Compassionate Care with Dr. Loren Tschetter
Dr. Loren Tschetter is a 2015 South Dakota Hall of Fame Inductee who opened his practice of internal medicine, hematology, and oncology in Sioux Falls in 1974. Dr. Tschetter went on to change what cancer care looks like in South Dakota, focusing especially on compassionate care for patients. As a founding member of the Mayo-based North Central Cancer Treatment Group, he helped establish the state's first Institutional Review Board and opened the door for local patients to take part in national clinical trials. That early work laid the foundation for the NCI Community Oncology Research Program at Sanford Health, which remains the only program of its kind in the Dakotas and continues to bring new treatments to families close to home.
Dr. Tschetter measures his legacy by the patients he has served and the progress made during his time as a physician. When asked what it means to be an Inductee of the South Dakota Hall of Fame, he called it "a humbling thing" and "certainly an honor." He also found a gift he had not expected. After a career spent largely in the exam room and the hospital, he said being inducted "opened a whole new world to me.”
Deep Roots in the Dakota Territory
Dr. Tschetter comes from a long line of hardy pioneers. His great-grandfather, Paul Tschetter, led the German-Russian immigration to the Dakota Territory in 1875, and Loren was born in Dolton in 1942, about the fifth generation of his family to call South Dakota home. After recently reading Giants in the Earth, he gained a new appreciation for what those first years demanded. "I realized what a hard life that was, and I'm not sure I could have made it," he said.
His own early years carried their share of hardship. His parents separated when he was fifteen, and his mother moved the family back to Sioux Falls, where he finished his last two years at Washington High School. "We always had enough to eat and a place to live and love and all of those things that are important," he recalled. "But there wasn't much money." When it came time for college, he chose Augustana because he could live at home just a few blocks away and the tuition was within reach. He counts his mother among his first mentors, a woman who returned to Sioux Falls and built a successful life with little education.
The Question That Changed Everything
At Augustana, Dr. Tschetter studied chemistry and planned on graduate school, where an assistantship would help him pay his way. As a sophomore, he met his future wife Jean, a freshman medical technology major, in the chemistry stockroom where they both worked as lab assistants. They dated through college, and after he had accepted a chemistry assistantship at Kansas State University, she asked him a simple question: what did he really want to do?
"I said, well, I always thought I wanted to go into medicine. And she said, ‘well, then why in the world are you thinking about chemistry graduate school?’" he remembered. "And I said, that's a good question." He changed directions, and to this day he calls Jean his "bring me to my senses person."
He completed his first two years of medical school at the University of South Dakota, which was then a two-year program, and finished at the University of Kansas School of Medicine in Kansas City.
Arriving as a junior in a class of one hundred where he knew no one, he was approached by a fellow student named Jim Reynolds. "There's this one kid that comes up to me and says, ‘you look lost, and it looks like you need some guidance and direction,’" Dr. Tschetter said. Reynolds, who had worked as a medical technologist before medical school, introduced him to Dr. Mark Dodge, a Kansas City internist who welcomed medical students into his office and whose interest in hematology sparked Dr. Tschetter's own. After a residency in internal medicine and hematology at Mayo Clinic, where Dr. Bob Kyle became a lifelong mentor, he returned to Sioux Falls in 1974 to begin his practice.
Bringing Research Home
Not long into his practice, Dr. Tschetter received a phone call from a physician at Mayo Clinic. Mayo trained many hematologists and oncologists who went on to practice in their own communities, and the clinic hoped to stay connected with them through a shared research group. Would he be interested? "I didn't have to really think about that," he said. "I said, yes, I'd be interested."
In 1977, he became a founding member of the Mayo-based North Central Cancer Treatment Group. Before patients in Sioux Falls could take part in clinical trials, however, the community needed an Institutional Review Board to review each study for safety and to be sure patients truly understood what they were consenting to. Today nearly every university and hospital has one, but as Dr. Tschetter remembers, back then "there wasn't one in South Dakota." With help from colleagues across the country, he established the first.
For Dr. Tschetter, research was never a side project. It was the heart of what made the work meaningful. Following accepted treatments for an entire career would have meant practicing good medicine, he explained, "but that's not exactly how you make progress. You have to be able to ask questions and do new things, and test them." He called it "actually the exciting part of the practice."
That small community group went on to do remarkable things. Its work helped show that a treatment given after surgery could improve cure rates for colon cancer, and that a new approach for advanced disease could raise response rates from about 15 percent to as high as 75 percent. The National Cancer Institute took notice and built its Community Clinical Oncology Program around the model, and today the NCI Community Oncology Research Program based at Sanford Health remains the only one of its kind in the Dakotas. True to his nature, Dr. Tschetter is quick to share the credit. "I was just part of the cog," he said.
The Human Side of Medicine
Dr. Tschetter believes the science of cancer care is only part of the calling. "I think as oncologists, one has to realize your own mortality. And once you do that, you're a better oncologist," he said, "because these patients are under a lot of stress, and they need empathy and they need caring, and they need that as much as good medical care."
He learned some of those lessons along the way. Nurses later confided that they had once been afraid of him in the hospital, and he came to see that "they were really my helpers." They kept track of everything when he could not be there, which was most of the time, so he changed the way he worked alongside them. "That was for only the good," he said.
When difficult decisions arose, he relied on honest conversation, weighing each patient's wishes alongside a realistic view of the treatments available. He also made time to teach, welcoming the interns who rotated through his service in his early years, and he speaks warmly about the value of every kind of education, from medical school to the trades. "We need good electricians, we need good plumbers," he said. "We need to value all kinds of education."
A Life of Meaning
Looking back, Dr. Tschetter is proudest of the research effort he helped build and the hope that it will keep serving patients for years to come. "If I just would have practiced oncology and done standard of care medicine, it would have been all right, and it would have been good, and it would have been useful," he said. "But I think that what I did turned out to be more useful. And that's comforting to me."
The work shaped him as a person, too. His grandfather and great-grandfather were both Mennonite pastors, and he sees a quiet thread connecting their calling to his own. "I've often said to myself, and sometimes to other people, that I was a little bit of a minister, being an oncologist, in a way," he said. As for the journey as a whole, he puts it simply: "It's been fun. Life has been good."
Learn more about Dr. Milton Mutch's life and legacy here.