Ask a gaggle of anatomic pathologists what their most important tool is, and they will almost certainly tell you it is their microscope. Ask them who their most intimate friend is and they may tell you the same thing. We know every metallic curve and protuberance, every knob and dial. Line up five microscopes in the dark and I doubt any of us would have any difficulty identifying our own by feel alone. We have chosen each eyepiece with care and selected the magnification we want on each objective. Those of us who do lots of very high power work such as examining blood smears or bone marrow aspirations do our best to keep the immersion oil we use from infiltrating every crease and crevice, not always with success.

I am on the third ‘scope of my professional career, an Olympus model with an ergonomic head and five different magnifications. It has a video attachment so that I can share my findings with my colleagues and take photographs, but like every pathologist for over one hundred years, I am looking through my eyepieces at an actual glass slide when making my diagnosis. The dimming of that era is beginning. The microscope may be on its way to joining the typewriter and the land telephone line in the Smithsonian Museum Hall of Relics.

There has been much interest in “liquid biopsies,” extracting DNA from a patient’s bloodstream to diagnose cancer and other diseases. Progress has been made, but widespread utilization is still more than a few years away. The change I am talking about is happening now. In April the FDA gave Royal Philips, a Dutch firm, permission to market its Intellisite digital pathology system for primary diagnosis in the US. What is the Intellisite and why could it spell the end to my intense affair with my microscope?

First let us examine how the slide under my microscope objective was made, and how it got to my desk.

• The biopsy tissues we receive are transported to us “fixed” in formalin which prevents deterioration.
• Our histology team then processes the tissue (we use a special laboratory microwave for the processing) to prepare it for paraffin infiltration.
• The tissue is placed in a plastic cassette which is then filled with paraffin wax. The wax also infiltrates deep into the tissue, solidifying it.
• A histotech cuts the tissue block into thin sections, which float on a water bath and are scooped onto a glass slide.
• The slide is stained with a variety of dyes and passed on to the pathologists.
• The pathologist examines the slide under the microscope and determines the proper diagnosis.

So what changes with digital pathology? Virtually nothing, until the end game. Instead of the slide being turned into the pathologist, the digital system photographs the entire slide creating a virtual image that can be seen on a local digital network, or with enough bandwidth, on the Internet. Instead of moving the slide along the flat stage of a microscope, we maneuver the image using a mouse or keyboard. Just like the original glass slide, the virtual image can be viewed at varying magnification.  And just as radiologists can read an x-ray from anywhere in the world, pathologists will have the same ability with digitized slides.

Now that Philips has gotten the OK to market this system, are changes going to happen overnight? Not at all. Radiology changed quickly because it was possible to eliminate x-ray film and go directly to digital images. But as we have seen, in pathology the glass slide must still be prepared, a time and labor intensive operation. Digitizing doesn’t eliminate any of this; it is an additional step. And the equipment won’t be cheap.

Other hurdles? Reading a digitized slide takes some training. I have had the opportunity to examine them in training courses and my comfort level in making a diagnosis definitely doesn’t match the confidence I have with the glass slide on my ‘scope. In addition, state health agencies may restrict how and by whom slides of patients in their states can be read.

The early use of digital will probably be in consultation, seeking an expert opinion on a particularly tough case. Currently, if I want to do that, I package the glass slide and FedEx it to my consultant. Moving the case from the recipient hospital loading dock to the consultant’s desk may add a day or two to the process. An electronic way to send the case eliminates much of this delay. Voila! Instant consultation. There will also be some use in remote hospitals and in small hospitals that are part of larger medical systems but don’t necessarily have pathologists on site.

But for now, I can continue to have a relationship with my microscope. I think she will last as long in this business as I do . Of course, I  said that about my old flip phone too!

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Miss yesterday’s post? Click here: A Dad’s Look at his Daughter’s Wedding.

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We gave Alex our blessing, and I didn’t cry.
We toasted Laury and Alex’s engagement, and I didn’t cry.
We chose the hotel and the band, the florist and the photographer, and I didn’t cry.
We saw Laury model her gown, and I didn’t cry.
We sent invitations to friends and family everywhere, and I didn’t cry.
We counted responses and unpacked gifts, and I didn’t cry.
We picked the menu and planned the seating arrangements, and I didn’t cry.
We rehearsed and watched the video montage, and I didn’t cry.
We dressed and primped, and I didn’t cry.
We posed for the photographer, and I didn’t cry.
We witnessed the Ketubah signing, and I didn’t cry
We lined up for the procession, and I didn’t cry.
We entered the room and took our place by the Chuppah, and I didn’t cry.
We anticipated as the trio began playing “Edelweiss,” and I didn’t cry.
We beamed as Laury walked down the aisle, and I didn’t cry.
We listened to the Rabbi as he married together our daughter and our new son-in-law, and I didn’t cry.
We dined, we danced, and we laughed with our guests, and I didn’t cry.
We gave our toasts and cheered as our son Michael give his, and I didn’t cry.
We “Raised our Glass,” we were elevated by the Horah and we went down low to “Shout,” and I didn’t cry.
We hugged our guests as they left, and I didn’t cry.

All night long I smiled and smiled. And yes, at the end of the night my eyes were still dry. Amidst it all, the celebration, the excitement, the music, and most of all amidst all the love, I just didn’t have room for tears. But maybe I will shed one or two now. Or maybe a whole flood. You never know.

 

 

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There is always a moment or two of panic. With every new blog, there is the worry that no one will read or respond to it. That fear leads to moments of hesitation before I hit the “Publish” button, and another when I send word of the new post to my mailing list (you can join the mailing list down below.) Then there is the concern that a blog doesn’t belong on a Facebook page, that the post will be mocked, or even worse, ignored. Fortunately, nothing like that has ever happened. Nothing I have written has ever gone viral, but on the other hand with almost every blog someone tells me it’s their favorite piece. So I have never been truly embarrassed on the digital pages of ChicagoNow.

My other public ventures have been pretty much red-faced free too. While I may have asked some naive questions early in my tenure on the local school board, and probably later in my tenure too, I don’t think I ever really embarrassed myself. And the commencement addresses I gave as President of the Board were generally well received, even the year I opened with the history of our dog, Max. Eventually, even that speech had a point, and people seemed to get it. I was also careful to never trip any of the graduates coming on stage to get their diploma and shake my hand.

My TV appearances have been less than fully satisfying (second place finishes never are) but not a total humiliation. Lots of people don’t know how to spell Navratilova or might confuse the University of Iowa with Iowa State University. At least I knew that T.S. Eliot won a posthumous Tony Award for Cats. And my onstage appearance at DisneyWorld playing a newscaster during the Gorbachev-Reagan years? I carried it off with aplomb, successfully broadcasting my “He wanted to see the Russian Dressing” line.

So where have I stumbled and landed flat on my face? Let’s go back to the mid 1990’s. The Internet was just beginning to rock. I created a small business, almost a hobby,  called Pathwise, “translating” diagnostic biopsy reports into plain English for people who wanted to understand their results. I had a website, a toll-free number, and even a publicist. He did a good job getting feature articles for Pathwise in a few ladies magazines and Sunday supplements. (Only one of the magazines replaced our phone number in their story with the toll-free number for Gamblers Anonymous.) But he was also the seed of my humiliation.

My publicist decided to list me in a circular of speakers used by radio stations to hunt down speakers for their talk shows. This was at the height of some Clinton health care iniative, and unbeknownst to me I was listed not as a pathologist with a business, but as a healthcare legislation”expert”. And I got bookings! I was the featured guest on two different radio call-in shows, each somewhere in the plains of middle America. On both shows the hosts gave their spiel, I gave mine, and it was clear we were on very different pages as to how we wanted the scheduled half hour to go.

I don’t know how many listeners there were. I don’t know if either of these guys had Arbitron Ratings that could be seen without a microscope. But I do know that the combined number of callers for both shows was Zero. Zilch. Nada. Dead Air. If anyone had been listening I am sure they turned off or tuned out. And if I were the manager of those stations I would have immediately fired whoever booked me as a guest.  Absolute humiliation. That’s why you will never get me as a guest on a radio show or even a podcast again…there is only so much embarrassment a guy can take!
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President Trump, today is your birthday.

At Passover Seder, a celebration of freedom from tyranny, it is customary to sing “Dayenu”. The word means  “it would have been enough,” and recognizes all that God had done to free the Jewish people from bondage in Egypt over 3000 years ago. With that in mind, what “would have been enough” for me to wish you a Happy Birthday?

• If your business career had been honorable and your workers and creditors treated fairly, it would not have been enough.
• If you had spent your life respecting women rather than taking advantage of them and bragging about it, it still would not have been enough.
• If you had truly debated your Republican Primary opponents rather than insulting and belittling them, it still would not have been enough.
• If you had run campaign that had embraced the disabled rather than mocking them, it still would not have been enough.
• If you had surrounded yourself by reasonable men and women and learned to listen, it still would not have been enough.
• If you had a vision of a great America that was an inclusive America, it would still not have been enough.
• If you had not tried to convince America that Hillary Clinton was the devil, or at least married to him, it still would not have been enough.
• If you had valued a free press rather than decrying “fake news”, it still would not have been enough.
• If you had accepted your victory with grace and thoughtfullness, it still would not have been enough.
• If you had appointed Cabinet members who were worthy of sheparding their departments with policies that would maintain our greatness and world leadership, it still would not have been enough.
• If you had endorsed immigration policies that were Constitutional and balanced, it still would not have been enough.
• If you had treated our allies with cordiality and respect, it still would not have been enough.
• If you had proposed a budget with  numbers that added up, levied taxes where needed, and supported rather than slashed, it still would not have been enough.
• If you had recognized and acted on the data that the world’s scientists were giving you, it still would not have been enough.
• If you had desired bridges instead of walls, it still would not have been enough.
• If you had worked with Congress to improve health care in this country rather than mindlessly “repealing and replacing” the system we have, it still would not have been enough.
• If you had understood and respected the checks and balances of our tripartite Federal government, it still would not have been enough.
• If you had recognized the role of the President of the United States was the greatest honor on earth, not a mechanism for forced adulation and familial wealth, it still would not have been enough.

Maybe I ask to much–but I don’t think so. If you were a mensch, that would be enough for me to wish you a Happy Birthday.

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The opinions expressed are the opinions of the author and do not represent UroPartners LLC.

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photo credit: NormLanier – Publisher DailyDisneyPhoto.com Hall of Presidents’ Seal via photopin (license)

With Laury and Alex’s wedding less than a week away, it is no surprise that I have matrimony on my mind. Maybe that is why I was stopped cold by a headline in Saturday’s digital New York Times. I read The Times for its political commentary, but I was intrigued by the headline “Irresistible but Unavailable, at Least for a While.” The article used the NYT high-falutin prose to document the courtship of a former Miss Teen US Continental to an employee of the National Football League. The story is complete with the romantic hold outs, hard-to-gets, and almost giving ups. It is tale of love and desire that instead of being in Us Magazine has somehow claimed one of the tops spots on my Times “Recommended for You” clicklist.

I started to wonder how a high class rag like the Times might have described the courtship and nuptials of Barb and I way back in 1978–assuming we had been fortunate enough to attract their notice. It might have gone something like this…

Barbara Sue Jacobs and Lester John Raff were married November 12 in a ceremony and luncheon at the aging Drake Hotel in Chicago. Rabbi Howard Addison, a former youth group leader of the groom, served as officiant and stayed for lunch.

Mrs. Raff, 22, is an Occupational Therapist at the Rehabilitation Institure of Chicago. Occupational Therapy, also known as Jewish Physical Therapy, is the practice of preparing patients for the activities of daily life. She is a graduate of the University of Illinois, reknowned as the home of Garcia’s Pizza and a library built underground so as not to block the cornfields from sunlight. She is the daughter of Lee and Bea Jacobs. We  at the Times are happy to say the senior Jacobs both hail from the East Coast and are thus worthy of mention.

Mr. Raff (soon to be Dr. Raff,) also 22, celebrates Northwestern University as his alma mater. NU, as he affectionately calls it, still trails archrival University of Chicago in Big Ten Championships, despite U of C dropping out of the league prior to World War II to concentrate on building atomic bombs. He is currently a student at the Abraham Lincoln School of Medicine of the University of Illinois. (During his life, Mr. Lincoln, an attorney and not a physician, repeatedly denied the rumor that he gave Governor of Illinois several shoe boxes of cash to name the Medical School for him.)  Mr. Raff is currently interested in pursuing a career in pathology, the art of being a doctor without having to see patients.

The relationship between Mr. and Mrs. Raff began while watching a televised program in the social hall of the Medical Center Dormitory, when both were residing on the mostly deserted campus during a weekend. A nearly silent first date consisting of observing a polo match and pizza followed several weeks later. Attendance at polo matches was not to be repeated by the couple, though pizza dinners were to become a standard. Other future encounters included visits to The House on the Rock in Spring Green Wisconsin, the University of Illinois at Champaign-Urbana, and a Neil Diamond concert. According to Mr. Raff, “I really knew she was the girl for me when she cursed out the gang-gangers hanging out on the street in front of my rat infested Wrigleyville apartment.”

The wedding party consisted of numerous friends and relatives. Chicken was served.

It sounds so classy!  I hope Laury and Alex can compete.

 

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Barb and I completed our bookend concerts Saturday, on a very temperate moonlit night at Soldier Field. The Lumineers “Hey-Ho-ed” the opening, and an hour later U2 rocked the crowd with their Joshua Tree anniversary tour.  A nice evening out, marred only by total human gridlock leaving the stadium after the show. I suppose the crowd flows more freely after Bear games, with disappointed fans starting to leave halfway through the fourth quarter rather than everyone waiting for the final note from the Edge’s guitar.

The week before we were parked in the United Center for Neil Diamond’s return to Chicago. Neil is an act that Barb has watched transform from the urgent young man in black leather, through the glitz and glitter of the Jazz Singer days, into a mature, almost low-key performer. There was no opening act, but eye candy for the audience was provided by one spectator whose skin tight gold lame dress barely covered any of her very abundant “assets.” She openned more eyes than a Patrick Kane spin-o-rama shot on goal.

A pair of concerts, different as can be, but both celebrating the music of our generation. Both evenings so good, so good so good.

Here is a quick concert quiz. You don’t have to have been at either concert to score a perfect 100%!

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You can talk about your Twinkies. You may hustle for a Ho-Ho. And I’ll admit I have pined for a Pop-Tart or two (blueberry, unfrosted, untoasted, please.) But the childhood craving that is always knocking at the door is the one for Oreo Cookies. Those two, crispy, cardboardy, chocolate wafers, that pseudo-cream white stuff in the middle–heaven was a twist, a lick, and a bite. The grainy brown coating on my tongue was proof of indulgence. Calories didn’t count, saturated fats were smiled upon, and worrying about the glycemic index was decades in the future. Sure, I might wind up with a mild sugar buzz, but that was part of growing up.

In those days Oreo was a product of National Biscuit Company, Nabisco.  Nabisco is still around but is now a part of Mondelez International, headquartered here in the northern suburbs. And as reported in yesterday’s Tribune, Mondelez is undergoing some shake-ups.  A pair of top officers, Roberto Marques and Dana Anderson, are on their way out, separation packages and stock options in tow.

Not being an avid reader of financial reports or stock analyst newsletters, I am in the dark as to what precipitated the purge. Wikipedia lists at least 60 varieties of Oreos. Was one of those the downfall? Did Fireworks Oreos, with their blue and red popping candy explode in the wrong person’s mouth? Did Swedish Fish Oreos swim afoul of proposed import-export tariffs? Or did the FDA get around to perusing the nutritional composition of Triple Double Oreos as closely as it scrutinizes newly developed laboratory tests, and put a big black box warning on the label:  “Warning-Consumption of these cookies may lead to immediate death by disgust”?

The Tribune article reports that former Executive Vice President Marques is receiving a separation package of $895,000. That doesn’t seem an incredibly big settlement for a hot shot from a company with almost $26 billion in sales in 2016. But I like to think of it in terms of a stack of Double Stuff Oreos, reaching up to the sky. Would that stack reach the clouds, the stratosphere, the moon? And double that stack if Target was having a BOGO sale. Let’s hope there would be no Firecracker Oreos in the mix. A few explosions and we might wind up with a nation covered in granular brown dust. And that’s way too much for me to lick off by myself. Care to help?
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Do I smoke? Not since I lit up a Muriel Cigar in high school, lured in by Muriel pitch woman Edie Adams. Do I drink? Wine with dinner, beer with pizza, Margarita’s for Fathers Day and a good Scotch with my friends, but really nothing overboard or hepatotoxic. Do I do drugs? Not a pill or a puff. Legalize weed wherever you want, my one or two teenage experiences just made me sleepy. BUT…ask me a trivia question and I can feel the needle entering my arm, the obsession coursing through my veins.

Nothing new about this. There was Jeopardy and It’s Academic and Trivial Pursuit. I have bragged about elevating a pub trivia team from the brink of despair. And I can’t forget being a five time winner on WXRT’s “3 for Free” trivia contest, even if there probably aren’t THAT many listeners at 6:40 in the morning. But these habits are as manageable as my Margaritas. I can quit any time.

And then I stumbled on Sporcle, a website built to ensnare hopeless factoid freaks like me. And to put it bluntly, OH MY GOD. An endless stream of unnecessary trivia, with everything from match games to map games. Who said this, who starred in that? Which book came first, which author doesn’t belong? A rainy afternoon can turn into a marathon of right and wrong answers, with no penalties for going down the tubes. In this trivia wormhole time has no meaning. Questions pop up at the speed of light, new challenges never stop flowing.

I suppose the website does some ranking of players. I wouldn’t know, I haven’t stopped answering quizzes long enough to check. And I really don’t care where I rate. I am there for the rush, the first jolt of adrenaline when my brain finds the answer and my fingers hit the keys. And it’s all perfectly legal in 50 states, and not just for medicinal purposes!

Are you Sporcle material too? I’ve created two quizzes to get you started. The first measures how well you have been following our lives in the “Downsize-Maybe” blog. The second is a bit of musicana trivia for those who like it live. Just press the green tabs. Have fun!

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What song is each of these spoken lines associated with in a “live” recording?

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photo credit: Leo Reynolds <a href=”http://www.flickr.com/photos/49968232@N00/12364944″>question mark ?</a> via <a href=”http://photopin.com”>photopin</a&gt; <a href=”https://creativecommons.org/licenses/by-nc-sa/2.0/”>(license)</a&gt;

Laury and Alex’s wedding is one month from today.  RSVPs are being counted. Dresses are being formed, fitted and accessorized; tuxedos are coming out of hanging bags and sent to Zenglers Dry Cleaning to be pressed. Rehearsal dinner and morning after brunch, both courtesies of the groom’s family, are planned.

We have picked the pictures for the video montage and found the perfect music. The decor is almost finalized.  The selection of the passed hors d’oeuvers is complete, the menu for the wedding dinner is set, and the place cards are on order. We have previewed the set list with the band leader, who has also mentioned he may be able to add in a world famous drummer for the gig–we will pass on that little extra expense.

Laury is researching the perfect late night treats. The kids are working on their dance moves and Barb and I are trying to remember ours. The hairstylists and makeup artists are scheduled. I have my pre-wedding haircut in my calendar although Tina my stylist asks me why I am bothering. “After all,” she says, “it is all about the bride and the bride’s mother. No one will ever be looking at you.”

All in all, quite a bit different from Laury’s Bat Mitzvah, 17 years ago this month. Laury did a great job that day, reading Torah and leading worship. But the Bat Mitzvah had only one day of celebrations. There was only one set of families to include. Instead of a society florist, we had a Jungle Kingdom theme with a pre-dinner visiting animal menagerie. There was no band; we hired a fast-talking New York style DJ who promised he wouldn’t do anything to embarrass us and then walked on the edge.

It was a fun party, we were proud of Laury, but for a family that had never made religion a centerpiece of our life, it had the feel of very much ado about…not so much. After a few days, the significance had passed. Despite that, the video is still fun to watch.

No matter how much work and energy is spent in the next month, no matter how much stress there is now, and how much elation there will be that weekend one month from now, we hope the kids remember one thing. Unlike the Bat Mitzvah, it is the marriage, much more than the wedding, that counts. As both sets of parents can tell them, the significance of the wedding day will never pass, the commitment goes on and on and with each day becomes stronger. This is a life changer.

But we still hope the video will be fun to watch!

——

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photo credit: FestivitiesMN <a href=”http://www.flickr.com/photos/38227433@N04/20261961825″>Radisson Blu – Wedding – July 2015</a> via <a href=”http://photopin.com”>photopin</a&gt; <a href=”https://creativecommons.org/licenses/by-nc-sa/2.0/”>(license)</a&gt;

When I was young I believed a wedding ring was forever. After you put one on, you never took it off. That same ring remained on your left ring  finger till death do you part, or even beyond. It is a direct line to the heart and all that. But over the last 38 years I have learned that one ring doesn’t necessarily fit all. Rings can change, just as the nature of a marriage can.

My first wedding ring, the ring the rabbi told me to place on Barb’s finger as we said our vows, was a gold band. It had a groove in it, but was otherwise a pretty simple affair. Our lives were pretty simple too. We were 22. I was in  medical school, Barb’s was in her first OT job.  Gefilte the gold fish and Riff-Raff the parakeet made easy pets. No kids, no mortgage, and not that many responsibilities. An easy time to travel, even if the budget allowed only a bare bones European tour of 10 countries in 20 days. The motor coach was overheated and the tour guide sported a lousy attitude.

But the free and easy life didn’t last and neither did that first ring. I don’t remember if it became too tight, or if Barb just decided to surprise me with a new wedding band. This one was a more eye catching number. Four small diamonds, perhaps indicating we were checking off a new station in life. A good hospital position with lots of extra duties for me? Check. Extra training and certification in hand therapy for Barb? Check. Nice suburban homes? Check. Dogs and cats replacing fish and birds? Check. Two kids, days loaded with school, sports, b’nai mitzvahs, graduation? Check. So a little sparkle on my finger, and better accommodations on the next European tour.

Glitz has its attraction, but it can sometimes fade. The children go away to college for lives and families of their own, jobs change and so do goals and ambitions. My third wedding band, the one I now wear, does away with the diamonds and their twinkle. It is gold and platinum. Bimetallic, similar to the mechanism in old fashioned thermostats, it sets the perfect temperature balance. Just as our marriage does.

I have been having a little trouble with the ring lately. On many days, it is too tight for my finger. I suppose I should get it sized up. Or is it time for a new ring and a new stage of life? After all, we are in the new home, we are grandparents twice over, and our youngest child is soon to be married. Maybe it is a new phase of our marriage. I wonder what a new ring, or Marriage Phase Four, will be.

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