Was Your First Job a Perfect Fit? Is it Ever?

The candidate seemed like a good fit for the position we were advertising. She was a new graduate, had the requisite college degree, and impressed the Human Resources phone screener. She was punctual for her interview, had obviously researched our company online, gave appropriate answers to our questions, and asked the right ones of her own. The reference checks were all positive, and after a bit of salary negotiation, she accepted our offer. We welcomed her to the fold.

The first week seemed to go well. Corporate orientation, the lab orientation, review of our electronic Standard Operating Procedure Manuals, shadowing of co-workers–all the usual. Even a perfect score on our (admittedly simple) open book test on lab techniques. So I was not quite prepared…

I walked into my office at 6:00 a.m. Monday morning. Less than 30 seconds later, she was telling me “I need to tell you that this job is not a good fit for me. I am resigning.” It was an out of the blue stunner. In a bit of a pique, I asked her to leave immediately and let her know NOT to use us a reference. And in a flash, she was gone.

Later that day, after I had cooled off a bit, I emailed to ask her what she meant by “it was not a good fit.” She responded promptly that she had not anticipated that she would have to do the same thing every day. This surprised me, as the duties had been pretty much laid out during the interview process. We are a diagnostic laboratory. Every day we get specimens, every day we process them. Everyone is free to make suggestions for changes in our processes, but the daily requirement doesn’t change.

In retrospect, she was probably over-qualified (my bad) but what entry level job isn’t repetitious or not quite the perfect fit? The new associate in a law firm does the scut work, a sales person sells every day, the beginning of my pathology residency was autopsy after autopsy. But aren’t those great chances to learn work etiquette, teamwork, and inner resolve?

The same day, I read an article in the New York Times, “On Campus, Failure is in the Syllabus.” Smith College has found it necessary to teach their students what it means to screw up. Many of them have never had to deal with failure, and just don’t know how. A sequela of the participation trophy era? As I grew up I earned plenty of academic honors but flopped miserably when trying out for any basketball, baseball or football team. I dealt with it and moved on. It was what you did. It seems students at Smith and other colleges just don’t know about that.

We will interview more candidates. I will be sure to make crystal clear that the job “is what it is.” And I think I will add in a new question. “What have you failed at.” Because there will be days when the specimen delivery is late and the formalin spills and label machine jams. I don’t want it to be the first time our new employee has ever experienced a setback or ever missed a deadline! I will want to know they have the fortitude to keep on going. It’s what you do!

The opinions expressed are those of the author and not the opinions of UroPartners, LLC

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Will Digital Microscopes Replace the Real Thing?

professional-microscope — My microscope ready for action

Ask a gaggle of anatomic pathologists what their most important tool is, and they will almost certainly tell you it is their microscope. Ask them who their most intimate friend is and they may tell you the same thing. We know every metallic curve and protuberance, every knob and dial. Line up five microscopes in the dark and I doubt any of us would have any difficulty identifying our own by feel alone. We have chosen each eyepiece with care and selected the magnification we want on each objective. Those of us who do lots of very high power work such as examining blood smears or bone marrow aspirations do our best to keep the immersion oil we use from infiltrating every crease and crevice, not always with success.

I am on the third ‘scope of my professional career, an Olympus model with an ergonomic head and five different magnifications. It has a video attachment so that I can share my findings with my colleagues and take photographs, but like every pathologist for over one hundred years, I am looking through my eyepieces at an actual glass slide when making my diagnosis. The dimming of that era is beginning. The microscope may be on its way to joining the typewriter and the land telephone line in the Smithsonian Museum Hall of Relics.

There has been much interest in “liquid biopsies,” extracting DNA from a patient’s bloodstream to diagnose cancer and other diseases. Progress has been made, but widespread utilization is still more than a few years away. The change I am talking about is happening now. In April the FDA gave Royal Philips, a Dutch firm, permission to market its Intellisite digital pathology system for primary diagnosis in the US. What is the Intellisite and why could it spell the end to my intense affair with my microscope?

First let us examine how the slide under my microscope objective was made, and how it got to my desk.

The biopsy tissues we receive are transported to us “fixed” in formalin which prevents deterioration.
Our histology team then processes the tissue (we use a special laboratory microwave for the processing) to prepare it for paraffin infiltration.
The tissue is placed in a plastic cassette which is then filled with paraffin wax. The wax also infiltrates deep into the tissue, solidifying it.
A histotech cuts the tissue block into thin sections, which float on a water bath and are scooped onto a glass slide.
The slide is stained with a variety of dyes and passed on to the pathologists.
The pathologist examines the slide under the microscope and determines the proper diagnosis.

So what changes with digital pathology? Virtually nothing, until the end game. Instead of the slide being turned into the pathologist, the digital system photographs the entire slide creating a virtual image that can be seen on a local digital network, or with enough bandwidth, on the Internet. Instead of moving the slide along the flat stage of a microscope, we maneuver the image using a mouse or keyboard. Just like the original glass slide, the virtual image can be viewed at varying magnification. And just as radiologists can read an x-ray from anywhere in the world, pathologists will have the same ability with digitized slides.

Now that Philips has gotten the OK to market this system, are changes going to happen overnight? Not at all. Radiology changed quickly because it was possible to eliminate x-ray film and go directly to digital images. But as we have seen, in pathology the glass slide must still be prepared, a time and labor intensive operation. Digitizing doesn’t eliminate any of this; it is an additional step. And the equipment won’t be cheap.

Other hurdles? Reading a digitized slide takes some training. I have had the opportunity to examine them in training courses and my comfort level in making a diagnosis definitely doesn’t match the confidence I have with the glass slide on my ‘scope. In addition, state health agencies may restrict how and by whom slides of patients in their states can be read.

The early use of digital will probably be in consultation, seeking an expert opinion on a particularly tough case. Currently, if I want to do that, I package the glass slide and FedEx it to my consultant. Moving the case from the recipient hospital loading dock to the consultant’s desk may add a day or two to the process. An electronic way to send the case eliminates much of this delay. Voila! Instant consultation. There will also be some use in remote hospitals and in small hospitals that are part of larger medical systems but don’t necessarily have pathologists on site.

But for now, I can continue to have a relationship with my microscope. I think she will last as long in this business as I do . Of course, I said that about my old flip phone too!

Miss yesterday’s post? Click here: A Dad’s Look at his Daughter’s Wedding.

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Tears for the Father of the Bride

We gave Alex our blessing, and I didn’t cry.
We toasted Laury and Alex’s engagement, and I didn’t cry.
We chose the hotel and the band, the florist and the photographer, and I didn’t cry.
We saw Laury model her gown, and I didn’t cry.
We sent invitations to friends and family everywhere, and I didn’t cry.
We counted responses and unpacked gifts, and I didn’t cry.
We picked the menu and planned the seating arrangements, and I didn’t cry.
We rehearsed and watched the video montage, and I didn’t cry.
We dressed and primped, and I didn’t cry.
We posed for the photographer, and I didn’t cry.
We witnessed the Ketubah signing, and I didn’t cry
We lined up for the procession, and I didn’t cry.
We entered the room and took our place by the Chuppah, and I didn’t cry.
We anticipated as the trio began playing “Edelweiss,” and I didn’t cry.
We beamed as Laury walked down the aisle, and I didn’t cry.
We listened to the Rabbi as he married together our daughter and our new son-in-law, and I didn’t cry.
We dined, we danced, and we laughed with our guests, and I didn’t cry.
We gave our toasts and cheered as our son Michael give his, and I didn’t cry.
We “Raised our Glass,” we were elevated by the Horah and we went down low to “Shout,” and I didn’t cry.
We hugged our guests as they left, and I didn’t cry.

All night long I smiled and smiled. And yes, at the end of the night my eyes were still dry. Amidst it all, the celebration, the excitement, the music, and most of all amidst all the love, I just didn’t have room for tears. But maybe I will shed one or two now. Or maybe a whole flood. You never know.

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The Most Humiliating Event in my Semi-Public Life. It is Not This Blog.

pathwise — The Pathwise Logo, circa 1997

There is always a moment or two of panic. With every new blog, there is the worry that no one will read or respond to it. That fear leads to moments of hesitation before I hit the “Publish” button, and another when I send word of the new post to my mailing list (you can join the mailing list down below.) Then there is the concern that a blog doesn’t belong on a Facebook page, that the post will be mocked, or even worse, ignored. Fortunately, nothing like that has ever happened. Nothing I have written has ever gone viral, but on the other hand with almost every blog someone tells me it’s their favorite piece. So I have never been truly embarrassed on the digital pages of ChicagoNow.

My other public ventures have been pretty much red-faced free too. While I may have asked some naive questions early in my tenure on the local school board, and probably later in my tenure too, I don’t think I ever really embarrassed myself. And the commencement addresses I gave as President of the Board were generally well received, even the year I opened with the history of our dog, Max. Eventually, even that speech had a point, and people seemed to get it. I was also careful to never trip any of the graduates coming on stage to get their diploma and shake my hand.

My TV appearances have been less than fully satisfying (second place finishes never are) but not a total humiliation. Lots of people don’t know how to spell Navratilova or might confuse the University of Iowa with Iowa State University. At least I knew that T.S. Eliot won a posthumous Tony Award for Cats. And my onstage appearance at DisneyWorld playing a newscaster during the Gorbachev-Reagan years? I carried it off with aplomb, successfully broadcasting my “He wanted to see the Russian Dressing” line.

So where have I stumbled and landed flat on my face? Let’s go back to the mid 1990’s. The Internet was just beginning to rock. I created a small business, almost a hobby, called Pathwise, “translating” diagnostic biopsy reports into plain English for people who wanted to understand their results. I had a website, a toll-free number, and even a publicist. He did a good job getting feature articles for Pathwise in a few ladies magazines and Sunday supplements. (Only one of the magazines replaced our phone number in their story with the toll-free number for Gamblers Anonymous.) But he was also the seed of my humiliation.

My publicist decided to list me in a circular of speakers used by radio stations to hunt down speakers for their talk shows. This was at the height of some Clinton health care iniative, and unbeknownst to me I was listed not as a pathologist with a business, but as a healthcare legislation”expert”. And I got bookings! I was the featured guest on two different radio call-in shows, each somewhere in the plains of middle America. On both shows the hosts gave their spiel, I gave mine, and it was clear we were on very different pages as to how we wanted the scheduled half hour to go.

I don’t know how many listeners there were. I don’t know if either of these guys had Arbitron Ratings that could be seen without a microscope. But I do know that the combined number of callers for both shows was Zero. Zilch. Nada. Dead Air. If anyone had been listening I am sure they turned off or tuned out. And if I were the manager of those stations I would have immediately fired whoever booked me as a guest. Absolute humiliation. That’s why you will never get me as a guest on a radio show or even a podcast again…there is only so much embarrassment a guy can take!
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President Trump’s Birthday–What Would be Enough?

presidential-seal — The Presidential Seal

President Trump, today is your birthday.

At Passover Seder, a celebration of freedom from tyranny, it is customary to sing “Dayenu”. The word means “it would have been enough,” and recognizes all that God had done to free the Jewish people from bondage in Egypt over 3000 years ago. With that in mind, what “would have been enough” for me to wish you a Happy Birthday?

If your business career had been honorable and your workers and creditors treated fairly, it would not have been enough.
If you had spent your life respecting women rather than taking advantage of them and bragging about it, it still would not have been enough.
If you had truly debated your Republican Primary opponents rather than insulting and belittling them, it still would not have been enough.
If you had run campaign that had embraced the disabled rather than mocking them, it still would not have been enough.
If you had surrounded yourself by reasonable men and women and learned to listen, it still would not have been enough.
If you had a vision of a great America that was an inclusive America, it would still not have been enough.
If you had not tried to convince America that Hillary Clinton was the devil, or at least married to him, it still would not have been enough.
If you had valued a free press rather than decrying “fake news”, it still would not have been enough.
If you had accepted your victory with grace and thoughtfullness, it still would not have been enough.
If you had appointed Cabinet members who were worthy of sheparding their departments with policies that would maintain our greatness and world leadership, it still would not have been enough.
If you had endorsed immigration policies that were Constitutional and balanced, it still would not have been enough.
If you had treated our allies with cordiality and respect, it still would not have been enough.
If you had proposed a budget with numbers that added up, levied taxes where needed, and supported rather than slashed, it still would not have been enough.
If you had recognized and acted on the data that the world’s scientists were giving you, it still would not have been enough.
If you had desired bridges instead of walls, it still would not have been enough.
If you had worked with Congress to improve health care in this country rather than mindlessly “repealing and replacing” the system we have, it still would not have been enough.
If you had understood and respected the checks and balances of our tripartite Federal government, it still would not have been enough.
If you had recognized the role of the President of the United States was the greatest honor on earth, not a mechanism for forced adulation and familial wealth, it still would not have been enough.

Maybe I ask to much–but I don’t think so. If you were a mensch, that would be enough for me to wish you a Happy Birthday.

The opinions expressed are the opinions of the author and do not represent UroPartners LLC.

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What Would The New York Times Say About YOUR Wedding?

young-barb-and-les — The future Dr. and Mrs. Raff at a prenuptial event.

With Laury and Alex’s wedding less than a week away, it is no surprise that I have matrimony on my mind. Maybe that is why I was stopped cold by a headline in Saturday’s digital New York Times. I read The Times for its political commentary, but I was intrigued by the headline “Irresistible but Unavailable, at Least for a While.” The article used the NYT high-falutin prose to document the courtship of a former Miss Teen US Continental to an employee of the National Football League. The story is complete with the romantic hold outs, hard-to-gets, and almost giving ups. It is tale of love and desire that instead of being in Us Magazine has somehow claimed one of the tops spots on my Times “Recommended for You” clicklist.

I started to wonder how a high class rag like the Times might have described the courtship and nuptials of Barb and I way back in 1978–assuming we had been fortunate enough to attract their notice. It might have gone something like this…

Barbara Sue Jacobs and Lester John Raff were married November 12 in a ceremony and luncheon at the aging Drake Hotel in Chicago. Rabbi Howard Addison, a former youth group leader of the groom, served as officiant and stayed for lunch.

Mrs. Raff, 22, is an Occupational Therapist at the Rehabilitation Institure of Chicago. Occupational Therapy, also known as Jewish Physical Therapy, is the practice of preparing patients for the activities of daily life. She is a graduate of the University of Illinois, reknowned as the home of Garcia’s Pizza and a library built underground so as not to block the cornfields from sunlight. She is the daughter of Lee and Bea Jacobs. We at the Times are happy to say the senior Jacobs both hail from the East Coast and are thus worthy of mention.

Mr. Raff (soon to be Dr. Raff,) also 22, celebrates Northwestern University as his alma mater. NU, as he affectionately calls it, still trails archrival University of Chicago in Big Ten Championships, despite U of C dropping out of the league prior to World War II to concentrate on building atomic bombs. He is currently a student at the Abraham Lincoln School of Medicine of the University of Illinois. (During his life, Mr. Lincoln, an attorney and not a physician, repeatedly denied the rumor that he gave Governor of Illinois several shoe boxes of cash to name the Medical School for him.) Mr. Raff is currently interested in pursuing a career in pathology, the art of being a doctor without having to see patients.

The relationship between Mr. and Mrs. Raff began while watching a televised program in the social hall of the Medical Center Dormitory, when both were residing on the mostly deserted campus during a weekend. A nearly silent first date consisting of observing a polo match and pizza followed several weeks later. Attendance at polo matches was not to be repeated by the couple, though pizza dinners were to become a standard. Other future encounters included visits to The House on the Rock in Spring Green Wisconsin, the University of Illinois at Champaign-Urbana, and a Neil Diamond concert. According to Mr. Raff, “I really knew she was the girl for me when she cursed out the gang-gangers hanging out on the street in front of my rat infested Wrigleyville apartment.”

The wedding party consisted of numerous friends and relatives. Chicken was served.

It sounds so classy! I hope Laury and Alex can compete.

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Ninety Years of Music-Neil Diamond and U2 Play Chicago

Barb and I completed our bookend concerts Saturday, on a very temperate moonlit night at Soldier Field. The Lumineers “Hey-Ho-ed” the opening, and an hour later U2 rocked the crowd with their Joshua Tree anniversary tour. A nice evening out, marred only by total human gridlock leaving the stadium after the show. I suppose the crowd flows more freely after Bear games, with disappointed fans starting to leave halfway through the fourth quarter rather than everyone waiting for the final note from the Edge’s guitar.

The week before we were parked in the United Center for Neil Diamond’s return to Chicago. Neil is an act that Barb has watched transform from the urgent young man in black leather, through the glitz and glitter of the Jazz Singer days, into a mature, almost low-key performer. There was no opening act, but eye candy for the audience was provided by one spectator whose skin tight gold lame dress barely covered any of her very abundant “assets.” She openned more eyes than a Patrick Kane spin-o-rama shot on goal.

A pair of concerts, different as can be, but both celebrating the music of our generation. Both evenings so good, so good so good.

Here is a quick concert quiz. You don’t have to have been at either concert to score a perfect 100%!

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