Congratulations to our 2024 Winner!
Christopher Podgorski
Partly motivated by my own experiences with food allergies and anaphylaxis, I chose the immune system for my fifth-grade assignment, a report on a system of the body. Unfortunately, my science teacher nixed my choice, telling me that the immune system was "not really a system." Though derailed from the start, and after a detour into chemical engineering, I found my way to medicine, and increasingly, back to the immune system. A biomedical engineering course on the development of monoclonal antibody therapeutics, taken late in my undergraduate engineering coursework, changed my career path. This time I was not so easily deterred. While I had many initial interests during my medical school clinical rotations, I was again drawn back to immunology when I admitted a patient with Crohn's disease suffering from an infliximab-induced lupus-like syndrome. This unusual presentation was a reminder of the complexities of our immune system, both its power and specificity to protect us from "other", and its destructive capability when misdirected against "self". I was hooked, and I began the pivot towards rheumatology.
My fellowship at Washington University in St. Louis, Missouri presented more opportunities to witness the full spectrum of complex rheumatologic disease processes, often with multi-organ involvement and complicated therapy. One of the most impressive cases I have been involved with was a young girl who was suffering from a lupus flare and diffuse alveolar hemorrhage refractory to rituximab. While counseling her on fertility risks and egg preservation prior to starting cyclophosphamide, I found myself wholly unsatisfied at the use of a toxic and nonspecific immunosuppressive. Nonetheless, it was remarkable to watch her stabilization and slow improvement with the right choice of therapy. Patients like this, with so much at stake, have been the most intriguing and gratifying to work with over the course of my fellowship training. I am humbled by how a system designed to protect can be misdirected to harm and destroy.
I have now chosen to pursue a career in community-based clinical rheumatology practice that will allow me to foster meaningful patient relationships and effectively manage their disease over time. The known increasing prevalence of rheumatic disease requires a need for thoughtful, specialized care. While I find fulfillment in unpacking diagnostic challenges, I also am motivated by the nuanced choices of treatment planning on an individual level. There is ample opportunity to develop personalized medicine, including targeted therapies and testing of drugs in combination that may be able to help patients at earlier stages of disease and with fewer toxicities. The development of these therapies and the possibilities they hold within the greater field of rheumatology are exciting to me. Additionally, teaching patients about the disease and goals in treatment returns a sense of autonomy to the patient. Emphasis on quality of life and shared decision-making provides a platform for comprehensive patient care that I find deeply satisfying. Contrary to what my fifth-grade science teacher may say, I hope to impress upon them the significance of the immune system as a real body system and its deep complexities.