Dr. Crane: The moment I knew medicine was my calling

AMA Wire
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Physicians are privileged to see patients at their most vulnerable, to reshape lives and continually revitalize the nation’s health system. In a challenging practice environment, physicians remain driven by the power of healing and the indelible connections they form with patients and families.

The AMA Wire®When I Knew Medicine Was My Calling” series profiles a wide variety of doctors, offering a glimpse into the lives of the busy women and men navigating new courses in their careers and in American medicine. No matter their age, their specialty or their career stage, they were born to do this and they tell us why.

Share a moment with: Genevieve Crane, MD, PhD, research/clinical fellow in the Department of Pathology and the Children’s Research Institute at UT Southwestern Medical Center in Dallas. In June, she moves to the University of Rochester Medical Center, in New York, where Dr. Crane will serve as assistant professor of pathology.

I was born to: Challenge, discover, serve.

The moment I knew medicine was my calling:  My father, who was a triathlete and physicist, developed sudden and progressive neurologic symptoms when I was just 5 years old. At first it was difficult to even diagnose, but when we found out it was a primary progressive form of multiple sclerosis, there was still no treatment. I simply could not accept the limitations in our medical knowledge. As I watched the disease relentlessly progress, I vowed to pursue a career to help change the disease course for others facing chronic or debilitating illness.

An experience from residency that confirmed my calling as a physician: We came across a case of an unusual type of brain lymphoma in a patient with a renal transplant. The oncologists were surprised, one stating he had not seen a case like that in nearly 15 years. We then saw several more, with others arriving in consultation. On reviewing all of the patient histories, historical data and a nationwide database, we discovered that the rise was due to a particular type of transplant medication being used less frequently compared to ones more recently introduced.

While patients on immunosuppressive drugs are at increased risk of certain types of lymphoma, we found calcineurin inhibitors such as cyclosporine actually protect the brain as compared to other sites. At this point, I realized how important the observations we make as pathologists can be, and the potential to harness my skills and inquisitive nature into improved disease understanding and real patient benefit.

An experience from prior training that kept me going: During a rotation in the intensive care unit, we admitted a profoundly ill, elderly woman with acute sepsis from a ruptured bowel. With some reluctance the surgeon had agreed to repair the colon, but there was much debate on aggressive care given her age and grave condition. My ICU attending stayed above the discussion—it was sepsis, and in sepsis you have to act fast if you are going to save the patient. We instituted early continuous dialysis, antibiotics, fluids, even a novel therapy that had recently come to his attention.

She stabilized that night, but it was a slow recovery for the return of her respiratory and other organ function. Her sister was always by her side—covering the room with modern and historical pictures that pulled us into the vibrant and fascinating life the patient had prior to this acute event. As a young woman, she had been a model in Paris—I can still vividly see the black-and-white photo of her wryly smiling at a strange man in an overcoat on the Champs Elysees.

Rounding on the night of Christmas Eve, many of the nurses put festive Santa and elf aprons on, and I decided to wear my angel wings. Just as we were leaving the patient’s room, her eyes opened for the first time, and she spoke out, “I love your wings.” Wow! After being drawn into this patient’s life, it was so amazing to see her now have a chance to come back to it. And, of course, I was super excited that a Parisian model appreciated my wings! It is so important to keep up hope, and to appreciate each complex and loved soul that you encounter, often at their most vulnerable time.

My source of inspiration: While my father’s illness inspired me to go into medicine, my mother’s perseverance, positive attitude and unrelenting support are a source of continued inspiration in both my personal life and my career. She raised three children while also taking care of my father as he became unable to stand, bathe or eat on his own. There was always a new challenge to adapt to given the nature of his disease, and she rose to it, redefining herself and her career along the way.

My hope for the future of medicine: I have recently become actively involved in social media, particularly Twitter. It has given me the opportunity to meet a range of people with shared interests in medicine, pathology and science across the globe. Some are just at the beginning of training, eager to learn and excited to share knowledge as they discover it themselves.

Meanwhile, several leaders in the field have joined in to share some of their favorite cases, insight and questions. It is incredible to see the interaction across generations that I think will help not only to educate the next generation in medicine but inspire them to ask important questions and learn the power of sharing new knowledge to make a difference. A closer collaboration between patients and doctors is also made possible through social media and could impact the ability of physicians to better understand and address their concerns.

The hardest moment in medicine and how I got past it: Medicine is comprised of diverse specialties, each with their own personality, demands and challenges. Before becoming a pathologist, I did two years of surgical training, which, while often exhausting, were also exhilarating and incredibly rewarding given the combination of skill and fast thinking required to improve patient outcomes. Choosing to start residency over again caused many to question me and also made me question myself. However, pathology is truly my calling and my experiences in surgery have made me a much stronger pathologist. Hard work and incredible mentors who believed in me were how I got though that transition.

My favorite experience working with the medical team: Reviewing blood and bone marrow smears on call, in particular on one Thanksgiving Day while I was a fellow in hematopathology. My attending physician and I rushed in to the multiheaded scope to meet with the clinical team. Leukemia was high on their differential, but after reviewing all of the slides and clinical data, consensus was reached to begin treatment for hematophagocytic lymphohistiocytosis. In pathology, we are often behind the scenes, so the chance to be involved in critical decision-making in the moment, as I had been on surgery, is very much a privilege for me.

The most challenging aspects of caring for patients: Realizing that sometimes you are wrong and that you are going to be wrong despite your best efforts. There are some gray areas in pathology. Clinical, molecular or other data can change the differential, the diagnosis and the recommendations for treatment. The slides remain unchanged and enable all of us to learn from those mistakes.

The most rewarding aspect of caring for patients: Each new case presents as a puzzle. The faster and more efficiently you can solve that puzzle, the better for the patient and the health care system as a whole. Solving new puzzles, particularly by identifying patterns that improve our understanding of disease mechanisms and enable better treatments for patients, is the reward I strive for.

The skills every physician should have but won’t be tested for on the board exam: Knowing their limitations and having humility. Through a long course of training, we dream of emerging with expertise and authority, but knowing when to swallow your pride is also critical to avoiding patient harm.

One question students should ask themselves before pursuing medicine: If you don’t get into medical school, will helping others still be your greatest passion?

A quick insight I would give students who are considering medicine: Keep an open mind. Your heart will lead you to where you can make the greatest difference, whether that is within medicine or another path.

Song to describe my life in medicine: Everything is Awesome,” from “The Lego Movie.” As in the film, everything is, of course, not always awesome. But a positive attitude, teamwork and the knowledge that what you are doing is crucial to helping others keeps you going. Singing this song doesn’t hurt either.

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Sep 21, 2017
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