Tony Fauci recruited me to join the vasculitis program at the NIH in 1986. As a clinician-investigator, now with unprecedented opportunities to collaborate with like-minded people in other specialties and basic scientists and epidemiologists, I was ecstatic. I made many friends with lab-based colleagues interested in antineutrophil cytoplasmic antibodies and mechanisms of vascular and pulmonary injury, vessel growth and differentiation, and clusters of patients with granulomatosis with polyangiitis that raised questions about environmental triggers. It was like being a kid in a candy store. I will always be grateful to Tony for hiring me and being a friend and mentor.
TR: What lessons have you learned from patients that have contributed to your own growth as a clinician?
GH: Someday, unfortunately, we will all be patients. Some of us will become victims of life-threatening diseases. When I think about patients with crippling musculoskeletal and autoimmune diseases or those with large or small vessel vasculitis, what stands out most is their resilience and courage. Most people find the will to fight, to survive and restore their lives as active students, spouses, friends and workers. I have witnessed this so many times, from children to the very elderly. It is inspiring and deserving of our respect and admiration.
TR: What skills, habits or experiences have you found most helpful in finding the right diagnosis in medical mystery cases that heretofore had been unsolved?
GH: One has to accept that, even if we are thought to be experts by our peers, our fund of knowledge is profoundly limited. Medical mysteries are not rare, whether they be a new variation on a familiar theme or, less often, an unrecognized, new disease. Fortunately, literature searches are far easier today than going to Index Medicus (some old-timers may remember that).
Depending on the pace of disease progression and severity of illness, one may or may not have time to review the literature. Depending on consultations should not be considered a sign of weakness. Under the best of circumstances, you may even want to set up a brainstorming session with colleagues. I am not hesitant to do this with colleagues at my institution or in other institutions and am always flattered when someone calls me for advice.
I recommend you pick up the phone or have a problem-solving meal with colleagues. Do not underestimate how sharing a meal, especially in your own home, can promote bonding and may solve medical mysteries.
