(In Part 1 I discussed being the man who “gives people cancer.” I promised that Part 2 would be a little background as to how I got here.)

July, 1977

A hot day during what will be a steamy summer. The elevators in the University of Illinois Hospital are always too slow and too crowded. So I take the stairs up to the 13th floor, catching glimpses of the West Side Medical Center through the stairwell windows as I climb. It’s a long way up, but likely to be the only exercise I will see on this day.

It is the fifth day of my medical student rotation in Internal Medicine. There are three others on my team: Jerry, a second-year resident, Madelyn, a newly-minted intern, and my classmate Paul. We are E-Service, one of five trainee groups responsible for the diagnosis and management of all patients admitted to the UIH. Most patients are indigent or close to it; the paying patients in the area are down the block at Rush-Presbyterian-St. Lukes Hospital. We have an attending physician, a “real” doc, as part of the service, but she dips in and out of the ward, eager to get to her Infectious Disease consults at one of the other local hospitals.

The day is a mirror of the last four and presages the rest of my two-month rotation. We care for a  young man who has lost an eye to a muscle tumor and is in for his monthly chemotherapy. A woman with Behçet’s Syndrome, suffering from ulcers from her mouth to her colon, gargles viscous lidocaine, without much relief. It is all that we have to offer to her.

In contrast to our Behçet patient, we are having much better luck treating Mr. George, an older fellow with stomach ulcers. We are using an experimental drug named cimetidine, the first of a new class of drugs called H2 antagonists. It is working wonders. By the end of the summer, Mr. George will be pain-free, and cimetidine will be released as the blockbuster ulcer drug, Tagamet.

I sweat throughout the summer. I examine patients. I take medical histories. I draw blood, do EKGs, and hold emesis basins. And I come to a realization. I don’t want to be doing this. I am good at book learning, but patient care is “not my forte and not for me.”

Following those long, hot, months, I investigated the non-patient care fields; pathology and radiology.  Glass slides seemed more tangible than shadowy images on a piece of film, and I became a pathologist. It was the right choice for me.

I recently queried physicians throughout the US, Canada, and the UK about what led them to pathology. There was a unanimous consensus that a student didn’t enter medical school aspiring to be a pathologist, though one respondent had fond memories of a childhood microscope. Analogous to me, some became disenchanted with treating patients during medical school or internship.  One felt that if he had to see one more patient he would wind up “in the stairwell with a straitjacket.” Some admired pathology professors and decided to emulate them. Others discovered they wanted to be detectives and learn the truth, and that truth was in the tissue.

All of us admit to liking the lifestyle, with the minimal call and only rare midnight hours. And a good friend tells me she feels like “an angel behind the scenes.” Who wouldn’t want that?

No, I don’t give people cancer, and neither do any of my hard-working pathologist colleagues. We search for the truth, and if at times we help vanquish cancer and other diseases, we can be happy with our lot.

The opinions above are the opinions of the author and not the opinions of Uropartners LLC.

Link to Part 1

Link to Some Thanksgiving Thoughts

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I had the following conversation with a new acquaintance at a recent dinner party:

“I do merger and acquisitions, it was slow for a while, but now it is heating up again. I do OK. How about you, what do you do.”

“I guess I do OK too. I’m a pathologist. I run a medical diagnostic lab for a big group of urologists.”

“What does that mean. You run blood tests?”

“Oh, we do some blood testing, but I spend most of my time looking at biopsies. As a urology group, we get mostly prostate biopsies to decide if they are benign or malignant.”

“So you give people cancer.”

It is not quite accurate of course. I don’t pass out diseases from a punch bowl. I am not Typhoid Mary reincarnate. No need to quarantine me. But a few dozen times a week, yes, I am the first to say “Mr. Kranz has prostate cancer, Mr. Ferrick has prostate cancer, Mr. Blaine does not.”

I have the best staff and equipment to assist me, I have my valuable colleagues to verify my work.  But in the end, it is my electronic signature on a report that is going to set into motion life-changing events. In that way, I DO “give people cancer.”

About half of the patient biopsies I see I will diagnose with prostate cancer. It is “flip-a-coin” likelihood, and like a coin flip, it sometimes feels very random. An eighty-year-old retiree with a firm prostate on the urologist’s exam may have a negative biopsy, while the 50-year-old executive with a slightly increased blood PSA level may have an aggressive tumor filling each core of the biopsy.

As with a coin flip or with the spin of a roulette wheel, things sometimes get “streaky.” There are days when I am merciless, with case after case receiving a malignant diagnosis. I feel as if I am a curse or have developed an evil eye. At other times, each biopsy I look at is bland and harmless.

After a few negative diagnoses in a row, I begin to wonder if I have suddenly forgotten what prostate cancer looks like under a microscope. I begin to worry about each minor aberration, each slightly enlarged nucleus or shrunken gland. I take a deep breath and regain my balance, knowing that over the course of a few weeks, the numbers will even out. The statistics I calculate every month tell me so.

Of course, the urologists have a harder role to play than I do.  They must tell the patients with cancer the news, apprise them of the risks and benefits of the various therapies, hold their hands and dry their tears. But they also get to pass our the good news when a biopsy is benign or when treatment is a success.

So why would I go into pathology, and deal with cold glass slides instead of warm-blooded patients? In Part 2, I look at what brought me, and other pathologists around the country, to this field. We didn’t all start out this way…

In the meantime, read up about PSA.
Rather read a shaggy dog story? Here’s the link to our previous post: It’s A Dog’s Life

I Give People Cancer, Part 2

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The opinions expressed above are those of the author. They are not those of UroPartners LLC.

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A Catholic Priest, a Protestant Minister, and a Jewish Rabbi are all asked the same question on a TV talk show. When does life begin? The Priest quickly answers “at conception.” The Minister wrinkles his forehead and says “when the Lord blows a soul into the tiny fetus.” The Rabbi grins and replies “When the kids leave for college and the dog dies!”

It’s an old joke, but it has been on my mind a lot recently. As you all know, our faithful companion and gentle giant Max passed away in April. Our sadness was profound, but there was a degree of freedom that we gained that we have not had in the last 33 years of child and/or dog parenting. Weekend days and nights out became more long and leisurely instead of “Oh, we have to get home for the dog.” But there was an emptiness when we did make it home…

I am not the “dog person” that Barb is. When we lost Max, she said she never wanted to again face the trauma of putting a loving pet down. And for the first 6 months, she held to that. But I could see her resolve was weakening and that she was beginning to ache for a wagging tail and a cool, wet nose when she returned home from work or from a day of babysitting. The kitten tried to impersonate a dog as best she could, but for Barb, it just wasn’t the same. I knew the tide had turned when Barb began reading out loud the dog histories from rescue center postings that popped up incessantly on her Facebook stream. I didn’t try to fight the urge, I just stipulated that anything under 10 pounds didn’t meet my criteria for a good dog pet.

When a free Saturday afternoon rolled around on Thanksgiving weekend, it felt like all the planets were aligned. With one of our granddaughters, we checked out an adoption “event” at a local Petsmart but saw no dogs that interested us. On our own later in the afternoon, Barb said: “Let’s check out Kay’s.” Meaning Kay’s Animal Shelter in Arlington Heights, the shelters from which both Max and our first dog Murphy had found us. It was pretty clear our dogless days were coming to an end.

It wasn’t without a bit of a battle. There was only one dog that moved us. He was 18 months old, not a puppy (good,) and he weighed more than ten pounds (even better,) but we had competition. A young couple had seen the pooch a few minutes before we had, and seemed infatuated with him. They were only concerned that there might be a “situation” between this pup and Gimlet, their beloved Irish Terrier. The wife went home and brought Gimlet back with her. The two dogs played together well at first in the fenced-in yard at Kay’s  but after a few minutes, some teeth were bared and the dogs decided they didn’t care for each other all that much. Barb and I looked at each other, knowing what the other couple would decide, and that the little four-legged fellow would be spending his life in our home.

The shelter called him a Pomeranian mix. With his curly tail, Barb has him pegged as a Shiba Inu. On a call from her Thanksgiving break in Palm Springs, Laury named him Milo, adding to the litany of “M” names for our dogs.  He has been a prince since Saturday, readily adapting to our house and yard. Yes, we had to do some schedule rearranging, and quickly hire a dog walker for those days when we both work. And carry out dinners replaced restaurants over the weekend. But the smile on Barb’s face when Milo cuddles up in her lap proves that life begins when it begins in your heart.
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My vision for Thanksgiving 2018.

The Oval Office, Monday, November 26, 2018, the first workday after Thanksgiving.  President Donald Trump (R), meets incoming House Majority Leader Nancy Pelosi (D-CA), and  incoming Senate Majority Leader Charles (Chuck) Schumer (D-NY.)

******

Schumer: Now that all the disputed districts have been finalized, I think it is pretty clear Democrats are going to have a majority in both Houses, Mr. President. That doesn’t mean we won’t work with you. We aren’t veto-proof, we know that.

Pelosi: It’s been two years Mr. President, and we now agree it is time to Make America Great Again.

Schumer: And we know where to start Mr. President. We are ready to reach across the aisle and with our Republican partners, we will fulfill your greatest election promise. We, the Democrats of Congress, with your help, are ready to repeal and replace Obamacare.

Trump: You’re only ready to take this step because I am the master negotiator. I’m the one with the biggest balls. I stared down that little punk Kim Jong-Il. I stared down that little punk Al Franken. I stared down that little punk Paul Ryan. I’ve got no problem staring down the Democratic Party. So what is your timeline?

Pelosi: First we repeal the Affordable Care Act. And then we replace with a plan that includes great features.

Schumer: We’ll include portability.

Pelosi: We’ll cover all pre-existing conditions.

Schumer: Kids until age 26, no problem.

Pelosi: Medicaid expansion, millions of additional people covered. And a government option across all states.

Schumer: Nancy, don’t forget to tell the President about the individual mandate, we talked about the mandate.

Pelosi: Yes, the mandate. We’ve got to have the mandate. And we pay for it all with a 2% increase in the inheritance tax.

Trump: This is a disaster, this is worse than Obamacare. If you ever pass this I’ll veto it and kick your asses out of Congress.

Schumer: But wait for the best part.

Trump: Best part? There is no best part, this is all terrible. You’re all insane. You’re all fired.

Pelosi: The best part is…

Schumer: …we name it THCAmerica.

Trump: THC?

Pelosi and Schumer: TrumpHealthCare

Trump: I love it. It will be HUGE. Where do I sign?

********

Well, I can dream, can’t I?
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It was a cold afternoon at Soldier Field on Sunday. Not brutal, but cold nonetheless. The November sun did what it could to provide a hint of warmth, but long johns, two down jackets, a wool hat and fiberfill gloves did a better job.

Michael and I knew we wanted to take in a game this weekend, and using weather as our guide, going to the Bears-Lions game Sunday made a far better choice than the Northwestern football game in Evanston on Saturday, when rain and snow emptied the stands long before the Wildcats finished their 39-0 decimation of the visiting Minnesota Golden Gophers.

Michael found tickets for pretty good seats on Ticketmaster, I worked Spot Hero for some decent parking just a mile walk from the field and bundled up for a polar expedition we took in the game, my first pro game in about ten years. As we all know, the Bears, unlike the NU ‘Cats, were losers, but it was a close and exciting game, coming down to the last few seconds. Some observations from the 30-yard line:

1. There were no unlicensed vendors outside the stadium selling knock-off Bears gear. The McCaskey family must have quite a bit of clout with the Mayor, the Park District, and the Police Department.
2. Maybe they could use some of that clout to improve the pedestrian route to get from the north end of the stadium to past the Museum Campus. The crush wasn’t as bad as after the U2 concert last July, but who needs hairpin turns for 60,000 fans?
3. The Bears sideline looked a little flat. Maybe they need a picker-upper like the Northwestern Strength Coach Alex Spanos, whose tee-shirted escapades on the NU sideline in the rain showed about three times as much effort as the Minnesota defense.
4. Grilled Vienna Hot Dogs, nice touch. Men’s Rooms without urinals, odd touch.
5. The injury to Leonard Floyd was a chiller. The parade of Bears walking over to give him words of encouragement or a high five as he was carted off the field conveyed a lot of warmth.
6. The sprinkling of Lions fans in the stands had a good time and didn’t seem to be hassled, at least in my section. I have seen far worse treatment of visiting fans at college events where the true fanatics live.
7. With the game being played in “Bear Weather,” why did I pack a blanket, and then leave it in the trunk of the car?
8. During the first 50 minutes of the game, the Bear fan behind me issued more F-Bombs then the casts of  “The Wolf of Wallstreet” and “Casino” combined. They were directed at the Bears, the Lions, the coaching staffs and the refs. I have never sat near a more passionate fan. So what did he have to say during the crucial last five minutes of the game? I don’t know, he left. I guess he wanted to beat traffic.
9. Promo tee shirts getting flung into the crowd don’t fare any better in the wind than a last ditch field goal effort.
10. The Bears will be better. But it will be a few more years before they end a season with more wins than my NU Wildcats. Unless Cat’s Coach Pat Fitzgerald decides to move a few miles south. And takes Alex Spanos with him!

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Do I want to go to a concert? First, a few questions to answer. Am I a fan club member? Do I have a credit card from the bank sponsoring the tour? Will I have a chance to take a break from looking at slides in my office at exactly 9:00 am (9:01 will be too late) to log in? Do I want to go to see the show enough to make this all worthwhile? Or have my U2 days passed me by?

It used to be fun and exciting to get tickets for a show or concert or game. You could go to the box office and lay down cash. You could send a check to the stadium with a self-addressed stamped envelope (remember those?) and check your mailbox every few days in anticipation. For immediate gratification, you could call an 800 number, and armed with a BankAmeriCard or MasterCharge, order your tickets. Or if you were lucky, you knew an insider who had gotten a hold of a stack of tickets and would sell you a pair of great seats for face plus a bottle of Seven Crown. Ah yes, the Good Old Days. Barb and I saw a lot of Neil Diamond in those simpler times.

Then came the Internet, and Ticketmaster online, and automated bots getting all the front row center seats. The common consumer was left to find their way to the secondary market, the Stubhubs and Craig’s Lists of the world. You paid your money and you took your chance, as our son learned after getting ripped off on a pair of Final Four tickets.

But now the artists and the venues are creating new party games, trying to make sure those valuable tickets find their way to the “real” fans. They are doing their best to get the bots and the brokers out of business. How? It’s Pre-registration, baby!

For the last 3 weeks, I have been barraged by emails about the U2 concert at the United Center next May. Bono and the boys want ME to get insider access. Just a few things they want to know:

1. Am I a fan club member? Well, I probably am, but I sure don’t remember my username or password. And I really don’t want to be on another mailing list.
2. How about credit cards. Do I have the “preferred” one to gain pre-public access? Here I might be in luck, as my wallet contains enough plastic to build a tower to the newly discovered habitable planet 6 light years away. Citibank is the sponsor this time around and voila, I have a never used Citibank card that came with my now defunct Costco membership. So hallelujah, I am preferred. All I have to do is make the necessary preparations:

I have filled out and sent in my pre-registration form.
I have checked my phone and received my secret access code.
I have a timer set on my phone, set to go off at 8:59.
I have my Citibank card out on my desk.

My goal–tickets for 2, not too far back, not behind a pair of seven footers, and with a view of the Jumbotron. That’s what I call preferred. I’ll let you know if I succeed. In the meantime, what are your tricks to get the best seat in the house?

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Some popular recent posts:
Trump at Gettysburg
What Hillary Clinton Should Have Done

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This is where we are now. The Justice Department is being pushed by the President to investigate the Clinton Foundation. Allegations against Ray Moore are reigniting the “Bill Clinton did worse things to women than this southern gentleman ever did, and Hillary stood by him” conversation.  And we are coming to recognize just how deeply sexual harassment has permeated Hollywood, Washington and probably all places in between.

Hillary, you missed your chance to make a mark on all of these.

It wouldn’t have taken a lot, just a couple of hundred words back in late 2015, words that might have been more important than cozying up to the Democratic National Committee. Surely you and your staff could have produced a statement that went something like this:

“I want to be your candidate for the Presidency of the United States, and beyond that I want to be your President. I have the experience, the temperment and the body of advisors that will be necessary to create a successful, progressive administration. I will not fail you.

There is one matter that may cloud my candidacy. The glass ceiling I am seeking to smash is held in place by many factors. One of those factors is the impediment placed in our way by ongoing sexual harrassment and unfair treatment of women in the workplace. Men have abused their positions of power to put tough women, resilient women, creative women, in positions of disadvantage or worse. One of the men implicated in such situations, both in and out of the work place, has been my husband, Bill Clinton.

I love and trust my husband. However, I must recognize the multitude of incidents attributed to him. With that in mind, Bill will have no role in any aspect of my campaign for the Presidency. He will not fund raise, he will not advise, he will not speak on my behalf. I further pledge that during my term as President, Bill will not be a part of the administration. He will devote his time and energy to the Clinton Foundation, with the assistance of an oversight committee that will ensure the separation of the business of the Foundation from the business of the State.

Our administration will miss the experience, knowledge and talents of my husband. It is a sacrifice that I make sadly but willingly. Women must and will be respected as our country enters a new age.”

You could have done it, Hillary. Banished Bill. Acknowledged his shenanigans and harassments. Even kept him off the tarmac with Loretta Lynch. And two things might be different today. Ray Moore might be just a footnote to history. And you might be President.

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Keep your fancy oatmeal. I don’t want your prehistoric grains, your quinoa, your Kamut©. I don’t care what “multiple research studies” will have to say about the right cereal lowering the risk of heart disease in middle-aged men with a tendency towards corpulence. There is only one hot cereal for me, smooth and well-sweetened Cream of Wheat, made the proper way in a simmering pot on the stove.

I don’t know why my mother chose Cream of Wheat as the favored hot cereal for us on those cold winter mornings that we had time for a sit-down breakfast. Was it a favorite in her native Vienna? Perhaps she picked up a taste for it during her short stay in England, or maybe she was just attracted to the bright red box with the picture of chef Rastus. But on those special mornings growing up, Linda and I would enjoy a steaming hot bowl of cereal without a Pennsylvania Quaker in sight.

Through the years my preferred breakfast has changed as frequently as the Bears have changed starting quarterbacks. Early on, half a box of Salerno Chocolate Chip cookies fed my morning sweet tooth. Then a school friend introduced me to Kellogg’s marvelous innovation, Pop-Tarts. A pair of blueberry Pop-Tarts, untoasted and unfrosted, became my breakfast for most of high school.

Doesn’t a muffin sound like a healthy start? But there wasn’t much nutritional value in the overly sweet Sara Lee raisin muffins that kept me going for years. And nothing healthy in the delectable treats that drug reps used to supply on a daily basis to the Doctor’s Lounge of my old hospital in Des Plaines. Eventually, it was recognized that those tasty 50¢ morsels were an illegal inducement (I was never sure what I, as a pathologist, was being induced to do) and the drug reps stopped making daily visits with their haul from the local bakery. I entered into my “cold cereal years.”

Using my mad scientist background I experimented with preparing the ideal mix, eventually arriving at the combo of Nabisco Shredded Wheat, Shredded Wheat’n’Bran, and for a touch of sweetness, Quaker Oat Cinnamon Squares. I never add milk to cold cereal, so the mixture, which tasted like hay mixed with straw, was missing out on things like healthy fats and protein.

I moved on. For the last few years, breakfast has been whole grain toast slathered in natural peanut butter all covered with a mountain of blueberries. I get some fiber, some protein, and a nice wallop of free radicals. It gets me out of bed in the morning ready to face the long drive to the lab.

But some days the dairy aisle at Marianos or Whole Foods will call to me. I’ll pick up a pint of fresh milk (the cow variety, not the soy or almond substitutes) and look forward to the following weekend when I can stand leisurely at the stove with my metal whisk and stir up some Cream of Wheat smoothness. It takes me a long way back, and it never disappoints. My mother would be proud.

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Our Veteran’s Day Blog is on the front page of today’s Chicagotribune.com. In case you missed it here is the link: Trump at Gettysburg

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A mysterious audio file appeared on my screen this morning. I publish an unedited transcript.

“Four score and seven years ago–(what is that, about 90 years? Math wasn’t on my IQ test) our forefathers (white men, great white men) brought forth upon this continent (I got to tell you it is a great continent, loaded with coal, loaded, with coal) conceived in liberty (I would have liked to have conceived a few things with Liberty if you know what I mean) and dedicated to the proposition (or is it preposition, these 5 syllable words all sound the same) that all (white, European) men are created equal (and should be allowed to avoid inheritance taxes.)

“Now we are engaged (I have been engaged a few times-don’t recommend it, puts a crimp in the pussy grabbing) in a great (the absolute best) civil war, testing whether that nation (that we will make great again) or any nation (did you know Lincoln was a Republican?) so conceived (got to put some more conservatives on the Supreme Court) and so dedicated, can long (I have very long hands) endure. We are met on a great battle-field of that war (and they used rifles, so rifles are very historical). We have come to dedicate a portion of that field (would make a great golf course), as a  final resting place for those who here gave their lives that that nation might live It is altogether fitting and proper that we should do this. (Or we could have just compromised on this slavery thing and all gone home and watched FoxNews.)

“(Blah Blah, this is getting boring so I am going to skip ahead to my big finish.)  It is rather for us to be here dedicated to the great task remaining before us (building great walls, mining coal, making threats)—that from these honored dead (and I called one of their mothers. Lovely woman, can’t remember her name) we take increased devotion to that cause for which they gave the last full measure of devotion—that we here highly resolve that these dead shall not have died in vain (if I can remember I’m gonna tweet that and say it was my idea)—that this nation, under (my) God, shall have a new birth of freedom—and that government of rich white men, by rich white men, for rich white men, shall not perish from the earth.”

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And from me (Les) wishes for a peaceful, meaningful Veteran’s Day to all.

What should Hillary Clinton have done differently? Click here to find out.

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I have made a change. You may not have noticed, but beginning today, my blog has a shiny new name.”Downsize, Maybe” has been retired.

When I started writing in the middle of 2015, Barb and I were still contemplating what sort of house we would build. We thought we would probably be downsizing, but we weren’t quite sure that things would turn out that way, hence the original title of the blog “Downsize, Maybe.” I wonder if anyone recognized the phrasing as a take-off on the hit song, “Call Me Maybe?” As Carly Rae Jepsen sang, and Barb and I knew, “this is crazy.”

So a lot of the early posts, particularly from the pre-ChicagoNow days, were adventures in home designing, financing, and building. It was often a rocky road (when isn’t it) and lots of the frustrations made it into these pages. But Barb and I have been in the house since January, and since that time we are just typical suburbanites. I really haven’t written very much about our “Crystal Palace” these last few months. So like Dart on Stranger Things, the time has come for this blog to molt its skin and take on a new identity. “Downsize, Maybe” is becoming “Getting More From Les.”  The king is dead, long live the king!

Where will we go from here? I suspect there will still be plenty of glimpses into our lives and passions and challenges. I will continue to observe the absurd, police the politicians, promote the prostate, and chime in for or against the national zeitgeist. I may return a bit more to the music I love.

I hope to keep writing as long as you will keep reading. As always, comments, criticisms and new subscribers are welcome. Pass it on!Like what you read here? Add your name to our subscription list below. No spam, I promise!

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