From the Microscope to Life’s Bigger Picture

Some pathologists are balkers. They dither and debate, unable to decide until every morsel of information has been individually processed, every unlikely diagnosis ruled out. When they hear hoof beats, they don’t just think of zebras; they think of zebras that have been extinct for 100,000 years. You cannot run a pathology department with a batch of balkers.

Michael Kaufman, MD, who passed away last month, was not a balker. If he had a motto, it was “Let’s get this done. Now.”

Mike was one of the attending physicians during my pathology residency at Evanston Hospital in Chicago’s northern suburbs. I was at Evanston for four years. He was there for almost 40.

There were many outstanding pathologists at the hospital during my training. But none were better than Mike in evaluating the big picture. The answer to a diagnosis on a biopsy wasn’t necessarily in the minute details of each slide, but rather, as he put it, in the gestalt. The moment the first field of a slide hit the microscope stage, he had an impression of the diagnosis and knew what he wanted to do to confirm it.

Mike was rarely wrong, and even less often inefficient. With caffeine as his fuel, he would glance at a stack of slide trays, calculate the number of slides they contained, and set a time limit for completing that afternoon’s work. When a rafter of residents was slow, Mike pushed them along like a golf ranger urging a slow foursome to pick up their pace.

He needed to be that efficient. Mike was the master of the side hustle before the term even existed. He always had some place else he needed to get to, or a case he had to study for his sideline medico-legal consulting services.

He was happy to spread the wealth, hooking the residents up with Medical Records gigs, and even ear-piercing at the local Carson, Pirie, Scott’s Department Store. We were also his off-site autopsy service, performing post-mortem exams at other North Shore hospitals. If not for Mike, I never would have driven around town with formalin-fixed body parts in the trunk of my car—something I never did mention to Barb.

I learned how to be a better pathologist, time manager, and entrepreneur from Mike. Those lessons guided my career. But my most vivid memory is of him walking through the lab with little Jamie on his shoulders—showing us all that joy belongs alongside work.

Mike was never a balker, in medicine or in life. May his memory be a blessing.

It’s Hard To Resist When Artificial Intelligence Offers to Write Your Blog Post

I came close to caving in. But I’m not ready to do it yet…

Today, an old marketing tagline popped into my head. It was from the 1960s, an era when I was watching plenty of Huckleberry Hound and Yogi Bear on TV, and Kellogg’s Cereal was the superstar advertiser of all those cartoon shows. Each ad for their sugar-sweetened apple-flavored crunchy cereal ended with “Apple Jacks will not be sold to bullies.”

I thought that line, nostalgia for the 60s, and commentary for the current day would make a nice amalgamation for a 500-word blog post. It should have been easy. But then I checked my files and saw that in the past year, I have written two posts about bullies, beginning with a holy terror from my high school days and concluding with the unholy Donald Trump. I didn’t see how I could drink from that well a third time.

But we are in 2025, not 1965, so I decided to see what AI would say. I clicked ChatGPT’s tab on my toolbar and gave the program the following instructions:

Create a blog post relevant to today, recalling the old tag line of Apple Jacks cereal that “Apple Jacks will not be sold to bullies.”

In less time than it took for me to type the prompt, the chatbot produced a well-executed, near publishable version of what it thought I wanted to say on the subject.

It wasn’t perfect; for one thing, it was loaded with em-dashes, the trademark of AI. And the first version was too preachy. But with a few rounds of suggestions and responses, I had a piece that met my standards to deliver to the Substack world.

I could have justified the post as the best of both worlds, a plug-in hybrid, combining my gas with the website’s electricity. But unlike Oscar Wilde, I can (sometimes) resist temptation.

So I’m not using the Frankensteinish creation. This is my post, all my own words, that you are reading. Every mistake, cliché, and bad simile is mine and mine alone.

Maybe someday I’ll discover something new I want to say about bullies. Until then, just keep eating your Apple Jacks. A bowl a day might keep Presidents and AI away.

On the art of small talk, bottle-cap lasagna, and why I’ll stick to haiku.

You’re Probably Doing Small Talk Wrong was the headline for a guest essay in the New York Times this week. Maya Rossignac-Milon and Erica Boothby dissect the art of small talk, particularly those first few minutes when you meet someone new, be it on the job, at a cocktail party, or on a pickleball court.

The authors, both behavioural scientists, argue that our meet-and-greets often fall flat when they consist of exchanging standard formalities, such as “How are you?” and “How was your weekend?” or (in Chicago) “Da Bears.” If we want to create bonds with the people we are meeting, Rossignac-Milon and Boothby maintain that riffing is the way to go.

I had heard of riffing in music, but never in terms of conversation. The article doesn’t define the process, but my browser’s AI describes it as “the spontaneous exchange of comments, in a playful manner, where participants build on each other’s thoughts.” That’s a mouthful, but the Times article gives the following example:

“How was your weekend?” “Good, but I spent way too much time watching people make tiny food on TikTok.” “Whoa, like … dollhouse-size?” “Yes! If you want to learn to make a lasagna in a bottle cap, let me know.”

I have never had a conversation even remotely approximating that one. I don’t think I am capable of it. For me, conversations rarely veer into bottle-cap lasagna territory. In fact, they usually stall out right around ‘Where are you from?’

Give me time to prepare, and I’m fine — my remarks to the Lake County Finance Board about mosquito control even earned a mention in the Tribune. I can write blog posts, plays, even haiku.

But riffing? Not so much. I’ve never been fond of miniature food, anyway.

From Sloppy Sam to Dr. Emanuel: What Really Makes Students Learn

“Virtually no one can hand write 125 words per minute for 90 minutes.”

That’s a quote from an article by Ezekiel Emanuel (Rahm and Ari’s brother) in Thursday’s New York Times. The article discusses his decision to ban cellphones and laptops from his classroom at the University of Pennsylvania. His justification is that while a student may be able to speed type an entire lecture into their device, no one can do the same while writing by hand. Thus, the student must mentally process the lecture in real time to take adequate notes. The result is a deeper understanding of the material, leading to better learning.

I agree with Dr. Emanuel’s philosophy, but while he sees handwritten notes as a guarantee of deeper engagement, my own experience as a student showed that it doesn’t always work. In fact, it is what the worst teacher in my Chicago Public School education required his students to do!

I attended Sullivan High School in Rogers Park, Class of 1972. In those days, long before it earned a reputation as a “newcomer center,” Sullivan was a highly regarded high school serving a predominantly middle-class population. We had many fine educators, but sadly, not all our teachers reached a level of excellence.

Like all incoming freshmen, I was required to take a course called Early World History. My teacher, Sam, was an unkempt man, probably in his late fifties. Sloppy Sam’s classes never varied.

“Take out your notebooks,” he would say a moment after the bell rang to begin the period. He would begin to recite, and our only task was to capture every word. “Roman numeral II, Part B, subpart iv, Causes of Peloponnesian War,” he would drone. Thirty pens scribbled his outline into thirty spiral-bound notebooks, careful that every subheading and every detail was correct.

On a Friday before the end of each grading quarter, we would turn in our notebooks. The following Monday, we would have them back again, graded, any omissions noted, and the lecture cycle would resume.

And as Dr. Emanuel would suggest, no mental processing of Early World History was taking place.

I have had other poor teachers — the computer science instructor who needed the class to teach her computer science, the Hebrew teacher who thought teaching meant terrorizing his students. Fortunately, their number pales compared to the wonderful teachers and professors I have learned from.

I have never forgotten Sloppy Sam; it’s the causes of the Peloponnesian War that still befuddle me. While Emanuel may be right about banning devices in the classroom, it is not how you take your notes; it is the skill and passion of the instructor that makes learning come alive.

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A neighborhood walk turns into a lesson in friendship, concern, and resilience.

I’m usually a solo walker. Along with our labradoodle, Cooper, I cover two to four miles a day, looping around our neighborhood and greeting neighbors and their dogs. Sometimes Barb joins us, and if the day feels glorious, I’ll treat Cooper to a drive to a nearby park, where we can climb the sledding hill as part of our route.

Last week, two friends, Jack and Greg, invited me to join their Wednesday walk. I did a quick loop with Cooper, then drove with them to an access point on the Des Plaines River Trail. Caps on, sunscreen applied, water bottles in hand, we set out into the warm midweek sun.

The wide gravel trail wound through shady woods, alive with walkers, joggers, bikers—and the occasional pile of horse manure. We talked about family, sports, and old jobs as the miles slipped by. When my watch told us we’d hit three miles, we turned and headed back.

Walking three abreast through the forest reminded me of Stand By Me, the 1985 film where four boys trek along the railroad tracks in search of a body. We could have been their senior counterparts, though our only quest was exercise and camaraderie.

Near the parking lot, almost six miles in, Greg suddenly asked Jack if he was okay. Jack said yes—then crumpled to the gravel, flat on his back. His face was pale, but he was breathing and had a pulse.

In that moment, the doctor you want at your side is not a retired pathologist like me. Fortunately, Greg’s long career was in anesthesiology. He quickly sized up Jack’s condition: dehydration. Together, we eased Jack upright, and before long, he was sipping water, color returning to his cheeks.

We walked slowly to the car. Jack bounced back quickly and insisted we keep to our lunch plans. I checked in the next day, and he was fine.

Yesterday I heard Bob Stroud play Ben E. King’s Stand by Me on his Rock’n’Roll Roots radio program. It brought me back to the movie, to our walk, and to standing with Jack as he recovered.

We didn’t need a body at the end of our walk—friendship, concern, and relief were more than enough.

The play’s the thing.

Are you a regular reader of mine? Do you remember my unsuccessful foray into playwrighting? Two years ago, I wrote a two-act play, a dialogue-heavy drama. A part-time dramaturge I know polished it and sent the shining version to a theater producer he has worked with. The producer was dismissive, the golf season was starting, and after writing a blog post about the experience, the play went into the purgatory of an archived Word file.

Until this week, when two unrelated circumstances have joined to give me the push I need to revisit that dusty file.

First came a notification from a Facebook playwriting group. A Chicago theater company was advertising a new play competition for previously unpublished works. The submission process was easy and online, and unlike many other competitions, no entry fee was required. This seemed like an opportunity for a neophyte like me.

A few days later, I was listening to an audiobook of a thoroughly awful novel. It was a murder mystery-psychological thriller dripping with misplaced metaphors and even sillier similes. Despite the poor prose and not knowing or caring “who did it,” I listened day after day.

My patience was rewarded when I heard one of the characters, an elderly, dying mystery writer, say to his daughter, “We should talk.” SPOILER ALERT: Those words are a key line of dialogue in my play.

I have decided I cannot ignore two signals, both pointing me in the same direction. I want to get in.

I’ve located an early draft of the play, a draft from before the dramaturge held sway. While I appreciate his help, I want to be where the characters still feel like my own. This is where I am beginning.

I’m carefully reviewing the producer’s comments and reflecting on the few bits he thought worked well and the roughly 95% he thought didn’t work at all. I’m creating new scenes and new relationships. I am eliminating clunky dialogue. I’m keeping that “we should talk” line, but I’m giving it greater impact.

It’s a blast waking up my old characters, working and molding them in their own images, as they whisper to me what they need to do and say. I love them all, even the more despicable ones.

The deadline for submission is August 31. A countdown clock on the theater company’s website tells me that as of now, I have nineteen days and fifteen hours of prep time left.

Do I anticipate winning the contest? It’s a long shot. But I’m giving it a try. Because, as one of my more optimistic characters says, “You can never run out of hope.”

Stories from the parking lot and beyond.

If you use Reddit, you may be familiar with a Subreddit called “Am I The Asshole?” Contributors describe real-life situations they’ve faced and ask the internet to judge: Were they in the wrong? The respondents can concur that the original writer is the greatest jackass of all time, or let them off the hook with a gentle “You did no wrong.”

I consider myself a pretty decent guy. I don’t cheat at games, I appreciate everyone’s cooking, and since I don’t expect perfection from the people around me, I usually don’t badger them if they fail to meet even my limited expectations. But three incidents in the last week have got me wondering, am I the asshole?

Incident #1: I was picking up Cooper from his Monday Doggie Daycare experience in Wheeling. The facility has limited parking, with only two legal parking spots, as well as one space for disabled drivers. When I began my turn into the lot, I saw that the regulation spots were both taken. Knowing that the drivers and their dogs would be out shortly, I braked and waited in the single driving lane. A car driven by an able-bodied teenager zoomed by me on the left, almost sideswiping my car, and pulled into the disabled driver spot.

Once we were both inside the daycare building, waiting for our dogs, I told him, not too politely, that I didn’t appreciate his driving maneuver and that the spot was reserved for people who needed it, not impatient teenagers. Am I the Asshole?

Incident #2: I pulled into a parking spot in the sprawling parking lot at Woodman’s Market. As I left my car, I was approached by a woman pushing a packed shopping cart. She wanted me to pull my car back out so that she could wheel her shopping cart through the parking space to her car, a few spaces to my right. Rather than backing out, a risky maneuver in the always crowded lot, I showed her that less than 10 feet to my right was the wide, very well-marked, pedestrian lane, perfectly suited for her purpose.

She gave me an angry look, but I didn’t back down, and I didn’t back out. Am I the Asshole?

Incident #3: Barb and I were doing our weekly shopping at the Sunset Foods Store in Northbrook. The deli case was on our right as we waited to place my usual order of lunch meat. A woman in a motorized shopping cart came speeding toward us, a mere foot from the counter. The look on her face made clear her impatience with us as we scrambled to get out of her way.

Twenty minutes later, we saw the same woman maneuvering back and forth in her attempt to get the mobile cart into the checkout lane. She was muttering loudly, clearly frustrated. I knew I should help her, but our previous encounter had left a bitter taste in my mouth. I stayed in my checkout lane until store personnel assisted her a moment later. Am I the Asshole?

So, readers, what do you think? Three decisions on my part to either not help out or not turn the other cheek. Am I the asshole?

Spoiler alert—I don’t think I am!

It’s less than I think!

If you are a Facebook user, have you noticed and interacted with Meta AI, the virtual assistant that occasionally pops up in your Facebook feed, summarizing or explaining posts? Most days, I ignore it—I would rather read actual comments than have my device explain them to me. But on Wednesday, Meta’s little rainbow circle symbol on my post caught my attention.

“More about the author’s work,” read the flag.

“OK,” I thought. “I’m game for that. Let’s see what Facebook and Meta AI have to say about me.”

I imagined the link would whisk me away to a glowing summary of my hundreds of blog posts. I envisioned a detailed review of my family, my career, civic service, and my travels, and how it all came together in my prose. I was even hoping there might be mention of my two favorite quotes, Alec Trebeck’s “wrong again, Les,” and my golfing buddy’s “nice shot, Les.”

Simply put, I anticipated that Meta AI would create the equivalent of a Wikipedia page, all about me, something that has long been missing from the digital world. I understood that, as with all AI products, there might be some hallucinations—it might brag about my major league baseball career or my lunar landing—but those were minor errors I was willing to accept.

I clicked the link, eager for a big payoff. I didn’t get it. Rather than a Wikipedia page, I got the equivalent of a book jacket review:

From this post, we can infer that Les Raff’s writing style is personal, reflective, and humorous. He shares his personal experiences, such as his encounters with COVID-19 and vaccinations, in a lighthearted and relatable way.

It’s not what I expected, and yes, I felt let down by the skimpy AI analysis. But I shouldn’t complain too much. The remarks do capture what I try to do most of the time when I sit down at my desktop and chat with you (only my Trump rants are not quite so light-hearted).

So I’ll get over my disappointment and keep writing. Maybe someday a real human will write my Wikipedia page in the future, and I will be overjoyed—even if it skips centerfield and doesn’t fly me to the moon!

Remember life in 2020, when COVID turned everything upside down? A lot has changed—vaccines and testing have made a difference.

But oh, those vaccines! In the last five years, I have been jabbed, poked, and stabbed. I’ve been ping-ponged from Moderna to Pfizer and back again. Sometimes I’ve been injected with the “Pinch” and sometimes without it. But despite all the pokes, prods, and best intentions, just like in 2020, I am sitting here with a case of COVID.

I’m not sure which strain I have acquired. There are too many to keep track of these days. And it is anyone’s guess where I picked it up— it could have been at the food bank, the golf course, or the grocery store. The little viral freeloaders are everywhere.

My symptoms began overnight Saturday, with an intense sore throat that had almost disappeared by morning. Barb, always prescient, predicted I had COVID, but I dismissed the possibility. I spent two listless days before finally breaking down and using the last COVID test we had.

I didn’t need to be a retired pathologist to interpret the bright red line that appeared on the test strip almost immediately. A kindergartner could have solved that puzzle.

I haven’t kept up with recommendations for handling COVID, so I had my first Telemed visit, a discussion with a Nurse Practitioner on my internist’s team. We talked about Paxlovid (not for me), isolation (barely an issue anymore), and whether to take acetaminophen or ibuprofen (I prefer the latter).

I’ll stay home for another day or two, with my books, newspapers, and crossword puzzles. Barb bought a new box of test kits and tested negative, so she can go to her volunteer shift at the hospital while Cooper keeps me company. The Advil jar and Kleenex box are close at hand, my tea cup is perpetually full, and I am grateful I have nothing more serious than a bad case of the sniffles.

And that we have left 2020 far behind.

A reflection on what I wrote eight years ago and why it matters even more now.

If you’re a Facebook user, you’ve likely seen notifications like “You have memories,” linking back to posts from one, five, or ten years ago. The memories are generally happy ones. I suspect the Facebook algorithm chooses them with that in mind.

Today, I got a notification from Team Zuckerberg about a post I had written exactly eight years ago. It was a link to the Getting More From Les blog entitled “It’s Time to Repeal and Replace Donald Trump.” That blog remains the most widely read in my collection—the only one to surpass 10,000 views. Reading it today, I can only shake my head at how naive we were eight years ago.

My emphasis in that post, seven months into Trump’s first term, was on Trump’s attempt to abolish the Affordable Care Act (Obamacare) and replace it with…nothing. I also wrote that Trump’s

“foreign policy is a sham apparently designed to protect his personal interests; his Cabinet is mostly packed with lightweights; and his communications team is a joke.”

I ended by calling for impeachment or the use of the 25th Amendment to terminate his presidency.

Could we have imagined in 2017 that two impeachments would mean nothing? That foreign policy would flip-flop daily? That cabinet members—already lightweights—would willingly sacrifice public health, national morality, and global standing to serve Trump’s grievances and ego? Or that a violent attack on the Capitol Building would be seen as a heroic event, its perpetrators excused from responsibility and prison.

Eight years ago, ICE was kept in our freezer, and the National Guard was kept at home. CBS still had some dignity, and Stephen Colbert’s best days were ahead of him. We could have a reasonable discussion with those on the other side of the political aisle. Does anyone still have discussions like that?

Trump will not last forever. But, likely, the damage he has done will long outlive him. He didn’t start the fire, but he has fanned the flames, and because of his presidency, we may lack the resources to put it out.

And eight years from now, I doubt Facebook will be reminding me of this happy memory.