Editor’s Corner
Magical Thinking
O
KAY, I CONFESS. I exhibit magical thinking. I believe in jinxes,
in woo woo, and in all of the medical lore and superstitions I
learned as a resident.
My superstitions are limited to the realm of medicine,
though. I don’t care when Friday the 13th rolls around, or when
black cats cross my path, or when I walk under a ladder.
When I’m in the clinic, I never tempt the gods by saying,
“Gee, we haven’t gotten a lot of consults today.” Or, “Wow, it sure
is quiet right now in the ER.”
And I get really upset if someone else does. It never fails: As
soon as someone tells me, “Gee, looks like you have a nice short
consult list today,” BAM – three consults roll in after 4 p.m.
Throughout my career, I’ve developed my own collection of
superstitions, old doctors’ tales, and beliefs.
I believe all patients with thrombotic thrombocytopenic
purpura (TTP) wait at home – febrile and confused – just so
they can come in on Friday night, preferably during a thunderstorm. The same goes for patients with acute leukemia who have
developed disseminated intravascular coagulopathy.
I’ve also realized that, for some mystical, unexplained reason,
all patient transfers take six to eight hours, even if a patient is
leaving the emergency room from a city only 45 minutes away
and even if he or she is coming in by helicopter.
I make sure to knock on wood and hold my breath in a variety of situations: when I’m discharging a patient, reading a biopsy
report, looking at the board scores of my trainees, or looking at
the platelet count of my recently discharged patient with idiopathic thrombocytopenic purpura.
And then there’s the cursed first-year fellow. It rapidly becomes clear the identity of the cursed creature who will assume
the mantle, “the Fellow of Doom.” I hate it when I’m on service
with this unlucky creature.
There’s one every year, and I remember one particularly bad
year when a fellow came in to admit seven (count ‘em, seven!)
cases of TTP – all between July and November. To put that into
perspective, there are entire medical centers that won’t see this
many TTP cases in an entire year.
I witnessed his bad luck firsthand: He was on-call four nights
during my two-week stretch on service, and I had to come in to
consult for potential TTP four times! Three of these patients had
TTP and one had Evans syndrome. And, on one of those nights,
a patient had already been admitted with TTP earlier that day.
True story.
It didn’t stop there: He was
so unlucky that he shook hands
with a patient with a palmar rash
and – yup, you guessed it – the
patient had secondary syphilis.
So, our hapless fellow went to
Employee Health to get shots
of benzathine penicillin. He
Alice Ma, MD, is an
returned moaning about how
associate professor in the
much the shots made his rear
Department of Medicine,
hurt, only to be called back by
Division of Hematology
Employee Health when they realand Oncology, at the
ized that the shots he received
University of North
had been penicillin G and not
Carolina School of
benzathine penicillin, and could
Medicine in Chapel Hill.
he please return to Employee
Health for more shots. You can’t
make this stuff up!
Another year, a different Fellow of Doom tied the record for
the most TTP patients in a single day (three), and another set
the record for the most consecutive days with a TTP admission
(five). One unlucky fellow pulled me out of bed and into the
hospital twice in one nig ht – the first time was for a patient with
TTP and the second time was for a patient with a white blood
cell count of 600,000 and new bilateral deafness.
Last year’s Fellow of Doom, who tried to dispel his moniker
by calling himself a “white cloud,” was called in from home every
night he was on call, for 15 sequential calls.
I should have told him that tempting fate when you’re on call
is never a good idea – especially on a Friday night and especially
in a thunderstorm.
What are your superstitions, readers? Let us know at
[email protected].
The content of the Editor’s Corner is
the opinion of the author and does
not represent the official position of
the American Society of Hematology
unless so stated.
Have a comment about this editorial?
Let us know what you think; we
welcome your feedback. Email the
editor at [email protected].
12
ASH Clinical News
July 2016