Lucky 13 ... And Counting

Thirteen years ago, Nathaniel R. Evans III, MD, arrived at Jefferson, changing the practice of thoracic surgery not only throughout the enterprise, but across the globe. And what a “Lucky 13” it has been, not only for the patients and their families who have benefited from his expertise and compassion, but also for those who have been inspired and empowered by his legacy.

Evans was exposed to medicine early on through his father, Dr. Nathaniel Evans II, an emergency medicine physician. “There were not then and there are not now a lot of Black male physicians,” he says. “I have memories of being out with him, and he knew everybody. He’d taken care of them or their family. A lot of the people in our community were excited to see him in or outside of the hospital.”

In college, Evans explored his career possibilities. “I looked into engineering and studied biology,” he says. “It became clear that I would be best at medicine. It fit with my personality and my goals to solve problems and make the world a better place.”

Surgery was always squarely in his sights. “The reason I’m a surgeon is I’m much better at, ‘This is a specific problem, we have a plan, we’re going to fix it today, and tomorrow it will be better,’” he shares. “I went to medical school thinking I wanted to be a neurosurgeon. In my medical school rotations, I thought I wanted to be a heart surgeon.”

Lightning struck when Evans was introduced to thoracic surgery as a resident at Massachusetts General Hospital. “I found it very interesting. The disease processes are quite varied. We treat lung cancer, esophageal cancer, infections of the lung, and benign processes in the esophagus. In most of them, there are things that we can do to make patients a lot better over a short period of time.”

Evans found inspiration and mentorship in his teachers and colleagues at MGH’s thoracic surgery program. “That more than anything else colored my decision, seeing people that I admired, looked up to, and tried to emulate,” he says.

Following residency, Evans headed to Philadelphia and to Jefferson. “Part of it was being closer to family,” he says. “A bigger part was an opportunity to start something new in an academic medical center. There wasn’t much in the way of modern thoracic surgery happening in Philadelphia. The person who recruited me indicated that this was a chance to build a national or world-class thoracic surgery program in an academic center that didn’t really have one, and I agreed. The day before I started, that person left.”

Evans was undaunted. “When I started at Jefferson, I was the only thoracic surgeon at TJUH and Methodist Hospital,” he shares. “There was clearly a need for patients to have access to the best quality thoracic surgical care. I thought that it presented a unique and exciting opportunity. I tell this to the fellows and the residents all the time. Especially as young surgeons, you don’t really know what you’re capable of until you have to do it by yourself. I was the busiest first-year thoracic surgeon in the country.”

Now professor of surgery and director of Jefferson’s Division of Thoracic and Esophageal Surgery, Evans looks back at the experience with nothing but gratitude and positivity. “In retrospect, it was great,” he says. “I got a lot of experience very quickly. You learn what you’re capable of, where to find help, and how to evolve as a clinical surgeon.”

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.”