Within hours of receiving two publishing rejections, I received a laboratory result that should have delighted me. My estimated glomerular filtration rate, or eGFR, was 86.
Instead, I found myself staring at a different number. Ninety.
Like many physicians, I know exactly how absurd that sounds. We spend our careers teaching patients not to obsess over single laboratory values. We explain that trends matter more than isolated data points. We urge them to look at the overall clinical picture rather than fixating on one number highlighted in red on a laboratory report.
Then we become patients. Suddenly all that wisdom evaporates.
I had momentarily forgotten another number. Forty-seven. That was my eGFR on September 16, 2024.
Real physician voices, twice a week
Free, and one click to unsubscribe.
The difference between 86 and 90 is 4 points. The difference between 47 and 86 is 39. Yet my attention drifted immediately to the smaller number.
The medication responsible for much of that improvement had been prescribed primarily to protect my kidneys. Like many newer therapies, however, its benefits extended beyond the organ that originally attracted my attention. Over time, my kidney function improved substantially.
But the kidneys were not the whole story. Earlier in my evaluation, another test had presented a much more alarming picture.
A CT scan of my coronary arteries suggested significant coronary calcification. The report implied the possibility of extensive coronary artery disease. As physicians, we know what happens next. One test leads to another. A probability becomes a concern. A concern becomes a plan.
The discussion quickly advanced to cardiac catheterization. The invasive cardiologist approached the procedure expecting he might find lesions requiring intervention. I jokingly told friends that there was a reasonable chance he would emerge announcing that he had spent the afternoon drilling out my coronary arteries.
Instead, he found almost nothing requiring treatment. My arteries were not pristine. At sixty-eight years old, I would not have expected them to be.
What he found was mostly non-obstructive coronary artery disease, roughly 30 percent narrowing in several locations. There was no major blockage. No stent was needed. No drilling was necessary. No emergency intervention was required.
The CT scan had been frightening. The catheterization was reassuring. The difference between the two studies reminded me of a lesson physicians routinely teach but occasionally forget.
A test result is not the same thing as the truth. A screening study is not a diagnosis. A probability is not an outcome. A data point is not a verdict.
Writers understand this phenomenon as well. The literary agent who rejects a manuscript is not issuing a final judgment on its value. The publisher who declines a proposal is not declaring the book unworthy. They are providing information. Sometimes useful information. Sometimes incomplete information. Always a single data point among many.
This week, I received two such data points. One literary agent concluded that my novel was not right for his list. One publisher determined that my nonfiction proposal was not the right fit for its publishing program.
As every writer eventually learns, rejection is part of the process. So is persistence.
As I prepare for another medical procedure, I am finding that medicine contains many of the same lessons. Recently, the nursing staff carefully reviewed the medications I needed to hold before admission. Some were being held because of bleeding concerns. Others because of potential effects on cardiac rhythm. Others because they could complicate blood glucose management during hospitalization.
The explanations were thorough and entirely reasonable. Then came the final instruction.
“Be sure to get a good night’s rest.”
Moments later, I was informed that I would need to wake up at 3:30 a.m. to take my morning medications before reporting to the hospital at 5:30 a.m. Patients occasionally discover that medicine contains a sense of humor.
The nurses also informed me that my glucose would be checked every four hours during my stay. As a physician, I understand exactly why. As a patient, I suspect I will understand exactly what sleep deprivation feels like.
The older I get, the more I realize how often we focus on the wrong numbers. I worried about an eGFR that remained 4 points below 90. I worried about coronary disease that ultimately required no intervention. I worried about rejection letters while continuing to write and submit new work.
In every case, I found myself concentrating on what remained unfinished rather than what had already improved. Perhaps that is a hazard of both medicine and writing.
We are trained to identify problems. We are rewarded for finding what is wrong. We become so skilled at recognizing deficiencies that we sometimes overlook progress.
If one of my patients had come into the office and told me that his eGFR had increased from 47 to 86, I would have congratulated him immediately. I would have emphasized how far he had come. I certainly would not have focused on the 4 points that remained between him and an arbitrary threshold.
Perhaps it is time I learned to take my own advice. The most important number was never 90. It was 47.
Progress is not measured by how close we are to perfection. It is measured by how far we have traveled from where we began.
And sometimes, whether in medicine, writing, or life itself, that is the only number that truly matters.
Ronald L. Lindsay is a retired developmental-behavioral pediatrician whose career spanned military medicine, academic leadership, and national advocacy for dignity-centered neurodevelopmental care. His NIH-funded work with the RUPP Autism Network helped define evidence-based approaches to autism and related developmental disorders.
He directed the LEND Program at The Ohio State University and founded JBLM CARES, a $10 million autism resource center for military families. His writing spans clinical scholarship and long-form fiction. He is the author of The Mercy Directive and the six-novel Cassandra series, a completed political and medical fiction saga tracing the rise of the Cassandra system from its origins to its national and international legacy. His forthcoming memoir, The Quiet Architect, examines how conscience and structure collide in modern medicine.
He shares updates on LinkedIn.
