I’m not an ant-vaxxer I agree with all my might That getting stuck, like a sitting duck, Is the way to do things right.
But in the last six months it seems My arms are getting sieve-y So many holes, that bless my soul My favorite drug’s Aleve-y.
It started with the shingles shots A pair I’d heard were scary It would burn your toes and crinkle your nose And turn your tonsils hairy!
Next ‘twas time for the annual boost Of the vax for influenza The pharmacist jabbed, and the air I grabbed. As I fainted ‘gainst the office credenza.
Six weeks ago it was my turn For my left arm to surrender I stood in line, whittled away the time For two doses – the Moderna protector.
And when I thought that I was finally done With Band-Aids, needles, and an alcohol wipe At today’s physical exam, where I learned I am Old enough for an additional type.
I’m Medicare age (a young 65) Ripe for the shot that blocks out pneumonia A vicious disease, brings the old to their knees Those damn pneumococci will own ya.
But now I at last I think I’m done, I’ve gone through all the potions I’ll roll down my sleeve, put my doctors on leave With my mind full of all healthful notions.
Photo courtesy Health Stock photos by Vecteezy
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Microscopic appearance of prostate cancer (left) with special stain (right.)
When I talk to folks, or blog to you all about making diagnosis, what I usually chat about is the time spent looking down the twin ocular barrels of my Olympus BX43 binocular microscope. After all, that is when my eyes and brain are most engaged in looking at the prostate tissue and forming a diagnostic impression. But in fact, that microscope time is probably less than half the time I spend on the hundreds of pieces of prostate tissue I see every day.
In the morning, while our crack anatomic pathology team is busy grossing, processing, embedding, cutting, staining, and cover-slipping prostate tissue to prepare beautiful slides for me, I am getting my paperwork rolling. I download a spreadsheet of all my cases for the day, using it to create individualized worksheets for each case. That lets me know the age of each patient, the name of the urologist doing the biopsy, and how many parts I can expect with each case. Basic stuff.
I then take my worksheets and progress to our online medical record (I love those online records!) Here I can get information on the patient’s past prostate history. Has he been biopsied before? What did we find? I can look at the most recent PSA blood test, and also look at a timeline of all the past PSAs to see how the values have changed over time. In addition, many patients have a “targeted biopsy,” aimed at “regions of interest” in an MRI of the prostate. I can read the radiologist’s report and learn just how suspicious those ROIs are.
All this information is running through my head when I look at the slides. Although it is a pathology maxim that “the truth is in the glass” the other data can guide me as I am making decisions on what I see. Oh, and while I am looking at that glass I am recording my findings on my worksheet, leafing through textbooks or websites for help on difficult cases, ordering the special stains I need, and filling out billing sheets. Sometimes it feels like my head is bouncing back and forth like a ping-pong ball, with a glance through the ‘scope as I am turning left and right.
Once I have handled the last slide of the afternoon I drop the worksheets with our administrative team. It is their job to transfer all my codes into our Lab Information System to create a nicely formatted report.
Next morning, I review the reports and add any information I have garnered from the special stains I ordered the day before. It is almost time to electronically sign the reports, and whisk them via the magic of interfaces to the performing urologist. But before that can happen, especially in malignant cases, there is one essential review step.
Nobody wants to call a benign biopsy malignant. So before a cancer case is signed out, we have it reviewed by at least one additional member of our pathology staff. In the oldest days that would be done at a multi-headed microscope. In the more recent old days (i.e. pre-Covid) we would review cases on a video screen in my office. Since the pandemic, we have avoided congregating and now place our slides on a tray and pass them to another pathologist for review in their own offices. A log sheet ensures all cases are seen and diagnoses are concurred with. Only then are the cases signed and distributed.
Am I done at that point? Almost! Since UroPartners has a very vibrant Cancer Registry, my final step is to mark the parameters of each cancer (grade, number of positive cores, length of involvement, other findings) on a sheet for our Tumor Registrar. This data allows our group to have an ongoing understanding of the patients that pass through our doors and to follow large cohorts of patient data. This has fueled numerous scientific papers and advancements in prostate cancer treatment.
My microscope may be my best friend, but it has lots of help in making sure our patients have the correct diagnosis in a timely manner. And that is always my goal.
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The above is the opinion of the author and does not necessarily reflect the opinion of UroPartners LLC.
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Don Quixote with an impossible quest. Ponce De Leon exploring for the Fountain of Youth. Humphrey Bogart seeking gold in the Sierra Madre. Great searches all, but none can compare to my hunt for the Mini-Snickers Ice Cream Bar.
As a candy craving youth, I was never a tremendous fan of the Snickers Bar. While I did prefer Snickers to its stablemate, the overly-fluffy 3 Musketeers Bar, Snicks just didn’t compare well to the smooth and sweet Milky Way Bar. The peanuts in the Snickers Bar just felt wrong.
It was between 7th and 8th grade, while a camper at a Rogers Park summer day camp, that I discovered frozen Snickers Bars at the concession stand. I found that the crunch of the peanuts merged perfectly with the icy-chilled nougat, chocolate, and caramel. I enjoyed those frozen bars at break time all summer long, and then forgot all about them when the school year rolled around and camp came to an end.
It was years — more like decades–later that I came across Snickers Ice Cream Bars at the local grocery. Snickery flavored ice cream, chocolate coating, one or two peanuts. I bought a box and fell in love.
But there was a problem. Six to a box, they were large and loaded with calories. A blood glucose nightmare. Fortunately, on my next weekend shopping trip, I found Mini-Snickers Ice Cream Bars, a box of 12 with just 90 calories each. Surely my nutritionist couldn’t object to that.
So each evening, after finishing dinner and before clearing the plates off the table, I would pet the dog and walk to the fridge, open the freezer door (frequently forgetting to close it after) and treat myself to my 90 calorie bar of heaven.
Until the pandemic. While you were noticing the toilet paper disappearing from the supermarket shelves, I noticed that there were no Snickers Ice Cream Bars of any size to be found. My depression was palpable.
I replaced the Snickers with Mini-Ice Cream Sandwiches, squishy concoctions of phony ice cream between two faux-chocolate wafers. Dreadful. And I waited. After a few months, the full-size Snickers Ice Cream Bars reappeared. But where were the Minis? Nowhere, man.
And still, a year into Corona, I search. At every grocery store we go to (Sunset, Woodman’s, Mariano’s, even Whole Foods,) I prowl the freezer cases hunting for the elusive 90 calories. Barb knows we can’t leave the store until I have investigated. And I find nothing, nada, zilch.
What about online shopping sites? I enter Snickers Mini Ice Cream Bars into search bars and the sites just say Not Available in this Zip Code, Not Available In this City, Not Available All!
But one day they will be back. I just know it. Until then, I will join Don Quixote and dream the impossible dream.
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One year. One long, never-ending, never-repeatable year.
One year ago I told the story of our shopping trip to Woodman’s, as a maskless, non-socially-distanced, throng filled the aisles and their shopping carts with paper towels and toilet paper and anything else they thought would help them in a long siege. Our year of Covid-19 had begun.
I sit here now, as one of the fully-vaccinated, physically undamaged, lucky survivors. No one close to me lost their lives, indeed, I have to think hard to come up with anyone in my circle who even tested positive.
We never closed the lab, though we limited our on-site staffing in the early days. We never stopped seeing our children and grandchildren, with drive-bys graduating to driveway and back yard visits, then in-garage celebrations, and eventually, small gatherings in the kitchen.
We avoided one pet while gaining another, the dog who has grown and grown both in his own body and in our hearts. We have joined Boards, volunteered, and served on committees, now knowing enough to mute our microphones on interminable Zoom calls.
And what have we learned? The pleasure of welcoming our friends and neighbors to our socially distanced back yard, instead of trying to converse in a noisy restaurant. That many movies are just as good at home as at a multi-plex. That books can still take us away from our everyday life. That science will win out–but not always right away.
My thoughts go out to all of you who have suffered much much more. The fact that we have turned a corner may be no solace to those of you who have lost a mother or father, lost a job, lost financial security. Still, I pray we are all on our way to a better place and time.
Setting: Jerry’s Apartment Jerry: Did you get it? George: I got it. Jerry: Where did you get it? George: I got it in my arm, where do you think I got it! Jerry: No–I mean where did you go to get it? George: I went to the Clinic. Jerry: Oh, the Clinic. George: What’s wrong with going to the Clinic. Jerry: Oh nothing, you know it’s just… George: Just what? Jerry: They treat things there. George: I didn’t go to get TREATED. I went for the vaccine! Jerry: Who gave you the shot? A nurse? George: I don’t know, she was wearing a white coat. I think she was a nurse. I don’t know. I didn’t ask. You know how I feel about authority figures. Especially in white coats. Jerry: Yeah, you melt and you fantasize. George: No fantasies! No fantasies! I was thinking about my health. Jerry: So did she give you the “pinch?” George: The “pinch?” Jerry: Yeah. They lift up the skin on your arm jab the needle in there. George: Now that you mention it, yes I got the “pinch.” Jerry: Hmmm George: What’s hmmm? Jerry: I read that the “pinch” makes it less effective. George: Oh great, so I went to the Clinic, waited two hours, and now I’m still gonna get the virus? You kill me Jerry, you just kill me. Jerry: It won’t be me, George. Buzzer rings Elaine’s voice comes over the intercom: Let me up, Jerry. Jerry pushes the door buzzer button and Elaine bursts into the room and does a happy dance. Jerry: Look at that, I think she’s infected. Elaine: I got it, I got it. George: Did they give you the “pinch?” Elaine: Hell no–they give you that you die anyway. George sinks his head into his hands, mumbles. Elaine: They gave it to me in my car, and then I had to sit in my car for another 30 minutes to show I wouldn’t pass out. Jerry: Wasted time? Elaine: No–the tech who gave me the shot was sort of sexy so I… Jerry: Oh you… Elaine: It was a good half-hour. Knock on the door. Newman’s voice from outside the door: Hello, Jerry. Jerry swings the door open: Hello, Newman. Newman to Elaine: I saw you there. And I saw that smile on your face. I know what you were doing. Elaine: And what else did you see. Newman: Nothing. Elaine: And that’s all you are going to see…ever. Kramer explodes into the room, carrying a metallic contraption. Kramer: Have you seen the lines? It’s taking them waaay too long. But I’m going to do something about it. Jerry: And what is that, dare I ask? Kramer: I made this auto-shooter. It takes my shooter half the time that it takes a nurse to give the vaccine. George: Is it battery operated? Kramer: No, you have to plug it in. Let me show you. Kramer pulls out a power cord, plugs into a wall outlet, sparks crackle, and the room goes dark. Camera pans out to the whole building, and then the whole city, all going dark. George: Why did she have to give me the “pinch?”
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Did you know me in the summer and fall of 2005? I was on my way out of Holy Family Medical Center and creating the UroPartners Lab. We were leasing an office suite in a commercial building with the goal of transforming it into a laboratory that would pass muster with the Illinois Department of Public Health and earn the stamp of approval of Medicare and the College of American Pathologists. I had a thorough knowledge of what was needed, a reasonable budget, a cracker-jack team I was bringing with me from Holy Family, and a business consultant to boot.
So why wasn’t it my finest hour? Why wasn’t I reveling in the White Sox World Series Championship season? Why did a trip to Milwaukee to see Paul McCartney seem like a trip to hell? Why couldn’t I sleep at night? I was worried about just one thing. What if we couldn’t fit the equipment through the door? Was I going to wind up with a lab in a parking lot?
Of course, that didn’t happen–everything worked out fine, and we have had a 5-star high-quality lab here inside the building for the last 16 years. But those nightmares had been haunting me again for the last few days…
A lab like ours needs a backup power system, particularly to make sure that our refrigerators and freezers containing patient samples and expensive reagents don’t degrade during a power failure. While I would love an inline generator, some investigation in the past has shown the cost to be more than we could bear. Instead, we installed a backup battery system that during a power failure can power red outlets throughout the lab that control the refrigerators, the freezers, and some incubators in microbiology as well. It has served us well, but after ten years of juice the company that installed and maintained the system, let’s call them Power Is Us, told us the unit was badly outdated, and we agreed to purchase a replacement.
PIU hired a freight company, NoWay, to pick up the new unit from the PIU Wisconsin plant and deliver it to the lab. This was to be a two-stage process, with the unit to be first taken to Badway’s warehouse near O’Hare, and then delivered to the lab on a subsequent day. Easy-peasy, right? After all, we are only 15 minutes away from NoWay’s warehouse.
I did have a few requirements. One, I needed delivery to be between 8 am and noon, when we had a staff available to unload a couple of pallets worth of equipment and heavy batteries. And two, we don’t have a loading dock, so the delivery had to be with a lift-gate truck. All this was conveyed to NoWay, and the delivery date confirmed. And what happened?
Scheduled delivery date 1: No delivery “Our truck didn’t leave the yard until 11:30 so we knew we couldn’t get to you by 12:00.”
Scheduled delivery date 2: No delivery. At 4 pm, the last person in the lab is heading out the door when she gets a call. “We’ll be there a little later. We have until midnight, right?” Um, no. 12 pm means noon, not midnight!
Scheduled delivery date 3: No delivery. “Our driver didn’t think his truck would fit in your parking lot, so he just drove away.” (In fifteen years, no delivery truck has ever had a problem getting into our lot.)
So yeah, pretty frustrated by this point. The good news? PIU has agreed to deliver the unit to us themselves, take it off the palettes, and put it into place. It is what they did when they delivered the original system back in the day, and what I wanted them to do this time in the first place. A happy conclusion.
I’m sure I’ll get some sleep tonight.
The above are the opinions of the author and not of UroPartners LLC
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“My fellow Americans, I’m pleased to tell you today that I’ve signed legislation that will outlaw Russia forever. We begin bombing in five minutes,” President Ronald Reagan, 1984.
“And when you’re a star, they let you do it. Grab them by the p—y. You can do anything.” Donald Trump, 2005
“It’s really unfortunate that they want to pick on us because they want their babysitters back,” Lisa Brizendine, Oakley Union Elementary School Board president, 2021.
Yup, those hot mics will catch you. Especially during this time of Zoom meetings, you better know what is being broadcast versus what is in the sanctity of your own private group.
But as a former member and president of the Board of Education of District 125, solely comprised of Stevenson High School in Lincolnshire, I sort of get it. Most people run for election to a school board not for some sort of ego trip, not for the perks (minimal) or monetary benefits (none) but to give something to their community. They spend long winter nights hearing about curriculum and the latest ‘new math” philosophy, they spend months negotiating teacher contracts, they look under rocks for the next up-and-coming superintendent superstar, who their district probably won’t have enough tax revenue to afford, anyway.
Sometimes they deal with problems of their own making, such as poor hiring, disciplinary processes, or financial planning. Sometimes it can be unequal enforcement of district boundaries or giving an athlete too much leeway. But in general, school board members follow one star–to give the students in their district the best possible education under the circumstances in which they find themselves.
And then COVID-19 comes and turns everything on its head. Follow the science, or follow the old president, or follow the new one? Think first about the students, or about the teachers, or about the parents? Or put it all in a blender and hope it turns out for the best?
So sometimes you vent. Let’s be honest. Doctors bitch about their patients, lawyers mock their clients, presidents fantasize about blowing up countries. And sometimes school board members say things they shouldn’t–but that doesn’t mean that they aren’t trying to do what is right. Judge them by what they accomplish not the sometimes foolish things they say.
Speaking of school board accomplishments, Steve Frost, Fei Shang, and Gary Gorson, three Stevenson School Board incumbents, are running as a slate for re-election in the spring election. I served with Steve and Gary, and marvel at the wonderful stewardship they have provided for the district. If you live within the bounds of District 125, please give their StevensonExcellence slate your vote on April 6th.
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When first I walked the hospital floor
A young whipper-snapper always ready for more
I dressed to kill in my 3-piece suit
A really sharp dude, no way to dispute.
Suit coat, cool vest, and pants with neat creases,
I really shone in all those pieces
Tailored for me at my favorite store
Mark Shale in the city, had a great rapport.
And ties with a crest from a fancy designer
Cardin, Hermes, no one ever looked finer
What was holding it together, yeah making it sing?
It was my scarlet red suspenders, made me feel like a king.
Mine fastened with a button, no clips for me
Two in front, one in back, it’s 1-2-3
Who needs a belt when your pants are sitting
Just right on your hips for a perfect fitting.
In the UK you know they call them all braces
Not on their teeth, it’s the belts they replaces
Steve Urkel used to wear them on the Family Matters
Larry King had ’em on when he talked with lots of chatters.
For me times have changed and I’m dressing more cazh
Knit sweaters, tapered jeans, and all that jazz.
Got belts with metal buckles in black and brown,
Don’t have to look cool, not going downtown.
Just one problem that I’ve been noting
My body’s been changing, more weight I’m now toting
And while that’s going on, my tush is disappearing,
An old man’s figure is what I’m now rearing
Belts don’t do the job when your middle is missing
And once again it seems I find myself wishing
For suspenders to keep my pants tight on my hips
So I don’t give the world a total moony eclipse.
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Mercy Medical Center-photo courtesy Chicago Tribune
Mercy Medical Center filed for bankruptcy yesterday. That’s a pity for the neighborhood, losing a source of medical services in an area that lacks sufficient resources. For me, it unlocks memories from almost 45 years ago, when I had more hair, less belly, and a whole lot of medicine still to learn.
In the summer of 1977, just entering my third year of medical school at the Chicago campus of the University of Illinois, I spent a grueling summer doing an eight-week internal medicine rotation at the old U of I Hospital. I was scheduled to follow this up with another two months at the “U” doing a surgery rotation. A bird whispered in my ear that if I wanted a posher palace for my introduction to surgery, I should arrange a switch to Mercy Hospital.
At the time Mercy was part of the Metro Six, a group of community hospitals including Illinois Masonic, Lutheran General, and Weiss Hospitals with a training affiliation with the University. I applied to the Dean for a schedule change using some vague reason and about a week before my surgical rotation was about to start, got the notification that my change had been approved.
In contrast to the in-depth, hands-on patient care I experienced on the internal medicine rotation at the University Hospital, my eight weeks at Mercy was truly a posher experience. I was on a service with two surgical residents, neither of whom had much interest in teaching. I can visualize their faces, but not recall their names. I learned to do pre-op physicals, learned how to scrub into an OR, and learned how to tie surgical knots on a practice knot board. But I never held a scalpel or dislodged an internal organ. My OR time was spent suctioning body fluids, retracting fat, and somehow managing to annoy the anesthesiologist.
One unique aspect of the surgical rotation at Mercy was dog lab. As horrible as it now sounds, students and residents spent one afternoon a week in a shed on the parking lot performing surgery on canines. I don’t know where these unfortunate beasts came from, and now I can only regret my actions, but I did manage to do some bowel resections—and according to the keeper who managed the menagerie, my victims did ok post-op. The only saving grace is that since that time Barb and I have given many four-legged friends a wonderful home.
Barb also experienced Mercy. Rules were much laxer in those days, and I had no difficulty obtaining permission for her to spend a day in the hospital with me, including time in the Operating Room, a first for her. She was carefully positioned by the surgical team, not too close, but still with a view of the procedure, an inguinal herniorrhaphy on a young man. The patient was prepped, surgical drapes placed, and the scalpel wielded. As blood seeped from the incision, I heard a groan and turned to see Barb beginning to wobble. She was hustled from the OR, a victim of too much gore–hard to believe she went on to spend a career dealing with messy post-op wounds!
I never did another general surgery rotation. As I became a surgical pathologist, I realized that a better understanding of surgery would have helped me in working with surgeons during intra-operative consultations, but I had lost my chance. I will never think like a surgeon–but damn, I can tie a good knot!
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You go on trial today.
They’ll say you incited
Your lawyers will fight it,
The riot, disquiet
In the city on the hill
Your talk was disruptive
You always did want this
The power, the glory
Your own favorite story, your quarry
Four more years laudatory
We’d all pay the bill
You have your defenders
Your fantasy blenders
With lasers more flavors
Of loony tune lies about liberal invaders
Who’d brainwash us, gun quash us
Until America was finally still
Your lawyers will story
It was all allegory
No violence no turmoil
Was ever to recoil
It was all just for fun, just to say that you won
To build up your branding, your standing, the fees you’re demanding
For your book and your speeches, ’bout living hell of impeaches
So two is better than one
When the time has come to chill
Your lawyers talk about process
Can the law really want this
Too tardy, too late, to wipe out the slate
While Constitutional scholars are betting their dollars
That it’s all elementary, to impeach is the sentry
Protecting our nation from a monster’s creation
As he delivers a poison pill
For a change you are quiet, your tweets on a diet
You won’t testify,
Won’t look in the eyes
Of the Senators, those jurors
Who will hear of your furors
And of the pretense as you challenged Mike Pence
His hiding, your chiding, over ballots presiding
He stopped being your shill.
The result is not debatable
The numbers not inflatable
Two-thirds of the Senate is not going to get it, they’ll let it
Give you your acquittal, your wrist slapped a little.
But still it is worth it, the House didn’t shirk it
You go on trial today.
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