In this edition, Amy DeZern, MD, MHS, talks about the life experience that cemented her desire to go into medicine and the value of managing expectations.
Where did you grow up?
I’m a Texan through and through. I was born and raised in Fort Worth, where I lived until I went to college at the University of Texas in Austin.
My childhood was idyllic. We lived in the same house the whole time, and my younger brother and I went through the same school system. Our parents were both engineers. My nuclear family is just fantastic, and we are all still close. My father passed away during my first year of medical school, but my mother now lives with our family and helps take care of our four children.
What type of engineering did your parents do?
My dad was an aerospace engineer and my mom was a chemical engineer. And my brother is an electrical engineer and patent attorney.
So, as a doctor, are you the outlier in your family?
Yes! It’s kind of a joke – I’m the “soft” scientist in the family.
When did you become interested in medicine as a career? Were you expecting to become an engineer?
I don’t think I ever felt that engineering was for me. I was probably always on the
path to becoming a doctor – medicine suits my personality in many ways, and I’ve always been more science-oriented than liberal arts-oriented.
However, there were no doctors in the family, so I didn’t have much exposure to medicine. That changed when I was 13 years old and my mom was diagnosed with a liposarcoma. She was treated on a clinical trial at MD Anderson Cancer Center, so she moved to Houston during that period. Her parents moved temporarily to stay with her while she was in treatment, and my dad stayed in Fort Worth with my brother and me.
From then on, there was no other life choice for me outside of medicine. I went with her to her first visit and consultation, and then we would periodically visit her in Houston, which is about 5 hours south of where I grew up. For a couple of years, we saw her one weekend per month.
Her physician, Dr. Papadopoulos, was incredibly engaged. He clearly cared a lot about his patients. It has been nearly 30 years since her treatment, and she’s done well ever since, so it’s almost something that we forget now. But, seeing her go through the diagnosis and treatment firsthand cemented that I wanted to go into medicine.
I’m a singularly focused person, so once I knew I wanted to become a doctor, I got involved with activities that set me down the path toward medicine. In high school, I volunteered frequently at Cook Children’s Medical Center in Fort Worth. As an undergraduate, I majored in chemistry and shadowed physicians through summer programs. Then, I attended medical school here at Johns Hopkins, where I’ve been ever since – almost 20 years.
When you were beginning your training, was there anyone who shaped your eventual career path?
There wasn’t one particular person, but a collection of people. I was in the honors program in the College of Natural Sciences at the University of Texas, which was – and is – a huge undergraduate institution. We gained exposure to many people working in many different areas of science and other disciplines. I also partly put myself through college, so I held a whole bunch of fun jobs – from lifeguard to certified pool operator – including one in the Health Professions Office at UT Austin. In that office, I was surrounded by people who wanted to do the same thing I wanted to do.
After my first year of college, I went back to MD Anderson to do research. I worked with an inspiring surgeon, Dr. Diaz. He spent an inordinate amount of time with me – more than any undergraduate could reasonably expect. Again, like Dr. Papadopoulos, he was an engaging clinician who loved his profession. He also was a diehard Texas Longhorn, so we had plenty in common.
I’m fortunate to have had a tremendous group of supportive mentors throughout my career. My primary mentor during fellowship was Robert Brodsky, MD, who is Director of the Division of Hematology at Johns Hopkins and current Secretary of the American Society of Hematology (ASH). I couldn’t have asked for more in a mentor, professionally or personally. He cared about my career and always helped me do what I wanted to do and also cared about my happiness. Dr. Brodsky made sure that I didn’t get derailed by things that I thought were important academically but ended up not being important at all. That balanced perspective was extremely valuable.
What eventually drew you to your focus in bone marrow failure disorders?
To me, bone marrow failure disorders bridge benign hematology and malignant hematology, and it’s not always clear what the diagnosis is from the outset. In solid tumor oncology, for example, a patient’s organ usually has a solid, visible mass, so the diagnosis is a little more clear cut. In the bone marrow and in blood, though, there could be several reasons the patient is experiencing cytopenias. I enjoy the process of working through a diagnosis with patients; it allows me to develop intense relationships with them – both in the acute and chronic care settings. Every week that I’m in clinic, I meet a special individual or see one of the patients whom I’ve grown close to, and I remember that I’m where I should be.
What have been the biggest changes in medicine since the beginning of your career?
I’m humbled by the scientific changes in this field every month. In the 20 or so years since I started medical school, our understanding of basic biology and pathophysiology has grown by leaps and bounds, and with it, so has our ability to correlate clinical phenotype with genotype.
In the space in which I practice, those scientific advances have had tangible results at the bedside. The supportive care now available means that treatments that a patient may not have even survived in the past have become relatively easy, or at least manageable.
There are also practical changes, like the evolution in documentation requirements, from writing our notes by hand and putting copies in paper charts to clicking boxes and typing everything. The culture of medicine has shifted as well. I’ve spent my career at one institution, and, when I started, I was on call every other day. Even then, I still felt like I missed half the good stuff! Now, there is much more focus on “work-life balance.”
Do you think that shift in the culture has affected how you work with trainees?
Occasionally, trainees require a shift in their mindset about what they need and deserve in the setting of a training environment. I try to impart that, first, you need to love what you do, and second, that each relationship you are a part of is symbiotic. Whether that’s at the bedside, where patients teach us as we care for them, or in the mentor-mentee relationship, where mentors work hard to assist students and students need to put in as much work, it’s a two-way street.
I also keep a quote from American singer-songwriter Ray Wylie Hubbard on my desk that anyone can see: “The days that I keep my gratitude higher than my expectations, I have really good days.” It sums up how I approach my life – both in and out of medicine.
Speaking of work-life balance, you mentioned that you have four children. How do you approach balance?
Well, to be honest, I don’t really focus on the concept of work-life balance, if for no other reason than that work is part of life. I love what I do. I don’t feel like I have to make a choice. I don’t see it as the push-and-pull that some people do.
My husband and I have three daughters (ages 8, 5, and 10 months) and a son (age 3). I love being a mom, a wife, a doctor, a daughter, and all of the other roles in my life. However, I also recognize that I’m in an advantageous situation. My husband is an intensivist in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins. We met during our training and were residents together, so we each know what the other is going through. He knows what it means to have a patient that you can’t leave. He’s an incredibly supportive partner – and very much a partner. By and large, we share responsibilities 50/50, but that split changes depending on the day and what we have going on. And, of course, we’re so fortunate that my mom lives in Baltimore now and helps out tremendously with the kids. It’s a huge relief to know they are with someone who loves them and who will keep them safe in the same way that I would.
I tend not to evaluate things in life as positive or negative, which helps me keep perspective. Things are what they are; you change what you can, accept what you can’t, and make the best decisions with the information at hand. That’s my approach in medicine and, more or less, it’s my approach for how I “triage” our lives outside of medicine.
With four kids, we can spend half of the weekend in the car shuttling to tennis matches and soccer games and birthday parties. My “secret” to handling that is that I enjoy being busy. I also value executive functioning above many other traits, so we’re an incredibly organized family. Our life wouldn’t work if we didn’t plan most of our year at one time, so my husband and I sit down and set our priorities on the calendar and the rest of it falls into place around those. For example, my husband and I go out of our way to not be on clinical service at the same time, and we set a goal that one of us is always home for dinner and always puts our kids to bed. Being in academic medicine means that I can be home for dinner or to read bedtime stories, then edit manuscripts, write trial protocols, review data, or finish patient documentation after the kids go to bed.
What does your ideal weekend with your family look like?
We would get up early because our kids are early risers and have pancakes for breakfast, which is my son’s absolute favorite food. Then we’d play outside in the backyard and spend a good portion of the afternoon in the kitchen cooking. I love to cook and get my kids involved. They knead the bread dough or decorate the cookies or stir the soup or whatever we’re doing. Of course, there are certain things I wish I had more time for, just from a practical perspective. I never seem to have time to exercise, and I wish we could travel more (travel is a rigmarole with four kids!).
Who would be your dream dinner party guest, and what would you ask them?
I would want to talk with the late Janet Rowley, MD, an icon in the field of myeloid malignancies and the scientist who discovered the first chromosomal translocation in acute myeloid leukemia. I also read somewhere that she had four children, so I would like to ask to her about doing science while raising four children. I also have a fascination with Indra Nooyi, who was the former CEO of PepsiCo. She and her husband were both incredibly successful in their fields and they have two daughters, so, again, I’d like to ask her about running a business in a two-career family and about raising daughters. They both seem amazing, and I’m sure would offer helpful advice and perspective.