Double Duty

Dr. Laura Fluke is among the surgical oncology fellows from the armed services who are doing Saint John’s proud.

By Nancy Brands Ward

Laura Fluke, DO, is a decorated military officer who volunteered to serve as a surgeon aboard the USS Dwight D. Eisenhower aircraft carrier during the 2021 troop withdrawal from Afghanistan. She’s an accomplished researcher whose recent work on disparities in colon cancer screening during the COVID-19 pandemic was selected for presentation this spring at the prestigious international conference of the Society of Surgical Oncology. 

She’s a wife and mother of two young daughters. She has also nearly completed the first of her two years in the highly competitive Donald L. Morton Complex General Surgical Oncology Fellowship Program at Providence Saint John’s Cancer Institute—the latest in a long line of surgical oncology fellows who have sought training at Saint John’s. 

The fellowship, founded by the revered surgical oncologist Donald L. Morton, MD, was among the first program for complex surgical oncologists on the West Coast recognized by the Accreditation Council for Graduate Medical Education. It remains one of the largest in the country.

The program’s relationship with the U.S. armed services is yet another point of pride for Providence Saint John’s Health Center. Dr. Fluke—who is 37 and a lieutenant commander, a rank equal to a major in the other military services—is one of three military surgeons training in the highly selective program. The other two, Jessica Weiss, MD, and Julia Greene, MD—both from the U.S. Army—are a year ahead of her. The Complex General Surgical Oncology Fellowship Program selects four fellows a year, training eight at one time.

Over the years, the program has trained 170 fellows. While neither the program nor the candidate has ultimate choice in the fellowship matching process, 10 of those 170 fellows have been military surgeons. That may not sound like a lot, but there aren’t many surgical oncologists in the military. Those 10 comprise a higher percentage than those trained by any other fellowship program. 

“Surgical oncology fellowships are highly competitive,” says Trevan Fischer, MD, assistant director of the Saint John’s program. “They gravitate to our program because we’ve trained armed services surgeons in the past. If their boss trained with us, they’re likely to recommend applying to our program.” 

“The neat part of this,” says Dr. Fischer, who trained in the institute’s fellowship program, “is that as a civilian I get to play a small part in helping to keep our active forces healthy by sending back well-trained fellows to the military.”

Military leaders highly value fellowship-trained surgeons, says Col. Tyson Becker, MD, a trauma critical care surgeon. The Armed Services General Medical Education surgical programs are typically at the top of national rankings for academic performance. Surgical oncology residents see a broad range of complex cases, he notes.

The fellowship-trained surgical oncologists better prepared for some of the most challenging trauma seen on the deployed battlefield,” Col. Becker says, adding: “Surgical oncology is one of the few general surgery fellowships that doesn’t narrow a surgeons’ skill set but rather expands it, creating a general surgeon that is competent and confident to handle some of the most lethal injuries in some of the most anatomically difficult and complex regions of the body.”

Saint John’s fellowship program has earned praise from former fellows, he adds.

“The program is wel- suited to prepare military fellows with comprehensive training in a wide range of complex surgical oncology disciplines, including opportunities for both bench research and clinical research,” Col. Becker says. “This broad scope of practice prepares military surgeons to be clinical and academic leaders in the Defense Health Agency.”

In keeping with the Saint John’s Cancer Institute’s focus on clinical translational research, the multicampus fellowship program covers technical operative skills in cancer surgery, multidisciplinary aspects of clinical surgical oncology, skills to become an academic clinical scientist, clinical translational research that links patient care and laboratory studies, and laboratory basic science research that can be applied to the clinic.

“The fellows are all accomplished general surgeons,” says Dr. Fischer. “We’re not teaching them how to operate. We’re giving them in-depth training in all aspects of cancer care. We’re teaching them when to and when not to operate.” 

Both Dr. Fluke’s parents work in health care. Her father was a Navy Corpsman, an emergency medical technician and a medical technologist. Her mother was a nurse. That explains Dr. Fluke’s interest in medicine. But it was the kindness of an anesthesiologist who cared for her during surgery to repair a broken nose after a car accident that propelled her toward a career as a physician. 

Growing up in Oklahoma, where “college football is religion,” Dr. Fluke’s family watched the Sooners and Cowboys and, of course, Navy games. Medicine and the Navy came together after she earned her medical degree in 2012 at Oklahoma State University and then completed an internship and surgical residency at Naval Medical Center Portsmouth in Virginia. 

Initially, she intended to become an anesthesiologist. Then she fell in love with primary care as her training progressed. But during a clinical rotation with James Sumner, MD, in rural Oklahoma, Dr. Fluke was so awed by the legendary surgeon’s smarts, skill and care for his patients that she took a long, hard look at surgery. 

“Surgery is a long, stressful, intense training,” Dr. Fluke says. “But I like that when people come to us as surgeons, we can fix their problems. I have a cure for appendicitis. Even these days, we can sometimes cure cancer with surgery.” 

Relationships with her mentors also propelled her into surgical training. “Nothing scares those guys. The more hectic things get, the calmer they are. Some of that comes with training,” she notes.

The Saint John’s Cancer Institute’s fellowship has taken Dr. Fluke to the next level, she says. The cases are complex and challenging. “The complexity makes these patients’ diseases difficult to manage. We have to work closely with a multidisciplinary team of specialists from surgeons to medical oncologists and geneticists and radiation oncologists. That was something that really attracted me to the program.” 

Both Dr. Fluke and Col. Becker praise Saint John’s’ strong academic and clinical reputation.

“Saint John’s is famous for the work Dr. Donald Morton did toward melanoma research,” says Dr. Fluke, referring to the institute co-founder. “We continue to have cutting-edge research for melanoma with Dr. Richard Essner who has a grant and funding. Saint John’s is known, over decades, for turning out solid fellows, and Santa Monica is definitely a desirable location for training.”

The health center’s expertise in breast surgery and melanoma, in addition to its research program, were also big pluses in Dr. Fluke’s decision to pursue a fellowship at Saint John’s. “When I ask for help, it’s given—whether clinically or on the research front.” 

For a naval officer whose career has kept her on the move around the world from Virginia to Yokosuka, Japan, to the middle of the Arabian Sea and back, Dr. Fluke is delighted by the friendly welcome and stabilizing support she and her family receive from the Saint John’s community. 

“After completing the fellowship, a high percentage of our trainees go into academics,” says Dr. Fischer. “But cancer care is different in 2023 than in the 1990s. Now much of it is done in the community. This allows patients who could not previously access high-level complex care without traveling long distances to academic hospitals to receive it in their communities.” 

Before entering the fellowship, Dr. Fluke served as assistant program director for the general surgery residency at Portsmouth and was attached to the USNS Comfort, a 1,000-bed hospital ship. She is an assistant professor of surgery at the F. Edward Hebert School of Medicine in Bethesda, MD. She most recently served the hospital as the interim director of the breast oncology service line and as the Committee on Cancer NMCP cancer liaison physician for the hospital.

When she completes the surgical oncology fellowship next year, Dr. Fluke says the Navy wants her to train surgeons in what she’s learned. But she and her family will have to wait until this winter to learn where they’ll be living next. She could be stationed at one of three Navy hospitals: Portsmouth, San Diego or Maryland.

Outside her fellowship training, Dr. Fluke, her husband, Pablo Lavin, and their two daughters, Zoe, 5, and Audrey, 3, have been exploring California as first-timers in the state and enjoying life in Westlake Village. The girls play soccer like their mom, who played for Loyola University in New Orleans in college. The family also enjoys setting up an art studio in the backyard so the kids can paint, and hosting kitchen dance parties where they all rock out to Lavin’s guitar playing and singing. 

The Navy pays Dr. Fluke’s salary during her fellowship, but the salaries of other fellows, research support and other costs—such as travel to present research results—are fully dependent on philanthropy. Most other fellowships are supported through government funds. 

“We depend on the generosity of our supporters and friends to continue this robust and prestigious program,” says Dr. Fischer. “Unlike other surgical oncology fellowship programs that have only one fellow per year, we enroll four each year.”

The fellowship is the kind of program that provides far-flung benefits, as the fellows take their skills into the world and train others, he adds. “When people think of giving back, they might donate funds for a CT scanner or other medical equipment, which helps people and is great. When you support a fellowship, you’re contributing not just to the surgeons’ training but to the expertise that will be distributed throughout the country.”