Mehra Golshan, EMBA ’19
Mehra Golshan, EMBA ’19, joins Christopher Reichert, MOT ’04, to share his story of battling cancer while he was attending MIT Sloan. They also discuss Mehra’s decision to enroll in the EMBA program and how his own cancer diagnosis informed his work as the Distinguished Chair of Surgical Oncology at Brigham and Women's Hospital.
Christopher Reichert: Welcome to Sloanies Talking with Sloanies, a candid conversation with alumni and faculty about the MIT Sloan experience and how it influences what they're doing today. So what does it mean to be a Sloanie? Over the course of this podcast you'll hear from guests who are making a difference in their community, including our own very important one here at MIT Sloan. Hi, I'm your host Christopher Reichert and welcome to Sloanies Talking with Sloanies. I'm with Mehra Golshan, a 2019 graduate of Sloan's EMBA program. Welcome.
Mehra Golshan: Thank you for having me.
Christopher Reichert: So, before we talk about what you've been up to since Sloan, let me step back and just tell everyone a bit about you.
Mehra Golshan: Well, this will be interesting.
Christopher Reichert: Yeah! So, Dr. Golshan is the Chair of Surgical Oncology at Brigham and Women's Hospital, he's the youngest physician to hold this position. So, congratulations, well done.
Mehra Golshan: Thank you.
Christopher Reichert: He's also the Director of the Breast Surgical Oncology Fellowship at Dana Farber Cancer Institute/Brigham and Women's Hospital, and MGH, and an Associate Professor of Surgery at Harvard Medical School. He received his medical degree from Case Western Reserve University School of Medicine, and of course, just completed your MBA at Sloan this past May. So you've been quite busy.
Mehra Golshan: It's been great. It was a great 20 months.
Christopher Reichert: That's right, the EMBA program. So we'll get to that shortly. You're also the author of over 115 peer-reviewed publications and a recipient of funding from the Breast Cancer Research Foundation and the National Institute of Health. Plus, you’re married and father of two teenage boys. Or is one of them 20 now?
Mehra Golshan: One of them is 20 now. So, yeah, getting a little bit older.
Christopher Reichert: And he's in college?
Mehra Golshan: Yeah. We have one that's a freshman at Brown and the other that's a junior at Tufts, so both pretty close by.
Christopher Reichert: All right. Excellent, wonderful. So life is very busy. Your focus on clinical research is on minimizing the extent of surgery required for women with breast cancer through the use of... okay. Let's see if I get this right, neoadjuvant therapies, which is to say the administration of therapeutic agents before the main treatment?
Mehra Golshan: Correct.
Christopher Reichert: And also, novel intra-operative, another thing I had to Google, techniques which is during the operation. You are introducing different and novel ways of operating on people. I guess I have so many questions to ask. Firstly, how did you choose this specialty over other medical practice possibilities?
Mehra Golshan: So when I went to a medical school I always thought I was going to be some kind of surgeon. My father is a head and neck surgeon who's retired now. But when you go into surgical training, you go into this kind of broad field of general surgery. And it's really just over time that you then hone in on one specific area, and breast cancer was the area that I really found the most interest in. I think it was pretty interesting in terms of it gives you probably the most contact with patients compared to a lot of other disease processes. Meaning that when a woman is diagnosed with breast cancer and 99% of breast cancer is in women, and occasionally men, they come to you in really their most vulnerable time in their lives. And as a surgeon, I like operating and spending time in the operating room, but in the world of breast disease, you actually spend almost as much time outside of the operating room in terms of counseling patients and supporting them and their families during the journey.
Christopher Reichert: Right. Yes. I'm going to come to that in a minute. I think your training and your personality presumably, which is diligence to get through medical school and focus on a particular area of medicine, has given you lots of knowledge, a deep technical knowledge, a lot of expertise. And with that I'm sure comes the confidence in your abilities, in your problem solving and helping other people with their cancer treatments and whatnot. So I guess that brings me to a question about your journey through that very process yourself. Because you had cancer as well, right?
Mehra Golshan: Yes. After I finished my first year at Sloan, it was in September, I went in for a colonoscopy. And I was actually diagnosed with colorectal cancer myself. It was a shock to say the least, for both me and certainly our family, and it was a very difficult and challenging year for a variety of reasons. But it really gave me a really unique, I think, look into how we end up providing care for our patients just through the care that I received myself. The great news is, yes, it was a long year, it was a challenging year, but I got through it, our family got through it. But it has certainly taught me a lot about myself, but more specifically about the healthcare system. And things that we think that we do well, we can certainly do a lot better. And certainly, I've learned that in my own practice now that I'm back at work.
Christopher Reichert: And how has that informed how you practice? Whether it's interacting with patients or even, the whole process?
Mehra Golshan: I think it's like taking a deep breath and slowing down. A lot of what we do when we see a woman with newly diagnosed breast cancer or any form of cancer, this is something they want out of their body as soon as possible. And the process of meeting with a surgeon and oncologist, maybe a radiation oncologist, it's a very overwhelming period of time. And there are a million questions that come into the patient's mind, their family’s mind. And I think what I've learned is just to slow down and listen, and not just say what I think they want to hear or that they should hear when they're newly diagnosed. An example of that is whenever they come in to see me with a new diagnosis of breast cancer—I've been doing it for 16 plus years at a great institution. We provide world-class care. And I thought I kind of knew it all. But it's really different once you go through it yourself and you see how it affects not only the individual but certainly all the people that are around them, whether it's family and friends. So it's really changed things.
Christopher Reichert: We talked earlier about how you're bringing in novel approaches to it. So that's the therapeutic agents before the treatment. How has your illness and your process of being treated affected the way you treat your patients?
Mehra Golshan: It's interesting. So a lot of the research that I was doing, and I'm continuing to do this neoadjuvant therapy, or minimizing the extent of surgery, is kind of almost counterintuitive in terms of I'm a surgeon, I make my living by operating and whether it's doing surgery or seeing patients in clinic and then getting them to the operating room. But what we've learned is that we tend to sometimes do a little bit too much surgery and that it really should be tailored to that individual's tumor and cancer and specifically to a lot of the things, expectations, that they have afterward. It's not “one shoe fits all” in terms of surgical treatment. I think the original work that I had done kind of made a lot of surgeons feel uneasy. That's our livelihood, is to be spending time in the operating room. Yet a lot of what I'm doing is saying that we're actually doing this a little bit too much and in certain cases a lot too much. We have to certainly take our time to answer those questions and usually, that comes through clinical trials. There are now a lot of them that are underway saying that there are certain women who may not need surgery or need a much lesser form of surgery.
Christopher Reichert: Interesting. I was thinking about all the business cases that we study at business school. You think about how organizations get caught up in their day-to-day or current way of doing business.
Mehra Golshan: Correct.
Christopher Reichert: And I keep thinking about the time when GM said, "We're in the muscle car business. We're in the internal combustion engine business. We are there to move steel,” kind of thing.
Mehra Golshan: Correct.
Christopher Reichert: As opposed to thinking that they're actually a transportation company and stepping back and saying, "Wait a minute. It doesn't really matter if it's internal combustion or heavy metal or V8. It's just really a transportation challenge that we are a part of." And so thinking about what you just said about surgeons thinking that they need to be in the operating room performing surgeries, as opposed to thinking about they're there to provide healthcare solutions to people. How that might change how, well, I guess the whole medical profession might think about the role of the individual surgeons or pre-care or post-care people in the whole operation.
Mehra Golshan: Correct. And you got a lot of what the pharmaceutical companies are, they're developing new drugs that are doing wonderful things and making either the surgery easier or in some cases not needing to do surgery yet. A lot of their emphasis also is on sometimes finding out how long you need the duration of treatment. Certainly, if you give a drug longer, the downstream effect is it's going to help that company's bottom line. Sometimes having that discussion with them is uncomfortable. Maybe we should be testing a shorter duration versus a longer duration of treatment. And again, a lot of these conversations that we're having are difficult. They're difficult for my colleagues in the medical field, and certainly colleagues that are outside of medicine providing us with a lot of the kind of exciting breakthroughs that we do see in cancer treatment.
Christopher Reichert: My perception of the training that goes into becoming a doctor of any stripe is that there's a lot of knowledge, and certainty maybe, of knowing the answer, right? As part of it? But I guess what I'm hearing is that really the reality is that there's a lot of more unknown than known.
Mehra Golshan: I agree 100%. I think the easiest way to answer that is that breast cancer still exists. There'll be 250,000 women that'll be diagnosed in the U.S. this year, about two and a half million women worldwide. For all the wonderful care that we've been providing, all the philanthropic support that we get, support that we get from the National Institute of Health and other organizations, breast cancer is still there. It still requires treatment. We haven't been able to certainly prevent breast cancer. We've done a better job of treating it, yet women continue to develop it and we still have a lot of work to do.
Christopher Reichert: I think about my undergraduate education, which was in the classics. Some of the things that we read were, particularly in the medical area, hilariously misguided. Thinking about, “The body has so much heat and you have to let the heat out.” Or “bloodletting.” And what was interesting about it was that they were convinced that this was the way that medical treatment... leeches and all the rest of it. Now certainly we've come a long, long way from that, right? But I think it's telling that what you just said really reveals the complexity of the human body and that there is still so much that's unknown. So as a doctor, I guess you manage that, right? You manage what you know and what you don't know and how you relate it to patients?
Mehra Golshan: We do, but we don't necessarily always do it in the best way because, again, often patients will come to us and they want to know that you are the expert. You're going to be able to give them all the answers. I think some of our training kind of pushes us into that direction, but occasionally you'll have to say, “We just don't know.” Even when I was diagnosed, it was one of those things that was kind of hard to hear is that "We're going to start this treatment and we think it's going to work but we won't know until we start it." Hearing that you “don't know” and you're “not sure,” doesn't always exude a lot of confidence but it's sometimes the truth and it's the way you give that information to that patient, to their family. I think those are a lot of the nuances that, again, I thought I had all the answers to and certainly now I've spent a lot of time reflecting on it and just the patients I saw yesterday in clinic or that I'm going to be operating on tomorrow morning, my approach to them is very different than it was in the past. Technically I may be doing the same thing, but my conversations with them are very different.
Christopher Reichert: Much more empathic I imagine, right? As them as a human dealing with uncertainty.
Mehra Golshan: Absolutely. Not just where is the next source of revenue coming for our hospital system? Why can't we see more patients, do more operations and cases? I certainly see that aspect of things. But at the same time, they're, again, coming to us at this really difficult and challenging time. And just spending the time in terms of listening to them, answering their questions. In fact, I almost sometimes now stay so long that they're kicking me out of the room like, "We're done with you. We've gotten all our questions answered." As opposed to jumping up and rushing to thinking that there's three other people that need to be seen down the hallway.
Christopher Reichert: I think about this constant discussion that we have in this country about the healthcare system.
Mehra Golshan: Correct.
Christopher Reichert: We compare it to other countries, how they're handling it, whether it's nationalized or whatnot. Then the conversation turns around to that we have the best healthcare systems in the world because we have the best schools and we have the best whatever. But then there's the economics of it, right? I've been thinking that because there are so many uncertainties in that we don't know about how to solve health issues…
Mehra Golshan: Correct.
Christopher Reichert: That putting it on the same sort of conversation level as to how do we solve a known economic problem, right? We can be more efficient building cars or widgets or whatnot. But because there's so much unknown in the healthcare industry that maybe it's not solvable in that level, that the notion of rising costs is built into the fact that we just don't understand as much as we need to.
Mehra Golshan: We don't understand as much as we need to. And again, we may solve one specific area of a disease process or find an antibiotic that'll take care of an infection. But there are many new ones that'll come into place or there'll be a resistance that will form to that answer that we thought that we had, and we have to start thinking of new ways to do that. That obviously requires a lot of research, a lot of R&D and investment in it. Often that leads to an increase in healthcare costs like we see here in the U.S.
Christopher Reichert: Right. How did you decide to go to business school and Sloan eventually?
Mehra Golshan: Very interesting question. I actually thought about it a couple of years before I started the program in 2017. I think I alluded to this a little bit before, that a lot of what we do is revenue stream, how many patients that we end up seeing in clinic, how many operations that I do each year, where are we going to find the next source of patients? Is it through a different part of the region, should we be investing in our international oncology programs and bringing high net worth individuals from Gulf states or from China? And to me, I work for a not for profit, yet so many of our conversations revolved around money. Which was uncomfortable. But at the same time, if I'm going to have a voice at the table when we were having those discussions, I wanted to have a little bit of that background to be able to understand some of that decision making from the financial aspect. I think really that first year of school, the accounting and financial management really helped answer those questions because a lot of times doctors are invited to these meetings where those discussions happen. But we're almost kind of pushed to the side and just told like, "This is what we're going to end up doing." When they do show us numbers and the financials, many of us just didn't have the background to understand it. So I really went into it to understand the numbers. But it was like really during that second year where you learn a lot of the skills in terms of interacting with people, and how systems are set up, and a lot of the dynamics that occur in institutions that I ended up learning, I think just as much as I did numbers-wise. Then on top of that, I was diagnosed with cancer. I was in the middle of treatment, so it was really kind of a very personal experience in the middle of all of this.
Christopher Reichert: Absolutely. So do you have any favorite Sloan class or a memory?
Mehra Golshan: Yeah. There are so many. I still look back to that first day when you walk into those introduction sessions and lectures, and you just see all those faces in the room. And now I know every one of those faces. I know all the names. I got to certainly know some of the people in our class a lot more closely than others. But I can tell you that every one of them are absolutely amazing people and individuals and families. I just loved being able to connect with them. Professors, again, the way they teach is so different than the lectures that I give at conferences or when I'm teaching medical students. We're much more kind of regimented in the, "Our slides need to look like this. The font needs to be this." Our presentation style is very regimented. But it was so much more free-flowing, yet there was obviously a very detailed agenda in what we needed to cover. Yet they're able to do it in a style that it's pretty mesmerizing.
Christopher Reichert: Yeah, absolutely. Do you have any “do-overs” that you'd want to go back?
Mehra Golshan: I don't know about “do-overs,” but I think these [Executive] Elective weeks that were still offered are just great opportunities to kind of hone your skills or look at things that you just didn't spend enough time on. And again, that second year I was pretty sick. So I was actually coming into class on chemotherapy, I actually brought a pump in, and was getting chemotherapy. So there were times when I would just, my body just couldn't take it and I’d have to get up and take a nap, not in class, they actually have prayer and meditation rooms believe it or not in Sloan, that you get to... I walked by them 1,000 times and never knew they existed, but they're on each floor. I would bring a blanket and a pillow and take a nap and come back a little bit stronger for the second half of a class. So I think I missed out a little bit on it just because of my health during the time. But at the same time coming into school and class was a way of getting away from the trials of dealing with the disease process. I was treated at the same place I work. So everything revolved around the hospital and care providers, my job did, my treatment did. So coming to Sloan was kind of a special place.
Christopher Reichert: A break from that, right?
Mehra Golshan: Yeah.
Christopher Reichert: As part of your illness, did you turn to religion at all to help you through any of that?
Mehra Golshan: Oh yeah. So when I say I use the prayer and meditation rooms, I didn't actually pray in those rooms.
Christopher Reichert: Sure, sure.
Mehra Golshan: Although, I did see people praying. And I actually got to meet a lot of very great people that use those rooms for a variety of reasons. I think I was one of the few that actually took a nap in those rooms. But it's interesting, a lot of our friends who strongly do feel religious would tell us, tell me or my family, "We're praying for you." Or, inshallah “everything is going to go well." And whatever their religion was. At the beginning, I don't know if I dismissed it but I just didn't really take it to heart. But this is, it's very important for a really large swath of our population of this country and around the world. I can't say that I decided to take on religion, but I'm very, very understanding of those that do. I am sure those prayers and thoughts were super helpful in helping me get through this.
Christopher Reichert: I guess the reason I mentioned it is because I think that, the tension between sort of secular and science-based and all of that, and then there's the more spiritual side. I don't know that they're mutually exclusive, but there's certainly a tension there.
Mehra Golshan: There is.
Christopher Reichert: I wondered if that line moved for you at all?
Mehra Golshan: It probably moved a little bit. And again, I think I am a little bit more open to listening to others who have a much stronger basis in their faith and in their religion. I really respect it, and again, it didn't take me to go to church or to the synagogue or to the mosque on a regular basis. But a few of my friends told me just to come into church just as a peaceful place to reflect and listen, and I think it was an absolutely wonderful thing to do.
Christopher Reichert: I agree. I'm not particularly religious in a sort of formal sense. But I went to Assisi in Italy and that's a very spiritual place. Also, there are no cars throughout this entire hillside village, there are no cars, which in and of itself creates a peace and a spirituality. That it gets into you in a way that I turned and I said, "Wow. I think there's maybe something in here beyond the organized religion, the sermons and the rituals and whatnot,” just being, slowing down, and taking a bit more time as you go through your day or your life, or your profession.
Mehra Golshan: Oh, absolutely. I wrote a little bit about this and we lived in our house for over a decade and in Newton for 16 plus years. But I can say that I never really watched the light that came into our house during the course of the day or the leaves changing in the fall. Certainly, we see the bunch of leaves that we needed to rake or have cleaned up. But I just never saw that change. While I was sick and I had to take some time off from work, I really got to see so much more of life that I just let blow by each day and just take, as you said, things maybe slowed down.
Christopher Reichert: What part did your partner play in your decision to go back to business school, or add to your schedule?
Mehra Golshan: Absolutely. First of all, none of me getting through the cancer treatments, certainly supporting me through Sloan's experience, that's all because of my wife and two wonderful, amazing kids. During my second year when I was diagnosed and in school, and going through all of this pretty harsh treatment for the type of cancer that I had. My younger son was a senior in high school, so he was going through the whole admissions process. We were pretty checked out, certainly, I was. Yet my wife, a full-time breast radiologist at Harvard, running the household, keeping me on schedule with my treatment, driving me to classes when I couldn't drive myself. Absolutely no way I would have been able to do it without her.
Christopher Reichert: What's your definition of success now? I know when you started maybe as you went through medical school…
Mehra Golshan: Yeah, very different.
Christopher Reichert: ... and have been the youngest physician and whatnot.
Mehra Golshan: Yes. I think it's not taking things for granted as much anymore. Certainly, I was fortunate that my treatment was successful, but it really did take a lot out of me. And now that I'm back, I've decided to slow things down a little bit. The number of patients that I used to see, the amount of time I spent in the operating room. I'd rather spend a little bit more time individually with those patients. Maybe not see as many as I did before. Certainly making it a priority to be around for our family, which was always very important. But knowing that I'm not bulletproof and life is finite, you never thought, I never thought in my forties that I'd be dealing with a serious cancer. It really kind of gives you perspective on how you want to move forward.
Christopher Reichert: Do you have any parting advice for prospective Sloanies or someone considering going back to school?
Mehra Golshan: I can tell you that my classmates, the EMBA staff, the professors, were amongst the most empathetic people that I've ever had the privilege of working with. And in fact, I've told my wife and friends and children and said, "My classmates just cared about me and us so much.” We'll never be able to thank them for all the support that they've given. And that they continue to give.
Christopher Reichert: That's wonderful. Well, thank you Mehra Golshan for coming in today to talk to us on Sloanies Talking with Sloanies.
Mehra Golshan: Thanks for having me on this warm, balmy Boston December day.
Christopher Reichert: Here, here.
Mehra Golshan: It's great. Thank you.
Christopher Reichert: Thank you very much.
Mehra Golshan: Cheers.
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