Cyclothymia and the ASH Annual Meeting

David Steensma, MD
Edward P. Evans Chair in MDS Research and Institute Physician at the Dana-Farber Cancer Institute; Associate Professor of Medicine at Harvard Medical School; Editor-in-chief of ASH Clinical News

After years of attending the ASH annual meeting, I’ve come to understand my meeting-related emotional cycle well enough to avoid taking it too seriously. Each December, I rotate through a set of five now-predictable peri- and intra-meeting moods, paralleling Freytag’s classical dramatic arc – a trivial version of Elisabeth Kübler-Ross’ canonical stages of grief.

If you attend the ASH annual meeting this year, perhaps you will note some of these states of mind reflected in your own temperament.

Phase 1

Months of expectation-building logistical management serve as background and exposition: jumping on housing website within the first six minutes of its opening to secure a hotel as close as possible to the convention center; scrambling to round up co-author approvals and submit abstracts in the closing moments before the August deadline (that magical day of the year with the greatest outpouring of hematology research); blocking out time to attend key sessions; and scheduling side meetings and advisory boards.

When December finally arrives and I sign out my pager on departure day, I feel like an eager schoolboy – fresh Trapper Keeper in hand – heading off on a crisp September morning to the first day of class. I board an airplane bound for one of the five cities that the ASH annual meeting now rotates among (San Diego, San Francisco, New Orleans, Atlanta, and Orlando, but somehow never Las Vegas) with a legal pad listing exactly where I need to be and when.

Phase 2

The hyperkinetic second phase of the annual meeting cycle begins when the plane touches down. Phase two is a frenzy of saying hello to old friends, making new ones, and rushing from room to room to speed-date with the ideas of scientists and clinicians from around the world. (In recent years, early meeting activities have also included filling out forms at Friday Satellite Symposia so that Senator Chuck Grassley can personally review how much I ate for lunch and predict the influence of that meal on my prescribing behavior for the subsequent year.)

News and greetings materialize as fast as starfields when the Millennium Falcon jumps to light speed entering hyperspace. Meetings start as early as 6 a.m., while receptions stretch until after midnight; by Sunday night, exhaustion looms.

Phase 3

And perhaps that exhaustion contributes to the inevitable arrival of an unwanted third phase: a deep, enervating depression. The fundamental human condition of chronic disillusionment – interrupted only by daily crises – begins to weigh heavily. Repetition of buzzwords and trendy topics (I’m looking at you, “personalized medicine” and waterfall plots) lead to ennui, which begets a dispiriting cynicism.

Every new treatment, no matter how ineffective and toxic, seems to be labeled “worthy of further investigation” and “tolerable”; every scientific observation, no matter how far from the clinic, is hyped as the basis of the next major therapeutic advance, an easy drug target and a slam dunk for approval by the U.S. Food and Drug Administration. At the same time, my own work feels increasingly worthless in view of all the genuinely amazing developments.

To escape the cacophony, I usually skip at least one planned evening reception to curl up in my hotel room with a novel. Coincidentally and unintentionally, books by Julian Barnes have accompanied me to at least three recent meetings, but as Barnes wrote in Flaubert’s Parrot, “Books make sense of life; the only problem is that the lives they make sense of are other people’s lives, never your own.” If, amidst the hustle and bustle of phase one I forgot to pack a novel, reading the annual meeting education book can serve as sufficient distraction.

In bad years, I never escape the gravitational pull of this existential black hole. But, much more commonly, I emerge from solipsistic neuroses before returning home – reverting away from unrealistic self-appraisal and a skewed view of the world of hematology and graduating into a sober, balanced phase four.

Phase 4

My birthday is Pearl Harbor Day, which usually falls mid-meeting, so I’ve celebrated getting older with hematologist friends for 14 of the last 16 years (save for the 2002 meeting in Philadelphia when a snowstorm kept me and thousands of attendees home, and the 2005 meeting in Atlanta that had to be rescheduled due to Hurricane Katrina). A close friend from residency and fellowship days is an epicure who can always be depended on to find a fantastic restaurant, where good food and great conversation help restore equilibrium.

Phase 5

My annual meeting–induced cyclothymia ends with the fifth and final stage: re-entry to “normal life” and resumption of quotidian tasks. Even though I delete emails rapid-fire between sessions – punching at my smartphone with the digital alacrity of a courtroom stenographer or a kid playing Mattel’s 1977 electronic football game – at least seven emails per day require action and can’t be so easily dismissed.

No matter how tired I am, I usually go straight from Logan Airport to round at the hospital, and maybe perform a marrow biopsy or two. There are patients to see, calls to return, faxes to sort through, irrelevant queries from Contract Research Organizations to answer (for example: “Doctor, please clarify: Did Mrs. Jones on a phase I trial for refractory AML have her gallbladder removed in 1983 or 1984?”), and heartfelt thanks to convey to the gracious colleague who kept the home fires burning.

And there is also next year’s annual meeting to begin to prepare for, as the cycle begins anew.

The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

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