A Tribute to Dr Lillian M. Fuller

On September 29, 2017, Dr Lillian Mary Fuller passed away peacefully at the age of 94, after a lengthy period of physical decline. She remained mentally sharp until the end. Her impact transcended the hugely important role she played in the Division of Radiation Oncology at the University of Texas MD Anderson Cancer Center, where she had been a faculty member for almost 40 years before her retirement in 1994. She was a champion of interdisciplinary care, from long before “multidisciplinary” became a buzzword. Happily, that part of her legacy lives on. One former colleague also noted her dedication to long-term follow-up of her patients; in that sense, she was also a pioneer in the focus on survivorship. Such visionary accomplishments stand on their own merit. It is all the more remarkable that she achieved these heights as an accomplished woman in the predominantly male-dominated world of academic medicine during that era in the United States. Lillian was born in Stratford, Ontario, Canada on September 11, 1923. In her high school years, while weighing career options, she considered health care possibilities such as being a nurse or laboratory technician. Lillian quoted her father as advising her to “aim for the top, be a doctor.” He could hardly have imagined how thoroughly she would succeed. At the time when Lillian chose her path in medicine, there were very few women physicians in Canada or the United States. Through her mother's family, Lillian knew of Dr Vera Peters, who had forged a successful radiation oncology career at the Toronto General Hospital. Later, Dr Peters became a close friend of Lillian's and a mentor in the treatment of Hodgkin disease. During her medical school years at the University of Western Ontario in London, Ontario, Lillian stood out enough that Dr Ivan Smith, the chief of Radiation Oncology, took her under his wing. She thrived on the patient contact that followed, and the discussions about their care. She resolved to pursue radiation oncology. She also recognized the importance of other disciplines and sought additional training in both pathology and diagnostic radiology. By the time she was seeking a radiation oncology residency, she knew that she wanted a scientifically oriented program, and found a position at the prestigious Strong Memorial Hospital in Rochester, New York. It was during that time that she developed her interest in lymphoma, with the cutting-edge notion of pursuing definitive rather than palliative treatment strategies. Her career path took her to Memorial Hospital in New York City for 18 months, subsequently a brief stint at the Radium Institute in Liverpool, England, and then to MD Anderson, where she was recruited by Drs R. Lee Clark and Gilbert Fletcher. Before transitioning from Liverpool to Houston, Fletcher and Clark also asked, and arranged for, her to spend time at the Christie, Royal Marsden, and Hammersmith Departments of Radiation Oncology. From 1956 onward, she was at University of Texas MD Anderson Cancer Center, where her patient care and research focus soon became centered on the lymphomas, including Hodgkin disease. She sought out collaborations with pathology, notably Dr James J. Butler; diagnostic radiology, notably Dr Bao Shan Jing, who was an expert in the emerging area of lymphangiography; and surgery (in the early days of the use of staging laparotomy), working with Dr Richard Martin. She was more than just a firm believer in teamwork; she also had a knack for finding high-caliber teammates. With Dr Fuller's substantial input, she and the medical oncologists Drs Jess Gamble and C. C. Shullenberger formalized a structured multidisciplinary lymphoma clinic. The collaborations they fostered made patient care better, and the resultant database archive stimulated forward-looking clinical research. Lillian was a driving force in those activities in the 1970s and 1980s. Although the focus of this Tribute is on Lillian's accomplishments in medicine, her lively outside activities also deserve to be noted. She was an art lover and thrived in that often eccentric crowd. She knew colorful members of the press, specifically the old Houston Post. She lived a dynamic, multifaceted life. After her retirement, she became active in a local Houston group, the Retired Physicians' Organization, in which, not surprisingly, she became a ringleader, serving at various times as both President and Social Chairman. Lillian remains a role model for living with gusto, for finding logical order where others saw chaos, and for recognizing that some artificial barriers deserve to be broken. Her impact was far-reaching while she was with us. She helped build the foundation of the lymphoma program at one of the world's premier cancer centers. She mentored and inspired numerous caregivers (us included), many of them far afield from her specialty of radiation oncology. Last but not least, she played a key role in the care of a large number of long-term lymphoma survivors; she would consider that her greatest legacy.