counseling,” for this is what genetic counselors will be doing in the near future.

Was George Washington really the father of our country?
No! A number of pieces of evidence point to the fact that George Washington was infertile. Although I don’t know exactly what caused his infertility, the fact that he and Martha never had children, even though Martha Washington had borne four children during her first marriage, leads me to believe that the problem was in George. So, because he was infertile, George Washington could not have been the father of our country! Paternity testing is therefore indicated!