The Next Dr Waldenstrom?

As I near the 1-year anniversary of my crowning as a World’s Expert, it seems like only yesterday that I was just an average citizen. You see, in April of 2011, I published a case report¹ which effectively distinguished me as a leading authority on olanzapine-induced agranulocytosis in white male New England teenagers with a primary psychotic illness. It’s a limited field of expertise, with some 40 cases of this reaction documented across the literature.

But my Grandma was sure proud: “What a wonderful article,” she called to say, “I have no idea what it means or what’s happening but it was a wonderful article!” She then gave the phone to Uncle Jon, who was busy watching ESPN and didn’t have too much time to waste beyond asking me, “What the heck is Tangerine Osmosis?” My sister-in-law-always an optimist-promised she would skim the whole paper in between changing her newborn’s diapers.

My family’s true Osler, Aunt Kat, has written literally hundreds of peer-reviewed publications, book chapters, and editorials on global healthcare, utilization of resources, and other important topics. But I’m still the only physician in the family who’s been the lead author on a paper describing olanzapine-induced agranulocytosis in the patient population who can only see R-Rated movies with an adult. And Aunt Kat was frankly encouraging about the whole thing: “This is a great start to your career in influencing the care of really sick patients beyond the scope of your own clinical practice.”

Other people tried to be supportive. I got a pat on the back from my program director, which was nice. At least 1 of my co-residents had strongly considered reading the abstract-I got a text page saying, “Heard you got published . . . will check out the link after seeing 4 new consults and 6 follow-ups!”

I did not expect honors such as those bestowed upon Dr Jan Waldenstrom, the late Swedish physician who in 1944 described the lymphoplasmacytic lymphoma that bears his name. I don’t long for olanzapine-induced agranulocytosis in adolescents to be dubbed “The Freedman Reaction.” My sights are not set on an honorary membership in the Royal Society of Medicine alongside the specter of the departed Dr Waldenstrom.

Some deeper, more personal reward was missing.

And whatever that something was didn’t begin to dawn on me until my co-resident finally read the abstract-after seeing 19 patients on the psychosomatic medicine consult service-and sent me the following text: “Good job, buddy. How much time did you spend doing this though?” It was only then that I was able to do a proper accounting of all the hours that went into writing up the case report-15 hours of research, 7 hours on the first draft, 6 hours deliberating on the 2nd draft, 9 hours of rewrites and emails-it was a lot.

This wasn’t wasted time. On the contrary, I had learned to write up a case and had received excellent mentorship and supervision from my senior co-authors. I had made my family proud. But the endeavor highlighted the sacrifice required of clinicians who conduct research and publish papers.

Did I wish such a sacrifice to be my own?

More than once I’ve listened to Aunt Kat waxing rhapsodic on how she misses being a full-time clinician. To misquote her: “I often forget how beautiful it is to spend one’s days in the trenches of diagnosis, clinical management, and the patient-physician interactions-overflowing with humanity-that are the true magnificence of our profession.”

This sentiment resonates in me. I am at heart a clinician and a consummate clinician is what I aim to be. So, while it’s certainly a nice thing to be a World’s Expert, I’m becoming more and more convinced that a focus on clinical medicine might suit me best. Grandma will still be proud.

Acknowledgement: The author would like to thank Dr Ze’evi Sherman and all the people who read his case report either willingly or through friendly coercion.

Reference1. Freedman JL, Ryan CA, Coffey BJ. Olanzapine-induced agranulocytosis in an adolescent male with psychosis. J Child Adolesc Psychopharmacol. 2011;21:185-189.