At the risk of publishing another essay in the first person, I am taking the opportunity in this issue to introduce two new features to The Hematologist. The first is our very first “No-data Zone.” As I described in the January/February issue, this recurring department will explore clinical situations that are both 1) commonly encountered and 2) lack adequate clinical research for clinicians to make data-driven decisions. The goal is to provide an overview of what guidance does exist and to describe how collaborative projects might result in a clinical trial to answer the unresolved questions. In this issue, Drs. Donald Arnold and Amaris Balitsky have taken up the reins and submitted a fascinating discussion on the use of anticoagulation in patients with thrombocytopenia (page 6). The authors examine the cases of a 75-year-old woman with immune thrombocytopenia and a 34-year-old man who develops deep-vein thrombosis following stem-cell transplantation. They explore the landscape of available data (or lack of it), and propose a path forward for future research that will help carry us “out of the zone” for this particular clinical scenario.
A second department, which I hope will be recurring, will be called “Off the Shelf.” The concept is to carve out some space for readers to reflect on what calls us to the practices of science and medicine, and on what makes work sustainable and enjoyable. With “Off the Shelf” we invite readers to submit short essays recommending choices for nonmedical reading. I am most interested in hearing about books, essays, poetry, and other literature that has changed the way that hematologists approach their day-to-day work. These may be books or writings that may have altered the filter through which you see your patients or your research, tweaked your perspective, or helped salve the scars that this kind of profession inevitably inflicts.
Because good conversations often begin with self-disclosure, I will go first. I considered numerous candidate options for this initial essay. As a fellow, my mentor Dr. Wendy Stock recommended I read Victor Frankl’s staggering work Man’s Search for Meaning. I found this book to be a tremendous resource and comfort during my first year as an attending physician — one of the most difficult years of my career(s). Another option was C.S Lewis’ A Grief Observed, which, if you have never picked it up, is a poetic, raw, and articulate account of losing a loved one. Lewis’ writing helped me feel closer to the experiences of my patients and their families.
However, the book I would like to highlight for this first feature is a small volume I received from my brother-in-law two Christmases ago. Seven Brief Lessons on Physics is just that — a small handful of a book written by the Italian physicist Carlo Rovelli with the kind of love-of-subject that one only gets from a passionate educator and a lover of language.
The essays are indeed brief, in some cases punctuated by small sketches to illustrate a point. Yet, they tackle fundamental questions of our natural world: the theory of relativity, quantum mechanics, the origins of the universe, and the concept of time, among others. The essays are written for an audience without a physics background and with the clarity, patience, and respect of a sophisticated and practiced teacher.
How did reading this alter my practice and affect my day-to-day work-life?
First, I think they reminded me of something that I have recognized since I was a child; namely that contemplating the universe, for me, provides reassurance and consolation. After a long day of charts, unsolvable medical quandaries, or unwinnable dilemmas, taking the time before bed to read, even briefly, about gravitational fields or what preceded the big bang, refilled me with optimism. It reminded me of standing on a beach as a child with my father, staring out into the night sky over Nags Head, North Carolina. “It’s okay to feel small, isn’t it?” he said as his arm swept along the bright stripe of the Milky Way.
He was right. I have found that raising my thoughts to that scale, to the incredible, incomprehensible largeness of reality, has the paradoxical effect of helping me feel both insignificant and yet more personally valuable at the same time. I find that both these energies when experienced simultaneously help me get up in the morning and approach my day and my patients with hope, purpose, and humility. When Tait Shanafelt, the oncologist who has provided so much valuable research on self-care for physicians, talks about resilience among health care providers, he discusses the role of belonging to something bigger than oneself: family, faith, or community. It seems to me that the stars should count.
The second way this book helped me with my work was by reminding me of the power of the written word to teach. I can only understand a small fraction of the physics that Rovelli addresses in his work, but he has brought me along despite that limitation. His language is simple, and as a reader, you feel respected, like an ally. Once I completed it, I thought about his feat of taking a physics novice and leading me through these sophisticated, intimidating scientific theories. What if I was able to teach that way? What if I was able to recontextualize the complex in such a way for patients and trainees? The bar has been raised for me, personally, by Rovelli’s words, his clarity, and his respect for his readers.
So, here is the formal invitation: We would like to publish your experiences at the intersection of literature and work. What have you read that inspired you? What has changed the way you approach your practice? Is there a writer out there who has articulated some decent advice on managing your day? Is there a book of poetry or memoir that brought to life an experience you had with a patient or colleague, or even with yourself? Perhaps you can think of some piece of nonfiction that explains some aspect of our human experience? Submissions should be on the shorter side (500 words or so), and we will publish these articles once or twice per year. Given that this is an open invitation, I don’t know that we’ll be able to publish all of the submissions (or if we’ll even get any), but our hope is that each of us will expand the stacks that sit next to our beds as we share creative insights on the work that we do and the scope of the missions that we have undertaken.
From Rovelli’s essay on Probability, Time, and the Heat of Black Holes
“…our experience of the passage of time does not need to reflect a fundamental aspect of reality. But if it is not fundamental, where does it come from, our vivid experienced of the passage of time? I think the answer lies in the intimate connection between time and heat. There is a detectable difference between the past and the future only when there is the flow of heat…”
