The Calling of the “Inner Nerd”

An informal gathering of rheumatology elders occurred recently in the Five Sails Restaurant at the Pan Pacific Hotel in Vancouver, British Columbia. The occasion was a small party marking the end of the 9th International Congress of Lupus, an exciting conference that showcased advances in lupus research from bench to bedside. As multiple meeting presentations made clear, investments in research are bearing abundant fruit as studies on lupus are defining the genetic substrate of disease, the cellular anomalies driving autoreactivity, and, most importantly, targets of new therapy. Not surprisingly, after hours of lectures, hallway conversations, and frenetic tours of posters, a pleasant evening of conversation and libation was most welcome.

The Vancouver waterfront, with the Pan Pacific Hotel on the right.

Vancouver is a spectacular city that is unique in North America. Rising majestically from the water that surrounds the city are walls of towering mountains that, even in June, are topped with snow. The air is crisp and cool. Seagulls fly solo or in formation, gliding and soaring, as sea planes buzz on their takeoff and landings, right next to the giant cruise ships that dock in the harbor. Notwithstanding its scenic beauty, Vancouver is a modern bustling city, populated with silver-white skyscrapers with architecture that seems more from Miami Beach than Ottawa or Montreal.

In the Five Sails Restaurant, our council of elders tasted local British Columbia wines that would easily rival those of nearby California, Washington, or Oregon. We had a restrained but fruity chardonnay and a pinot noir redolent of cherries. This was the real deal, splendid offerings from the land of Moosehead and Molson Golden.

Comparing War Stories

With the ascent of our blood-alcohol levels—a biomarker as good as any—our group told war stories of venerable and venerated rheumatologists and reflected on the good old days of training when house officers worked every other night and the idea of duty hours would seem preposterous, indeed a sign of weakness that, may I dare say, would be viewed as unmanly. Embroidering lavishly a tale from the past, one of the world’s eminent rheumatologists described an incident from his day as a medical student. He told us how, working in the mayhem and howling of a big city hospital, he asked his patient, a young prostitute strung out on drugs, to join him in a utility closet so that he could hear better her heart and lungs. The uproarious account of subsequent events left us sputtering with laughter and eyes pouring with tears.

Talking about our youth, the elders inevitably made comparisons with today’s trainees. Despite the festive atmosphere and jubilant spirit of our group, the conversation turned serious. Those of us in academics have great affection for our trainees and respect for their accomplishments. Nevertheless, we worry about them. We worry whether the current generation has enough of the right stuff—chutzpah, cojones, and sang-froid— to keep rheumatology a vibrant and prosperous specialty. We also worry whether there will be enough academicians to take the helm of medical center divisions as current chiefs retire.

Struggling with the “Nerd Factor”

Another facet of this worry relates to the seeming paucity of trainees who are pursuing laboratory training and electing careers in basic biomedical research. Let me be clear. I believe strongly that basic research is the heart and soul of any medical specialty. Unless basic research bubbles with ideas and overflows with talent, a specialty can wither.

Our group pondered serious questions. Why do today’s trainees appear reluctant to follow a path that, in the past, has produced such enormous improvements in the treatment of rheumatic disease? Where are the dreamers, adventurers, and revolutionaries among the rheumatology trainees of the year 2010?

As the sun set in Vancouver and we savored the last ruby red drops of our pinot noir—watch out Burgundy for the upstart Canucks—one of our group brought up the nerd factor (a primo feature of researchers) and how it may impact career choices. In other words, does the prospect of being a nerd—be honest, not the most respected or admired kind of person—turn off trainees from a life in the ivory tower?

Frankly, most academicians are nerds, not just possible or probable nerds, but definite and classical nerds. Indeed, in current lingo, we are artisanal nerds. We read and write incessantly, fuss over footnotes, struggle with sentences, annotate references, contemplate, cogitate, conceptualize, theorize, hide in our offices, enjoy solitude, and focus our lives on what seems to be downright minutiae. Socially, we have issues, and our attention seems to wander.

Fortunately, traits of the nerds are not distressing to those who have them (I speak from long personal experience) and, on a much larger scale, they can be of great benefit to society. In their aggregate, nerd traits lead to striking advances in science, technology, and medicine. Witness how new approaches to the diagnosis and treatment of lupus have come from the work of nerds on the genes regulated by interferon, the biology of B-cell subsets, and the role of private variants on the genetic disease susceptibility.

A Challenge for Trainees

So, to you trainees reading this column, while the elders of rheumatology are still around and kicking, give your mentoring committee a break in its ponderings and take a visit, better yet make it a pilgrimage, to the haunts of one of these gray-haired, absent-minded profs—a real nerd—who hopefully your institution still supports. I especially recommend someone who has a small, cluttered office, the kind where stacks of reprints rise perilously, precariously, upwards from floor and desk, the sheer volume of dry combustible paper a fire-code violation. As you enter this sanctum, turn off your cell phone and pager. No tweets, no texts, and no Facebook updates for an hour for a heart-to-heart talk about life with someone anchored in the past.

In that crowded, dingy, and musty office, ask that sage about the rewards of a life of research. Ask what it means to pursue a big question in science—a real Moby Dick, a great white whale of a challenge like the cause of lupus—and, even with a slim chance of success, go after it, mental hammer and tong, every day for 10, 20, or 30 years. Listen carefully to their words, which I predict will be filled with joy, wonderment, and fulfillment. Let yourself get hooked.

If, as I hope, some of you will go for the gusto and give lab research a whirl, I have to tell you that life will not always be easy and you may have a tightrope existence. You may even look into a career abyss or two as your transgenic mice stop breeding, your cultures get contaminated, your papers are rejected, and your grant applications get triaged and trashed. Nevertheless, you will have a blast, your research may make a difference, and you will never regret for a moment embracing a life devoted to science.

Dear trainees among my dear readers, look deeply into your souls. Find that inner nerd bursting to get free. Let that nerd out. Nurture it carefully. Let it flower and bloom and someday you too can share a delightful evening, drinking and laughing with treasured friends, excited, even exhilarated, by the progress of your field.

Then, as the evening grows late and your friends get tipsy, a gull will swoop past your view, its body shining silver-gold in the glare of a restaurant’s flood lamps, and you will look across the bay and startle at the beauty of the city lights, fireflies in your mind, as they flash and flicker against the black curtain of the rising mountains.

In that precious moment, inhale deeply to savor the fleeting vapors of vintage wine. You will smell some of life’s most fragrant roses.

That moment is not given to everyone. It must be earned.

Do not be afraid. You can do it. You too can become a nerd.

Dr. Pisetsky is physician editor of The Rheumatologist and professor of medicine and immunology at Duke University Medical Center in Durham, N.C.