I Had To Come to Boston To…

Following my second year at Case, I wrote a similar Ode to Cleveland. Here, I list all the reasons I had to come to Boston. Some are scenarios I planned to experience. Some very much caught me by surprise. Happy 2 Year Anniversary, Boston.

I had to come to Boston to:

  1. Realize I can live more than 900 miles from my parents.
  2. Build confidence in my ability to do science
  3. To transform from grass —> to a tree. Grass is trampled on, struggling and just trying to grow (much like a post-step 1 human). Trees are growing, but they can provide shade to the grass. 
  4. Realize that I could actually be happy in Boston! In fact, I love it here!
  5. Try oysters for the first time (and an entire lobster too)
  6. OKCupid is bad in any city. Even Boston. I have a lot of stories…!
  7. Learn that it is ALWAYS worth it to invest in your personal relationships. You never know where they will take you. I am so glad I tried my first year because that made my second year even more personally fulfilling.
  8. Start taking taekwondo! 
  9. Take day trips to the Metropolitan Opera (4 thus far!)
  10. Learn how to work with difficult personalities and navigate challenging relationships. UNDERSTATEMENT.
  11. Learn how to become self-motivated in the absence of a structured environment (ie med school)
  12. Watch George Daley become dean of HMS
  13. Live in the Longwood Christian Community. Realize that a group of Christians living together isn’t necessarily a cult! 
  14. Learn how to ride a bike. 
  15. Give a ton of science talks 
  16. Build collaborations with other scientists.
  17. Improve my kayaking skills 
  18. Learn how to use a flow cytometer 
  19. Be reminded again that great mentors didn’t have to look like me. They just had to care about me.
  20. Learn how to culture iPS cells and make red blood cells from them. Start modeling sickle cell anemia.
  21. Reunite with Hana Erkou and Tolani Akinola 
  22. Go to England for a super fancy conference (and have breakfast with JEREMY IRONS) and AUSTRALIA 
  23. Revitalize my deep interest in the Kennedys (and see one in real life!) 
  24. Take my successes and many, many failures in stride. 
  25. Remain a stubborn optimist 
  26. Meet all of the living Karp 7 Peds Hematology Heroes (Sam Lux, David Nathan, and Stuart Orkin) and internal medicine-hematology hero, Frank Bunn! Mission Accomplished! 

Now that I’m starting my third year of medical school, the next few months are filled with certainties and uncertainties. Certainties: I’ll be finishing my research, submitting my paper, moving to Cleveland again and preparing for a new adventure in an old city. 

Uncertainities: Possibly going to New Orleans, publishing my paper, passing third year with flying colors.

Whatever happens, I am glad I am where I am, and I am very proud of where I have been. Just like how Cleveland was where I was meant to be, Boston was as well. I feel that oh so strongly! These two years have changed my life forever. I’ve grown so much as a scientist, a Christian, and a human being. 

I think I have grown to be a bit gentler with other people and especially with myself. We are only human after all and all we can do is try our very best. 

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One should never take for granted the great minds that surround you everyday.




Middlemarch: A Masterpiece About Marriage

Middlemarch, A Study of Provincial Life is a masterwork of fiction by British novelist George Eliot (really Mary Anne Evans) which was published in the late 19th century. When I watched an adaption by the BBC a few weeks ago, I was immediately embarrassed that I had not read the book already. Many have remarked that Middlemarch is one of the best books ever written, and I can certainly imagine that to be true because the characters are so fascinating–their motivations so real. It really IS a study on people and their motivations in life. And, it’s a very interesting piece about marriage and why people go about it, why it ends well or often doesn’t. I have since bought the book!

I LOVE period dramas and have read tons of Austen and Jane Eyre is my favorite book, but I found Middlemarch so refreshing with it’s unsanitized portrayal of marriage, and why it succeeds or fails. And, it isn’t simply because people have crazy wives in the attic or silly husbands. It’s because we look at the institution in a very selfish way.

The story takes place in a fictional British town called Middlemarch with a wide cast of characters with their own plot lines that intersect at points:


Dorothea Brooke – A wealthy young woman who wants to improve the world–especially the lives of those impoverished. She is attracted to knowledge and grows weary of her superficial, wealthy relations.

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Dorothea Brooke played by Juliet Aubrey

Rev. Edward Casaubon – An older clergyman and academic. Prideful but intelligent, Dorothea finds him quite refreshing, and he, an experienced bachelor, welcomes some female companionship.

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Causabon (Patrick Malahide) and Dorothea

Arthur Brooke – Silly, wealthy and foppish uncle of Dorothea and Celia. He does not consider the suffering of the poor but would like to run for parliament as a “reformer”. He is a bachelor.

Arthur Brooke (Robert Hardy)

Celia Brooke – Dorothea’s younger sister who is not burdened by her privilege and interested in Sir James Chettam. She’s annoyed at times of her sister’s idiosyncrasies and angst.

Sir James Chettam – A neighbor to the Brookes who is infatuated with Dorothea and would like to improve living conditions for his tenants. Dorothea is uninterested as he is not a scholar.

Celia (Caroline Harker), Sir James (Julian Wadham) and Dorothea

Will Ladislaw – Rev. Casaubon’s younger and much better looking cousin. He is a man of many talents with no profession and no money because his grandmother married a Polish musician for love and was disinherited. He and Dorothea become friends. He and Causbon do not get along.

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Will Ladislaw (Rufus Sewell; the most famous person from the cast)


Tertius Lydgate – an idealistic and ambitious doctor who comes from money but has none. His well-traveled and charismatic nature make him attractive to many of the young ladies in Middlemarch–particularly Rosamond Vincy. Although he flirts with her, he is much too interested in his work to settle down. He is new to Middlemarch.

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Tertius Lydgate (Douglas Hodge)

Nicholas Bulstrode – A banker and hyper-spiritual Methodist with strong opinions and a lot of money. Much of the town does not like him (as they owe him money). He is the great patron of the new hospital that attracts Dr. Lydgate to Middlemarch.

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Nicholas Bulstode (Peter Jeffrey)

Rosamond Vincy – Although she was brought up on Middlemarch, she is very uninterested in the town. Instead, she is interested in a young, rich man to take her away from her provincial life. She is highly proficient at playing the pianoforte.

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Rosamond Vincy (Trevlyn McDowell)

Fred Vincy – Rosamond’s brother who is kind-hearted but rather wastes his potential getting into billiard debts. He fancies Mary Garth, a maid outside of his class

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Fred Vincy (Jonathan Firth) YES HE IS COLLIN FIRTH’S LIL BRO

Rev Camden Farebrother – A worldly vicar and naturalist, Mr. Farebrother becomes fast friends with Dr. Lydgate. He fancies Mary Garth as well but has not told her so.

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Mr. Farebrother (Simon Chandler)

Mary Garth – A book-reading maid who has liked Fred since childhood but cannot take him seriously as a potential husband unless he betters himself. She’s practical and friendly.

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Mary (Rachel Power) and Fred

So that’s the cast of characters! Their stories come together in ways one may not expect, and it’s amazing how flushed out and developed they are by the end of the story. I tell you their names so you can have a better context when I make some concluding points below. There are some minor spoilers but nothing major! Middlemarch considers the following key questions:

Why DON’T people get married? 

  1. There is not a financial need. Although still young, Dorothea is not pressured into marriage by her uncle. She has plenty of her own money and as a woman you married back then (and today still) so that someone can help look after you + you have children. The bachelors in the story (namely) Casaubon and Arthur Brooke are both wealthy and do not seem to want to be bothered with marriage. They do not need to marry a woman to bring them extra funds either.
  2. You are in financial need. Will Ladislaw is short on funds which would make I’m an unattractive marriage prospect. Such is the same with Fred Vincy. Lydgate himself says he cannot “afford a wife.” 
  3. Set in one’s ways. Marrying someone can turn your world upside down for better or worse. For a few characters from Dorothea to Casaubon to Brooke and even Dr. Lydgate, marriage can be a distraction from one’s “greater pursuits.” I think this is true unless this is the right person. 
  4. No one has chosen you. Celia is definitely willing to get married, but as a woman back then you often had to wait until a bloke was interested (pretty much the same today). 
  5. No one has chosen you THAT YOU LIKE. Such is Rosamund’s problem. She wants a particular kind of man she has not met until she meets Dr. Lydgate. She is unwilling to shift her standards for someone else.
  6. They don’t make any moves. Rev Farebrother would have probably been married if he made a move. He is financially constrained which also may be a reason. This is the person who never goes out or meets new people but is quietly feeling sorry for themselves for being single. 

Why DO people get married? Timing and perceived personal benefit.

  1. A need for a change. Whether it’s a desire for companionship, money or a change of pace. 
  2. Societal expectation and desire for children. This is Celia’s reason as well as Sir James’. They are both very traditional in that regard. While Lydgate does not desire marriage, it is expected of him after his flirting gets out of hand. 
  3. Mutual respect. Finding a partner one respects and deciding to build a future with that person. 

Why do marriages fail? Selfishness usually. 

  1. Marriage is about fulfilling your own needs rather than serving another person. Everybody wants to be loved but loving another person is a lot of work–even if you like them a lot. 
  2. Marriage is not secondary to respect and affection but obligation and lust. LYDGATE. Today, if you flirt with someone in public no one expects you to marry them…so thankfully this isn’t much of an issue. But, I think particularly in conservative courtship situations, you find that you like someone enough and you’ve been together so long you just might as well? Marriage is seen as a natural progression instead of a serious life change. AKA let’s not fornicate so let’s get married.
  3. Loving “status of marriage” rather than the person. Marriage brings a lot of changes, many of them good. When to an apparently respectable person it builds social capital.  This is not necessarily bad, but if the pursuit of an individual is to improve your social standing or gain more power, things may not end well. 
  4. Misplaced purpose. A common issue is trying to find all of one’s purpose in the spouse they have chosen. If you expect all of your happiness to come from your spouse, that is certainly setting yourself up for disappointment. Dorothea and Rosamund experience this in SPADES. It also is not fair to the person you are marrying either. Talk about pressure!
  5. Feelings if isolation from one’s partner. Often people get married and want to go about their lives as though they are single. MISTAKE.
  6. Sick of being single. People are tired of being on their own. Not a good reason to get married! If you are sick of you, what makes you think you’ll stop being sick of you when you are with someone else? Chances are that they will be sick of you too. Like yourself!

Why do marriages succeed? 

  1. No rushing. The smart marriages are the ones where people move forward thoughtfully and not impulsively into the union.  
  2. True respect between both partners. There are not too many happy marriages in Middlemarch, but two arise purely because of the immense respect that is apparent between both individuals. 
  3. Honoring of each partner’s individual purpose and support of other in accomplishing goals and dreams. It is very gratifying to have someone support you as you become better and doing that to someone in return. The successful couples are better than the sum of their parts because they challenge each other to grow lovingly. 
  4. Consideration of another’s feelings. Basic but this is an issue for folks!
  5. Sticking with another person in good times and bad. You can never downplay commitment! 

BBC’s Middlemarch should honestly be required viewing for anyone thinking about getting married (and/or love all the drama in period dramas)! I’m definitely in that season of life right now as like 80% of my newsfeed is getting married/engaged (post medical school graduation). And while I am so happy and excited about this, time has shown that marriage is a lot of work and more often than not—we get married for the wrong reasons. And, while it isn’t 1872 anymore, we still have much to learn from this cast of characters!

Available now on Amazon Prime!

To See and Feel You Do Not Need Feet

I’ll never forget a lecture my first year of medical school from a phenomenal GI pathologist. His name is Dr. Joseph Willis, the division chief of clinical pathology at University Hospitals Cleveland Medical Center. He was an amazing lecturer as he taught us the definitions of an ulcer, a fistula and more with a lilting Irish accent.  He’s a great teacher but three years later what still strikes me about that lecture is the magnitude of empathy and compassion he had for patients. He would say that as he looked at tissue sections and slides, he could understand their pain even though he did not have to look them in the eye.   Even though he had never had cancer, he could imagine how they might be feeling physically and also emotionally. He challenged that notion that pathologists do not like/care about people. He cared immensely for patients even if he did not have to physically examine them. Dr. Willis shows that you can care even if lacking direct contact. Why? Because he had decided to care.

I haven’t understood that quite from the medical perspective until I started working with primary blood samples from patients with sickle cell disease (SCD) and beta-thalassemia. The blood, an elixir of life, is red and a single microliter is normally packed with 5 million red blood cells which carry oxygen from the lungs to the tissues. But over time, even a “student doctor” like me can see visually when a patient’s blood is “too thin” with a low hematocritA normal patient’s blood is an opaque, deep red but patients with SCD with severe hemolysis have visually thinner blood. And, when I wash one microliter of that blood in PBS and spin it in a centrifuge, the pellet of RBCs is visually smaller in the SCD patient. My heart aches imagining how much harder it is for their bodies to survive. 

It is easier, perhaps, for me to feel empathy because I have many close to me with SCD. I have seen real faces and real families impacted by this disease. But, I can never fully walk in someone else’s shoes with it to fully understand.

It has been said that to understand a person’s perspective you must walk a mile in their shoes. I think this is not wholly accurate or helpful. This is similar to the saying I heard often in elementary school that we should treat everyone the same no matter their color because we are “all the same on the inside.” It shouldn’t be about “sameness.” It should be about what is morally right.

Empathy begins with a decision to care–by choosing to see and to feel, and sometimes it is impossible to live another one’s experience. We can often become lazy and dull to the needs of others while we wait for this impossible situation to happen.

I say all this now because of how moved many of us have been with the immigration crisis at the border between the US and Mexico–how cruelly children are being separated from their patients and cowards dare to use the Bible as some kind of validation. This. sets. me. off. If we are gonna talk about what JESUS felt about children–he LOVED THEM.

 “But Jesus said, Suffer little children, and forbid them not, to come unto me: for of such is the kingdom of heaven.” – Matthew 19:14

Do these people and their electorate REALLY think Jesus would be happy with this behavior? They need to re-read the gospels instead of continuing to spew garbage.


Many of us have been moved by this picture of a child crying as she is separated from her parents. Why? Because her parents were “illegally” living here. Seriously?

I just watched an excellent film on my plane to Australia called Hostiles staring Christian Bale, Rosamund Pike and Wes Studi. It takes place in 1892 and is about a white captain from the Indian Wars (known for his brutal hatred of Native Americans) charged with the task of safely returning a Cheyenne chief to his lands in Montana so he can die there in peace. People may grow tired of the “Cowboys v Indians” genre of film but in my opinion there will never b enough film about the atrocities done to Native Americans. It is very well done. The irony at the end of the movie is that, the white land owners refuse to have a “red skinned bastard” buried on their land.

Do you see how foolish this is? American history is riddled with this kind of evil and NOW is the time to show that we have progressed–to show that we have some compassion. To show we are better than we were before. To show we have humanity.

NOW is the time to understand that we do not need to walk a mile in another man’s moccasins to know that we are doing them wrong. To know that what is occurring is awful.

Do you remember a time you were separated from your parents in a store or public place? The ensuing panic? The relief when you were found? The minutes seemed like hours to your parents and to you. Do you remember a time you were at a theme park or mall and heard announcements over the intercom describing a missing child. Did you feel anything? Did you try and look?

Imagine how these children and parents are feeling. Separation from one’s parents is truly traumatic.

You do not need to walk a mile in someone else’s shoes but it is fine to try.

You do not need to be Mexican.

You do not need to be an immigrant.

You do not need to be from a marginalized group.

You just need to be human.

To see and to feel you do not need feet.

Harrison Solo

When I heard about the new Star Wars film, Solo. I couldn’t really let myself get fully excited, and I’ve been trying to understand why. Is it because Disney is too obvious about milking their acquisition of LucasFilm? Because Han Solo’s major character development is in the original trilogy? Because Alden Ehrenreich doesn’t really look like Harrison Ford? I think we are getting hotter.

I was not excited because Alden Ehrenreich is not Harrison Ford. I do not think we have any need for a Harrison Ford impersonator when we can literally go watch the old movies and be happy. And, if you just watched Solo and want to fight me on this please watch just two minutes of Harrison Ford in the Empire Strikes Back. IN TWO minutes he is more charismatic, interesting and commanding of the screen than his successor in 2 hours. 

Han Solo is my favorite Star Wars character in the original trilogy (Obi-Wan in I-III; not much to choose from though!). He has the best character development, best ship, best best friend (Chewbacca) and looked great while doing it.

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Harrison Ford as Han Solo

So I went into Solo directed by Ron Howard with pretty low expectations. In fact, my little sister actually VENMO-ED me telling me to go.

My sister enables and sometimes FUNDS my Star Wars fan-girling

Having low expectations in life sometimes works out in your favor because then it’s harder to be disappointed. This is the case with Solo. I was pleasantly surprised with some of the visuals–especially the Kessel Run (BEST PART). That scene was exhilarating! It’s not a terrible film. It’s just an unnecessary, basic film. I am not alone in this as the box office revenue for this one is the worst for Star Wars yet. Star Wars fatigue is REAL and Disney must reach out with their feelings, use the Force, and be wise about what movies they release and how often!

The acting and characters were rather underwhelming, I’m afraid. Ehrenreich did NOT knock it out of the park and kudos to him to not impersonating Harrison Ford, but he was just kind of boring… I’m not sure I particularly enjoyed watching a semi-love sick Han Solo pining after someone who is clearly burdened with some INTENSE BAGGAGE. This guy needs to stop for a second and figure out what your old flame, Qi’ra (Emilia Clarke) has been up to!! Her character is not well-developed but perhaps for good reason. Nonetheless, I just kept on thinking: When is Leia coming? Oh wait, not until Episode IV. How much longer is this? Donald Glover as Lando also was not that great either…was rather confused with the L3-37 situation….  

The baddies were like B-list bad guys (except for the reveal at the very end! I felt a little cheated and thought that was bizarre, but I suppose not for die-hards who read the books it was not a shock), and the heroes felt like B-list heroes too–including Han. If there IS a sequel to Solo it will be BY FAR more interesting than this film as we start to deal with some REAL villains but only at the very end.

Solo is what happens when Disney makes a random prequel just to make some money. I think my feelings about it are a less extreme version of how people may have felt about the Phantom Menace in 1999. But, let us be reminded that not all prequels can be bad! Rogue One was the PERFECT example of a good prequel. It shares a NECESSARY plot point with the audience and seamlessly adds to and improves the saga. Solo does NOT achieve this.

I was entertained at some bits. Bored at others and confused the entire time why money was spent on this film and not donated to the Tolu Med School Loan Foundation (Message me if you’d like to donate).

When something is done “solo” it is done alone. By one’s self. ONLY. After watching this film, I am certain that for now, we should stick to Harrison Solo.

You feeling lucky?

I cannot ask this question without thinking about Dirty Harry. However, unlike Clint Eastwood, this question is obviously NOT being asked to you at gun point. The goal is to encourage self-reflection rather than fear! So I’ll ask again. Do you feel lucky? Or if you do not believe in luck, do you feel good things are likely to happy to you?

How you answer that question is actually rather important.

At the American Society for Clinical Investigation meeting last month, the HHMI fellows had a special dinner with Nobel Laureate, Robert Lefkowitz. He is famous for elucidating the structure and function of the G-protein coupled receptor (GPCR) a very important class of proteins that are the target for 30% of drugs (like beta-blockers!). I share more about him in a previous blog post from last year’s meeting. At the dinner, a fellow asked him what he looks for in a trainee–to which he responded:

“I ask them if they think they are lucky. If they say they are not, I usually do not take them.” 

HHMI, Medical Research Fellows Program dinner with Dr. Robert Lefkowitz, April 20, 2018
Dr. Lefkowitz is second from your left in the front row.

Why do you think he asks that question?

I think it’s because a positive attitude goes a very, very long way. Fatalistic, pessimistic perspectives often do not breed the most productive people. To some degree, our decision to get out of bed everyday is an optimistic one–its a choice to live and believe that what we will do outside our beds is worth getting out of bed for. You hope that you will get paid for your work and won’t get hit by a car on the way there. You hope that the things you are learning will be of use to you–or at least the degree you are working toward will somehow improve your life. There is a little bit of an optimist in all of us if we have the will to keep waking up everyday.

This issue of “luck” does not erase the reality of a lack of privilege. Some people have objectively had more opportunities and access to resources than others. Period. When you have been beaten down by disappointment, it can be much harder to be hopeful about the future in comparison to someone who always seems to get what they want.

But, I tell you, I have met people who have gone through some extremely difficult situations but because of their perspective realize they could have been worse–and for that reason, “feel lucky.” They feel like their lives are not doomed to some failure. They experience hope.

People who are eager to learn, think positively and don’t think their experiments are always doomed to fail are much easier to teach and to work with.

When I ran track in high school and had my eyes set on the State Finals, my coach, Coach Havey told me to, “expect it.” Champions let it happen she said. There is this radical mind-set shift where you go from a victim to life’s misfortunes, to a willing acceptor of the gifts you have received and will receive.

So much of my internal strength came from running track and being mentored by Coach Havey. Taken May 2009. I went to state the following year.


How can pain become productive? I’ve been dwelling on this for a long while but a lot more recently. Many of us believe that being opening about our difficulties presents a certain weakness. Since I have a blog, I think it makes sense for you to assume that I am an open person. People close to me know when things are going well, and when they are not. I process my pain openly with people I trust. As I process aloud, I am encouraged by those who care for me, and it is also an opportunity for me to learn from them and they from me. Hearing about my issues have helped others avoid the same situation. People have come back and told me this. When I hear that, I feel satisfied that at least one person did not have to live through my own crisis. My pain was not for nothing. It has become productive.

We become stronger when we can help another person in the midst of our pain. When we can see beyond it, we gain perspective and realize that our struggles are not everything. Try it out.

So do I feel lucky? Absolutely yes. I do not have everything that I want, but I have what I need. I realize that what I have been given during the last two years in Boston has been so wonderful. I had the privilege of giving a speech at the ASCI meeting last month as well as meet Irv Weissman (the father of hematopoiesis) for a second time!



In fact I have had a chance to interact with a few of my hematology heroes including Dr. H. Franklin Bunn, the man who discovered hemoglobin A1C! It was suggested that I talk to him about optimal conditions to induce sickling in my cells. At one point he got out a pen and paper and started teaching me about the dynamics of oxygen tension and sickling, and it was such a treat. The textbook, the Pathophysiology of Blood Disorders, I read my second year of medical school was written by him, and I got to sit with him for an hour!!

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Such a nice and brilliant man.  I asked him for a photo and he said, “Like a selfie?”

I’ve also brought the researchers of the Longwood Christian Community together for the first LCC Research Symposium! I know my neighbors better than most people, but we really do not know much about each other’s research. It was amazing to hear what everyone is doing! I live in a community full of brilliant minds.

I also have my eye on my return to clinical medicine in September and have started to shadow more intensely. Yesterday, I spent most of the day with Dr. Francisco Marty of Brigham & Women’s. He’s spectacular and without a doubt one of the best physicians I have had the chance to shadow. He’s an ID physician specializing in infections in immunocompromised patients like those with cancer and/or recipients of transplanted organs/tissues. One of the most beautiful moments was his ability to make a terminal cancer patient smile by presenting her with one of the photographs he had taken (he’s an amazing photographer! Check out his instagram!) I was touched by his compassionate care and wonderful teaching style!

A selfie with Dr. Marty after a wonderful day of shadowing! Saw some textbook cases of Steven Johnson Syndrome and disseminated C. tropicalis infection

I’m currently working on my manuscript which is all new territory for me. It’s really hard to finish something and to finish it well. I feel so much pressure and do not have much time left in Boston and need to submit soon. So this post is going to end!

But, whenever I am tempted or allow overwhelmed feelings and ungratefulness to seep in, I need to check myself.

Life is a gift. I am so lucky to be alive, and there is so much good for us all to do with what we have been given. Good things can happen and they will.

Choose to be lucky. Make your own luck.

The Agency & Faith of the Shunammite Woman

This blog is primarily medically and science-oriented, but I would be remiss if I did not share some of the very important aspects that shape how I see the world from time-to-time. I’m a Christian, and as C.S. Lewis said long ago:

I believe in Christianity as I believe that the sun has risen: not only because I see it, but because by it I see everything else.

My world-view is very much impacted by the stories in the Bible, and today I’ve chosen to share one of them with you. The values I have garnered very much inform the way I see and participate in both science and medicine and engage with the people I meet.

Given the age and cultural context surrounding the collective accounts recorded in the Bible, my attention is always peaked when I read about rather impressive and amazing women. There’s Ruth, Esther, Rahab, Sarah, Deborah, Mary the Mother of Jesus, a few other Marys… quite the handful of very interesting women. There’s also that unnamed “Proverbs 31” woman too. They get some pretty good attention. But, as I’ve been reading through 2 Kings, I’ve come across another unnamed, “Shunammite Woman” with a story that really resonates with me. She’s so independent! But more importantly, she teaches me about the value of hospitality, faith, hope, persistence, and obedience. 

Let’s first look at her story.

2 Kings 4:8-17 – Hospitality 

One day Elisha went on to Shunem, where a wealthy woman lived, who urged him to eat some food. So whenever he passed that way, he would turn in there to eat food. And she said to her husband, “Behold now, I know that this is a holy man of God who is continually passing our way. 10 Let us make a small room on the roof with walls and put there for him a bed, a table, a chair, and a lamp, so that whenever he comes to us, he can go in there.”

  • The Shunammite woman is a woman of means and is unselfish. She shares what she has with people in need–not because she wants anything in return, but because she has a kind and generous heart. How can we use what we have to bless others?
  • Her husband is present, but she is willing to advise him. She is also married to an unselfish person. She does not always wait for him to make decisions, but respectfully includes him in her own decision-making process. If you have a good idea, you do not have to wait for someone else first to share it. You can be the first one. A wise person recognizes the value in a good idea.

11 One day he came there, and he turned into the chamber and rested there.12 And he said to Gehazi his servant, “Call this Shunammite.” When he had called her, she stood before him. 13 And he said to him, “Say now to her, ‘See, you have taken all this trouble for us; what is to be done for you? Would you have a word spoken on your behalf to the king or to the commander of the army?’” She answered, “I dwell among my own people.” 14 And he said, “What then is to be done for her?” Gehazi answered, “Well, she has no son, and her husband is old.”15 He said, “Call her.” And when he had called her, she stood in the doorway.16 And he said, “At this season, about this time next year, you shall embrace a son.” And she said, “No, my lord, O man of God; do not lie to your servant.” 17 But the woman conceived, and she bore a son about that time the following spring, as Elisha had said to her.

  • When asked by Elisha what he can do for her, she does not make any request. She simply wants to serve. Determined to do something good for her, finally Elisha’s servant says what she lacks–children.
  • The Shunammite woman probably has given up on this prospect of children, and it doesn’t look promising (#oldhusband #erectiledysfunction)
  • Sometimes crazy, unexpectedly amazing things can arise out of generosity beyond our expectations. 

2 Kings 4:8-17 – Faith, Hope and Persistence 

18 When the child had grown, he went out one day to his father among the reapers. 19 And he said to his father, “Oh, my head, my head!” The father said to his servant, “Carry him to his mother.” 20 And when he had lifted him and brought him to his mother, the child sat on her lap till noon, and then he died. 21 And she went up and laid him on the bed of the man of God and shut the door behind him and went out. 22 Then she called to her husband and said, “Send me one of the servants and one of the donkeys, that I may quickly go to the man of God and come back again.” 23 And he said, “Why will you go to him today? It is neither new moon nor Sabbath.” She said, “All is well.” 24 Then she saddled the donkey, and she said to her servant, “Urge the animal on; do not slacken the pace for me unless I tell you.” 25 So she set out and came to the man of God at Mount Carmel.

  • The child grew up and dies from meningitis (?). Imagine how distressing this must have been to her–especially when it was so unlikely for her to have a child in the first place. (SIDE NOTE: isn’t it annoying when you are living your best life, and then you get “Rick-rolled” by God? He gives you something and takes it right back! We are left to grapple with this and discern when to fight and when to accept the losses we experience and move on).
  • Sometimes men do not have all the best ideas! The Shunammite Woman had faith her child could be healed and was ready to do something about it–even when her husband did not. She did not despair saying, “All is well.” She was ready to fight. She gets up in search of help herself. 

When the man of God saw her coming, he said to Gehazi his servant, “Look, there is the Shunammite. 26 Run at once to meet her and say to her, ‘Is all well with you? Is all well with your husband? Is all well with the child?’” And she answered, “All is well.” 27 And when she came to the mountain to the man of God, she caught hold of his feet. And Gehazi came to push her away. But the man of God said, “Leave her alone, for she is in bitter distress, and the Lord has hidden it from me and has not told me.” 28 Then she said, “Did I ask my lord for a son? Did I not say, ‘Do not deceive me?’” 29 He said to Gehazi, “Tie up your garment and take my staff in your hand and go. If you meet anyone, do not greet him, and if anyone greets you, do not reply. And lay my staff on the face of the child.” 30 Then the mother of the child said, “As the Lord lives and as you yourself live, I will not leave you.” So he arose and followed her. 31 Gehazi went on ahead and laid the staff on the face of the child, but there was no sound or sign of life. Therefore he returned to meet him and told him, “The child has not awakened.”

  • She is honest in her grief asking Elisha why she was given a son for him to be taken away. Bad things can happen to good people for reasons that are difficult to explain or lack concrete explanation. It is okay to wrestle with this. 
  • Thankfully in this story, but not every story, there was hope for this sad news to be changed.

32 When Elisha came into the house, he saw the child lying dead on his bed. 33 So he went in and shut the door behind the two of them and prayed to the Lord.34 Then he went up and lay on the child, putting his mouth on his mouth, his eyes on his eyes, and his hands on his hands. And as he stretched himself upon him, the flesh of the child became warm. 35 Then he got up again and walked once back and forth in the house, and went up and stretched himself upon him. The child sneezed seven times, and the child opened his eyes. 36 Then he summoned Gehazi and said, “Call this Shunammite.” So he called her. And when she came to him, he said, “Pick up your son.” 37 She came and fell at his feet, bowing to the ground. Then she picked up her son and went out.

  • Her faith and persistence is rewarded and her child comes back to life.
  • The Shunammite Woman is thankful.

A few chapters later we encounter her again. This time, there had been a famine for many years and she had to leave her land and wealth behind.

2 Kings 8: 1 – 6: Obedience

Elisha talked to the woman whose son he had brought back to life. He said, “You and your family should move to another country, because the Lord has decided that there will be a famine here. It will last for seven years.”

So the woman did what the man of God said. She went with her family to stay in the land of the Philistines for seven years. After seven years she returned from the land of the Philistines.

  • The woman could have stayed in her nice house, but she obeyed Elisha (I guess he is a prophet who resurrected her kid so…)
  • Because she had helped him, she was privy to important information like the coming famine

She went to speak with the king to ask him to help her get back her house and land.

  • She, not her husband, goes to the king to get back what is hers.

The king was talking with Gehazi, the servant of the man of God. The king said to Gehazi, “Please tell me all the great things Elisha has done.”

Gehazi was telling the king about Elisha bringing a dead person back to life. At that same time the woman whose son Elisha brought back to life went to the king. She wanted to ask him to help her get back her house and land. Gehazi said, “My lord and king, this is the woman, and this is the son who Elisha brought back to life.”

The king asked the woman what she wanted, and she told him.

  • She shares her testimony and receives her land again. She does not keep the amazing things God has done for her to herself, but shares it with the king.
  • Sometimes we go through things–whether good or bad so we can share our stories with another person. 

Then the king chose an officer to help her. The king said, “Give to the woman all that belongs to her. And give her all the harvest of her land from the day she left the country until now.”

The Shunammite Woman’s story represents various states of being. Sometimes we are in a situation when we can give. Sometimes we are the ones that need help. What I have learned from this woman is to give what I can, to have faith even when those around me lack it, and to not be afraid to ask for help when I need it. She was so dynamic and active–vigorously making a difference wherever she went. I am so inspired by her story and her faith.

Rembrandt; Departure of Shunammite Woman.jpg
“Departure of the Shunammite Woman,” Rembrandt

Shaker Heights: Childhood

For me it seems nearly impossible to track when one memory begins and the other ends. Contained in these many little memories is one large one: the memory of childhood. The first home I can recall was in an old, apartment complex in Shaker Heights, Ohio. It was situated in front of a busy road–Van Aken Road, with scarlet red bricks and rough sidewalks—sidewalks that were so rough that when I took the “poisonous” berries off bushes in attempt to draw on them I skinned my knuckles in the process. The summer’s sound of ice cream truck jingles, quick slaps of jump ropes on the cement ground, and children’s cheers are engraved into my memory. I remember the hot summer walks to the beautiful Shaker Heights Public Library. This former school building has the grandest playground I have ever seen until today! Instead of woodchips, it had the state-of-the-art spongy, recyclable material that we find on today’s playgrounds, and sections of the playground were connected by numerous bridges fostering my imagination. Inside, I can still smell the papery scent of books, see vividly colored bean bags, old, smiling librarians and hear the pleasant silence. Since Shaker, I have not felt the same magic I once did when walking into the children’s section of a library, but seeing the distinct change in color from grey carpet to reds and blues speckled with yellow stars still reminds me of those wondrous years. Those where the years when I’d walk to the library almost everyday during the summer with sticky popsicle stains on my shirt, sandals on my feet, and daffodils dangerously close to the road—so close that my parents feared I’d stray too far to admire them.

In fall, the leaves changed, and the rain, a cool comfort in the summer, became a nuisance. Nonetheless, there was one day when I did not mind it too much. It was my mother’s birthday, and her day off so she decided to take me to the bus stop.  I do not remember too much of her in my early childhood. My maternal grandmother was very hands-on raising me for the first 5 years of my life. Having two parents as resident doctors makes their presence even more poignant in one’s memory because the times when they were not ripped away by work or weary from late night calls were seldom. Some specific details evade me now such as the clothes I was wearing and the faces of the other children at my stop, but the morning my mother walked me to the bus stop, I do remember what I felt: love. With so many details lost in time, I do remember my mother taking a red, velvet ribbon and tying it into my hair. It was the kind of velvet I think of when I rub my hands on a plush Christmas stocking. Perfectly, (and only my mother can do it perfectly) the bow hung on my ponytail, and as I hugged her goodbye and was ushered on to the bus with the other children, my heart was full of joy because for those few moments I had her all to myself. Taking the window seat, I rubbed the fogged up window with my palm so that I could see her as the bus drove away. The condensation was wet and cold like the falling rain. I once told my mother this story, and she could not recall it at all. The memory is somewhere lost in the sea of her mind and it is remarkable. Even though it was her birthday, the true present was given to me.

I remember the tarnished gold “4” to the left side of the green peeled doorframe of the apartment. I am almost certain we had apartment number 4 because a few weeks after I turned four I was astounded by the fact my age finally matched up to the number outside our door. I do not remember what floor we were on and how many steps it took to get there, but if I kept on walking down the cement steps with my older brother and sister, eventually, we’d end up in the basement composed of a washer, dryer and a leaky sink. It was the only place we were allowed to rollerblade in the apartment building.

The first time I entered that apartment, it was before my younger sister, Emi, was born, and I have very few clear memories before that. It almost seems like a dream where only some details remain but no matter how hard I fight, the memories are lost.  It was nearly 21 years ago but remarkably, I remember what I was wearing: a starched white dress with a yellow and red pattern, red shiny buttons (the kind parents fear their children choking on), Knee-high socks with black shoes. My mother held onto my arm as my father walked on ahead with whom I can only imagine to be the realtor. Another fact I know for certain is that I was alone with my parents. As one of four children (and at that time, three children) it must have meant something to me to remember it. Perhaps subconsciously I have had the selfish desire of having them to myself. We walked into the three-bedroom apartment with a large living room. It’s exact size I am uncertain. A child’s memory often makes things much larger than they are for the world seems to swallow them whole.  I used to “ice skate” across the floor with Emi years after. In reality, it was really sock gliding, but the creaky, dusty wooden floor was perfect for our Michelle Kwan-esque “triple axels.” Until this day, when I see open wooden floors, when no one is looking, I do a quick spin on one foot. On that floor, my poor grandmother did her own slipping, sliding, and falling when mischievous Emi poured an entire vat of Johnson & Johnson’s baby oil on it. “Grandmommy” put up a lot with us, but she had a special soft spot for Emi. She used to look at her saying how much she looked like Mark, my grandfather. I feel as though my grandmother represented my childhood. There was so much sweetness and adventure, but there always seemed to be an underground melancholy.

I am not really sure if my grandmother was actually very happy. She was the type of woman who believed duty to be on par with love. Sweet words meant nothing unless hard work lay behind them, but she never did her work grudgingly. Her cooking drew our otherwise antisocial neighbors to our door. She was quite innovative transforming our old, “Sprinkles” yogurt cups into Jell-O containers for after school snacks, baked fresh bread, and even was quite fond of WWF Wrestling on TNT. A sturdy woman with large brown hands I got a few spankings from, she seemed massive to me, but when I look back at her photographs she was actually quite petite. Grandmommy had a stern face that bore the loss of three children in Nigeria, the backward nature of polygamy, a foreign culture, no living friends, and the death of a man she considered her best friend. My mother says that I never got to know her real mom as she still grieved the loss of my grandfather when I knew her.  I learned a few years later that Grandmommy also had a stroke in Shaker Heights, also changing her. It is hard for me to imagine a young, light-hearted grandmother, but when I open my mother’s old photo albums, I see a beautiful young woman with high cheekbones, the smoothest complexion and the softest eyes. Time can be a very cruel thing. Talk of my grandfather seemed to be a no-go subject with Grandmommy, but one day after a confused Sunday school session, I asked her if “Grandpa died on the cross like Jesus?” Surprisingly, she laughed and said, “No. He was sick.”

Nabokov says that existence lies between two cracks of darkness, and the brief wisp of my childhood seemed to end after my grandmother slipped into her second crack of darkness. How does one cling onto a memory? After my grandmother’s passing, my mother used to wear her clothes just to smell her. Some of her scarves are still unwashed after all these years, and if I open the green Rubbermaid bins marked from “Shaker Heights,” I can still smell her scent. I have not done this in years. She was not a woman for strong perfume. Even though one day her scent will die away, she will live on in my memory sealed in the Shaker Heights folder of my brain, locked with my childhood until it sinks back into a sea of nothingness.


The Physician Scientist, A Force for Change

On April 19, 2018, I gave the keynote speech at the American Society for Clinical Investigation Food & Science Event. Grant Achatz, head chef at the Michelin-star restaurant, Alinea gave the keynote last year, and I certainly had some big shoes to fill. He shared his experience as a patient with head and neck cancer and the impact of physician-scientists in his full recovery. This year, HHMI asked that I speak. Here is the full transcript of the speech, and I’ll share more reflections and photos on the meeting in general very soon. My audience was composed of the ASCI Young Physician Scientist Awardees, HHMI Medical Fellows, ASCI/AAP members who are very senior and established physician-scientists like my PI, George Daley. 

Here, I share my personal journey on why I research sickle cell disease and the real barriers and fears I and many others have to becoming physician scientists. 


Good Evening! Thank you George for that kind introduction, Melanie Daub and Dr. Cheung for inviting me to speak, and my family for supporting me and being here tonight. This evening, I will share with you what has motivated me to purse the path of a physician-scientist and what the scientific community can do to maintain the next generation in this sphere.

It has been said that “Our existence is but a brief crack of light between two eternities of darkness.”


We often find it troubling to think of the world after we are gone. But, Vladmir Nabakov once declared that too seldom do we consider the chasm of darkness before our birth—the anticipation of our mothers and fathers for our arrival, our empty cradle, the names our parents conceived to name us. Forces beyond our control began to chart the projection of our lives before our first breath and the forces within our lives continue propel us forward. So let me go back to the very beginning of my scientific journey. 7 millenia ago when the Saharan Desert was lush and green.

A child was born there with a special mutation that protected he or she from fatal malarial infections, and that child lived long enough to pass that gene on to their children.

Let’s fast forward to the 1980s.


My parents met in Nigeria, and they were tremendously fashionable.

They got married, and they had 4 children.

A son Olu, 3 daughters (Soton, Emi and me). It was always eventful in my house with frequent trips to Sam’s Club. My childhood was often very joyful, but we as a family have experienced quite some hardships.


The same year this picture was taken, one of my siblings spent 3 months in the hospital.

Two of them have sickle cell disease. SCD is the most common genetic disorder in the United States and a red blood cell disease due to mutated hemoglobin. Although carrying one allele of the sickle cell mutation is of benefit to those in malaria-endemic regions, as those patients are largely clinically normal, it is a very awful disease for those who carry both genes. The sickle hemoglobin within the cell, polymerizes distorting the cell’s shape. Awkward and stiff, they do not last long in circulation and occlude and damage the internal lining of blood vessels. Oxygen cannot be delivered properly to many tissues causing severe organ damage like stroke and tremendous bone pain. And most patients with functional asplenia are at high risk of deadly infections especially in the developing world.

I learned very early in life that SCD is a force that can transform outwardly healthy-appearing and joyful people into those overwhelmed with pain and illness—a shadow of who they truly are and can become.

On one of my sibling’s last day of 11th grade, 10 minutes into her Spanish final she felt a sharp pain in her lower back. An expert on pain, she knew what was coming. She also knew the inevitable crisis would soon render her indisposed and she was without help. My mother and father were away at work and the rest of us were working or far away in school. She did not go to the ER for reasons I will discuss later.

She opted to fail her Spanish final by not completing it, got her self in the car and drove home. When my siblings have had their crises, I have learned to walk gently into the room, because even the vibrations from the creaking floor can make a difference to someone in such extreme pain. She got herself up to bed, and instead of trying to lie as still as possible, the pain was so excruciating, she could not keep herself from writhing in pain and screaming.

When my parents, physicians, got home, they were able to get her the appropriate pain meds but that still did not help. When you sit with a person in the midst of a sickle cell crisis in this state—even as a physician, you feel tremendously helpless. You can give IV fluids, make sure nothing more sinister is occurring, but pain is completely out of your control. You must wait and hope for it to finally be over. Imagine living your life constantly wondering when a crisis will come? Never knowing what will be impacted whether a vacation, a test or your own wedding. Imagine knowing a crisis will come over and over until the end of your life. Many patients would rather not continue living.

This is unacceptable.

Sickle cell disease, like many other ailments, is the enemy of potential and wholeness. Over the years it has garnered some attention, but in my opinion, not enough as our exposure to it’s basic pathophysiology over the past century is inappropriately disproportionate to the number of therapies and cures generated and available for patients.

How is it that we have known about this disease for more than 100 years but until very recently had no way to treat it beyond the symptoms? We have only two FDA-approved treatments for SCD in adults and one in children. There is no safe, universal cure for patients either. And despite the fact there are 9x more people with sickle cell anemia on earth than cystic fibrosis, for example, it has a ninth of the funding CF does.

These disparities combined with my personal experiences lit a fire in me in college—compelling me to do and know more. I shadowed often in the sickle cell clinics and saw that most care revolved around the management of symptoms rather than the treatment of disease. The lack of curative treatments was jarring and compelling. In the ER, I would hear physicians complain about the sickle cell patients who came asking for Dilaudid not realizing that these patients were opioid dependent because we as physicians had failed in not providing a solution to their problems. I felt a disconnect from the way things are and how they ought to be for these patients. I wondered how my sister would have been treated if she went to the ER in the state she was in that day.

Science enables us to grapple with this disconnect and challenge the status quo to provide solutions for patients. To provide cures for patients. Physicians have such uniquely powerful potential to become compassionate scientists.

I realized in medical school, that I could not resign myself to giving palliative care to sickle cell patients when they are so deserving of a cure. Despite this realization and my heart for sickle cell disease, I honestly lacked the confidence in myself to believe that I could actually make a profound difference as a scientist. Many of the scientists I had met looked nothing like me and seemed too smart and capable to have ever doubted themselves.

Yet, I knew my life’s calling involved sickle cell disease. In the absence of a focused research experience like a PhD program, I suspected that Howard Hughes Medical Fellow Program would provide the opportunity to have a more in-depth exposure to science. I talked with Melanie extensively on the phone, she pointed me to George Daley whom I was super nervous about emailing cold. Much to my surprise and elation, he responded to my email and the rest is history! Working in the Daley Laboratory for nearly two years has been one of the most seminal experiences of my life. Dr. Daley’s commitment to his trainees and willingness to support my research and my dreams has not only been an encouragement but an inspiration. During this time, I have realized with more clarity that I could be a physician-scientist. I could have my work with patients inform my research in profound ways that will benefit them in the future.

The first fellowship year provided me with the intangible gifts of being in a research setting: learning how to troubleshoot, design experiments, ask questions, and actively seek mentorship and support from incredible experts and collaborators. I became increasingly more proficient at culturing red cells derived from induced pluripotent stem cells with the hope of modeling sickle cell anemia with them. By the end of year one, I didn’t feel like I was done in the lab and neither did George. He supported my application for an extension of my HHMI fellowship.

And the second year truly has been rewarding as I have made progress towards producing a manuscript, speaking at conferences and building collaborations.

I cannot emphasize enough the value of a second year of research. My parents at first thought I was a little crazy to take another year from medical school to do this, but I think now they have come around! HHMI Fellows remember that no matter the advice you receive, you are responsible for your own happiness and your own decisions. Seek council but find your inner guide and voice.

All of these experiences described have given me more confidence in pursuing the physician-scientist track in residency and beyond. And, I am sure it has for many of my co-fellows as well as those who have gone before us. But I know many of us also still unsure and a bit afraid of that prospect.

But what happens after I graduate? I leave the halo of the Daley Laboratory and I am back in the real world finding a way to balance rigorous medical training with inquisitive research questions.

Honestly, my fear, which I am sure is shared by many Medical fellows is finding that after 6 years of residency and fellowship, there is no place for us in the research space. That life circumstance has made us lose confidence in our ability to enter this sphere. The competition for funding is too great and protected research time is too little. The lab, a beautiful place, where we have had the chance to play and grow will become a hostile one. The stakes will be higher then as a post doc as we will then consider how we would like to make our impact career-wise.

We learned last year that the average physician scientist is 42 years old when he or she starts their own laboratory. And, the age is increasing. How will that age look in 6 years? Given our current political climate will we still maintain our interest in basic/translational science research funding? Will discovery truly be translated into patient care? Also on a personal note, will the NIH loan repayment program still exist? I took a look at my student loans statement this week while preparing my taxes and all I could do was laugh. It was not happy laughing. Will our financial debt sway us away from academic medicine?

How do we fight these fears and our pessimism? Age matters. Many studies show that the older you get, the less creative you get. Also the older you are the more responsibilities you garner. How can we incentivize young physician-scientists to not give up on research careers when the draws of a higher salary and a more predictable life style are so alluring?

These are the questions for the movers and shakers who have gone before me—incredible forces who have shaped the field before we younger folks stepped into it. How have you been preparing for our arrival?

Despite my fears, I remain sure about the need for physician scientists. The medicine we practice must be evidence-based. The medicine we practice must evolve and improve, with the goal of true healing for all patients.

Inquisitive, young minds are needed to solve today’s problems. They need to be encouraged when frustrated, challenged when complacent, and believed in when lacking in self-belief. Answer our emails. Say hello to us when you can tell we are hovering around trying to talk to you. Give us a chance when you see our enthusiasm but minimal experience. My mentors have done that for me, and I would not be here without them.


Passion is intrinsic to who we are, but often we need to be filled up by those around us. Whether it is by our families, our faith or our mentors. To more forward, we always must consider those who are behind. We must encourage and make the space for them to join us at the table.

As I close, remember that before our first breath, the world had been preparing for our arrival and for what we are destined to accomplish. And there are so many who are not even here yet who need our help now.

So to those who went before me, remember me. Remember us. Pave the way so that we can one day join you as physician scientists—forces for good in medicine seeking to raise the standard. Who are convicted by the notion of how things are versus how they ought to be- visionaries and innovators daring to see a better world with more cures, more gray hairs and more birthdays.

Thank you.

Miss Rosanwo Goes to Washington

The first time I went to Washington DC, I flew over on a fabulous 8th Grade trip with my class. It was my first sleep-away trip without my parents, and with a lot of young folks on the brink of high school it was a memorable, beautiful time- with a little bit of middle school shenanigans. We roamed from Ford Theater to the Spy Museum to the Archives, Smithsonian Air & Space Museum and presidential memorials with super enthusiastic social studies teachers.

Since then, I’ve been to DC many times–especially for research meetings as an HHMI medical fellow. I love taking their metro. It’s easy to navigate, and more importantly it’s fun to people watch! I see so many commuters in their suits and professional attire on the way to do something seemingly important. It’s like I am on an episode of The West Wing (amazing show!!) and could expect to see Toby, Josh or CJ on their way to Capital Hill.

What I’ve realized now as not simply a tourist to DC, is that the capital is a place of movers and shakers. This should be a natural conclusion as it is the CAPITAL, but I’ve been finally getting that so much powerful, influential STUFF is happening here–and it’s not just on Capital Hill.  In late March, I attended a meeting hosted by the NIH Heart Lung & Blood Program on Accelerating Cures in Hemoglobinopathies: The Cure Sickle Cell Initiative. 

I went to the meeting with my boss and was able to listen to and dialogue with national leaders in sickle cell disease. This event was one of the most inspiring and hopeful meetings I’ve had the chance to attend. What’s the goal? To see a real and broadly available cure for sickle cell disease in 5 years. After knowing about SCD for over 100 years this goal is lofty but long-over due.

How Can Sickle Cell Disease Be Cured? 

Matthew Porteus, succinctly described the current methods/strategies to cure sickle cell disease, and he broke it up into two major factions. “Beta-globin” focused and “Gamma-globin” focused. Does this already sound confusing? Not to worry! Let me back up and explain. Take a look at the diagram and caption below.

Over the course of our development,  we make different types of hemoglobin, the special protein in our red blood cells that binds oxygen. Hemoglobin is a complex protein molecule made of 2 dimer chains of amino acids (4 subunits total, a tetramer). From conception until 3 months in utero, we make “epsilon” embryonic hemoglobin (HbE), following that until around birth we make, “gamma” fetal hemoglobin (HbF). The mutation in sickle cell disease is found in adult hemoglobin’s “beta”-globin chain (HbB). We start predominately making this hemoglobin around birth and then it increases as we reach 15 months old (after birth). Red blood cells are made in various places in our bodies over time from the yolk sack, the liver and finally the bone marrow–where we make them now.

Since the mutation in sickle cell disease is not seen in the gamma globin (HbF) but only in the adult version, scientists have been very interested in the “molecular switch” that turns on adult globins. If we can find away to turn it off then we can keep people with sickle cell disease from presenting a diseased phenotype! BCL11A, a transcription factor, is the molecular switch that turns on the transcription (the conversion of DNA –> mRNA) of the adult globin genes.

Beta-globin-Focused Approaches to a Cure

The approaches below are about either getting new beta-globin or correcting the already present beta-globin mutation in the cells. The goal is to get a patient to a point where their disease is virtually silent–even if they still carry the mutation. People who carry one mutated copy of the sickle cell gene (those with the sickle cell “trait”) are essentially healthy.

  1. Getting NEW stem cells via a bone marrow transplant (BMT). This is a procedure where you receive new “hematopoietic” or “blood” stem cells from a genetically similar donor (usually). It’s really important for you to have a similar immune system to your donor because your body will view those cells as “foreign” and attack them if they look too different. The bone marrow, where blood stem cells are made, is wiped out with radiation,  chemotherapy suppresses your immune system and then new blood stem cells are added. This is the most common “cure” for sickle cell disease, and the first successful treatment was in 1984. So what’s the problem? Too few donors. Only 15% of kids with sickle cell disease have a sibling-matched donor appropriate for them. Additionally, the chemo and radiation make this procedure very dangerous and there is a 25% mortality rate with BMT.  
  2. Gene Correction via “genome editing.” We can use a technology called, “CRISPR” which acts like a targeted “molecular scissors” to cut a patient’s mutated DNA and correct their own stem cells. The mutation in sickle cell is very simple, and you can replace the bad DNA with good DNA. What are the barriers? It is very difficult to correct EVERY stem cell. Scientists are still investigating ways to make this process more efficient. How many stem cells need to be fixed in a patient? Some studies say 2% are needed for therapeutic benefit and some say greater than 20%. 
  3. Gene Addition via “lentiviral gene therapy.”  This method uses a patient’s OWN stem cells for therapy as well, but instead of using CRISPR to edit, they can add genes carrying fetal hemoglobin to the cells by infecting them with a virus containing the “good DNA.” This is very cool, and I was able to meet a patient who was cured using this method! Barriers? It is very difficult to harvest health stem cells from patients. Those who have sickle cell disease have inflamed bone marrows from the damage the sickle cells do to that environment. As a result, the cells retrieved are not very healthy and may not respond well to virus infection. Another issue is that reproducible viral transduction is difficult! Imagine all the times you meet someone with a cold. Do you catch their virus every time? No! Sometimes the cells do not “catch” this virus either. 

Gamma-globin-Focused Approaches to a Cure

  1. These approaches focus more on turning off the “molecular switch” I discussed before, BCL11A. There is currently a new clinical trial at Boston Children’s Hospital looking to target BCL11A by erythroid (red blood cell) specific shRNA knockdown (aka using an RNA that blocks gene expression to block BCL11A synthesis). They will infect patient blood stem cells with a virus containing this shBCL11A construct. BCL11A has a role that is important in making B cells (a type of white blood cell) so this construct is very cool because it doesn’t just target BCL11A but an erythroid “enhancer” region that is specific to BCL11A expression in red blood cells.
Basics of Gene Therapy

2. HPFH There are some “lucky” people with SCD who virtually have no disease because they naturally make a lot of HbF. Unlike most people, their fetal hemoglobin expression does not taper off after they are born, but continues at a higher level than normal. This is called “hereditary persistence of fetal hemoglobin” or HPFH. Scientists are also looking at the additional mutations these patients have and seeing if they can induce them in others using CRISPR-Cas9, the “molecular scissors” from before.

3. Small Molecules. Research is underway to make small molecules/medication that can target BCL11A and increase HbF without transplant. This could be like taking a pill.

No method is perfect so research is essential to optimizing each strategy so there can be multiple cures for sickle cell disease!

Getting Discoveries to the Clinic 

It was so amazing for me to hear patients who were cured of SCD share their stories at this meeting. The first patient to receive the lentivirus HbF treatment was there, and a woman who had a half-match who was cured via a regular BMT was also present. I had a chance to speak with the woman and she was so warm and encouraging and filled with so much JOY. On the other hand, some patients were there who had received BMTs but had adverse outcomes and were still uncured. I’m so glad their voices were also included.

There are so many barriers to getting a cure universalized. 

  1. Need to improve the preparation regimens for BMT. The chemo-radiation is very toxic and stem cell homing to the bone marrow needs to be faster.
  2. Cultural divide with necessity of transplant. With better sickle cell management, kids are living into adulthood and requiring organ damage later on. It’s wonderful that survival is better at this stage, but ideally children should be cured before their first stroke or the organs are damaged beyond repair. If BMTs stay dangerous (5-10% mortality in sibling-matched kids) less parents will be willing to take the risk. Additionally, physicians who would normally offer this to their leukemia patients, may be wary about offering BMT to their “okay” SCD patients.
  3. More clinical trials need and more patients. We can only know if these other methods could work if we have clinical trials. For very real and profound reasons, patients are apprehensive about being research.  The African-American community has had a history of exploitation by the medical field. Read this on the Tuskegee Study.

The goal of this meeting was to discuss ways to cure every three year old in the world. The hope is that real cures can be seen in the US in 5 years. Discovery is hard but implementation is even harder. Equity and distribution are certainly issues down the road. Most patients in the world with SCD are not close to academic medical centers like Boston Children’s Hospital, but in West and Central Africa.

My notes from the meeting


Patients, families health care providers, and community organizations will need to join forces together if a cure for SCD can be realized. Many of the physician leaders were called to start a SCD registry for their patients in preparation for future clinical trials.  My PI, told me to talk to everyone I could. “Expect to be a leader in Sickle Cell Disease,” he told me. My hope is to one day become one.

It was inspirational to have his support and invitation to have a seat at this table. To listen. To learn. It was such an honor to be a part of this discussion about sickle cell–to see the desire for us to “Use the C word” according to NIH Director, Francis Collins.

What’s the C word?


Excited to be around the SCD movers and shakers