henry's letters: June 22, 2014

Dear everyone,

The US plays Portugal in the World Cup in about an hour. Apparently Renaldo is a bit injured, and Pepe is out of the game because he was red-carded in Portugal’s previous game, so maybe the US has a chance. Meeko, of course, is quite excited by Holland’s success so far, and I have enjoyed seeing Costa Rica play so well - - why not? There are two large TV screens in the new Doctors’ lounge at work, and there are usually a cluster of internists and surgeons around them at lunch time and in the afternoon; I haven’t heard any “paging Dr. X, Code blue Dr. X…” so far, but the tournament is still young.

I was as an Aikido instructors’ seminar this weekend. Sadly, I am at a high enough level that I am expected to be one of the instructors who instructs! I guess my session went all right, but I am more comfortable behind the podium with power point slides. My technique will never be as clear or clean as some of my peers - - I guess this is a measure of my personality; I am happy with a good enough job. I also rarely want to discuss any possible metaphysical implications of what we do in class; the physical aspects of the art are difficult enough. We certainly don’t expect Rafael Nadal to explain the philosophical underpinnings of tennis serve.

Last week from Wednesday to Sunday I was in Portland Oregon for the Neuropathology annual meeting. These meetings usually have a three year cycle of West coast, Midwest, East coast, and I go to this meeting 1 or 2 time in this cycle. Last year the meeting was in South Carolina, and I skipped it, but I was at the two previous meetings (Seattle, and then Chicago). It’s always good to see old friends and meet some up and coming pathologists.

I saw my friend Peter Pytel, who is a neuropathologist at U of C, and we shared a taxi ride into the city with Kar-ming Fung, a neuropathologist from U Oklahoma. We were staying at a hotel right across the street from the pioneer courthouse called the Nines. The layout of the hotel is pretty unusual, because the first five floors are a Macy’s. You have to take an elevator to the 8^th floor for registration. Luckily my room was on the 7^th floor, and the conference was on 6, so I was able to use stairs to get from my room to the meeting.

I got in early enough on Wednesday to walk a bit through the city, and pass a whole passel of food trucks on 10^th street and Alder. I had some iced coffee and some take out Thai food for dinner, and then walked on to the Portland Aikikai dojo, where I had a good work-out for an hour. They were doing some variations on techniques that I have not seen before, and the pace was pretty vigorous, so I had a lot of fun. It was still pretty early when I got back to the hotel, so I had a drink at the bar, where I met Mike Lawlor, a neuropathologist at University of Wisconsin who was one of my medical students at Loyola, and Craig Horbinski, who is an up-and-comer at University of Kentucky (he gave one of the talks on Thursday).

Thursday we had a special course devoted to tumor pathways, and pediatric tumors. These talks, and some of the special talks on Sunday, June 22, 2014 were very useful for me, since I need to put together a neuro-oncology talk at Christ (it was supposed to be in July, but has now moved back to October). Our system of classification of these tumors is going to undergo some radical changes in the next 1-2 years. Previously our diagnoses of these tumors were based almost purely on the histologic pattern of the tumor under the microscope. However, now with some of the genetic data coming out of the Human Cancer Gene Atlas work as well as some others, it is clear that we can classify tumors better if we are also using molecular and genetic information. This has big implications for prognosis of the course of the disease, as well as our ability to predict response to therapy. It also makes a difference when trying to enroll patients into clinical trials (because you always want to compare two groups that are as similar as possible). In this way neuropathology is becoming a lot closer to hematopathology, where the diagnosis of leukemias and lymphomas for the last twenty years has been increasingly directed by molecular information. Thursday night after the course I had dinner with a whole raft of people from University of California San Francisco, which is fast becoming a major player in the neuropath world. I know a couple of the faculty there pretty well, Tarik Tihan from my time at Hopkins, and Arie Perry, who acted as one of my consultants when I was at Loyola and he was at Wash U St Louis. We were joined by about ten students, residents, fellows, ex-fellows, and other UCSF faculty at Punch Bowl Social (http://punchbowlsocial.com/) across the street in the Pioneer Place mall. The food was okay, the beer was good, but no one was interested in bowling. Maybe if they had had bocce!

I did spend one afternoon having some fun, on Friday I walked up the Washington Park to see the Rose Test Garden and the Japanese Garden (http://japanesegarden.com/), which seemed much the same as when we visited them years (17?) ago for Jeff and Joan’s wedding. Then, for Friday dinner, I connected with one my Yale roommates, Tim Crump. Tim is a nurse with the University health services here. He picked me up at the hotel, and we met his girlfriend, Diane, at the Kennedy school restaurant. (http://www.mcmenamins.com/427-kennedy-school-home). This is one of many restaurants operated by the McMenamins, who have made a business of buying up old unused city facilities (elementary schools, sanitariums, etc.), and repurposing them as restaurants. The Kennedy school was quite interesting, with different rooms devoted to the restaurant, separate bars, a cigar smoking room, even a movie theater. Half of the school has been turned into a hotel as well, and each room has a different work of literature as a theme. They had their own brewery in the school, and I had some fantastic stout with strong cherry overtones. The food was only so-so. After dinner we drove to one of the Voodoo donut locations, apparently a Portland institution. I had an ‘Arnold Palmer’ (a doughnut with lemon crème and tea powder as a topping). Tim had a ‘Memphis Mafia’ an enormous bearclaw thing with chocolate, peanut butter, banana and cinnamon. I don’t recall what Diane got. After the doughnuts we dropped Diane off at her house, where I met her goats, which she keeps as part of a neighborhood collective, and tried some very very green goat cheese, from the curds that had developed from that morning’s milking.

Saturday was more posters and presentations. That evening for dinner I stayed in the hotel, because I volunteered myself to be on the website committee for our organization. Our current site is pretty static, unlovely, and expensive. We can build a new flashier one on our own that ought to be more responsive to our needs, as well as be cheaper to service. So I now I am trying to learn what I can about Word Press, our probable Content Management System, although we have heard some good things about Joomla! as well.

Sunday morning we had some of the big talks, of note was one given by Dan Brat, who is a professor at Emory now, and was one year below me in fellowship at Hopkins. His brother is Dave Brat, who just won the upset primary victory against Eric Cantor in Virginia.

The flight home on Sunday was fine; I took the light rail direct to the airport. My luggage came off the airplane completely soaked. Luckily Chicago was my home destination. Everything at home has been going well. We got a discount from American Honda for some expensive repairs to the 2005 Honda hybrid that was just out of warranty - - I hope that car can make it another two or so years until Jasper is out of the house in college. At work, most of the pathologists are getting pretty fed up with the ‘updated’ computer systems, but I doubt there is anything that can be done.

Nicola was home for a couple days this week. She wrote a great fiction chapter as her final work for her creative writing course - - encourage her to finish the book for publication. Lucas is now in Maine acting as the tennis counselor for a summer camp about an hour drive north of Portland. Jasper is swimming.

Portugal tied in a squeaker against the US, who played really well.

Love, H

Pictures from Portland. Portland is so cute - - the downtown is like a little mini-city, with short blocks, and small skyscrapers