Q&A with Nicholas Avgeropoulos, MD

1) Tell us a little about yourself (where you’re from, family, hobbies, education, etc.).

My parents immigrated to the United States and I was born in Detroit, MI in the 1960s. Because my dad worked in the rubber and plastics industry we bounced around every year or two, but for the most part I grew up in northeast Ohio. I graduated from Port Clinton High School, a town of a few thousand on Lake Erie. From there I was accepted to NEOUCOM, a BS/MD program where I stayed until my second year of medical school proper. I then transferred to Medical University of South Carolina to complete my medical degree and then stayed on to complete my neurology residency and fellowships in neuroimmunology and neurovirology. During that time, my two children were born as my pride and joy. George has gone on to do internal medicine training to become a hospitalist and Gina has achieved a BSN and works here at Orlando Health. I continued training with fellowships in neuropathology at Yale New Haven and neuro-oncology fellowship at Massachusetts General in Boston. After that, Orlando has been home. These days, my wife, Teri, and I enjoy new experiences as they present themselves, learning from conversation and gravitating to places and people lending to that. We love to find a reason to travel (in the before times) with maybe a few set things on the agenda. There must always be time to wander and find the beautiful people, local favorites and situations that one can nor should ever script. Regarding my personal hobbies, I find they are not as eccentric as me; and I've come to like that. I play my electric guitars all too infrequently, I love watching an intense game of basketball, and like many, enjoy live venues for what is being served up that night (game, concert, food, play, festival). I’m a proud grandfather and am passionate about his future becoming unimaginably wonderful and that my kids keep those babies coming (no pressure...).


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2) Why did you decide to get into health care?

I did not experience living with or being influenced by any healthcare workers in my family or really know much about what being a doctor was about beyond what I would see in a doctor’s office growing up. Even then, beyond vaccines, I did not have much insight into what the whole deal was about; like many things, it seemed a bit foreign and separate. I knew then as I do now that I wanted to make a difference in the world in a way that would make my parents proud. I was asked almost daily at the dinner table not what I did, but what I had contributed, so that was my template. I knew then as I do now that I should follow signs before me and act when it made sense, at least at the time, to determine my trajectory. Case in point, somehow in the age before internet, I got a mailer through the school about a BS/MD six-year program and thought that might be a good idea. To quote Gimly the Brave, “Certainty of death. Small chance of success. What are we waiting for?”

From the time I left home for summer classes until the time I finished my last fellowship, I had spent as many years training to treat patients as I had been alive to that point in my life. My eyes were opened to a world where so, so many people with different abilities, trajectories and scenarios interacted under nominal to extreme levels of stress under varied acuities. I learned then and know now that the currency of being a healthcare provider is respect, love, kindness, acceptance without judgment (except for intolerance to intolerance), and striving for greater good through service. If it’s “about you / getting mine” at the core, then one has missed the point and joy of medicine. (However, this comment does not apply to authentic secret recipe Greek food at a big loud table at which point, you’d be stupid not to eat as much as you can.)

3) What brought you to oncology and what was your first role?
Neuro-Oncology is that wonderous space I never knew I needed. In fact, I didn’t even know it existed as a field because in the early 1990s I trained primarily as a neurologist, and that was a separate path. I kept following my passion beyond that and was in the lab at that point for about three years. I was and am always interested in where our humanity and nervous system intersect, how we become divergent, and what (molecular / genetic) forces drive change for the better (like Darwin's idea) and / or worse (like transmissible diseases and mutagens). I studied the impact of HIV on the nervous system and worked with prions in the lab days, but from residency, I had enjoyed reading comparative neuroanatomy and trying to better understand how stem cells knew what to do or where to go from embryo to adult. When I was doing my neuropathology fellowship, I would attend tumor boards and enjoy the rapport and clinical decision making depending on so many of the very things that were so keenly interesting to me. One day, and I remember it like it was today, one of my clinical neuropathology mentors looked up from our double headed sign out / teaching microscope and commented that I was suited to be a neuro-oncologist. I was like, what do you mean? What is that? So, I found out there was a fellowship training program for a guy like me in the situation I was in and knew right then that was the sign; that is what I was meant to do. I was following on faith that with hard work and an open mind, an answer would manifest, and it did. Three months later, I was in Boston training as a neuro-oncologist. Now, almost 25 years later, I believe that moment was true, and the right choice. I am growing together with my profession like an ever-present companion, part of me, shaping it and being shaped by the intensity of the situations of people I counsel and treat. I am humbled, improved, and matured by my colleagues, my patients, and have come to understand that no matter how bad things are, they can always, always be worse. It may not seem like it at the time, but yes it can be. Drop a 50 lb weight on your foot while rock bottom - I imagine you won't be better off.

Screen Shot 20210415 at 94712 AM4) Describe some of your most important responsibilities, projects or patient experiences with the cancer institute?
In my role as a medical neuro-oncologist, I have the privilege to be invited to be part of what is many times the most intense and indelible part of a patient’s and that person’s advocates’ lives. It is not a responsibility I take lightly. I am honored to work with tremendously talented and dedicated physicians in a teaching environment every day. I love our oncology fellows and starting this year, we will have neurology residents to teach as well. We have developed research alliances with the National Cancer Institute Neuro-Oncology Branch in addition to shared research projects with UF and industry. I have edited a book coming out later this year (boring unless you are into epidemiology) and like to contribute to and produce publications. Most recently, I have been asked to serve on Dr. Buchholz’ transition cabinet team in an administrative capacity where I have been able to play a role in adapting Orlando Health Cancer Institute to handle COVID in an EPIC way. Beyond that, I sincerely enjoy learning new roles for the times that call for them and look to adapt and improve the ways I can facilitate best outcomes.

5) In your current role, what are you most proud of/most passionate about?
I have been practicing neuro-oncology since 1997 and when I came to Orlando in 1999, there were only three neuro-oncologists in the state, none in South Carolina, and one in Georgia who had left to go to Houston. Neuro-Oncology was essentially a purely academic profession with very limited academic positions. I thought, where could I impact care the most in a large community setting as a resource? Here. Now there are nearly 20 neuro-oncologists in Florida. I’ve been at Orlando Health since 2008 and in my capacity as a neuro-oncologist have had the wonderful lens through which to view and participate firsthand in the building of brain tumor research alliances that required networking from local to international levels.

Screen Shot 20210415 at 103412 AM6) Do you have a message you’d like to share to the teams caring for and about our patients?
One never truly knows how much an action or inaction can impact a person downstream of that intersection in time; this irrespective of initial intention and expectations that may have been. Take emotional and tangible chances and allow vulnerability as a potential outcome. Work hard, do what you say the best you can, and take time periodically to make sure you are recalibrating your legacy; don't get washed so far downstream if you can help it for your situation. Ask for help and you will find it if your ethos, pathos, and logos ring true. Contribute like you do not know how many more days are yours to share. Also, watch more cooking shows that inspire you to be hungry, create and share.

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