The Biggest Losers

Keith Stewart, MBChB, MBA
Carlson and Nelson Endowed Director, Center for Individualized Medicine, and Vasek and Anna Maria Polak Professor of Cancer Research, Mayo Clinic in Scottsdale, Arizona

(Author’s note: The other biggest losers appearing herein will remain nameless and will owe me a nice dinner for sparing them, but more on that later …)

It comes with the territory in academic hematology: Early career aspirations to have an impact gradually get noticed, and when the first speaking invitations arrive, they are both gratifying and eagerly accepted. Early career advice from a department chair to be a “like a moth to a flame” is noted. The frequency, variety, and distances of trips to deliver talks at meetings increase while the durations quickly morph from reserving an extra day for sightseeing to precisely calculated, down-to-the-hour, how-fast-can-you-get-in-and-out competitions.

Noise-canceling headphones are purchased to better tolerate the frequent flights to those meetings and road-warrior mentality takes over. Expectations of better seating on those flights follow, along with significant aversion to companion animals and people who dare recline their seat, play video games on their phone with the sound on, or – horror of horrors – talk loudly for hours on end. An overhead space obsession that borders on pathogenicity develops, and checking luggage becomes a cardinal sin, marking you as a boarding-group 9 rookie. As former Spice Girl Victoria Beckham, wife of legendary soccer player David, famously said after experiencing first class, “You never want to turn right on a plane again.”

Then, one day, the inevitable realization dawns that you travel way too much for the good of family and friendships and for maintaining personal health (both mental and physical), plus there’s the fact that you might actually be employed to occasionally show up at the office. I once heard, in reference to a former colleague, “What is the difference between God and Dr. Travel? God is everywhere, while Dr. Travel is everywhere except here.”

To make up for your absence, out-of-office alerts are abandoned, a good book or movie are replaced with satellite connections, and an ability to ignore time zone changes – like they’re an overdue manuscript review – become second nature. Nevertheless, you muddle through, the family endures, and every New Year’s Day you solemnly swear to travel less. Yet somehow, it doesn’t get any easier to say “no.”

The Annual Biggest Losers Dinner circa 2016. Member 5 was absent nursing a deep vein thrombosis (true story).

So, the Biggest Losers Club was formed. Today, it consists of the five founding members, now at three institutions. It has nothing to do with weight, but rather, the person who spends the most time on an airplane away from family in a calendar year is crowned the Biggest Loser. The loser has to buy the rest – accompanied by their all-suffering partners – the entrée at the club’s annual dinner.

The rules are simple: You can only pick one airline and you must verifiably document miles flown. We also have competitions for total miles flown across all airlines, worst travel experience story, and “Family Guy,” awarded to the member who missed the most significant birthday, graduation, wedding, anniversary, school concert, or child sporting event. Each “winner” is rewarded by paying for the appetizer, the drinks, or the dessert.

I am pleased to say I have not yet won the overall Biggest Loser award. As we are all academics, of course we also developed a travel toxicity scale (with adaptable modifications allowed):

  • Grade 5 (near death): Middle seat in economy on a red-eye overnight with a 5 a.m. connection and same-day return
  • Grade 4 (recurring nightmare): Economy for six hours on a plane with no video system, and your neighbor discovers you’re a doctor and educates you about vitamins and cancer the entire trip; jet lag and waking up at 3 a.m.
  • Grade 3 (ugh): Short-haul flight in economy, with unavoidable stay at budget hotel that smells of bleach, then you’re forced to go on the conference dinner cruise with no means of escape
  • Grade 2 (aggravating): Second on upgrade list, hotel room not ready, last speaker of the day, when most attendees have gone to the bar
  • Grade 1 (almost tolerable): The white wine in business class was warm and the limo driver wanted to have a conversation

You might well be wondering, “Why not just stay home?” As a researcher and frequent complainer, I was mystified myself, so I kept better data this year. Setting aside the usual culprits (such as a professional obligation to attend), in 2019, I have received 38 unsolicited invitations to speak, review, represent, chair, advise, or moderate in both exotic and not so exotic locations.

Some were dead on arrival, too obviously inspired by the sneaky motivations of the godless heathens in Big Pharma and in clear violation of my institution’s no-fly list. For the rest, despite my best efforts and the use of plausible deniability (enthusiastically perpetrated by my complicit admins – thank you JV and Queen Lisa), I have ended up participating in 32% of the events. My justifications could be broken down as follows: friends or colleagues running the conference (n=3), guilt because I said no last year (n=2), curiosity for scientific topic (n=2), wife suggested location amenable to a few days of add-on vacation (n=1), recently turned 21-year-old child insisted on accompanying me to Las Vegas at my expense (n=1), and, yes, sometimes a pecuniary motivation to share every pearl of my aging neuron wisdom , since my college-age children keep stealing my money (n=3).

Of course, it’s not all bad – many friendships are formed, some beautiful places are seen, memorable “night science” will provide fodder for later storytelling, academic collaborations are arranged, and funny things happen. Just the other week, after I chaired an event, an older, friendly-appearing Dr. Lady-I-Did-Not-Know approached me. “Dr. Stewart, you spoke at my institution a few years ago.” Me, untruthfully: “Yes, I remember.” Dr. Lady: “You have put on weight.” True, but not what I expected. I blame the travel.