Life Coach
Alexandra Levine is not just teaching students how to practice medicine. She is passing along her passion for life.
It happens every year at the Keck School of Medicine of USC, as if scheduled on the academic calendar alongside spring break and final exams.
The curriculum office sends a list of names of medical students to hematologist Alexandra Levine, M.D., asking if she might mentor the physicians-to-be. She says yes. Then, a new student drops by Levine's office to talk, perhaps interested in HIV or lymphoma. Then another student pulls Levine aside after class.
More often than not, they ultimately ask Levine the same question: "Would you be my mentor?"
More often than not, she says yes.
Levine's passion for medicine is contagious. Long recognized as a compassionate physician, Levine-professor of medicine, chief of hematology and medical director of USC/Norris Cancer Hospital-has earned a place in the hearts of her patients dealing with blood-based cancers and HIV/AIDS. In the world of research, she has led multimillion-dollar, groundbreaking investigations into HIV/AIDS among women, pushed for an AIDS vaccine and hunted down risk factors for lymphoma, among other efforts.
Her patient advocacy, too, has won her numerous honors and responsibilities, including selection to the national Presidential Advisory Council on HIV/ AIDS, an appointment made by the President of the United States.
Despite the accolades, her joy comes from something of a lower profile: teaching future doctors.
"If you're a good physician, and you serve your patient well, it's a feeling of great accomplishment because you've done something nice for that person and that family. But if you teach someone to do the same thing, your ability to impact the world becomes bigger," says Levine, who has repeatedly won annual teaching awards from students.
"So much joy comes from trying to get to a young person's heart and soul," she adds. "It's relatively easy to teach facts, and have them sit back and memorize them, but so much more satisfying to impact the way someone pursues the profession and views human nature."
Listen and learn
Growing up in North Hollywood as the daughter of a teacher of English, French, Spanish, Hebrew and German, Levine might have seemed destined for education.
"My mother would tell me over and over I should be a teacher," Levine remembers. "I thought it would be boring to have to repeat everything over and over-I would always say, 'No.' "
No one in her family had ever pursued medicine, so Levine doesn't quite know why, as a child, she told her grammar school newspaper that she wanted to be a doctor. She joined the pre-med club in high school and became a candy striper, too-a volunteer at LAC+USC Medical Center, sporting a red-and- white striped dress and a ready smile.
Nothing could prepare the suburban teenager for her first day at the county hospital, though.
"I'd never seen illness or poverty before," Levine says, still seeing the patients in her mind's eye. After an orientation, she set out on her task of delivering fresh water to patients in the wards. At one point, an older patient stopped her, needing someone to talk to. She sat on his bed and listened, enraptured with the tales the man told about his life and his experiences. Though a nurse soon made her get up and move along, "the gentleman thanked me profusely, over and over," she says. "And yet I hadn't done anything."
That night she went home and cried, her thoughts in turmoil about the reality she had seen in the wards. "I didn't know if I could go back," she says. "But I thought about that man. Ultimately, that's what won out. Basically, I never left the hospital after that."
She went on to do her undergraduate studies at UC Berkeley, and when it came time for medical school, she returned to USC and LAC+USC Medical Center's General Hospital. In 1977, she joined the USC faculty; and 25 years and 4,000 students later, she is still excited about medicine. And she still has her candy striper dress.
Balancing act
What astounds many people who know Levine is her ability to balance the demands of teaching and mentoring, critical research and patient care.
She currently is involved in three rigorous research projects sponsored by the National Institutes of Health. The Women's Interagency HIV Study, for one, follows about 2,000 HIV-positive women and 600 similar HIV-free women across the nation, investigating the process of HIV infection and immune system decline and examining factors that influence disease progression and quality of life.
She ticks off a few examples of lines of research from the project: whether the presence of a particular variety of a gene in a woman increases her risk for developing AIDS-related lymphoma; how anemia might shorten an HIV-positive woman's life span; what causes high blood pressure among these women.
At any one time, she has 10 to 12 different clinical trials open for various kinds of leukemia, lymphoma or AIDS-related malignancies, and she has authored about 200 papers in medical publications. Yet she has the energy to listen to a student asking for help.
Shay Ashouri, M.D., was that student, only two years ago.
Tucked among his second-year medical student classmates in a lecture hall, Ashouri listened to Levine enthusiastically deliver a basic science lesson. Afterward, students went up to chat with her. He waited in the back, and as she began to walk away, he introduced himself.
She was striding quickly to her next appointment, but Ashouri began his question. It was not about himself, he explained: He wanted Levine's advice on finding treatment for his friend's father, who was seriously ill with colon cancer.
"She stopped and gave me her full attention," Ashouri says. "She grabbed a newspaper I was carrying and started writing phone numbers of the best people to consult. Then she gave me her direct number-and she followed up later.
"I thought it was amazing for someone who has so much going on to take that kind of time."
Like many of his classmates, Ashouri was struggling with the stresses of medical school and considered dropping out. Levine took him with her to see lymphoma patients at LAC+USC Medical Center.
"She goes into each room and sees patients with the residents," Ashouri remembers. "She hugs all of her patients. She's the most amazing patient advocate.
"It changed my mind and my outlook about medicine."
Over time, she reminded him why he had envisioned a medical career: caring for people. "She used to tell us, 'You always want to give patients hope,'" he says. "Even if they have the worst lymphoma, she tells them about treatments they can try. She sits down and gives a mini-lecture to each patient and tells them exactly what's going on, and she never leaves the room without giving them something real to hold on to."
As Levine puts it: "The most powerful treatment is words. They can create comfort and peace-or great anxiety and stress."
Ashouri graduated from the Keck School in May, and he will start his internal medicine residency at USC this fall. Then he hopes for a fellowship in hematologic oncology-Levine's specialty.
Keep it real
When the Keck School began overhauling its curriculum for medical students several years ago, Levine jumped in whole-heartedly to help rewrite it.
"If my heart isn't completely in what I'm doing, I won't do it," she says. "But if I'm involved in something, I'm committed."
It made sense for Levine to participate. The new curriculum aims in part to use real patient cases to teach medical students key concepts in health, and Levine and fellow hematologists had long based their coursework on practical cases.
"If you can focus learning on a patient and a problem, it's likely students will learn material with more enthusiasm," she says. "We always infuse the human aspect to it."
To take it one step further, when teaching about blood-based cancers, Levine often asks a young survivor of Hodgkin's disease or leukemia to talk to students.
"We talk about what it feels like to be a patient. How would you have liked the doctor to be? What was hard about the experience?" she says. "We then open it up to the class to ask questions, and they will go on for two hours or more, even though it's scheduled for an hour."
Sickle-cell anemia patients frequently tell students what it feels like to experience pain while facing the doubts of caregivers who don't believe them. Cancer patients discuss the effects of chemotherapy and the emotional side of illness that physicians, in their daily haste, might forget.
"This gives the opportunity to not just teach facts, but to create a sense of demanding and needing to find out the answers in medicine," Levine says.
Students' memories from such classes and the relationships forged with Levine last for years. Many have become prominent hematologists. Some have created art for her-and even named children after her.
"It's incredibly gratifying," Levine says. "Students might not always remember me necessarily for teaching about specific medical facts, but teaching about life."
"I'm trying to teach what being human is all about."
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