First, Do No Harm

Class of 1979 alumnus Geoffrey Dunn’s roots run deep—not only in the soil of Erie, Pennsylvania, where his family has lived for generations, but also to the founding of Jefferson.  His history is a storied one. A fourth-generation graduate of Jefferson, he proudly shares, “All of us were surgeons. All of us practiced in the same hospital. All of us were Fellows of the American College of Surgeons.” A charter member of ACS, his great-grandfather arrived at Jefferson in 1879 and graduated in the class of 1881. Dunn has the historic diploma, printed on parchment and signed by Jefferson luminaries Samuel Gross, MD 1828, and W.W. Keen, MD 1862.

Dunn’s surgical career started early, around age 11, when his sister was bitten on the ear by a horse. He held her as his father repaired the damage. “I was his assistant,” he shares. “This was my first patient exposure, and I was fascinated. I emulated him.” Dunn soon opened a thriving practice for his sister’s dolls, sewing on body parts and performing heart surgery on Raggedy Anne.  

In seventh grade, a new artistic passion emerged. After acting out in school, he was grounded. “My mother said, ‘You’re stuck inside for the next month, you’re going to need a hobby,’” he says. “She gave me the best lesson I’ve ever had, showed me how to use oil paint and do a still life. I loved it, and for a while I thought I was going to be an artist.”

Dunn majored in religion and painted extensively at Haverford College. After studying in Germany, he returned as a junior. A painting mentor’s candor followed by a family emergency set him on a new yet familiar path. He recalls, “He told me that I was one of his best and saw a good career for me in art, but said, ‘I don’t think you should do this; something’s holding you back.’ I sensed he was right, but I didn’t know what to do.”

Dunn then discovered that his mother faced a serious medical situation requiring surgery. He was horrified to learn of the poor treatment she received from her clinicians ahead of the procedure. “I thought, ‘I would do a better job,’” he says. “Medicine was familiar. I was good at science, and said, ‘This is what I should do.’ The next day, I signed up for every pre-medical course I could at a local college. I was accepted at Jefferson a year after I made the decision to pursue medicine. I never had any regrets.  The more I got involved, the more I knew it was the right decision. I loved it.”

Following medical school, Dunn performed his residency at the Harvard Surgical Service at Deaconess Hospital, where he was chief resident. The experience exposed him to ideas and themes that later defined his career. He returned home to Erie’s Hamot Medical Center as a general surgeon.

In 1988, Dunn was invited to establish a burn unit in a large teaching hospital in India. “I didn’t know about dowry burns, a form of homicide used so the spouse could remarry for another dowry,” he says. “Due to limited resources, training, and the magnitude of the burns that we saw, it was obvious to me that this was not going to be a burn unit. This was going to be a burn hospice. Even back in the U.S., a 90% burn was unlikely to be salvaged.”  

Hospice was in its earliest stages. “The idea that there was comprehensive humane care for people who are going to die was out there, and I thought that’s what this would end up being,” he says. “However, I couldn’t offer patient comfort because they didn’t have morphine available. I had to do everything with Tylenol.”

Dunn felt helpless and returned home. “I was busy, got happily married, and tucked that away, even though I had some PTSD,” he says. “Then, my mother got terminal cancer.” Following her passing, he threw himself into work. Six months later, burned out, he took a leave of absence.

A few weeks later, he was approached by a local hospice looking for a medical director. He agreed, and started making home visits. As someone who had worked in the hospital, he was not familiar with how hospice worked, or its benefits. For Dunn, it was a revelation. “I was stunned,” he says.  “Right away, I was seeing people, and it clearly was having positive impact.” Dunn made up his mind and chose a new path. He says, “I gave notice that I wouldn’t be back in surgery.”

After a few years, a former colleague invited him to speak at an ACS meeting about his work with terminal pancreatic cancer patients. “As I spoke, I thought, maybe it’s time to go back to the world of surgery with everything I’ve learned in the last few years with hospice,” he says. “I met another surgeon, Dr. Robert Milch, with an almost identical transition. Out of that came the concept of surgical palliative care—and together, we wrote the first paper on the topic.”

Dunn was committed to educating surgeons about this new idea. He defines it as “the treatment of suffering in all of its manifestations of patients and their families under surgical care.” He cautions that this doesn’t necessarily mean people having surgery. Patients under surgical care may be in ICUs, or have had surgery where there may be surgical implications in their future, or are being managed by intensivists.

In 1997, a respected burn surgeon helped to launch him onto the national stage, asking him to speak at an ACS symposium on physician assisted suicide. “He said, ‘Dunn, you have 10 minutes to change surgery. Don’t mess it up,’” he shares. Dunn seized the opportunity to introduce the importance of improving surgical palliative care, calling out critical issues including over- and under-treatment, pain management, artificial feeding and hydration, and the importance of family communication. “I said, ‘I promise I will do everything I can to advance this field, but I’m from a community hospital, and don’t have an academic position,” he shares. “It was the most senior, well-known surgeons that responded, ‘You have to stick with us. This is really important, and is long overdue.’”

“I claim some responsibility for ushering surgery into this new field of medicine, and making them comfortable with it,” he says. “This is a part of our tradition, but we don’t recognize it anymore. We’ve gotten good at fixing and curing things, yet we’ve forgotten how to comfort people.” Dunn is proud to have the first certificate issued by the American Board of Surgery in Hospice and Palliative Medicine. “I was the one who wrote the original pitch,” he says.

In 1998, Dunn pivoted to seeing patients in the hospital in a team-based format in consultation with their families. “My background in trauma and surgery was helpful, giving me credibility as a consultant in palliative care in our ICU until I retired in May 2018,” he shares.

While he had begun to return to painting in small doses, in the mid-1990s, Dunn began to paint again in earnest. “I paint outdoors in nature,” he says. “I do landscapes. I began to exhibit in 2008, and am now represented in about five galleries.” Today, Dunn partners with fellow painter and alumnus Gerald Marks, MD ’49, to interest surgeons in painting. “We feel the overlap of surgery and visual arts,” he says. “This is a perfect thing for surgeons to do, to relax, expand their spiritual reach and personal insight.”

“I’m grateful for my Jefferson experience,” he says. “This shared story with Gerry has brought it back to life. It’s wonderful that you can reach across generations and find a dear friend.”

Evans’ championship of research has taken the Division of Thoracic Surgery to new heights. “We are on the forefront of national and international research projects that change how we treat lung cancer and esophageal cancer,” he says. “We were one of hundreds of sites involved in a national trial looking at how we perform lung cancer surgery that will change how we treat and operate on patients. Similarly, we participated in a trial studying the use of immunotherapy in early-stage lung cancer patients.”

“We studied disparities in equity and care in lung cancer and esophageal cancer,” he says. “The closer you look, the more disparity you find. Often that pertains to whether or not patients have access to high-quality care, whether it be surgery, radiation, or another approach. We want to highlight those challenges, and ensure that at least here at Jefferson, they don’t exist. We are dedicated to getting out to every part of the health system to ensure that we are involved in our patients’ care. Even if I don’t operate on somebody, I can make sure they get the appropriate care, and be part of a team that’s going to do that.”

Evans recently led the charge on a groundbreaking initiative designed to bring lung cancer outreach, education, and screening to underrepresented constituents. Through a grant from the Bristol Myers Squibb Foundation, Jefferson, as a leading provider of safety net health services in the city, connected with some of the most medically vulnerable, high-risk residents to increase their access to lung cancer screenings, in the hopes of detecting the disease at an earlier stage, reducing the barriers to successful cancer treatment, and ultimately reducing mortality. 

Jefferson honored Evans with three awards in the past two years, including the Dean’s Outstanding Clinician Award, the Dean’s Award for Faculty Mentoring, and the Achievement Award in Medicine. “All three are equally important to me,” he shares. “There’s no point in being an excellent surgeon if you can’t pass it on to others, and if you’re not making the field and the community better for it.”

Evans finds inspiration daily from sources that feed his work—and his soul. “In the end, it’s not about us, it’s about the patients,” he says. “Every week I see a new patient who faces a challenge that I don’t know that I could ever face—with grace and humility in a way that I’m always impressed by—and we all try to do our best to help them along the way.”

When Evans is asked about his legacy, and the department that he has built from the ground up, he shares, “I worry less about how I’m remembered and more about how our division and program are remembered,” he says. “I would like to be remembered as having made Jefferson a thoracic surgery program that is recognized, and that delivers excellent care to patients in the region. I always tell the residents and my partners that oftentimes the surgeon has to remember that it’s not really about you, it’s about the patients. I’m encouraged that when we’re at national meetings and in national venues, Jefferson is recognized as a growing and excellent thoracic surgery program. I certainly can’t take credit for all that. I take credit for getting the people here who have helped make that happen. And to me, that’s more than enough.”