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Magical Thinking

December 30, 2021
Alice Ma, MD
Professor of Medicine in the Division of Hematology and Oncology at the University of North Carolina School of Medicine in Chapel Hill

Okay, 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 returned moaning about how much the shots made his rear hurt, only to be called back by Employee Health when they realized that the shots he received had been penicillin G and not benzathine penicillin, and could 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 night – 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

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


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