inflection point: dr. igor puzanov
I met Dr. Igor Puzanov over a video call in the spring of 2022. He sat in front of a bookcase in his Williamsville, New York, home, where he lives with his wife Martina and their teenaged daughter, the youngest of the couple’s three children.
Dr. Puzanov is a highly accomplished oncologist. He treats melanoma patients and serves as Senior Vice President of Clinical Investigation and Director of the Center for Early Phase Clinical Trials, among other roles, at Roswell Park Comprehensive Cancer Center.
In his free time, he’s outside with his family. He loves snowshoeing during the winter, riding bikes and kayaking when it’s warm. He says the nature around Buffalo, where he’s lived since starting at Roswell Park in 2016, is beautiful–he mentions hiking the Niagara Falls gorge, watching the river’s waves.
The mountains of Upstate New York are not dissimilar to those he knew in his childhood and early adulthood in the Czech Republic, he tells me.
Igor was born in 1967 in the then communist state of Czechoslovakia, just before the Prague Spring would begin and fail when Soviet forces invaded. His Russian last name, inherited from his grandfather who had emigrated to Czechoslovakia from Russia in the early 1920s following the White Army defeat in the Russian Civil War, lent him a familiarity with the feeling of being foreign, even in his homeland.
Growing up in Prague, he always wanted to leave–“I was always thinking about going somewhere else,” he says of his younger self–and he always knew where he wanted to go and what he would do there. Even as a teenager, attending a boarding school for students gifted in mathematics, Igor saw his path: He would finish college and eventually medical school, and he would go to America. He wanted to be a surgeon.
As a medical student in 1989, Igor helped to usher in the Velvet Revolution, which would mark the end of communist rule in Czechoslovakia. The peaceful resignation of the state’s leadership was followed in 1990 by the country’s first democratic elections since the 1940s and three years later by its split into the separate Czech and Slovak Republics.
Like so many Central and Eastern Europeans of his generation, Igor felt the world open up to him at the start of the 1990s.
When a unique opportunity arose to visit the United States through a cultural exchange program for students, Igor, about a year shy of his medical degree, seized it. The program offered a six-month stay during which participants would take what jobs they could find, work and make money, and immerse themselves in American culture.
Igor and his wife, Martina (who had by then just finished medical school herself and was pregnant with their first child), landed in the US in 1990 and quickly found jobs at a fast food restaurant situated inside a Massachusetts amusement park.
I wondered if the pivot from medical school to the kitchen might have felt like a hitch in Igor’s plans, his lifelong desire to practice medicine–but he doesn’t see it that way now, nor did he at the time.
“Food!” Igor exclaims. “My grandma was a war survivor, and she always told me, ‘If you work with food, you never go hungry.’ So we took the jobs and we flipped burgers.”
Igor is the sort of person who can adapt with optimism, going where the current takes him–but going with purpose. He never lost sight of his plans, seeking and taking any opportunity that would propel him into his medical career.
Just a couple of weeks after he started his restaurant job, Igor was connected by a coworker to Dr. John P. Remensnyder, Chief of Staff at Boston’s Shriners Burn Institute (now Shriners Children’s Hospital).
“I took a piece of paper after I finished work one night, at maybe midnight, and I wrote a letter saying, ‘I flip burgers here, but I want to be a surgeon.” He detailed his background, medical school and Czech politics, his family. He laid out his dreams. “And he wrote me a letter back a week later and said, ‘Igor, I talked to some people here, and we will be happy to have you.’”
After finishing up the summer at the restaurant, Igor began working at Shriners and Massachusetts General Hospital, in a role equivalent to that of a fourth-year medical student. He learned more than he would even realize until he returned to Prague six months later to finish medical school (this time with both Martina and their son, Igor).
“I brought an amazing amount of information,” he says. “My classmates looked at me and said, ‘Igor, you can write a PhD thesis from this.’ But I thought, no, because a PhD thesis should be new knowledge–this is not new, it is just translating some other knowledge. And I don’t want a PhD like that.”
After he finished medical school at Prague’s Charles University, while he interned in surgery and internal medicine, Igor began applying for graduate school in the United States. He was eventually accepted into a program at the University of Texas Southwestern and the Puzanov family headed to America again, this time to Dallas, Texas.
There, Igor studied under Dr. Vinay Kumar, conducting research on natural killer cells, reinventing himself as a pure scientific researcher rather than a medical doctor–with a purpose, of course. He picked up invaluable research experience and worked with great scientists. And, thanks to the success of his research, he and his family were granted national interest visa waivers.
“That was ‘mission accomplished’ in a sense, and then I switched back to clinical medicine,” he explains. “And I said, ‘Okay, so I’m going to go into internal medicine, oncology, and use what I learned in life, develop it, for people with cancer.’”
After his residency and some time in private practice in Dallas, Igor picked up his family and moved to Nashville, Tennessee, where he completed a hematology oncology fellowship at Vanderbilt University. From here, his career in cancer medicine and research took off in earnest, eventually bringing him to Roswell Park.
“I always thought, about life, that it’s kind of like an exponential curve, like the mathematics equation,” Igor tells me. “The initial part, remember, in the exponential equation, is pretty flat. And you don’t realize it. And then there is an inflection point. And it just … goes.”
For Igor, the inflection point was the completion of his fellowship, the end of the last phase of his formal education. The gentle slope up to that point was dotted with milestones that propelled him onward and upward–his foray into politics during medical school; his marriage and the births of his children; the hours spent over the grill at an amusement park; graduate school applications rejected and accepted.
Igor sees all of where his life has taken him as singular in direction–not as disparate journeys but rather as many legs of one path, twisting at points, curving one way or another, but never diverging.
“It’s one direction, I think. It’s just that you have these little side ways. But they end up being straightened in that one direction,” he tells me, thoughtfully, letting the visual come into focus for both of us. “That’s how I would describe it–that it’s still one direction, but all these little side businesses you may think are unimportant, they become important in their own way at the end. You never know what kind of role that event or that relationship or that skill you acquired may play before it’s all over. You just don’t know.”