Of Partners and Memories

My partner died a few weeks ago. Let me clarify, he was a former professional partner, not a personal one. Dave and I spent almost 20 years working side-by-side, or at least office-by-office, part of a threesome in the Pathology Department of HFMC. He welcomed me in when I first started as a very green, eager but naive first-time pathologist. He showed me the ropes, warned me of the pitfalls, and boosted my confidence.

Dave was an Assyrian, of Iranian descent, with the somewhat cosmopolitan air of someone who had spent part of his life in Paris. His position at HFMC was engineered by his cousin, a busy surgeon at the hospital. The place wasn’t the biggest Med Center in the neighborhood and didn’t have the reputation of being the best, but had a loyal core of supportive physicians and satisfied patients. Dave fit into that culture well, and by the time I joined the staff, he was friends with everyone, quick to share a personal joke, a friendly slap on the back, or an obscure memory.

Dave and I frequently strolled the hospital halls together, heading to lunch, or the surgical suite for intra-operative consultations. Every afternoon found time for case review at our multi-headed microscope. With all that togetherness, the medical staff lumped the two of us into one, and we garnered the nickname of The Tweens–someone’s mispronunciation of the word twins.

Dave’s connection with Dr. S, our department chairman, was a less collegial one. Dave never felt the professional relationship with S matched what had lured him to HFMC, and never really fully trusted S. It was only following S’s sudden death that Dave and I both became financial partners in what became our 2 man group. That small group was quickly swallowed up by a large university practice following a hospital coup-d’etat. We were welcomed in as partners, though Dave, ever more cynical than I, whispered to me that our termination was always right around the corner. Ten years later, three years after his own retirement, Dave was proven correct.

Dave was diagnosed with prostate cancer 10 years ago. He gave me the honor of reviewing his pathology slides to confirm the diagnoses, which I sadly did. Dave and Dawn, the love of his life, relocated to Florida, where we visited them twice over the next few years. A few months ago he emailed to tell me he was beginning hospice care, and that he was entering a final phase. Just last week, right after we had sent our annual holiday card to Dave and Dawn, we discovered the obituary.

One of my favorite movie quotes is from The Maltese Falcon–hard-boiled detective Sam Spade discussing the killing of his partner “When a man’s partner is killed, he’s supposed to do something about it.” Dave, you were my partner, but all I can do I can do is write and remember. Your tween will miss you.

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Musical Questions for the Boomer Generation. What is your answer to #2?

When COVID and politics get to be too much, I turn to a Facebook Group “I Love the 60’s and 70’s Music.” It’s filled with lots of music videos that I don’t vid, and queries as to who was the third drummer on the fourth album by Purple Fudge, but browsing through the postings is a good escape and an excellent time-waster while waiting to take the dog out one last time in the evening.

Just for the fun of it, I posted twice to the page yesterday, offering two different questions

Who is a better story-teller, Springsteen or Mellencamp?
Saddest holiday song? For me it’s Dan Fogelberg’s “Another Auld Lang Syne”.

The results have been voluminous, rapid, and non-stop. Lots of thumbs up and hearts and LOTS of opinions.

In response to my first question, it appears evenly split whether the responders prefer Bruce’s Jersey stories to JCM’s Indiana ones. As many people want to drive down Thunder Road as live in little pink houses. What I was not expecting was the vitriol of the many responders who hate both. Posers! phony singers! yuck, inspiring! Then again this is Facebook; haters are part of the scene.

But there were also lots of constructive suggestions for better story-tellers. James Taylor, Warren Zevon, Johny Cash, Tom Waits, and Harry Chapin were all put forward. I can’t complain about any of those, though Taylor puts me to sleep, and it’s sad that Zevon and Chapin died too young.

Lots of good responses to my second posting also. I struck a chord with the Fogelberg song. It seems I am not the only one who can’t hear that song without tearing up, as the snow turns into rain… As a matter of fact, there are teardrops on my keyboard now.

That wasn’t the only sad seasonal song getting named. Elvis’s “Blue Christmas” has a lot of weeping fans, as does the John Lennon tune “So this is Christmas (War is Over.)” “Grandma Got Run Over by a Reindeer,” a song with special memories for my family was named a few times, probably in jest. A more serious frequently named contender for the saddest song was the charity donation appeal song “Do They Know It’s Christmas” with its closing chant feed the world.

So, ChicagoNow readers. What’ll it be? The Boss, The Cougar, or someone else. And what is YOUR favorite sad holiday tune?

Keep the music and opinions coming.

All photos courtesy of Chicago Tribune

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Hail The Lizard Brain–Pathology’s Friend

I once had an experienced colleague named Paulo who claimed that within a second of starting to examine a Pap smear on his microscope he could tell whether it was going to be abnormal or not. Paulo “could smell it.” Since most pathologists I know have long had their olfactory sense dulled by the constant fetor of formalin and xylene, it was clear he was not literally smelling the glass slide on the microscope stage. Rather, his subconscious mind had taken notice of some subtlety, some minute, undefinable but not insignificant clues, that had his frontal cortex on alert. Soon he would find the cells that would lead to his assigning a grade of atypia to the slide and necessitating follow-up for the patient from which it had come.

I think of Paulo’s words often as I scan through hundreds of prostate biopsy cores each workday. There are definitive characteristics that define cancer of the prostate. Look up the description in a general pathology textbook and you will read about things like large nucleoli and invasive growth pattern. Turn to a text geared more for someone who specializes in urologic pathology and little tips like blue-tinged mucin and red crystalloids are pointed out as useful aids in the diagnosis. But frequently, long before I see those signs, I know I am dealing with a malignant prostate biopsy.

Just like Paulo with his Pap smears, thousands of hours of training and experience have made me aware of undefinable, indescribable, attributes in the patterns I see below me on a microscope slide. Maybe it relates to the density of glands on the slide. Maybe it is the way a certain cluster of those glands traverses the narrow width of the biopsy core. Whatever the signs are they trigger my “lizard brain,” deep in the primitive parts of my grey matter. It puts me on high alert–the odor of cancer is around the corner.

I am sure this feeling is widespread among pathologists. Whether dealing with a colon biopsy, a breast biopsy, or a thyroid gland aspiration, the well-trained, finely tuned pathologist has a sixth sense. Sure, we need to find the definitive microscopic signs, the nucleoli, the abnormal mitoses, the intranuclear inclusions– but sometimes we know before we see them that they will show up.

I suppose the radiologist feels the same way when he first looks at a chest x-ray and the surgeon does too when she first puts her hands on a tender belly. He knows there is a lung tumor, she knows the appendix is ready to burst. It may take a moment before their frontal cortex can describe how they know what they know–but as Paolo used to say, they can smell it.

Jim Morrison was the Lizard King. I will settle for just listening to my internal lizard. Especially when it roars.

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I Loved Reading Le Carre–And I Will Miss Him

One of my favorite authors died this weekend. Most of my readers won’t care much about John Le Carré. He wasn’t a Steven King, a J.K. Rowling, or a John Grisham. But Carré was a friend from my childhood who followed me into middle and old(ish) age. I will miss his annual contribution to my reading list and the anticipation I felt waiting for my name to reach the top of the library book reservations (never audio-his books were meant to be read) at the local.

He was a connection to my Dad, who first introduced me to the author with his 1968 Literary Guild Book Club purchase of A Small Town in Germany. Admittedly, I wasn’t overly impressed. Small Town was an espionage novel in which, in the opinion of my 12-year-old intellect, not much happened. It took me a while to rebuild my faith in Le Carré, although Dad redeemed himself by choosing Portnoy’s Complaint as his next Literary Guild selection. That particular Philip Roth blockbuster had much more action of the type a pre-teener might be interested in.

My view of Le Carré was upended when eight years later I came across Tinker, Tailor, Soldier, Spy which critics much more knowledgable than I have called the best spy novel ever written. It hooked me then, and it has hooked me every time that I have reread it. I found the movie version (3 Oscar nominations!) with Gary Oldman thrilling. Barb and our friends found it a dreadful bore.

The Tinker, Tailor experience set me off on the path of reading every Le Carré I could find, jumping for joy with each new novel, and burying myself in every TV adaptation. There was a special thrill with 2017’s A Legacy of Spies, which revisited The Spy Who Came in From the Cold, Le Carré’s first big success. I had hope that Le Carré would proffer a similar re-examination of Tinker, Tailor with his next publication. That didn’t happen-2019’s Agent Running in the Field took a different tack. And now, unless some post-humous efforts are forthcoming, my hopes of learning more deep secrets in the story of Tinker, Tailor’s Jim Prideaux and Operation Testify are extinguished.

I bid my farewell to you, John Le Carré. I am sure my late dad would agree that you will always be at the top of our list.

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Is This a Scare Technique, or Good Pharma Advertising?

OLYMPUS DIGITAL CAMERA — Uncoagulated blood.

How do you sell an anti-coagulant drug in a pandemic? If you are giant pharma such as Pfizer and Bristol Myers Squibb, you run a pair of radio and TV commercials putting a scare into listeners and viewers. Ads that tell you that if you have symptoms of shortness of breath, leg pain, or palpitations you need to run, not walk, to connect to your healthcare professional because as the tag line says there is “no time to wait.”

I’m not sure why these commercials, featuring a real cardiologist and a real ER doc bother me so much. I am a physician. I believe in early diagnosis. I even believe in disease screening, as those of you who are familiar with my involvement in PSA screening and prostate cancer know. But these scare tactics drive me up the wall, especially when the ads run back-to-back as they sometimes do.

The probable cause of my discomfort is that these ads, masquerading as a public service, are clever ways of pushing for use of Eliquis, an effective anticoagulant used in the treatment of pulmonary emboli, deep vein thrombosis, and atrial fibrillation. The drug isn’t mentioned in the two ads, and perhaps that’s what bugs me so much. I don’t love, but I have gotten used to, ads that tell us how wonderful our life with migraines, psoriasis, and rheumatoid arthritis can be with the proper (expensive) prescription medications. At least those are clear-cut advertisements. Nothing sneaky. It’s the non-mention of Eliquis in the two new ads that sets my teeth on edge.

Maybe I am being a pre-holiday, middle-COVID, Grinch. Maybe these spots are getting the right people to see their clinicians and they aren’t petrifying a lot of other viewers who are just having gas pains. And if in so doing, the ads sell some Eliquis, so be it.

What do you think? Let me know.

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Democracy in Action–Small Town Style

If all politics are local, our small suburban village proved last night, that tricky as it may be, it still works.

State law requires that municipalities of less than 5,000 inhabitants establish a caucus system for picking candidates to run for elected positions such as mayor or trustee. Both in 2018 and this year, I have served on the selection committee of the Caucus Party, charged with following state guidelines to pick a slate of candidates to be presented to the populace for placement on the final ballot.

Back in 2018 things were a breeze. Our committee met in person early in the summer and multiple times thereafter. We searched the community for interested candidates and reviewed their responses to questionnaires. We held a day-long session in Village Hall to interview each candidate and at the end of the day chose a slate to present to the community. The Village meeting to approve the slate was a dry affair, with barely a handful of registered voters joining us.

Those were of course the DBC (days before COVID.) This year the whole shebang was a bit more complicated. As with many businesses we spent our initial meeting figuring out how we would get a Zoom account that would provide us with all the bells and whistles we would need. We assigned various technological tasks that had not been necessary, or even thought of, two years before. We upgraded a website–and began to hope we could pull this off.

Using a combination of snail mail, newspaper postings, email blitzes, and personal contacts, the committee found an abundance of qualified applicants vying for a place on the slate. Questionnaires via email were a snap. All interviewing was done during a one-day Zoom meeting, which worked almost flawlessly thanks to a rehearsal by the committee a few nights before. On-line polling of the committee let us choose the candidates that we felt were appropriate for the slate.

That left one last hurdle. How to have a community meeting, limited to registered voters, at which the voters would approve the slate? Residents were again notified by multiple means that to attend the meeting they would need to send us their name and email address at least 2 days before the meeting. We would use their names to verify they were registered voters and their email addresses to send them a link to the Zoom meeting.

And word spread. We received over 100 requests to attend the meeting–a community record. I was appointed (or did I foolishly volunteer?) as the gatekeeper–matching the people arriving in the Zoom waiting room with the verified voters, and allowing them to pass into the meeting. That proved trickier than expected. The names that I saw in the waiting room were the names people have assigned to their computer/laptop/phone, not the name they had used to register. It took a bit longer than expected, but we figured it out.

So we had our meeting. And voters, using Zoom polling technology, approved the slate. Those lucky candidates will now be on the ballot for the (hopefully in-person) municipal election in the spring.

Every vote, every election, counts.

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Coop the Pisher

Today I turn over the keyboard to Barb, who last wrote a blog as acting General Contractor when we were building “The Big,” back in 2016. Time flies.

“Last week, Les introduced you to Cooper, the gorgeous Labradoodle that has moved in with us. And I am here to tell you — he is still around, and cuter than ever. After almost two weeks, I can give you a checklist of what is going right, and what is going not quite right.

The Good

We have never had a dog so lovable and loving. He cuddles in my lap, gazes at me with those puppy eyes, and my heart just melts away. Of course, he only weighs about 7 pounds now, the lap cuddling is going to have to end as he grows towards his adult weight — somewhere between 35 and 50 pounds of fur and muscle.
Cooper is the smartest little creature we have ever had (sorry, kids.) I taught him to sit, stay, and come in about 10 minutes. He will do anything for a treat. The Coop doesn’t follow commands quite as well for Les, or maybe Les just isn’t as patient with him as I am. And Les sometimes forgets the all-important treats. As long as he remembered my birthday.
The boy loves to play. Whether it is with a squeaky clown, the cat’s paw-at-the-ball in the track toy (ignored by the cat,) or playing fetch with us, he is always up for a romp.
We were warned we would be woken every hour of the night by a little pup that needed to “use the facilities.” Les has sort of let me know this was my dog–my responsibility. I have my robe, my shoes, and a leash ready at our bedside. Much to all our relief, Cooper has done a great job of sleeping through the night.
I get to say his name and dream of Bradley Cooper. ‘Nough said.

The Bad

Cooper is a nipper. The skin on my hands is paper-thin and offers no resistance to those sharp-as-daggers puppy teeth. My hands are now covered from the tip of my thumb to the base of my palm with bandages. I highly recommend the Nexcare Waterproofs from 3M. Those babies stick!
Our lad is not yet much of an outside walker. But he is still very young and small, and we are yet to find a harness that fits him well. We do have some very upscale sweaters for him though!
Not his fault, but Coop had me worried last night after a round of vaccinations at the vet. He was listless, in pain, and glassy-eyed. Les reassured me that he didn’t look any worse than I did after my second dose of the shingles vaccine, and sure enough, by this morning Coopie was fine. Quite an anxious night for me though. (Les had no problem sleeping.)

The Ugly

The little puddles of pee we find everywhere. Yes, Cooper is an equal opportunity pisher–inside, outside, wood floor, or throw rug, it is all the same to him. But he will learn–hopefully before we go through our remaining 27 rolls of pandemic-stockpiled Bounty paperer towels.”

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