Mike, Kevin and Darrell Ask “Can You Look at My Slides?”

| August 1, 2016

slides1We are all busy, and I’m not different. Between busy clinical schedules, travel for work and pleasure, the Spring and Summer are a blur.

But there’s nothing like voices from your past to force you to take a pause. I’ve recently received three requests from people from my past, all asking the same question, “can you look at my slides?”

I’ll start with Mike. We’ve known each other since 5th grade, and our siblings have known each other since 1st grade.  Somehow, during junior high I obtained a few phone numbers of Chicago Blackhawk players.  Mike was the first one to see if I was being truthful – so he called Dennis Savard and Doug Wilson to make sure I was telling him the truth.  To make us stop calling, we received signed photographs that we all still have.  And we stopped calling their homes.

Years later Mike and I would scalp tickets for Blackhawks games when we got our drivers licenses to go to the Chicago Stadium. It seemed like it was always cold but we usually got decent seats and only occasionally got stuck with phony tickets we could usually resell.

Mike called me in May. He and his family now live in Florida , and he had been diagnosed with Stage 4 esophageal cancer. Could I review his slides and confirm the diagnosis? Of course.  We reminisced a bit about the Blackhawks, and of course I agreed to review his slides and confirm the diagnosis.  He started chemotherapy shortly thereafter, and is currently doing well.  Far cry from freezing outside the Chicago Stadium. Mike is a few months younger than I.  It makes one think about their own mortality.

Kevin was a mentor at Northwestern.  Many decades ahead of me and in private practice, Kevin was an attending I wanted to emulate in terms of his commitment to patient care, empathy, and life long learning.  While he was not a pathologist, and I ended up not becoming a cardiologist like him, his approaches to clinical care have served me well and have applications in pathology. One of the first things he taught me was to “do everything the same way every time.” Kevin said it would decrease the chance you might miss something. For example, when reading a chest x-ray, start from top-down, left to right, inside-out, lungs, then heart, then bones, whatever works for you.  Just figure out what works for you and do it that way “every time” you do it. I learned how to read EKGs consistently by this method, whereas a more random approach would have led to errors committed by not seeing rather than by not knowing.  It works well in pathology too; low power, nearest the label, scan all the tissue, higher power as needed moving away from the label and looking at all the tissue.  Larger specimens require an outside-in approach, and sections of tumor require three-dimensional thinking by segmentally looking at two-dimensional sections – but a consistent approach allows you to minimize the chance of error.

Kevin emailed in June with a one-line question, “Can you do me a favor?” It was I who usually was asking him this question. Career advice, changes in healthcare, predict-the-future sort of stuff, given his lifelong experiences in healthcare and more recently in healthcare consulting. Of course I replied, “Anything.” He proceeded to tell me he was found to have bladder cancer with exercise-induced hematuria, running several miles a day at the age of 70! Could I review his slides? The mentee helps the mentor.

Darrell and I had kept in touch on Facebook but little more. The last time we saw each other was our 10-year high school reunion.  Neither of us made the 20th or 25th, but perhaps we will both make it to our 30th.  He seemed to be doing well given his FB posts, but apparently not as well as posted.  Apparently he had struggled with alcohol addiction since college and all the demons associated with being an addict.  He had fallen on hard times and his liver was beginning to fail him. He started the process to become abstinent of alcohol through Alcoholics Anonymous and other support programs. He failed initially, but fought through and attained some self-control.  Unfortunately, the damage to his liver was done and he was diagnosed with cirrhosis.

Darrell messaged me through Facebook last month to ask if I could review his slides. He wasn’t sure what a pathologist was until that biopsy, then thought I could help give him a second opinion.  We too are several months apart, having met in grade school. Despite now living in the same part of the country we had not spoken directly, but a liver biopsy changed that.  We reconnected and he discussed his struggles and addictions.  It sounded horrible, but he wanted to change his situation and be around for our next high school reunion and more.  He had goals for his life and dying of cirrhosis was not on his list.  He fought to eliminate the cause of the cirrhosis and start to get evaluated for a liver transplant.  His biopsy arrived in the mail last week.

Again, you count your blessings. Your health. The time that you have. You think about four square games at recess and nervously dancing with girls in 7th grade, catching baseballs on Waveland during batting practice and “fast pitch” behind the high school.  You think about the time you got caught with Mike and Darrell for “dipping” during French class, not about metastatic cancer and alcoholism.  Then the pink and blue images change the reality of the situation. We perhaps would all like to go back to those awkward dances and summer days, but this summer was a new actuality.

I wonder how many more slides will come in the mail from people like Mike, Kevin or Darrell.

And when I may call a former medical student or resident to ask, “Can you look at my slides?”

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Category: Anatomic Pathology, Blogs, Digital Pathology News, General Healthcare News, Pathology News, Patient Advocacy, Personal

Comments (3)

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  1. Kenn Laurie says:

    Hi Keith,

    Without detracting from the obvious concern and empathy for your friends, imagine how much quicker you could’ve been applying your skills and talent working with virtual slides. To me this anecdote reinforces the validity of digital pathology.

    I hope Mike, Kevin and Darrell all fare well.


    • In an ideal world, yes. In short, between the initial phone calls and actual delivery of slides, weeks go by. Much too long. Mike, in particular, had already started chemotherapy, truth be told by the time slides were actually mailed from department. Was not a diagnostic dilemna per se, but would have been nice to complete review in real-time or near real-time.

  2. Dan Cruser says:

    Wow. Very thought provoking. Thanks.