1. Pemmaraju, Naveen MD

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It was one of the more unnerving weeks I have ever lived through. I had weathered the storms of making it through medical school, completing a grueling residency, navigating a demanding fellowship, but this storm, this one in front of me now was a bit different. This one, this challenge, was literally a storm and I had to face it-and it was completely out of my control. Hurricane Harvey quickly (and rudely) introduced itself to us as soon as it made landfall approximately 10 p.m. on Friday, Aug. 17, and set out to promptly devastate our community, and extend its claws up and down this sprawling megalopolis and into our surrounding areas with historic rainfall and wide-ranging destruction.


In this confusing time, in addition to worrying about my kids, wife, family, friends, and neighbors, my thoughts also quickly turned toward the hospital and our patients and colleagues. My heart was heavy thinking about all of the possible areas of concern. Will our patients be safe? Will the ER and ICU have enough power? What about emergency generators, do we have enough oxygen tanks, what if our patients need to be evacuated? As we have all witnessed over recent years, the best of plans and preparations can still be upended by the utter unpredictability of natural disasters.


Reaching Out

I am a hematologist/oncologist. I worry. That is part of my job description. I worry about my patients. About their biopsy results. About the speed of getting back a CBC differential in clinic on time. About if my patients can travel from far and wide to make it to their appointments as scheduled. As the waters angrily rose and the streets of my neighborhood were suddenly transformed into canals for 4 days, I started to field concerned phone calls from folks who had seen Harvey was going to hit on the news.


My parents called. Fine. My friends and colleagues from around the country, some of whom I hadn't talked to in over a year called, emailed, texted. All expected. Childhood friends and acquaintances bequeathed the requisite social media posts. But in the midst of this technological-screen-lighting-up-checking-up on me, there was one development that really stood out and has stayed with me since the floodwaters receded several months ago.


It started out innocently enough. Checking through my work emails, as colleagues were making sure each was safe and who was able to take care of patients and who was safe at home with family, one email I saw was from one of my patients. I hurriedly clicked on this one, especially because this patient lives in one of the towns where Harvey had made landfall the night before. I assumed the email inquiry was to let me know about travel delays and a likely clinic absence, something I could quickly reassure my patient about and help reschedule while I had a moment of reliable internet access, and make sure she and her family were OK in the process.


Much to my surprise, the email was a short two-liner, plain and simple. "Hi Dr. P, just praying for you and your family, hoping you are OK, we saw that Harvey was heading towards Houston." As my friends and colleagues know, I am normally a man of many words. But in this instance, I was speechless. I just sat there and stared at my laptop screen from the top floor of my house where I had relocated the family in the setting of uncertainty with flooding. This young woman, 42 years young with relapsed/refractory acute myeloid leukemia (AML), now in the midst of a salvage chemotherapy program and awaiting possible allogeneic stem cell transplant (which would likely be delayed due to the storm), was emailing to check on me. This heroic woman, a mother of five, suffering with AML, took time to message me to make sure I was fine.


As a hematologist/oncologist, I take pride in the type of care and attention I provide to my patients, and am constantly trying to think about how to make the lives of my patients better. But I had never thought about how much patients are worrying back about their physicians' health and well-being all the while we are worrying about theirs.


The messages from my concerned patients kept coming. Patient after patient taking time out of their own crazy-busy lives to email me to make sure I was with my family, that we were safe, and that the floods were not too rough in my neighborhood. One of these patients was a gentleman in my practice in his 60s with chronic lymphocytic leukemia, retired now and travelling the world, who took time to send his thoughts and prayers. I was also moved to see in my inbox messages from spouses of my patients, too. One of these patients was the wife of a patient of mine with blastic plasmacytoid dendritic cell neoplasm-this couple lives in Europe! She had seen the news about the hurricane on the international news report and immediately thought of me and my clinic team. Finally, I even had messages from concerned spouses who were widows-their loved one had passed way from their leukemia in the years before-but they still took time out of their lives to email me to check up and make sure I was OK. Long after my abilities and my services were no longer needed, these family members still reached out to their former doctor to check on me and make sure everything was alright.


Community of Care

I was humbled and frankly moved to tears by these messages. It was surreal. While devastating to our region and to many families who were permanently affected by the hurricane, for me, I was viewing Harvey as a temporary crisis that we would all deal with together as a community and move on somehow or the other.


But for my patients with leukemia, many of whom are undergoing active therapy and have uncertain futures, I was blown away by the human capacity for compassion even in the face of their own already-existing permanent crises-their leukemias. Many of them are facing their cancers as a singular person, without the backup or protection of a community or family, and yet still had the wherewithal to reach out to check on me.


And so, in the experience of Harvey, one of the many valuable lessons I learned about was the concept of community, a reminder of our shared common human connection and vulnerability. I discovered that beyond the physical community that includes those in my immediate proximity, my office, my family, and colleagues-a greater community exists, one filled with well-wishers from past and present, a unique 360-degree grid of people all over the world thinking of each other, not simply in the traditional one-way doctor-to-patient concern, but rather, the one that has always been there in front of me all along-the patient and patient's family constantly thinking of their doctor in a time of crisis.


NAVEEN PEMMARAJU, MD, is Assistant Professor, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston.

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