Michael Collins died this week. Michael Collins, the man who came SO close. Michael Collins, Apollo 11’s Third Man. The man circling the moon in his cute little orbiter while Neil (One Giant Step) Armstrong and Edwin (You Can Call Me Buzz) Aldrin got to play on the moon!

So close and yet so far–how many times in your life have you been there? The job you were the “best candidate” for, but somehow didn’t get (remember me, Resurrection Medical Center?) The game show you were chosen to be on, but from whom you never got the final call (I am talking to YOU, Family Feud.) The Mega-Millions Super-Duper Jackpot you were only ONE NUMBER AWAY FROM (okay-that person never was and never will be me.)

In the late astronauts honor it’s time for the Michael Collins Almost Made It Award. And here are the nominees.

1. His Royal Highness Prince Charles Philip Arthur George, Prince of Wales: inching ever closer to the throne, but will he ever get there?
2.  Actor Phil Bruns. Who is he? Mr. Bruns played Morty Seinfeld (Jerry’s Dad) on exactly one episode of Seinfeld, only to be replaced in future episodes by Barney Martin. Poor Phil, he never made it to Del Boca Vista.
3. Stu Sutcliffe and Pete Best. The almost Beatles. ‘Nuff said.
4. A long line of “Miss America” runner-ups. The only exception, Suzette Charles, who received the 1984 crown when Vanessa Williams was stripped of her title.
5. Zeppo Marx. Would you recognize him if he passed you on the street?
6. Vicente Yanez Pinzor, captain of the sailing ship Nina that accompanied Christopher Columbus way back in 1492. No cities named after him! No statues to be torn down, either.
7. Rosalind Franklin–her work paved the way for discovering the structure of DNA–but it is James Watson and Francis Crick who get credit for the “double helix.”
8. Richard Burton was nominated for an acting Oscar 7 times without a win. He’s a near-misser even for the record on that –Peter O’Toole, and now Glenn Close beat him out with 8 losses each.
9. How about Al Gore. Eight years as VEEP, one heartbeat or one impeachment conviction away from the presidency, and then to ultimately win the popular vote for the highest office but be bounced by the Supreme Court. You can’t get much closer to being the most powerful man in the world than that.
10. Garth Brooks. Although I guess it’s not too bad to be the second best-selling musical act of all time with 156 MILLION units sold. That’s a mere 27 million units behind the Beatles (but about 155.999 million units more than Stu Sutcliffe and Pete Best.)

So there you have it, also-rans and almost haves. Who would you choose for the Michael Collins Memorial Award?

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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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