Lunching out for me can be like those in-between times when the long, hard periods in life seem to vanish and the smiles take over. When I’m alone I’ll go to a diner, order a tuna salad sandwich, some iced tea with lots of ice, and then eat quietly while I’m either editing an article or reading a book. I take my time, pick off the pieces of the sandwich I don’t like, chew, drink, and relax. If I’m with someone, I chat freely. Either way lunches out are terrific, as are breakfasts and dinners too. I love ‘em all.

My partial list leads with a lunch far different from the norm but fun, mesmerizing, and a brain boost to boot. Five of us sat in a booth last July, at Due Mari, an Italian restaurant in New Brunswick: my husband Ed and I1, Kim Hirshfield, MD, PhD, and Vassiliki (Valia) Karantza, MD, PhD, two of our favorite young physician scientists, both medical oncologists at Rutgers Cancer Institute of New Jersey2 (RCINJ), and Michelle Walker, RCINJ’s dynamic Director of Annual Giving. Deb Toppemeyer, MD3, the Director of RCINJ’s Stacy Goldstein Breast Cancer Center usually joins us but had to cancel that afternoon because of a last minute meeting.

The yearly lunches with Kim and Valia, Deb and Michelle, are a bonus for Ed and me, and keep us in touch with the latest research and news at RCINJ. As time passes, we become more familiar with each other and our conversations veer toward the free-and-easy; only afterwards come the serious discussions. The various topics? This year, they ranged all over the place:

· Herniated discs in the neck — Kim, Valia, Sue

· Exercise — running (Kim, Valia), speed walking (Sue, Ed), weight lifting (Valia, Ed)

· Work hours — very long for all but Sue and Ed; fulfilling for everyone

· New homes — trials of moving and reconstruction (Kim, Valia)

· Love life — not telling, but I did ask; at any rate, Ed and I are great!

· Cancer research — Kim and Valia talked about their lab work and what they were working on; Michelle sat quietly and beamed.

During the research portion of our lunch I picked up a few dandy sounding words. If I were Stephen Sondheim I’d put them to music. For example,

· Autophagy (aw-tofa-jē: segregation and disposal of damaged organelles [subcellular units] within a cell4 but better know to me as garbage cells).

· Angiogenesis (an′jē-ō-jen′ĕ-sis: development of new blood vessels5)

· Apoptosis (ap′op-tōsis: programmed cell death6)

Besides the essential quality of those rhythmic sounding words, I’d like to share a bit of Kim and Valia’s research work. I’ve taken the liberty of combining a small number of their individual writings on breast cancer and breast cancer outcomes into a whole without using individual citations.

To begin with, the research generally shows that similar to other cancers, breast cancer, the most common female cancer and the second most common cause of cancer death in women (lung cancer is number one7), often exhibits genetic changes that allow tumor cells to bypass the mechanisms controlling normal cell growth and cell death.

In search of these changes, Kim and Valia are focusing on the very basics of science: cell growth, cell division, cell death, and examining how to prevent DNA mutations from forming. A few of their experiments include a gene involved in cell growth and cell division. If too much of this gene is expressed, cells grow when they shouldn’t and make too many new cells when they aren’t needed.

Given that knowledge, the two scientists tested for changes within the gene and uncovered a surprisingly strong correlation between one specific change in the DNA: women carrying that particular genetic change are actually at lower risk of developing an early onset, hormonally-responsive breast cancer (about 60% of all breast cancers are estrogen-receptor positive, i.e., sensitive to estrogen8 ). They are also less likely to have a recurrence of their breast cancer. Now that is exciting! Nobel Prize in Medicine, anyone?

It seems, though, that too much of the gene makes breast cancer cells resistant to tamoxifen, an anti-estrogen drug used to treat and prevent breast cancer. Since the gene is not expressed in normal breast tissue to any significant degree, what happens that allows the breast cells to grow and divide when they shouldn’t? Currently under investigation is just how another change in this gene may lead to breast cancer and resistance to hormonal treatment.

Further research was based on an FDA-approved drug by others at UMDNJ to treat Lou Gehrig’s disease. This drug, targeting the gene under discussion, has now been shown by Kim and Valia that, in lab cultures, when both tamoxifen and this drug are used in combination, more hormonally-responsive breast cancer cells die than with either drug by itself. Therefore, if the gene’s actions can be blocked, sensitivity to tamoxifen would be restored and fewer women would have recurrence of their disease. More work is required, of course, but I believe that we’ll see positive outcomes arising from this research in the not too distant future.

To put it all together, Kim and Valia’s current research into this gene seeks to uncover who might benefit from the drug when combined with hormonal agents such as tamoxifen. Their long-term goal is to translate the scientific findings into clinical work and provide solid laboratory data for the rational design of breast cancer treatments9, an approach called translational medicine: in short, ‘from the bench to the bedside and back,’ the energizing mantra for all at RCINJ and the starting point for our very memorable lunches.

On a separate note, my daughter Stacy and I used to eat lunch out whenever we had the chance. Which was pretty often. We would both order tuna salad sandwiches, mine with lettuce and tomato — no tomato for her —, iced tea lots of ice, no sugar, slice of lemon for me — none for her — and then once the sandwiches were in front of us we’d precede to squeeze out most of the tuna and daintily push the pickles onto another plate. By the time we finished customizing our lunches, half the tuna sat on our plates instead of between slices of bread. Mayonnaisey fingertips were always on the agenda. There was no deviation.

It was less than a ritual but more than a mere custom. Stacy and I reveled in it. If anybody was with us for lunch we’d very sincerely apologize for the mess. But just the two of us? We did it our way. Not surprisingly, either one could rattle off the sandwich order for the other without hesitation. Add some gossip to the deal and lunch was just plain fun. Those memories are cherished.

The fancier lunches are almost as memorable, such as an elegant lunch that really had the cake but, unfortunately, not the tuna. In celebration of my 40th birthday, two of my best friends picked me up at my house in North Plainfield without a word as to where we were going. I only knew it was a surprise birthday outing. I was told not to wear blue jeans.

Driving into New York City was surprise enough but when a valet took the car in front of Lutèce — food critics proclaimed the restaurant’s wonders for years before it closed in 2004 — I was stunned and quite nervous about the food. It is certainly true: I ate only tuna salad sandwiches for lunch. But Lutèce served the wine that was the salve that soothed my picky stomach.

Without doubt, it was a wonderful afternoon despite shoving the strange-looking food to the edges of my plate; if I didn’t recognize it I wasn’t going to eat it. And embarrassing myself even further, I asked several questions continually throughout lunch. “What’s this?” and, “This looks kind of funny. What do you think?” Or, “Did I order this?” Oh well …

Nonetheless, all was forgiven when the birthday cake arrived. It was a chocolate fantasy like no other, and its arrival at our table introduced me to ganache, a sweet creamy chocolate mixture used as a filling or frosting. That ganache topped my cake like a queen’s crown and my finger was the first to ruin the perfect swirls. I have another friend who recently commented that my food habits hadn’t changed a bit. Hmmm.

Far from the elegant, and before Ed retired, I had a desk on the other side of his kitchen cabinet showroom. Either he or I would bring in sandwiches for lunch and eat on his blueprint-covered, rather sloppy desk or on my neat one. Real down and dirty but heavenly nevertheless. Lunches out, no matter where or what kind, are simply plain old fun.

Oh, but I cannot discuss lunches without talking about my Wednesdays with Ann. We met in a Rutgers sociology graduate class in 1986. Ann and I were both working toward our PhDs in medical sociology. She was a nurse therapist and I was planning on a free-lance research career. After getting acquainted during the first class, we discovered that her office was not far from my house. Meeting nearby for lunch to discuss sociology was the next step. Soon, sociology became less than a fly on the wall of a diner in Berkeley Heights.

 Ann and I have been meeting weekly ever since, our families commingle when given the chance — we all love each other — and lunch has been updated to a restaurant-brewery, an eatery slightly fancier than the diner. There is no tuna; I am distressed but survive. Still, the wait staff is wonderful. Any one of them will ask their question of the day, “The usual?” We nod and off they go to get two iced teas with lots of ice. Ann and I smile, sit down, and immediately start talking about our lives in 7-day increments. Nothing gets past us, except maybe, sociology.

 One newly-instituted lunch on the outside grew from Ed’s retirement. If one of us has been away from the house but is soon to head home, a quick call suggesting we meet for lunch is obligatory. I always say yes as does he. And now that I think of it, either one can order for the other as well: tuna salad sandwiches, iced tea, Ed gets the pickle. And I sit back and heave a sigh of relief as we chatter nonstop, our conversations filled with gossip, business, politics, and volunteerism. We have fun.

 And it’s clear. I enjoy all the memories of those in-between times, however they may come about, however large or small they may be. Like my lunchtimes, they are grand memories that yield smiles over and over again. Check out yours. Are they smile-worthy? I’ll bet they are.


 1. Ed and I first discovered RCINJ years before our lunches with Kim and Valia. We were impressed with the quality of the work RCINJ did, both in research and in clinical services, and decided to help support two young postdoctoral fellows in our daughter Stacy’s memory; both were unknown to us at the time as they transitioned to positions on the UMDNJ-RWJMS faculty. Several years after that, we officially endowed the Stacy Goldstein Breast Cancer Center at RCINJ. At the dedication ceremony in June 2009, both Kim and Valia, our two fellows, had, by then, transitioned to faculty as Assistant Professors of Medicine and were well-known to us. They spoke and caused tears on the faces of everyone listening. If I remember correctly, I think some of those tears were on Kim’s face as well. They were wonderful speakers and their words touched us all.

2. Rutgers Cancer Institute of New Jersey ( is the state’s first and only National Cancer Institute-designated Comprehensive Cancer Center and is one of just 40 in the nation. Its physician-scientists engage in translational research, transforming their laboratory discoveries into clinical practice, quite literally bringing research to life. RCINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.

3. In September 2011, Deb was named the chief medical officer at RCINJ. Her role includes oversight and responsibility for all of RCINJ’s clinical objectives and she serves as RCINJ’s ultimate authority on medical issues.

4. Stedman’s Electronic Medical Dictionary. Version 6.0. Lippincott Williams and Wilkins. 2004.

5. Ibid.

6. Ibid.

7. United States Cancer Statistics: 1999–2007 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2010.

8. The New York Times. Science Times. Vital Signs. A. O’Connor. October 23, 2011

9. Kim Hirshfield, M.D., Ph.D. Assistant Professor of Medicine. Rutgers Cancer Institute of New Jersey. UMDNJ-Robert Wood Johnson Medical School; Vassiliki Karantza, M.D., Ph.D. Assistant Professor of Medicine. Rutgers Cancer Institute of New Jersey. UMDNJ-Robert Wood Johnson Medical School.

Suzann B. Goldstein lives with her husband Ed and a tree named Buster, (12/1/2010 post, A Half-baked Story About a Crazy Dog and a Nutty Squirrel. Source: Sue is co-founder of The Valerie Fund with Ed, has her Master of Arts degree in medical sociology from Rutgers University in New Jersey, is a freelance writer and a poet, and has just recently completed her memoir, Unexpected Lives.