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Editor's Corner: Running on Empty

December 30, 2021
David Steensma, MD
Edward P. Evans Chair in MDS Research and Institute Physician at the Dana-Farber Cancer Institute; Associate Professor of Medicine at Harvard Medical School; Editor-in-chief of ASH Clinical News

When I was a boy growing up in New Jersey and Virginia, every year our nuclear family piled into an olive 1974 Dodge Dart Swinger and drove 800 miles to visit relatives in Michigan. It was always great fun to see grandparents, aunts, uncles, and cousins. But there also were plenty of hazards and annoyances on the tedious overnight journeys: snow and ice in the Allegheny Mountains, endless construction on the Pennsylvania Turnpike, carsickness and boredom, and even mob-run garages around Youngstown, Ohio.

Late one winter night, as the lights of suburban Detroit faded into the distance and we headed out onto a long stretch of dark highway, my father noticed that the car was running much lower on fuel than it had been just a few moments before. (The Dart's gas gauge was prone to sudden measurement surprises, like the one that startled pollsters on the night of the 2016 U.S. presidential election.) Roadway exits were scarce in that part of rural Michigan, and since it was well after midnight and a blizzard was approaching, the few service stations we stumbled across were closed. Mile followed desolate mile without relief. Soon, the needle was pinned below "E."

Near a state prison marked by rime-encrusted signs warning drivers not to pick up hitchhikers – always a source of childhood curiosity about just how often dangerous inmates were escaping – the Dart's engine sputtered and hesitated. It was a warning, and confirmation that the E fuel measurement was not "fake news." Somehow, though, the car found enough petrol fumes to regain momentum. My father silently gripped the steering wheel tighter as my mother intermittently sobbed and prayed, imagining being stuck with two small children and a baby in a lifeless car on the shoulder of a rural road, surrounded by howling winds and bitter chill – and maybe even hardened criminals.

Like the car carrying my anxious parents and their worried son in the back seat on that frightening night 4 decades ago, as 2020 draws to a close and insult follows injury, we're all running on fumes, sputtering and hesitating, wondering just how much longer we can go on like this.

Last December, I wrote an editorial for ASH Clinical News about how much I dreaded the year 2020. That anxiety was based on countless newspapers and childhood textbooks predicting that this would be the year by which some epic societal disaster or global catastrophe would have occurred.

A deep, bone-weary exhaustion has set in. Many of us now suffer from stage IV, relapsed/refractory outrage fatigue, 2020 subtype.

The most ruinous predictions of the Cassandras have not yet come true – e.g., a September Nature Astronomy paper suggested that there is microbial alien life on Venus, but giant hexapod aliens haven't yet visited and exterminated us – but it has been an awful year by most measures.1 There have been events I could not possibly have imagined last year: the complete loss of credibility of the Centers for Disease Control and Prevention; the FDA head muddling the Stats 101 concept of relative versus absolute risk in a White House press conference; blood-red sunsets and smoky haze here in Boston from massive wildfires started by a "gender reveal" party 3,000 miles away; or the need for the mainstream media to remind U.S. citizens that, contrary to Twitter and presidential suggestions, they shouldn't drink bleach or vote multiple times.

As the global pandemic gathers its second wind, we are all carrying heavy burdens. We despair about needless deaths, mask wars, and willful ignorance; about the seemingly undefeatable monster of racism; about riots in the streets, immigration crises and the killing of innocents. We hear warnings of stock market bubbles and massive storms and food instability. We lack only lions and tigers and bears in the streets, since they're now endangered as animal populations collapse. A deep, bone-weary exhaustion has set in. Many of us now suffer from stage IV, relapsed/refractory outrage fatigue, 2020 subtype – and that was before Ruth Bader Ginsburg died.

The moods I see in the patients in my clinic have shifted over the course of the year. In the first months of the pandemic, there was so much fear and uncertainty. Patients and families often expressed gratitude for what health care workers were doing and for the risks we were taking. I lost track of how many thoughtful gifts of maple syrup or chocolate I received. Now, frustration and gloom are the dominant emotions, punctuated by bursts of anger over having to wear a mask or being unable, still, to bring visitors to appointments.

Coworkers are under strain, too. Our residents and hematology fellows, physician assistants and nurse practitioners, nurses and young faculty who have children struggle to cope with strange school schedules, irregular child care arrangements, grandparents afraid to visit, and kids stuck at home far more than they should be. Clinics are especially draining, as our patients need more from us than ever and care logistics keep changing. Treasured rituals of group meals with colleagues, mood-lifting conversations, and shared jokes in the hallway now no longer happen, since we see little of each other outside the context of a computer screen. Our favorite medical meetings are all virtual, making it harder to catch up with friends from other cities and countries.

Academic and research efforts have endured heavy setbacks, and the future of institutions that have lost billions is uncertain. We mourn the deaths of so many of our patients and their family members, and grieve for lost friends and loved ones. From time to time we hear about colleagues who have taken desperate steps to end their pain, and in dark moments it is not so hard to imagine how they got to that point.

No matter which side of this era's charged political debates we fall on, the people who were on the other side will all still be there once the pandemic is over.

Even if we get through this pandemic and its consequences, without the collapse of civilization – if a terrific vaccine is developed, and the population learns to value competence in political leaders more than rhetoric and rallies and empty promises – we'll still have to face the cumulative toll of what we have endured in 2020. I hope that there will be an unprecedented opportunity to make the world better, but it will be a difficult task, in the same way that a weary Europe faced rebuilding after the dual ravages of World War I and the 1918 influenza pandemic. We'll need to confront long-standing festering social justice issues, head off the bleaker forecasts of climate change experts, keep artificial intelligence from running amok – and come to terms with the fact that, no matter which side of this era's charged political debates we fall on, the people who were on the other side will all still be there once the pandemic is over.

Despite the long slog behind and ahead, I still have some fumes left in my metaphorical fuel tank. Unable to travel, I've visited more local parks than I knew existed, and have treasured watching the New England landscape change across seasons. When things seem most dire, I turn off the computer and look outside at the busy bird feeder or the expansive night sky. I remember – and am grateful – that there is still food in my refrigerator, natural gas in my furnace, and a sturdy roof over my head. Those of us who are in stable situations need to do all we can to keep our engines of compassion from sputtering out. In the closing words of the Freakonomics Radio podcast: "Take care of yourself – and, if you can, someone else too."

That long-ago December night in rural Michigan did not end by the side of the road like a grim scene from Fargo. Eventually, a brilliantly lit all-night service plaza appeared in the distance, and it proved not to be a mirage. The Dart had just enough momentum to coast to a stop at the pump, at which point the engine stalled – but it no longer mattered.

In my mind's eye, I recall the service station attendant lifting the pump handle toward the car's fuel tank as a smiling Anthony Fauci–like figure, injecting a safe and effective restoring syringe of liquid into our fuel tank and wishing us a pleasant, peaceful, and safe journey.


  1. Greaves JS, Richards AMS, Bains W, et al. Phosphine gas in the cloud decks of Venus. Nat Astron. 2020 September 14. [Epub ahead of print]


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