In this edition, Jane Little, MD, recounts growing up as one of six children, learning from her colleagues in the Pasta and Red Cell Society of New York, and cycling around her new Chapel Hill home.
When did you first think about becoming a doctor?
My father was a doctor in academic medicine and so was my grandfather so, in a sense, you do what you know.
Pursuing a career in medicine is a clear and defined path.
I have five siblings, none of whom went into medicine. They had to actively decide what they were going to do for work. Once you decide you’re going to go to medical school though, you don’t have to keep justifying yourself to anybody. It’s a pretty good stock answer to the question, “What are your plans?”
I love being a physician, but I also think for me (with my family) it was kind of a coward’s way out! (Note that when I went to medical school, the cost was one-tenth of what it is today.)
Tell us about your childhood – what was it like to grow up with five siblings?
I had a conventional suburban childhood. Until I was about seven years old, we lived in Boston, then Cleveland, where I stayed through medical school at Case Western Reserve University. When I left I never thought I’d go back, but about 20 years later, I did.
With six kids, the house was always jumping. My mother was a homemaker, and she also volunteered in the community and had a rich life outside the home. At some point, I think our parents realized that children just raise themselves. They let us go and hoped that there were no mortal injuries.
Growing up and going to school together was fun. We all went to the same public high school in Cleveland, so there was always somebody during team tryouts to whom you were related. Coaches and other players would ask, “Which Little are you? Are you the athletic Little?” I don’t think that’s an experience many kids have today.
Which Little were you?
I was probably the amusing Little, but my sisters are all pretty funny, too.
When you started your medical training, what made you decide to specialize in hematology, and then to focus in sickle cell disease (SCD)?
I did my internal medicine residency at the University of Iowa. During my first month as an intern, I did a rotation in allergy and didn’t care for it. Everyone was sneezing! Then, I did leukemia the next month, and I found that I liked taking care of people who were facing such a difficult problem, so I went into hematology. Gordon Ginder, MD, a hemoglobin researcher at Iowa at the time, was the first person I worked with. It was great fun to collaborate with his lab group. Linda Burns, MD, a former president of the American Society of Hematology, also was part of that group.
It took a while before I chose to specialize in SCD, and that is largely because I was living in places without large populations of patients with SCD. I only became interested in SCD when I moved to Washington, D.C. to work at the National Institute of Diabetes and Digestive and Kidney Diseases with Ann Dean, PhD, a great person and thoughtful experimentalist. I also worked with Mark Gladwin, MD, who was researching sickle cell at the National Heart, Lung, and Blood Institute.
Working at the National Institutes of Health (NIH) was a very good experience. I learned so much there. Dr. Gladwin and colleagues treated SCD like it was an active disease to attack. To me, it was a new way to view it.
At the NIH, they had plenty of patients and were addressing their needs aggressively, and I came to appreciate how complicated and how sick those patients were. Working in leukemia, the patients we cared for were sick, so it’s not possible to overworry about a patient. SCD shares some of those same features, but patients are much sicker than they look. We have to keep our eyes open all the time.
After my time in Washington, I joined Albert Einstein College of Medicine in the Bronx as an attending and hematology consultant. In New York, I had a great group of colleagues (known affectionately as the Pasta and Red Cell Society of New York), who helped me think about erythropoiesis. Currently, I study red cell adhesion with a wonderful academic engineer at Case, Umut Gurkan, PhD, and have worked with exceptional physicians Sophie Lanzkron, MD, MHS; Carolyn Hoppe, MD; Deepa Manwani, MD; and Payal Desai, MD, to develop a multisite registry for people with SCD.
I learn from patients all the time, because their diseases are evolving in surprising ways. I feel lucky – it’s been a good job for me.
How did you learn to communicate with patients?
When I was in training, we were always schlepping around behind somebody, kind of like an apprenticeship. Because of that, I think we ended up spending much more time with patients. We observed their interactions with the senior physician and saw what worked and what didn’t work.
In medicine, you learn from people around you, whether they want you to or not. You see some people who are great at what they do, and others who aren’t. Smart teachers can highlight features of good communication with patients, like listening well and asking open-ended questions. Those skills can be taught, but they also can be observed. For me, the combination of being told what to watch for and then watching for it was how I built my communication skills with patients.
Having had the experience of working with patients with leukemia and patients with SCD, what would you say are the biggest differences in caring for those populations?
Patients with acute leukemia are “running for it”: They have an acute problem, they’ve assembled their family and resources to tackle it, and they’re going to have to figure out this problem fast.
Patients with SCD are almost the opposite: They have had this problem their whole lives, their issues are accumulating, and we are trying to decide when the problems are severe enough to require an intervention. When do they need transplant? When is a visit not just a regular visit? When do we shift patients’ perspective from looking at this disease as something they should attack, rather than something they’ve just had their entire life?
If you have been ill your whole life, you adapt to it. Sometimes that adaptation makes it challenging for you to do the hard things that may be necessary to improve your life.
With SCD, it’s more difficult to define what you need to do and when you should do it. That’s especially difficult for our younger adult patients with busy lives. They have little kids, they’re trying to get through school, they’re trying to work … Part of our job as health care providers is convincing them when their illness warrants a new approach. Of course, the issues are different in children with the disease, because their parents and caregivers are making the decisions, but for adults, it’s a real struggle.
Why did you decide to return to Cleveland?
Well, SCD is an unusual disease in the U.S., in that patients used to die in childhood, so for decades, there wasn’t much demand for adult providers. Over the last 40 years, though, pediatricians have done an amazing job taking care of kids with this disease. Treatment has improved tremendously, and the adult population has expanded, but their problems haven’t gone away. Plus, the number of providers did not grow along with the population. Around 2011, Case Western needed a provider for adult patients with SCD. Some of my family still lived in Cleveland, and it seemed like good timing, so we went back.
After eight years at University Hospitals, what brought you to the University of North Carolina this year?
I love Cleveland, and I loved my coworkers at the SCD clinic at University Hospitals and in the hematologic malignancies program with Marcos De Lima, MD, but there was no one at the time “training up” to be an SCD doctor. Meanwhile, I learned from Nigel Key, MBChB, that there were trainees at the University of North Carolina (UNC) who were interested in SCD; that their excellent provider, Ken Ataga, MD, had recently left for another institution; and that I would be working with Marcus Carden, MD, and others. UNC has a long tradition of “med-peds” fellowships in hematology, which turns out to be a good place to find trainees for SCD. So, my husband and partner-in-crime, Tom Hostetter, MD, and I moved here about six months ago. (He is a nephrologist and also works at UNC, but the center is big enough that I hardly ever see him at work.)
Moving isn’t an easy decision in my field, because you leave a hole wherever you left. Being an adult SCD provider is a bit like whack-a-mole; there’s just not enough providers in the country, so there’s a lot of jumping around to wherever the need is greatest. Personally, I think it’s a great job, and young providers should be eager for it, but recruitment is difficult.
How did you and your husband meet?
We met in Minnesota, then moved to Washington, D.C., New York, and then back to Cleveland. Now here we are in North Carolina. We’ve been together for about 20 years. He is a kind person and has excellent judgment, which I rely on. I don’t have kids myself, but Tom has two kids and two daughters-in-law, whom I love and admire, and four grandchildren, who are joyful.
How do you spend your time outside of work?
I am quite uninteresting. I do not run a winery in my spare time, raise alpacas, or juggle. I read a fair amount. The last book I read was The Purple Swamp Hen and Other Stories by Penelope Lively. Her writing is subtle and perceptive. I try to visit my friends and family when I can – which includes my stepchildren and their families, four sisters, and eight nieces and nephews spread everywhere from Cleveland to Kigali, Rwanda.
I’m also enjoying exploring Chapel Hill on my bike. When I first moved here, I was determined to find a route to the clinic so I could bike to work without getting killed! Not long ago, I discovered a dirt road that leads to the clinic – it’s like a secret road that no one’s on in the middle of this highway-rich place. I pass horses and crazy little outbuildings, and, when I arrive at the clinic, I’ve had this peaceful ride that cheers me up.
If someone asked you for the secret to your success, what would you say?
I value community a lot and am a card-carrying member of the red cell community and SCD communities (writ small and large). Second, I have found people I admire and respect, and then I worked with them. I’ve been lucky to have a lively family, good friends, smart colleagues, and wise patients to learn from. Finally, I am really good at failing: I just pick myself up, stay observant, try to contribute, and keep on moving.