Sharing My Thoughts With a Future Pathologist

The other day, when I was packing potatoes in my volunteer job at a local food bank, a shift supervisor approached me and said, “You’re a pathologist, aren’t you?” I confirmed that I was, and he asked me to come with him to meet a first-time volunteer.

He introduced me to a young man who was just entering a local medical school and wanted to be a pathologist. We exchanged a few words, and I left him with my email address and an invitation to contact me any time.

This morning, I had an email from him thanking me for speaking to him and asking about memorable cases. I emailed him back. Here is a copy of my response.

Hello Izaiah,

I’m glad Phil, the supervisor, brought me over to meet you. I had a wonderful career in pathology.

Your role in healthcare will most certainly wind up quite different from mine. The practice of pathology will change with the digitization of diagnostic material and the advent of artificial intelligence. Perhaps pathologists will become more active as liaisons between the world of the laboratory and the world of the clinician. And there will always be room for the innovative researcher.

As to memorable cases, the thousands and thousands of surgical cases tend to blend together. Individual autopsies are more memorable. My autopsy cases included death due to the unsuspected ingestion of a portion of a denture, the “double bubble” neonatal GI anomaly, death from tumor necrosis in the brain of a patient with thyroid carcinoma and cerebral metastases, and a case of Moya-Moya disease, a rare cerebrovascular malformation. I hope a significant number of autopsies will still be part of your training.

I also want you to remember how early you are in your education. Open yourself to all the fields you will be exposed to. You might find out you want to be a cardiologist or radiologist or plastic surgeon. Whatever you find, grab it with both hands and be the best cardiologist, radiologist, or surgeon you can be. Your life will be richly rewarded.

Best regards,

Les Raff, retired pathologist

Will Izaiah become a pathologist? I doubt it. It is a rare physician who sticks with their first medical school desire. And with all of medicine, all of healthcare, evolving so rapidly in the next few years, we may not now know the new specialties and opportunities that may arise. But as I said to him, do what you love, and you will know you have made the right choice.

I Owe Someone a Note

I’m listening to The Correspondent by Virginia Evans. I’m only partway through, so don’t worry. This isn’t a review, and there will be no spoilers.

One sentence made me stop and hit rewind.

“He was finding confidence behind the veil of ink on the page.”

That’s a beautiful line. It also made me realize how much of my life I’ve spent communicating through the written word.

One summer in high school, I came home from overnight camp corresponding with about fifteen girls. Long-distance phone calls weren’t an option. Fifteen nightly phone calls would have bankrupted my parents.

To keep eall the letters straight, I created a chart on a piece of cardboard. Down the left side were the girls’ names. Across the top were columns for the date each letter arrived and the date I mailed my reply. My personal correspondence log. Looking back, it may have been a little obsessive. At the time, it felt perfectly reasonable.

The cardboard disappeared years ago, which is probably for the best. Otherwise, one of my grandchildren might someday uncover it and conclude that Baba had been far more popular in high school than he actually was.

Letter writing eventually gave way to pathology reports, emails, newsletters, and blog posts. The audience has changed. The pleasure hasn’t. I still enjoy staring at a blank screen or a piece of paper, chasing an idea around until it finally behaves.

A few months ago, I found myself buying a box of correspondence cards on Amazon. Not birthday cards. Not sympathy cards. Just simple white correspondence cards with a gray border for thank-you notes and the occasional handwritten letter. The kind of stationery that practically insists you mind your manners.

In this era of texts, emails, Facebook posts, and emojis, buying stationery felt almost rebellious. But the cards are on my desk now, and every so often one finds its way into an envelope.

It turns out I never stopped being a correspondent. So excuse me, I owe someone a note.

I Rarely Click Banner Ads

I rarely click banner ads. Until one New York Times ad caught my attention.

It wasn’t the headline. It was the picture. I had never seen anything like it in a public advertisement before. To most readers, it was probably nothing more than an abstract swirl of pink and purple. They likely scrolled right past it without a second thought.

I couldn’t. It was a photomicrograph, a photograph taken with through a microscope.

For forty-five years, this had been my world. While other physicians examined patients or interpreted X-rays, I peered through a microscope, searching for the subtle variations that separate healthy tissue from disease.

The reproduction wasn’t especially good. The image was small and lacked the crisp detail I was accustomed to seeing through a microscope. Still, I recognized it immediately for what it was: a photomicrograph of a tumor.

In forty-five years of pathology, I had never seen a photomicrograph used to draw the attention of the general public. So I took a screenshot.

Only later, did I follow the link to a story about a clinical trial for women with resistant ovarian cancer. The research was interesting, but it wasn’t what stayed with me. The image did.

For the past month, every time I came across that screenshot on my desktop, I found myself wondering why it had affected me so much. Eventually I realized it wasn’t really about my evaluation of the images.

It was about seeing one of the tools of my profession in a setting where I never expected to find it.

During my career, photomicrographs were tools. They appeared in pathology textbooks, medical journals, conference presentations, and tumor boards. They helped physicians make diagnoses and decisions, teach students, and communicate discoveries. I never expected to see one used as the visual hook in an online advertisement.

I thought I had taken a screenshot of an unusual ad campaign.

It turned out I had taken a screenshot that inspired this blog.

Monkeys Tell No Tales, but I Do

I tried. I really did.

I know that the proper thing to do after our two-week vacation in Africa is to write a travelogue blog. So that’s what I started to do.

I was going to tell you about all the rare and exotic animals we saw on our safaris. I was going to wax poetic about Victoria Falls, “The Smoke That Thunders,” one of the Seven Natural Wonders of the World. And, of course, I was going to say a few words about the diversity and foodie scene in Cape Town. That is what any blogger should do, right?

But you all know me, and you know I can’t write that stuff without getting schmaltzy and falling into one cliché after another. So I stopped writing that post and began this one, about the unexpected moments that helped make the trip memorable.

Take the porter at the Johannesburg airport. Barb had asked him how we could check that our luggage had been transferred from our incoming flight from Amsterdam to our flight to Victoria Falls the following day. He held our boarding passes up to a scanner, nodded, and said we were fine.

I reached into my wallet and pulled out several South African rand notes. He looked at me with disgust.

“That money is no good here. I want twenty U.S. dollars,” he said.

I told him he was lucky to be getting ten. He swore and waved us into the wrong passport control line.

Then there was the evening our group ate dinner at a boma, a traditional African enclosure now commonly used as an outdoor dining area, and NOT an acronym for “British Officers Mess Area,” as one guide glibly told us.

We were enjoying our grilled dinner when a scream came from the far end of the table. A member of our party had received a gift from above. Whether it came from a large bird or a baboon, no one knew for sure, but it was unquestionably a direct hit, right on the top of her head.

That was a tough one for our otherwise implacable tour leader to deal with.

Nancy faced an even more delicate situation when a distraught fellow traveler reported that her outdoor shower had been interrupted by an unexpected visitor—not a baboon or an elephant, but a maintenance worker who had wandered into the wrong suite.

I suspect the poor woman would have been less distressed if it had been a baboon.

Monkeys tell no tales.

To be fair, the local staff performed some heroics as well. Our safari driver found a lost wedding ring in his vehicle before its owner even knew it was missing. Another porter successfully fished a fallen gold-and-diamond necklace from beneath a slatted wooden boardwalk. That saved its owner, a 22-year-old woman, from considerable grief, most of it likely coming from her worried mother.

So yes, the animals were magnificent and the falls thundered, but it was the little things that made our trip unique.

And next time, I’ll be sure to wear a hat to an outdoor buffet.

You never know what might fall from the sky!

The Accidental Book Club.

No meetings, refreshments or books about cholera.

I am very fond of books. It’s book clubs I’m not quite as fond of.

But I think I may have found something better.

Several years ago, I belonged to a book club that specialized in worthy nonfiction. We read biographies of Ronald Reagan and the Wright brothers, along with a detailed account of a cholera outbreak in London. I learned a great deal from all of them. Unfortunately, none of them made me eager to climb into bed and find out what happened next.

Eventually, I drifted away.

I do have several friends who share my taste in spy novels and mysteries. We happily trade recommendations, but rarely go beyond “You should read this” or “I liked that one.” What I miss is the deeper conversation.

So who do I turn to when I want to compare and contrast my favorite writers, revisit a twisty plot point, or find an outstanding BBC adaptation? These days, my favorite book club consists of one member and one artificial intelligence. Its name is ChatGPT.

The beginning of our “book club” was accidental. One day I asked Chat to rank the ten greatest spy novels ever written. Almost instantly, it responded with a list of twenty. In true AI fashion, a few books appeared twice, a couple were attributed to the wrong author, and the numbering was more aspirational than accurate. After a few minutes of back-and-forth, however, we had refined it to a credible Top Ten. Remarkably, at the very top sat John le Carré’s Tinker Tailor Soldier Spy, my personal favorite.

What surprised me was not the speed of the answers. It was how much the exchange felt like talking with another avid reader.

Over the next half hour, we dissected much of le Carré’s voluminous body of work. We discussed why my friends hated the film version of Tinker Tailor Soldier Spy while I loved it. When Chat listed the key characters in the George Smiley trilogy, I pointed out its glaring omission of George’s wife, Ann. Chat immediately conceded the point and offered a thoughtful summary of Ann’s crucial role in Smiley’s story.

Next we turned to my current favorite author, Mick Herron. Chat seemed as enthusiastic about the Slow Horses novels as I was. We discussed the many faults of Jackson Lamb and the brilliance of Kristin Scott Thomas in the television adaptation. I forgot to ask what Chat thought of the Mick Jagger theme song, but I’m confident it would have had an opinion.

My AI book club isn’t perfect. There are no hors d’oeuvres, no Scotch on the rocks, and no opportunity to impress anyone with my knowledge of John le Carré. But I can convene it at any time, discuss any book I choose, and never have to leave home. And what surprises me most is that the experience feels less like using a tool and more like talking with a fellow reader.

And unlike my last book club, nobody is going to make me read another book about cholera. One book about that is enough, even for a pathologist!

Miss American Pee

The Day the Tee Shirts Died

My grandfather collected buttons. My father collected sugar packets from restaurants. And I collected free tee shirts.

My shirts were neatly stacked on shelves. They came from every race I had ever run, every Lab Week UroPartners had ever celebrated, every blood drive and food bank giveaway I had ever joined. They came from gyms and hockey arenas, and from a visit to the Brookfield Zoo. They were green and gray, blue and orange, even 1960s-style tie-dye. I rotated wearing them in order. Just like with my grandchildren, I never played favorites.

Today, all of them, the would-be favorites and the also-rans, are sitting in a garbage bag in the garage, never to be worn again.

I first noticed the odor three mornings ago, about ten minutes into a session on my elliptical. At first it was so faint I thought I was imagining it. But as the shirt became more sweat-soaked, the scent grew stronger and unmistakable. I was smelling cat urine, and it was coming from me.

Our little kitten is almost sixteen years old now. She spends most of her time sleeping in her favorite spots: the wingback chair, the bathroom floor mat, the folded duvet on our bed. But when she isn’t sleeping, she is usually in one of her two litter boxes. The girl can pee.

I do my best to keep the litter boxes clean, emptying them every night and refreshing the litter regularly. Apparently not regularly enough. Maybe the litter no longer met her standards, or maybe one of the boxes had become difficult for her to reach. Whatever the reason, she eventually decided it was preferable to relieve herself on the neatly folded stacks of my tee shirts.

I know from experience that it is impossible to wash that odor out of clothing. It lingers and reblooms through Tide and Downy and Febreze. That is why all those shirts are now headed for the trash. Some of those shirts had been with me for decades, and it is a said, but necessary, parting.

From now on, maybe I’ll collect sugar packets instead..

Three Days of Comcast

Streaming bundles, endless transfers, and the limits of modern technology

When you ask friends and neighbors which mega-company provides the worst customer service, Comcast/Xfinity is usually the landslide winner. Few businesses generate more frustration than the area’s dominant cable and internet provider.

Until recently, I was not part of the anti-Comcast chorus. They provided a service, I paid the bill, and the internet and streaming kept humming along. Even after cutting the cord, I stayed with Comcast as the best way to keep everything connected. Then came a glitch.

When I transitioned to Comcast’s streaming package without cable TV, the bundle included services like Hulu, Netflix, and Apple TV. Comcast assured customers they would handle all the behind-the-scenes details, canceling old subscriptions and activating the new bundled versions without interrupting access to Ted Lasso, Your Friends and Neighbors, or our guilty pleasure, Shameless.

But then I noticed that Apple TV was still charging us separately.

In the grand scheme of things, this was hardly a major crisis. But Barb and I don’t enjoy Ted Lasso enough to pay for it twice, especially while the series is on hiatus. So began my three-day descent into the Comcast customer service labyrinth.

My efforts to resolve the problem included Comcast’s online chat assistant, multiple live agents, a visit to a Comcast retail store, a live video session with a Comcast representative in Egypt, Apple customer service, and ChatGPT, which by that point had become both therapist and technical consultant.

Each Comcast representative marched me through the identical sequence of links, toggles, logins, refreshes, and reboots, none of which resolved the problem. Each agent assured me detailed notes were being added to my file before putting me on hold. Those notes, apparently, vanished into the same digital black hole that swallows forgotten passwords and two-factor authentication codes. I have now come to believe that “putting a note in your file” is simply customer service shorthand for “the next person I hand you off to will know nothing.” KLM used the same line while we were rearranging our Africa trip, with identical results.

I would like to tell you that after all that work, our streaming issue is resolved. I would like to, but I can’t.

The final Comcast agent advised me to wait until the current Apple billing cycle ends in July and “see where we are then.” As he explained it, “Those people at Apple do things weird.”

And you can put that note into my file.

Our Gorilla Dilemma: How a Dream Trip to Rwanda Became a Daily Debate

It’s hard to let go of a dream.

Ever since our trip to Tanzania and Kenya nearly 20 years ago, Barb has had one item at the very top of her bucket list. While a meet-and-greet with Neil Diamond would rank a close second, number one has always been to follow in the footsteps of fellow occupational therapist Dian Fossey and see the mountain gorillas of Africa up close.

So when friends asked if we would like to join them on a tour of South Africa, we immediately recognized an opportunity. We could safari with them, and precede the trip with gorilla trekking in Rwanda’s Volcanoes National Park. Through a travel agent in Cape Town, we were matched with an outfitter in Rwanda, and soon the permits, accommodations, and travel arrangements were all in place.

But as the saying goes, “Man plans, and God laughs.”

Two weeks ago, when Barb first mentioned Ebola virus to me, I missed the significance. Since then, we have carefully scoured the news and public health announcements each day for any potential impact on our trekking plans.

The outbreak appears confined to specific areas of Uganda and the Congo, and there have been no reported cases in Rwanda. Our Cape Town travel agent has urged us not to cancel. In YouTube videos, tour guides implore viewers to ignore what they describe as hysteria from the Western media. ChatGPT and I have had daily discussions about the low likelihood of a larger outbreak. But Rwanda shares a border with Uganda, and the current strain of Ebola is quite deadly.

For the past week we have changed our minds daily, and sometimes hourly, about whether to risk the trek. Barb finally reached out to a friend who owns a home in Kenya. Her advice was to be very cautious, not because she thought we were likely to contract Ebola, but because if the outbreak spread across the Uganda-Rwanda border, our gorilla trekking permits could become worthless and stricter confinement rules might suddenly be imposed.

Our final decision is to continue with our plans is South Africa, but to cancel the gorilla trek. It has required a whirlwind round of emails and phone calls with our travel agent and the airlines. The Rwanda arrangements are non-refundable and our travel insurance excludes disease outbreaks, but we feel that with our permit fees, we have made a contribution to preserving African wildlife.

It’s hard watching Barb let go of a dream she has carried for nearly twenty years.

On the other hand, if anyone knows how to arrange a meeting with Neil Diamond, please let me know.

Right Down The Line — Missing a Tennis Partner, Lunch Companion, and Optimist

Years ago, Barb and I would drag ourselves out of bed early Sunday mornings to play in a tennis drill-and-play class at a local park district. We made lots of friends and accumulated future playing partners among the 20 or so people who showed up every week. The sessions were friendly, competitive, and frequently filled with laughter.

One of our companions was Joel Stern, an attorney, storyteller, and devoted sports fan. Joel wasn’t the most ferocious tennis player, but he had a gift for placement and rarely lost a set. I spent many moments between matches discussing his daughter’s progress through medical school, his beloved Cleveland Browns, and our mutual hero, Bruce Springsteen.

Covid put an end to the Sunday morning classes, and I didn’t see Joel for quite a while. When I retired, with plenty of time on my hands, I reconnected with many old friends, including Joel. Along with a few other fellows, we would play a few sets of tennis and then head out for lunch, sometimes fancy, sometimes casual.

It was during the first of these sessions that Joel told me he had advanced renal cell carcinoma. He also told me he would beat it. I never doubted him.

As time went on, it became harder to find time for our tennis matches. We still got together occasionally for lunch, but most of my contact with Joel came through his very detailed Facebook posts describing his status, his various therapies, and his always optimistic outlook.

Eventually, even our lunches came to a halt, as he gently rebuffed my overtures, letting me know he was on his way to MD Anderson, Memorial Sloan Kettering, or some other renowned cancer center. There was no clinical trial he wouldn’t consider, no avenue he failed to pursue.

Three weeks ago, I texted Joel to ask if I could stop by to visit him, perhaps bring lunch. He responded immediately that he was sorry, but he just wasn’t ready for visitors. I think he knew the end was coming.

Joel passed away yesterday. I am sure he went the way he lived: courageously and without self-pity. And I know he’s out there somewhere, hitting every shot right down the line, cheering on the Boss, and suffering right along with the hapless Browns.

We will miss him.

Back Together Again

Am I Making a Familiar Mistake?

It’s nice welcoming old friends back into my life. Friends who once mattered a great deal to me, but whom I’d barely thought about for the past three years. I ignored them because they had become boring, with nothing left to offer me. And honestly, I had nothing for them either. That’s just the way it goes sometimes.

But this year I told some people that I was willing to give the estranged relationship another chance. Maybe something could be rekindled.

And at least for now, it seems I was right.

The White Sox are back in my life.

I was five years old, living in Rogers Park, when I shared my secret with my father: I was a White Sox fan. I had no idea then how many years of frustration awaited me, growing up surrounded by Cubbie blue. Still, I clung tightly to my heroes through the collapse of 1967, the swagger and fall of the 1978 South Side Hitmen, and the near-miss of the “Winning Ugly” team in 1983.

My reward finally came with the 2005 World Series Championship, which allowed White Sox fans eleven full years of superiority before the Cubs finally won one too. But the last twenty years of Sox fandom have mostly been drab, and the previous three have been a calamity, a parade of not-ready-for-prime-time players losing more than 100 games each season.

Then the White Sox ownership made a key offseason move, signing young Japanese slugger Munetaka Murakami. The buzz was loud enough that it reached even strayed fans like me. It was time to pay attention.

It’s not easy to follow the White Sox. Most of their television broadcasts require a premium sports package I choose not to pay for. Their radio broadcasts are blacked out on my digital devices, and somewhere along the line I stopped owning an actual radio capable of receiving AM1000. Still, I have been following the season in the Tribune and receive a daily White Sox Google alert to let me know the score.

So far, my efforts have been rewarded. The White Sox were off to their best start in years, leading into last weekend’s Cub-Sox series at Rate Field. Those three games were broadcast on a local television station, and Sunday gave me my first chance to actually watch the team play.

In one of the most exciting games I’ve seen in years, the Sox and Cubs battled back and forth into extra innings before the White Sox finally emerged with a 9-8 victory.

With that game, the Sox officially hooked me in for the rest of the season. Or at least until their first ten-game losing streak.

It’s always a joy to welcome an old friend home. Even when experience tells me I better not tget too attached.