I Fell Into a Sink Hole. How Was YOUR Weekend?

It was a quiet Friday evening. Barb and I had finished dinner, washed the dishes, and were getting ready for an hour or two of quality TV time when Barb got a text from a neighbor a few streets away.

“It looks like there is a water leak across the street from our house. The grass is soaking and water is running into the street.”

Barb snapped into action. She put on her invisible Home Owners Association President ball cap, grabbed our high-powered LED flashlight, and asked me if I wanted to join her. With all thoughts of the White Sox-Guardians game banished from my brain, I led the way to the car, and off we went.

Our neighbor and her husband were waiting for us at the scene of the slime. The grass in the parkway was glistening and the street contained a rivulet of rapidly flowing water heading for the storm sewer. Barb, well-versed in similar matters, hit the Police Non-Emergency number in her contact list and we began to wait.

In the gloaming, the source of the water wasn’t clearly visible. Barb switched on the flashlight for better illumination and then the four of us saw it. A great hump arose from the parkway grass. The new addition to the neighborhood was 3 feet long, 3 feet wide, and a foot-and-a-half high. Water oozed from its surfaces before running to the street.

“What is that,” I uttered as I boldly walked where no man, or woman, had gone before. The ground felt squishier and squishier with each step I took. Mud sucked at my shoes. Finally, as I reached the crest of the mound, I felt the ground open beneath my foot. Down my leg went. Someone cried out and I had a vision of being tugged to the Stranger Things Upside Down alternate reality.

In a panic, I flashed back to a raft trip on the Colorado river. When my son Michael and I fell into the roaring rapids, our guide Olga reached down, grabbed one of us under each of her mighty arms, and pulled us to the safety of the raft.

My thoughts quickly returned to the present. I looked around and this time there was no Olga to save me. I was on my own. I gave a mighty heave, extricated my leg from the muck, and stumbled off the hump. An Old Faithfulish geyser burst from the hole my leg had created. Just as the police, responding to Barb’s earlier call arrived on the scene.

The professionals took over. By Saturday afternoon a deep trench had been excavated and the source of the leak was isolated and repaired. A boil order remained in place for 24 hours for the affected block. My sneakers began to dry out, and my jeans came out of the wash looking bright and fresh.

The rest of our weekend was great, filled with food, friends, and family. I even solved Sunday’s Wordle in two guesses. But from now on, when Barb goes on her Homeowners Association damage control excursions, I’ll just hold the flashlight. No more adventures for me!

Who Have You Thanked Today? Why Two People Thanked Me.

How many people snail mail hand-written thank you notes these days? And more to the point, how many people send thank you notes to pathologists? So I was as shocked as a dog going through an invisible fence when I received two thank you notes today, for two entirely different circumstances.

The first note was the result of a telephone consultation from last week. A call was transferred to me from Mr. M, inquiring about a particular patient’s molecular microbiology laboratory result.

After determining that the caller was the patient’s brother and not the patient’s physician, I explained that HIPAA regulations prohibited me from answering questions without the patient’s consent.

“OK, forget about my sister, can you just review some lab procedures to me?” Mr. M asked.

“Sure,” I said.

Following that, we discussed how molecular microbiology worked. I explained why some tests such as qPCR detected certain organisms, while other tests, including the technique known as next-generation sequencing, could detect a far greater number of bugs. I could hear the light bulb go off in Mr. M’s brain as he applied this knowledge to the facts of his sister’s case.

Mr. M’s thank you note revealed he was a retired radiologist. He let me know how grateful he was for the few minutes I spent speaking with him. From his spindly handwriting, I surmise that it has been quite a while since he has been actively practicing. I was glad to bring him up to date on a modality that probably didn’t exist back when he last reviewed a patient’s chest x-ray.

The other thank you note also came from someone whose knowledge wasn’t quite what they needed it to be. She was a rep for a software company, and she turned up in my office unannounced and badly uninformed.

She was brand new in this particular sales position and clearly had no understanding of how various lab systems worked–she really didn’t understand what she was selling.

Along with my associate, I spent half an hour in my office with this struggling sales rep. We talked about how a lab operated, we defined some important terms, and we explained to her what her product could, and just as importantly could not, provide to a lab. She took copious notes as we gave her the basics that her employer had somehow neglected to provide to her.

In her note, she thanked us for taking the time to provide her with some guidance. I hope we provided her with enough to save her career.

It’s a pleasure to receive notes like these two. Something that I will miss when I soon close my office door for the last time!

Was it COVID Brain Fog or Writers Block?

It’s time to let the creative juices flow once more!

It's been a while since I have done it.
Put words to the page and then I've spun it.
Sending to readers a timely missive.
Hoping my followers aren't too dismissive.

I'm not sure of precise causation
That caused two weeks of blog cessation.
What was it kept my fingers napping
Instead of on the keyboard tapping.

It started when two lines appeared
On the COVID test I'd commandeered.
The first line meant the test was working.
The second confirmed the virus's lurking.

Two Moderna shots then double boosted.
Yet still in my nose the microbe roosted.
With coughs and sneezes and feeling sickly.
Into quarnatine I disappeared quickly.

So empty moments were now my friend.
Hours  of leisure I thought I'd spend.
Writing blogs 'bout things that were popping.
I might have been sick but the world was not stopping.

My mind was all foggy, could not concentrate at
The things going on that I'd want to debate at.
But now it's much better and I'm seeing clearly
Here are some things I missed most severly.

There were hearings in DC that were causing a ruckus
They told how Trump and his friends were trying to f*ck us.
Thanks to Adam, Elaine and of course Ms Liz Cheney.
We were sure mesmerized learning about how insane he.

The planet is hotter, it's like a fire pit glowing
Who knows just what to our kids we're bestowing.
Heat waves, deadly storms, and still the President's action
Was blocked by refrains from coal's friend Hot Joe Manchin.

But up in the cosmos there was such delight
As the Webb telescope provided a sight.
Of the universe edges as they were at formation
I say it's Big Bang, some say God's creation.

Those topics I missed while my brain it was snoozing
So my silence for weeks I hope your excusing.
I'll do what I can to get back up to snuff.
For reading this verse, I can't thank you enough.

_________________________________

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Mr. Reinsdorf, It Is Time. This Pathologist Says So.

Loyalty. Forgiveness. Redemption

I rarely write about sports, but today I am compelled to do so, feeling a parallel in my life to something happening with my beloved Chicago White Sox.

In 1986 Tony La Russa was fired as manager of the White Sox. He went on to have a wonderful managerial career for other teams, winning three World Series and being elected to the Baseball Hall of Fame.

Before last year’s baseball season, Jerry Reinsdorf, the long-time owner of the White Sox (and Chicago Bulls) stated that firing La Russa was the biggest mistake of his career. In an effort to do a “make-good” and turn back the clock, Reinsdorf made an unpopular choice and rehired La Russa to manage the team.

For those who don’t follow the fortunes of the Sox, the team is populated by several young stars. Going into this season the Pale Hose were considered a strong competitor for their first World Series championship since 2005. But so far, this season has been mired in mediocrity.

Injuries have played a big part in this season’s disappointing results, but much of the blame needs be laid at the feet of La Russa. In the fairly unanimous opinion of fans and sportscasters, both local and national, many of his managerial decisions have been wrong, bizarre, and have cost the Sox victories.

Mr. Reinsdorf’s loyalty and desire to right what he perceives as an almost 40 year ago mistake have kept La Russa in his job, despite an outcry from most of us to dismiss him, hire a better manager, and give the team a chance to fulfill its destiny.

So where is the parallel to me? Almost twenty years ago shifting loyalties and relationships led to the ending of my partnership with a large pathology group. I went on to create and direct the UroPartners Laboratory, and while I may not be in any Hall of Fame, I think I have done a pretty, pretty, pretty good job.

And since then two of the principals in the group that “divorced” me have told me it was the biggest mistake of their careers. Just like Reinsdorf’s comment about La Russa.

But you know what? Neither of my former partners had any inclination to bring me back. Nor would I have wanted to. My time with them was in the past, and I would have had no business looking at a brain or bone biopsy after my years immersed in prostates and bladders. They told me they were wrong, I appreciated it, and that was that.

So, Mr. Reinsdorf, I understand you are trying to make up for what you perceive as your past mistake. But you have made your apology. La Russa’s time as an effective manager has passed. Now it is time to move on…and that means moving on without Tony La Russa managing the White Sox.

I am waiting.

The above is the opinion of the author and not UroPartners LLC.

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Thumbs, Tires, and Tradition. This Story Has It All.

Some people (such as Barb) are born with green thumbs. Some people (such as residents of the planet Twilo) are born without thumbs. And then, there is me, born all thumbs.

To lay it on the line, I am no handyman. I put this down to nature and nurture. My dad lived to be 80 years old, and I don’t believe he ever held a tool in his hand. From his upbringing in a fairly up-scalish home in Berlin, through adulthood in various Chicago apartments, there was always someone else to do the dirty work.

That’s not to say I haven’t tried to be a macho man. I can pull out a toolbox laden with wrenches and hammers and screwdrivers. Yet every hose I attach to any faucet leaks, every screw I drive quickly becomes stripped, and every smart device I connect laughs at me.

All this is a long way of saying, that the other day when a nice co-worker came to tell me she had noticed my car in the parking lot with a flat tire, my first impulse was NOT to get out the car jack and crank ‘er up. To be honest, I didn’t even know if I had a jack–or a spare.

So I did what most Jewish males would do in my situation–I made a phone call. AAA promised me a service truck within about 45 minutes…and two hours later one arrived. No, the tech didn’t have the right tools to get my old tire off or to properly hitch up my car for a tow. But he was a nice guy, and managed to load the car onto his flatbed, tightened the straps, and took me and my ride to the AAA service center, a country music Sirius station playing all the way.

The guy at the service center desk looked tired and overworked but was nice enough to squeeze my car into the schedule and onto a lift. Up went the car, and after some sledgehammer work, off came the tire, revealing a slash on the inner sidewall. In the More Bad News Department, no replacement tire was available.

On went the slow-drive spare (yes, I did have one), and I began the long drive to the north suburbs. Fortunately, it was now rush hour, so I had no problem limiting my speed to 50 mph on the congested Tri-State Tollway. Also, fortunately, the tire dealer where I have already replaced 7 tires on my 4-year-old car was open and they had my tire size in stock. It would be a 90-minute wait, so Barb picked me up, we had a carry-out dinner, and got back to the tire dealer just before closing time.

As I drove home, I noticed I still had all my thumbs, and they were all still grease and grime free. From Berlin to Riverwoods, some things never change.

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This is Us Worms into My Brain…and It Is Spooky.

I must be channeling This is Us. I don’t know why.

Yes, I watch all the episodes. But no, I have not shed a single tear over the Pearson family tragedies. And Barb and I nearly came to blows over my dismissal of last week’s episode. After six years of being ignored, we were suddenly supposed to care about Miguel? I didn’t get it.

So as we sat through last night’s episode (only interrupted once by Cooper’s need to get out of the house) I had my attention split between the show and a leftover crossword puzzle from the weekend Trib.

When I looked up at the screen I wondered why a past son-in-law and a past not-quite-daughter-in-law were part of the family gathering. I laughed at the last-minute arrival of Kate, now an international tycoon.

And then there was the train. As Rebecca in her fugue state was led from car to car, I kept thinking back to Snowpiercer, Bong Joon Ho’s futuristic masterpiece about a train hurtling around the earth, its occupants the only survivors in a frozen world. You never knew what would be in the next car, only that death was the ultimate destination. Did Rebecca have Rip Wheeler drive her to the station…

So with my obvious lack of appreciation for six seasons of This is Us, why do I feel that it must have been reaching across the ether to tap into my brain? A strange thing happened yesterday evening. When doing the dishes and making my lunch for the next day, I often as Alexa to play some music. I usually request something from the classic rock oeuvre (Bruce, U2, Steely Dan, et al.), but last night I inexplicably called for Joni Mitchell. Ever obedient Alexa came through with Joni classics “Freeman in Paris, Help Me, and The Circle Game. And those of you who watched This is Us know where this is going.

Halfway through the Pearson’s goodbyes to Rebecca, they leaf through a box of LPs. The camera focuses on Joni’s Clouds album. And the sounds of The Circle Game fill the air.

Call it synchronicity. Call it an amazing coincidence. Call it witchcraft. I just know it has me spooked. I may not care much for This is Us, but I sure am going to watch next week’s final episode. I think Rebecca is calling my name.

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I Just Lost in Wordle–Let It Be!

I used to solve the Wordle daily
On my phone, it seemed easy.
But now my joy has ended.
Let it be.

I would pick the likely letters
And make words like “Sprit” and “Spree.”
But today I couldn’t get it.
Let it be.

I felt like a Wordle Ninja
My streak had reached to ninety-three.
Until I hit a stumper.
Let it be.

Today the panic rose within me
As just three letters turned to green
And that was on my sixth try
Let it be.

Yesterday I was an All-Star
“Flair” in TWO, I said with glee.
But today I chucked up.
Let it be.

Some people post their score on Facebook
I did it too, but just rarely.
I’m done with Wordle boasting.
Let it be.

I’ll still read my daily paper
The Tribune and the NYT.
But Wordle thrill is fading.
Let it be.

So I’m back now to the crosswords
With my pen and cup of tea.
Wordle made my heart break,
Let it be.

—————————-

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How Has Your TV Watching Changed Through The Years?

Wednesday night was Barb’s book club night–a return to in-person book chat after pandemic-driven Zoom sessions. With Barb out of the house, I settled into my favorite chair, Cooper at my side, to watch the next few episodes of Slow Horses, my new favorite TV streamer on Apple TV+.

After maneuvering the proper remote controls (it takes three for us to get to Apple TV+) I prepared to click on Episode 4 of this series about the characters who swim in the bottom of the barrel of the British Intelligence service.

“What the F,” I exclaimed, as the TV screen informed me the episode would be available starting FRIDAY. “I want my Slow Horses now!”

How the times have changed. If you are from my generation, or from the Greatest Generation before me, your TV viewing was rigid. You had your TV Guide, you knew what nights your favorite shows were on, and you were satisfied with one episode of Bonanza, Mission: Impossible, or The Dick Van Dyke Show a week. Miss it, and you could hope to catch it during the summer rerun season. Otherwise, it was gone until, like I Love Lucy, syndication would immortalize it.

The video-cassette recorder was the start of an evolution. Whether you were into VHS or Betamax, you could now go bowling on Thursday night and still catch that week’s episode of Hill Street Blues during some free time over the weekend. No need to ever miss Furillo and Davenport getting hot under the sheets.

That technique served our family well for us for many years. Even in the early 2000s, when some people discovered TiVo and began to record their favorite show digitally, I still loaded a cassette into the old VCR every Sunday night to tape Tony Soprano and friends, praying the cassette wouldn’t break.

Finally, in about 2013, Barb and I discovered streaming. We had started watching Parenthood on NBC during its 4th season. Barb wanted to know how the Braverman family had gotten to where they were. We discovered we could find the old shows on Netflix, and began a ritual of watching an episode of our current favorite show every night. After Parenthood came Breaking Bad, and the Sons of Anarchy, and on and on— through Offspring and many more to our current favorite Yellowstone. (We are on Season 2 while you may be watching Season 4. )

So with the very few exceptions of the shows that we keep up with on a weekly basis (This is Us, The Walking Dead), I expect to have episode after episode of a show available to me–a full season at my fingertips. No stewing through seven long days waiting to find out what is going to happen next.

Thus my frustration with Apple TV+ and Slow Horses. I want to know how these lovable losers are going to screw up next–and I want to know!

——————————————

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A Prostate Pathologist Pencil Pusher. Making a Better Diagnosis.

Using a pencil in the laboratory? Absolutely verboten. If you write down something in the lab, make sure it’s in indelible ink, magic marker, or perhaps blood. Something, anything, that can’t be erased.

Does a tech need to make a change in what they see on an instrument printout? Our accreditation regulations (courtesy of the College of American Pathologists) are pretty strict:

Original (erroneous) entries must be visible (ie, erasures and correction fluid or tape are unacceptable) or accessible (eg, audit trail for electronic records).
Corrected data, including the identity of the person changing the record and when the record was changed, must be accessible to audit.

In layman’s terms, that means carefully drawing a line through your mistake, initialing, and then dating your correction.

So what am I doing wearing pencil after pencil down to its nub? I am making sure I am the best pathologist I can be.

Through this part of my career, looking at multitudes of prostate biopsies, I have developed, inaugurated, and continuously improved a printed, unofficial worksheet that I use for every prostate case. At the top of each sheet our laboratory information system prints the patient’s name, age, medical record number, and pathology case number. I then search the medical record and add in relevant clinical history, such as previous biopsy findings, PSA values, and results from imaging studies.

The sheet then contains a row for every biopsy location. After looking at each slide I can quickly pencil in whether I think the biopsy is benign or malignant, what the Gleason Grade is, the extent of tumor, and any special studies I want to perform. It is really a very efficient way for me to work.

And I do it in pencil. Why? Because diagnostic pathology is not all ink–it is an art as well as a science. Cancer cells don’t actually have a big “C” on them under the microscope. Malignant changes can be striking, but they can also be subtle, and first impressions can sometimes be misleading.

Sometimes looking at the 7th core in a patient’s biopsy series can affect how I view what I saw on the 3rd biopsy. Sometimes special stains are going to nudge me to call a biopsy malignant that I had originally noodled in as “atypical.” Sometimes viewing a core the next morning will clarify my thinking, or a word from my associates will lead me in a better direction. When any of those things happen I grab my worksheet and out comes my pencil, eraser end first. And I mark down my new, improved, diagnosis.

Eventually, the worksheets get turned into our administrative team, entered into a digital pathology report, and following my electronic signature, become very official. Corrections can still be made, but only through a very regimented procedure, with documentation of every step. No more pencils, no more erasers.

But rest assured, the next morning I will be at the sharpener, getting my favorite diagnostic tool ready for another busy day.

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Our Holiday Verse

A Holiday Greeting,
It's meant for the masses,
No matter how full,
Or how empty your glass is.

The year was a weird one
With DC insurrection
From Big Lie believers
And in the end from Joe Manchin.

With Covid we battled
Through every Greek letter
And vaccines J and J--
Moderna - Pfizer did better.

We boosted when able
Though we formed a greater schism
'Tween the vaxers and those 
Who feared the jabs caused magnetism.

At times we were joyful,
We thought our lives would recover
And we travelled a great distance.
To see a spouse, child, or lover.

But flying's a hassle,
The skies sometimes unpleasant
Unless you're first class or private,
And not in coach like a peasant.

We went out to the movies,
Or at least some of us tried to
Most found Prime, Netflix or Hulu,
The theaters we were confined to.

We had an Atlanta World Series, 
And a Super Bowl for Tom Brady.
The Summer Olympics were delayed
And not terribly paradey.

And with Omicron sweeping
This month to remember
Some leagues are postponing
Their games in December.

There's now a new worry
That is raising its head.
Prices are rising,
Inflation, it's said.

The costs they are higher
On cars new and used.
On gas and on beef steaks
And the Fed seems confused.

But a New Year is coming.
We hope life will be brighter.
So all raise your glasses,
And say "Cheers" with this writer.

———————————————————————-

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