For more than two decades, I have practiced emergency medicine. The job trains you to recognize patterns quickly because sometimes the pattern is the difference between sending someone home and recognizing a catastrophe that is still assembling itself. A heart…
For more than two decades, I have practiced emergency medicine. The job trains you to recognize patterns quickly because sometimes the pattern is the difference between sending someone home and recognizing a catastrophe that is still assembling itself.
A heart attack arrives after years of vascular disease and suddenly becomes an emergency. A stroke may represent decades of biology revealed in minutes. Sepsis can turn a functioning immune system into something …
Fibromyalgia is a chronic nociplastic pain syndrome characterized by widespread musculoskeletal pain, fatigue, non-restorative sleep, and cognitive difficulties (often called "fibro fog"), frequently accompanied by other symptoms such as mood changes or overlapping conditions like irritable bowel syndrome. It arises…
Fibromyalgia is a chronic nociplastic pain syndrome characterized by widespread musculoskeletal pain, fatigue, non-restorative sleep, and cognitive difficulties (often called “fibro fog”), frequently accompanied by other symptoms such as mood changes or overlapping conditions like irritable bowel syndrome. It arises primarily from altered central nervous system pain processing rather than peripheral tissue damage or inflammation.
Myth: Fibromyalgia is “all in the head” or purely psychological
This is dedicated to my fellow Zebras. I hear you. I see you. This is not an easy story to share, but I want to do so in the hope of bringing greater visibility to conditions that are often overlooked…
This is dedicated to my fellow Zebras. I hear you. I see you.
This is not an easy story to share, but I want to do so in the hope of bringing greater visibility to conditions that are often overlooked and poorly understood. This reflection explores my experience as both a patient and doctor navigating hypermobility and its associated conditions. My aim is to help reduce delays in diagnosis, encourage clinicians …
I live with eosinophilic esophagitis, often called EoE. It is an uncommon chronic immune condition that affects the esophagus. Living with it has involved appointments, procedures, uncertainty, and the ordinary disruption that happens when your body does not follow the…
I live with eosinophilic esophagitis, often called EoE. It is an uncommon chronic immune condition that affects the esophagus. Living with it has involved appointments, procedures, uncertainty, and the ordinary disruption that happens when your body does not follow the plan.
That experience taught me something useful, but not what people sometimes assume. It did not make me an expert in every uncommon disease. It did not give me permission to …
For years, doctors told this pediatrician her pain was fibromyalgia and depression. It was quietly starving her aorta. Victoria Rundus is a board-certified pediatrician who spent four years being misdiagnosed before an ER physician finally listened to her abdomen and…
For years, doctors told this pediatrician her pain was fibromyalgia and depression. It was quietly starving her aorta. Victoria Rundus is a board-certified pediatrician who spent four years being misdiagnosed before an ER physician finally listened to her abdomen and heard what everyone else had missed. This episode is based on her …
Medicine tells a clean story about diagnosis. A set of symptoms appears. A clinician evaluates them. Tests are ordered. Patterns emerge. A name is assigned. Uncertainty resolves. That version is comforting because it suggests order: cause, method, resolution. It also…
Medicine tells a clean story about diagnosis. A set of symptoms appears. A clinician evaluates them. Tests are ordered. Patterns emerge. A name is assigned. Uncertainty resolves. That version is comforting because it suggests order: cause, method, resolution. It also collapses under sustained complexity. For some patients, that collapse is not theoretical. It is lived over years.
Our son started entering hospitals at 8 months old.
F*ck fibromyalgia? No, f*ck diagnostic bias. I'm in pain today, so please forgive the profanity. Pain has become a constant companion for me for several years now, though some days are worse than others. I am also a pediatrician, which…
F*ck fibromyalgia? No, f*ck diagnostic bias.
I’m in pain today, so please forgive the profanity. Pain has become a constant companion for me for several years now, though some days are worse than others.
I am also a pediatrician, which means I am one of the “nice doctors” who does not curse. I have never been particularly good at following that expectation outside of the exam room.
What if the cure for physician burnout isn't a wellness workshop but a 10-minute exercise you can do alone in a quiet room? Brian Sayers is a rheumatologist in Austin, Texas, with nearly 40 years in private practice who founded…
What if the cure for physician burnout isn’t a wellness workshop but a 10-minute exercise you can do alone in a quiet room? Brian Sayers is a rheumatologist in Austin, Texas, with nearly 40 years in private practice who founded an anonymous counseling program that has funded almost 4,000 visits for …
On November 22, 2025, Tatiana Schlossberg, a 35-year-old journalist and the daughter of Caroline Kennedy, announced that she was dying from a rare and particularly aggressive form of blood cancer called acute myeloid leukemia (AML). In a heart-wrenching essay in…
On November 22, 2025, Tatiana Schlossberg, a 35-year-old journalist and the daughter of Caroline Kennedy, announced that she was dying from a rare and particularly aggressive form of blood cancer called acute myeloid leukemia (AML). In a heart-wrenching essay in The New Yorker, she described having been diagnosed with the disease just a few hours after delivering a healthy baby girl and when she was seemingly in the prime of …
If you are a child of the 1960s, chances are your mother or grandmother made some of your clothes from scratch. They would go to a fabric store, look through the hundreds of small packets of printed sewing patterns, and…
If you are a child of the 1960s, chances are your mother or grandmother made some of your clothes from scratch. They would go to a fabric store, look through the hundreds of small packets of printed sewing patterns, and select their next project. The patterns were sheets of thin tissue paper containing outlines of how the fabric should be cut, with instructions on how to piece them together. My …
For those who know me personally, you know that I have vitiligo. Vitiligo is an autoimmune disease affecting the skin, where there are patches of depigmentation (the skin appears white or pink). It is sometimes associated with other medical conditions.…
For those who know me personally, you know that I have vitiligo. Vitiligo is an autoimmune disease affecting the skin, where there are patches of depigmentation (the skin appears white or pink). It is sometimes associated with other medical conditions.
I met someone recently and they said that they were curious about my skin. I am used to looks or questions and am happy to educate people about vitiligo, so I …
Some illnesses do not storm the body to the brink of death. They don't show up in emergency rooms or leave dramatic scans behind. Yet they quietly hollow a life from the inside, stealing ease, stealing spontaneity, turning ordinary days…
Some illnesses do not storm the body to the brink of death. They don’t show up in emergency rooms or leave dramatic scans behind. Yet they quietly hollow a life from the inside, stealing ease, stealing spontaneity, turning ordinary days into endurance tests. Autoimmune disease and chronic pain often live in that space: not terminal, but relentless; not fatal, yet capable of dimming the world so deeply that survival becomes …
I have often heard people speak of numerology, weaving destinies around digits. They say that behind every event in a person's life lies the hidden hand of numbers. I do not know if such beliefs hold scientific truth. Yet, in…
I have often heard people speak of numerology, weaving destinies around digits. They say that behind every event in a person’s life lies the hidden hand of numbers. I do not know if such beliefs hold scientific truth. Yet, in medicine, numbers certainly matter. Numbers fill our trial registers, power our statistics, shape our protocols. In research, life is reduced to codes, columns, and counts.
Some battles announce themselves with trumpets; others creep in silently, spreading their fire unseen. His battle was the latter. What began as a hidden spark in his muscles had grown into an inferno consuming his young body from within. He…
Some battles announce themselves with trumpets; others creep in silently, spreading their fire unseen. His battle was the latter. What began as a hidden spark in his muscles had grown into an inferno consuming his young body from within.
He was barely thirteen, a boy from Bihar, when fate dragged him into this fight. By the time he reached us, fever had bound him for three relentless weeks. His pulse was …
I had been hearing so much about burnout in medicine; and one day, I realized it had crept up on me. It began at my mother’s funeral, when an acquaintance, a former family friend, approached me asking me to examine…
I had been hearing so much about burnout in medicine; and one day, I realized it had crept up on me. It began at my mother’s funeral, when an acquaintance, a former family friend, approached me asking me to examine her painful toe. I tried to avoid her, yet I could not say no. Through my grief and exhaustion, conditioned by years of striving to live a life of purpose, …
I was at one of the lowest points of my medical training. I had just finished my second-year exams. The stress had left me feeling hollow, anxious, and utterly drained. It was in this fragile state that my own body…
I was at one of the lowest points of my medical training. I had just finished my second-year exams. The stress had left me feeling hollow, anxious, and utterly drained. It was in this fragile state that my own body turned against me.
It started with a fever that would appear every evening. I told myself it was just the change of season. I took paracetamol and tried to ignore it. …
Introduction When I first arrived in North Carolina several years ago, I thought happiness would come easily. I had completed my medical education in Nepal, was ready to serve as a physician in the U.S. health care system, and carried…
Introduction
When I first arrived in North Carolina several years ago, I thought happiness would come easily. I had completed my medical education in Nepal, was ready to serve as a physician in the U.S. health care system, and carried the excitement of new beginnings. But I learned that happiness is not automatic—especially for physicians navigating American health care while maintaining their sense of purpose.
The transition from practicing medicine in Nepal …
I was midway through a busy afternoon clinic when my pager erupted—an inpatient consult request. The case sounded messy: Chronic pancreatitis that had suddenly spiraled downward. A fresh, sizable mass sat in the pancreatic head; tumor markers were positive. Two…
I was midway through a busy afternoon clinic when my pager erupted—an inpatient consult request. The case sounded messy: Chronic pancreatitis that had suddenly spiraled downward. A fresh, sizable mass sat in the pancreatic head; tumor markers were positive. Two endoscopic biopsies had failed, and surgery felt too risky for this frail patient. Cancer seemed the only plausible answer.
Rheumatology—my service—was called in because her ANA was weakly positive (1:40). In …
As a quadruple board-certified physician and a patient with a complex autoimmune disease, I live on both sides of the examination table. My professional life is about finding answers; my personal life has been about the agony of waiting for…
As a quadruple board-certified physician and a patient with a complex autoimmune disease, I live on both sides of the examination table. My professional life is about finding answers; my personal life has been about the agony of waiting for them.
This dual perspective makes it impossible to ignore a systemic problem in modern medicine: A class of diagnoses that live in the shadows. Seronegative Sjögren’s, mast cell activation syndrome (MCAS), …
Every week, I speak with patients who have spent years—sometimes decades—searching for answers. They've seen rheumatologists, neurologists, cardiologists, physical therapists, and more, trying to piece together a puzzle that no one provider seems to fully understand. Their symptoms are dismissed…
Every week, I speak with patients who have spent years—sometimes decades—searching for answers. They’ve seen rheumatologists, neurologists, cardiologists, physical therapists, and more, trying to piece together a puzzle that no one provider seems to fully understand. Their symptoms are dismissed as anxiety, growing pains, or “just part of being flexible.” But the truth is often something far more complex: A connective tissue disorder like hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobility …
