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The COVID-Based Hematologist: Mark Crowther, MD

April 20, 2022

May 2022

Mark Crowther, MD
Mark Crowther, MD

Institution: McMaster University

Specialty: Prevention and treatment
of blood clotting complications

Years Practicing: 27 years since
completing residency, and 22 years
on faculty

As chair of the Department of Medicine, I am responsible for the academic lives of more than 300 faculty and 250 residents and oversee more than 70 residency and fellowship programs. I work in “classical,” or benign, hematology. I provide, on average, five half-day clinics per month and cover the inpatient consult service about six weeks per year. The rest of my week is spent on administration and research. During the past two years, my work has changed in many ways because of the COVID-19 pandemic. There are once unimaginable pressures that come with working in a hybrid, in-person, and remote clinical and academic workplace. Here is how I spent a recent clinic day.

6:30 a.m. For the past two years, my days pretty much all start the same way. Today is no different. I wake up and check the news before getting out of bed to ensure that the world has not ended. When I’m satisfied that all is relatively well, I move on to tackle the day.

6:45 a.m. I go through my typical COVID-19 ritual of feeding the dogs and the birds and then drink my first americano while I try to figure out what to eat for breakfast. I scan emails that came in overnight to see if there’s anything critical to handle before I drive to work. During the drive, I listen to a low-intensity podcast to avoid hearing the news, which is always depressing these days.

7:30 a.m. When I get to work, I meet with one of the faculty vice-deans for half an hour in his office. During this meeting, neither of us can remember why we were meeting, but we have a fair bit to talk about, so it is still time well spent. We file the actual topic of conversation away for our next meeting.

8:00 a.m. I walk over to the outpatient clinic to find the usual crew of enthusiastic residents and even more enthusiastic medical students working their way through the land of telephone consultations and electronic medical records. Today’s clinic was scheduled to address some of our COVID-associated backlog. Although it’s a day that I normally wouldn’t have clinic, I’m here to help and so look over my schedule.

I have six patients scheduled, which isn’t a lot for me, and I see that four are supposed to be new consultations. However, the first patient is one I’ve seen before. She has long-standing moderate neutropenia, likely autoimmune. Nothing has changed in her life or story since I saw her before, so I direct the referring physician back to my previous clinic discharge note. We have a good discussion about COVID vaccination, during which I’m assured she’s had all three doses, and she agrees to watch to see whether she becomes eligible for a fourth.

The second patient had been lost to follow-up for almost a decade, but he suddenly resurfaced because he noted some recurrent symptomatology. I arrange the appropriate laboratory testing and book him for follow-up in a few months, as his problem is not urgent. He’s an airline pilot, so he’s both vaccinated and crushingly familiar with the testing policies for international travelers.

The third patient is also someone I have seen before. Seeing patients for the second or third time as a “new” consult is a consequence of being a senior physician – this sort of déjà vu is a regular occurrence for me. This patient has iron deficiency anemia due to an investigation-resistant cause, and he did not respond to oral iron (or perhaps he didn’t take it). I arrange for him to get some parenteral iron, check to ensure his gastrointestinal screening is up to date, and arrange to follow up with him in six months to recheck his iron status.

The fourth patient is actually new to me, a young man transferred from pediatrics with a history of spontaneous venous thrombosis in the setting of antiphospholipid antibody syndrome. He was appropriately treated with warfarin and wonders if he can start boxing again (answer: No). He also asks if he can be transferred to eastern Ontario, where he is already living (answer: Yes). I realize that in the world of Zoom clinics, I never really know where my patients are!

To my surprise, my fifth patient is also someone I saw almost a decade ago when he’d had a progression of alcohol-associated thrombocytopenia. As with the first patient, I refer his family physician back to my previous clinic discharge note since nothing has changed with his life or story that would alter my original recommendation.

The last patient is fascinating, and I feel a sense of reassurance that benign hematologic consultations are important. The patient has what we now refer to as “constitutional neutropenia,” and a long-standing mild anemia of unclear origin in the setting of sickle cell trait. He has more than a decade of otherwise asymptomatic thrombocytopenia, which I presume is immune in origin. At first blush, moderate pancytopenia in a younger gentleman is of significant clinical concern; however, my fears rapidly evaporate as I speak with the patient and review more than a decade of laboratory results. My initial fears of myelodysplastic syndromes, or worse, acute myeloid leukemia, are alleviated when I explore his story and prior bloodwork. I discharge him to be followed by his family doctor.

2:00 p.m. After clinic, I race home for my afternoon and evening Zoom meetings. During a meeting with a junior faculty member and her division director, our discussion evolves into more of a career counseling session. We encourage her to focus more on short- and medium-term objectives to increase the likelihood that she’ll obtain career funding. I enjoy conversations like this because a few minutes of my time can literally change someone’s life.

Next, I talk with the university IT folks about support for us being a pilot for the contact relationship tool, which is surprisingly helpful. Although I know it’s hard to work surreptitiously on email during Zoom calls, in the interest of getting through all my messages, I sometimes do it. I also use the time between meetings to review and respond to emails. My goal is to read every new email in my inbox by the end of the day, which is a challenge when 100 new messages survive the spam filter on a typical day.

As I look through my email, I am reminded of a pet peeve of mine. I find it frustrating to see so much waste, duplication, and unnecessary work from the previously paper-based administrative structure that has been thrust into the virtual world of COVID. I convince myself to see the glass as half full because I am sure that for all its strife and challenges, COVID will bring some benefits to our society. I remind myself that post-pandemic life will see many face-to-face meetings replaced with more efficient video calls and increased collaboration and accessibility; and many airplane trips will similarly be replaced by video calls, which are vastly more efficient, get much higher attendance, and can be scheduled much more quickly.

5:00 p.m. Moving into the early evening, it’s time for me to get on with the paperwork that I wasn’t able to complete earlier in the day. This includes reading more emails and responding to those that are time-sensitive and completing a needs assessment for our residency program, which is transitioning to a competency-based design.

6:00 p.m. I sit down to eat dinner with my wife and son, who has a great job that he can do from his bedroom. I suspect my wife is looking forward to me returning to my prior busy travel schedule, although I’m not particularly looking forward to it myself. COVID has taught me that my previous “frequent flyer” lifestyle was probably damaging to my health and the environment. A large majority of that travel seems unnecessary now, having been easily replaced with electronic communications.

7:00 p.m. After dinner, I take a phone call to discuss a governance issue at a peer organization and then head to the home office to complete one more report. When the screen starts to blur, I submit the project and then go down to the basement to ride the cycle trainer for an hour. After I finish my exercise, I head to bed, thinking about tomorrow with the realization that in many ways my current COVID lifestyle can be aptly described as “wash, rinse, repeat.”

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