It is Time to Repeal and Replace Donald Trump

trump-7-17Eighteen months ago I started out with a gentle parody of the Republican and Democratic Primary/Debate process. A little later I turned my focus more specifically to Donald Trump.  After his win in November, I beseeched him to be a President who listened to, and governed for, all of us–regardless of age, race, profession or social status. And even this week, my mockery was passive in nature.

I do not know what finally flipped my switch. Maybe it is the cumulative weight of his tweets, his shameless disregard for protocol, his lack of any consistent policy on anything that has turned up the burn. The ongoing debacle in the Senate is made untenable knowing that there is a President who will sign any bill obliterating the Affordable Care Act, probably without even knowing the contents, just to live up to one of his loudest and least thought out campaign pledges. Donald, who knew health care reform could be so complicated?

John McCain, whom you alternately say is or isn’t a hero, gave you and the rest of the Republican Senate majority some cover to allow you to try to work with the Democratic opposition to repair a flawed but savable health care plan. But instead, you and Mitch McConnell prefer a  blaze of destruction.

Your foreign policy is a sham apparently designed to protect your personal interests; your Cabinet is mostly packed with lightweights. Your communications team is a joke, even if we must say goodbye to Melissa McCarthy’s Sean Spicer impersonation. Today you fret and tweet about transgender personnel in the military while we read that North Korea is closer than ever to developing usable ICBMs. Do you represent the country’s priorities? Are you the man we need making key decisions while the Doomsday Clock ticks closer to midnight? Or do you calculate that a nuclear war might help us forget all about your hostility to the undeniable fact of global warming? I can see the tweet now “Oops, HUGE atomic explosion, nuclear winter will prove global warming GIANT hoax. #toldyouso #bigboom.”

Walls instead of bridges, vitriol instead of vision. Six months have already been too much.

So what will it be–do we repeal you with the 25th Amendment or replace you with impeachment? The time has come for one or the other.

 

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Our Family is Learning from the Trumps–This is How

tape-recorderThe following transcript was discovered in the hidden files on Sean Spicer upon his sudden resignation as White House Press Secretary.

 

Secret taping of Raff household during Sunday Barbecue July 16

Dr. Raff: Thank you all for coming to our lovely home today for this wonderful barbecue. I am about to go out and ignite our deluxe, 24 burner, gas grill, but before I do, I think you should all let me know just how you think I have performed over the last six months. No alternate facts, just the truth. Who wants to go first?

Son-in-law:  I have only been in the family for a few weeks, but I want to tell you that this has been the most fantastic family I could ever hope to marry in to. I love your daughter, but it was knowing that you were the pater familias that prompted me to ask her to marry me.

Dr. Raff: Thank you, though I don’t like foreign words around here. They will be banned as soon as I build a wall between our back yard and the neighbors.

Son: Thanks for having us here Dad. Every day of my life has been blessed by having you as my father. As an attorney I once defended some pretty sleazy guys, so it is no problem for me to defend you in anything you do. And I swear I have never had a secret meeting with any one at any time in any place.

Dr. Raff: Thank you son. I always knew you were a smart one. But now I want to hear from your lovely wife.

Daughter-in-law: I just want to say how enlightened and enriched my life has become since I have known you. I would trust every aspect of my life to you. Even though my own father is a physician, I have no doubt that you are the best and smartest doctor I have ever met.

Dr. Raff: I can tweet that—”best doctor in the world”. And what about the little ones?

3 year old granddaughter: Baba, I love you so much, that I just want to keep hugging you and playing with you. I am so happy I see you so much. I learn so much from you.

1 year old granddaughter: Baba! Baba!

Dr. Raff: Good to  see you are both being brought up the right way. Is there anyone we haven’t heard from yet? I see a few hands raised.

Daughter: Not only did you throw us the perfect wedding, your promise to pardon us from any crime we may ever commit is the warmest and most loving gift we could ever hope for.

Dr. Raff: That’s right honey. Your daddy will always be there for you. And now my lovely wife.

Wife: Dear, I never tell you enough how wonderful  a husband, father and grandfather you are. You put the bread on our table, the roof over our heads and make sure we have health care even though that freaking Obamacare doubled our premiums. If you are ever investigated I will do my best to hide any incriminating evidence.

Dr. Raff: Thank you all. I know your praises are heartfelt and that I deserve every bit of everything that comes my way. I am going to go out now to grill some fantastic steaks with the biggest baked potatoes this country has ever seen. Great, just great.

Sound of footsteps followed by door opening and closing.

3 year old granddaughter: What a bleep.

1 year old granddaughter: Bleep right.
——————–

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photo credit: JoeLosFeliz Dictaphone1 via photopin (license)

Oops We Did it Again–Another Research Paper Tells Us Pathologists Sometimes Have it Tough, This Time With Melanoma

the-big-c
Laura Linney starred as a melanoma patient in “the big C”.

I keep saying it. Pathology is hard. I know that it is convenient to believe that when your surgeon does a biopsy and “sends it to the lab,” someone you have never met will look down the tube of a microscope, make a definite diagnosis, call your doctor immediately with all the answers and then send you a bill. After all, they call us the “The Doctors Doctor.”

Unfortunately, another scientific article says life isn’t so rosy. As the study tells us (you can also read about it in the Tribune), we don’t always know all the answers. The current study looks at the diagnosis of melanoma, the potentially fatal skin cancer that has also affected my wife Barb. The lead author, Dr. Joann Elmore of the University of Washington, was spurred to do some research after conflicting diagnoses on her own skin biopsy. Working with a pathologist, she arranged for a set of microscopic slides showing a variety of pigmented skin lesions to be sent to a group of volunteer pathologists around the country for their diagnosis. A few months later, the same slides were sent out again to the same pathologists, garnering a second round of opinions.

A “reference diagnosis” on each case was obtained from three expert pathologists and this was used to measure the accuracy of the volunteer’s diagnoses. The volunteer diagnoses were also compared to their peers, and to their own conclusions from 6 months earlier. The results? Some cases were easily and consistently diagnosed as benign, some were clearly malignant. And in the middle was a big gray zone without much agreement. Maybe malignant, maybe not.

This may have come as a surprise to the author, but not to those of us in the pathology trenches.  A similar gray zone exists throughout diagnostic pathology. It is there in lesions of the breast. It is there in my field, urologic pathology. We even have a term to describe it in prostate biopsies, atypical small acinar proliferation, or ASAP. (A good rule of thumb is that the longer the diagnosis, the more uncertain the pathologist.) No matter how many sections we cut, how many special stains we do, we just can’t reach a definite diagnosis. Maybe the cells just aren’t atypical enough, or maybe there just aren’t enough nasty looking glands, for us to say the word “cancer.” One mentor’s lesson still rings in my ear–“don’t call a prostate biopsy malignant if you wouldn’t want that patient’s prostate gland in your hand the next day.” Our methods of treating prostate cancer have changed since then, with small tumors often not resulting in prostatectomy, but the mental image is still a potent one.

So what is a patient to do in an ambiguous situation? You can ask for a second opinion, but be prepared that you may not get a resolution. Ask if there are any new tests, particularly in the molecular biology spectrum, that might help make a definitive diagnosis. That field is exploding exponentially with new tests being released almost daily. Yet sometimes it may take patience, careful follow-up, or even an additional biopsy before you have an answer.

In the meantime, we pathologists try to get better, via continuing education, increasing our experience with a variety of lesions, and interaction with our experts and our peers.The goal one day is to see the headline “Pathologists Get It Right.”

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Recent Blog Follow-Ups:

IKEA provided us with a refund for the reclaimed wall units! I still begrudge them the 90 minutes on hold.

I jumped the gun with my Game of Thrones post. Now that the season 7 premier is truly upon us, read the GOT life lessons here.

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The above blog is the opinion of the author and does not reflect the opinion of UroPartners LLC .
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Why Game of Thrones Will Make You Smarter. 10 Life Lessons I Have Learned Watching Seasons 1-6.

game-of-thronesAre you a fan? Get your kicks watching Cersei and Jon Snow and fire breathing dragons? Then I am sure that you will be home Sunday night perched in front of your favorite TV set to watch the Season 7 premiere of “Game of Thrones” live. Sure you could go to a GOT party, but that’s like a Super Bowl Party, too much attention to the food, not enough attention to the onscreen action. And who wants to wait while your hosts try to figure out how to work the remote to replay a key scene?

We will be home in front of our new 4K HDTV megaset watching HBO with rapt attention and trying to remember how last season ended. Who is good, who is evil, who is alive, who is dead, and who is somewhere in between?

We have been watching for years, and I have read a few of the George RR Martin novels. But don’t think that is wasted time! Here are 10 life lessons I have learned watching since the beginning.

  1. Dragons cause mayhem. Unfortunately, State Farm doesn’t insure for THAT type of mayhem.
  2. Shadows make perfect assasins. They don’t leave fingerprints or DNA.
  3. Pretending your nephew is your illegitimate son can screw up lots of lives. And it won’t make your wife happy.
  4. Short people got no reason to live…no wait, that’s a Randy Newman song. In GOT the short guy kills it. Literally.
  5. Immature, egotistical teenage megalomaniacs make less than ideal rulers. No matter how old they are.
  6. Dogs WILL bite the hand that feeds them. And the arms, face, neck, toes etc.
  7. Walls have a purpose. When the bad hombres are White Walkers.
  8. Sex with siblings. It is as creepy as it sounds.
  9. Watching your sibling be killed by molten gold. Also creepy.
  10. Hotels charge more for Red Weddings. It’s hard to get the blood out of the carpet.

There you have it. 10 ways “Game of Thrones” has explained the world to me. Next week I’ll tell you what I have learned from “The Walking Dead…”

 

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Customer Service- This is Why We Will Go Back to Abt, but Not to IKEA

abt-vs-ikeaScenario #1: I told you about some ghosts in our machine. The new Sony TVs we bought at Abt Television and Appliances didn’t communicate well with our Comcast/Xfinity cable system. Frequent shutdowns and reboots made watching “The Walking Dead” and “Girls” even greater hardships than they otherwise would have been. In contrast, our older TVs and the non-Sonys seemed to work fine.

Every service man in the Lake and Cook counties took a shot at remedying the situation, with shiny new HDMI connectors, pulsating cable boxes and advice to start this or stop that, but nothing worked. Neither Comcast nor our TV installer had much of an explanation. My Google research DID suggest that we weren’t the only ones who had the Sony-Comcast issue, but it was as well hidden as the dark web. And other sufferers had no explanation either.

In desperation, Barb and I returned to Abt on a busy Sunday afternoon. For those of you not in the know, Abt is a family owned appliance store in the northern Chicago suburbs. Everyone shops there. We spoke with a manager who listened patiently and suggested a remedy. He would send out a floor model non-Sony television to temporarily replace one of the balking Sony’s. If that resolved the problem, the store would take back any of the sets we had difficulty with and replace them with new sets, different brands, of our choice and of equal value.

A few days later, we had the temporary replacement. It worked fine, and to our astonishment, all the other new sets now worked too! Maybe our Xfinity system had just failed when working with that many Sony sets. After all, Xfinity is not Infinity. We stopped back at Abt, spoke with our new manager-buddy, and selected the permanent replacement. Of course, we upgraded. And now everything works. A new UltraHDTV for us, a new sale for Abt. Good service and smiles all around.

Scenario #2: The house is almost furnished. But one wall in the loft still needs some bookcases.  After I nixed custom cabinetry from Stan the Cabinet Man, Barb found some workable pieces at IKEA. We worked with a knowledgeable salesman and selected the system we wanted. We chose to have IKEA deliver the pieces and do the assembly and installation as well.

The service company IKEA uses arrived at the prescribed date and time, carried the pieces to the loft, and assembled the bookcases. Then the fun began. Scanning the wall to find studs, they were shocked to find that there were water pipes in the wall. We were NOT shocked since there is a bathroom on the other side of that wall. The delivery/assembly/installation team informed us that IKEA rules prohibited them from drilling into a wall with water pipes. Calls to the delivery company and IKEA confirmed this.

“OK,” we said, “just leave the pieces and we will hire someone else to install them.”  A bit of a bother, but no big deal. “Nope,” they told us, “rules are we have to take these back to the store, where they will probably be thrown out.” Not the first time I have been amazed at the waste of a Scandanavian company!

And the aggravation continues. The next day I spent one hour and 38 minutes (yes, my desk phone has a timer,) on the phone with IKEA customer service, most of the time on hold, trying to arrange for a refund for the product that we did not have. The upshot? It will take weeks, and probably countless hours on hold before the credit appears on my Visa statement. “That,” I was told, “is the way it is.”

Scenario #1 vs Scenario #2. Which store would YOU go back to?

 

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