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Altimexis

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  1. Altimexis
    Well, I repeated my PSA and it came back at 3.0 this time, which is a hell of a lot better than 8.5, but not nearly as low as it was a year ago. The free PSA was a marginal 22%, which translates roughly to my having a one in ten chance of having prostate cancer. That's a whole lot better than I thought it would be! I'll go back for another repeat in three months and if it's still low, chances are I just had prostatitis. If it's up again, however, I'll need a biopsy but, as some here have relayed from their own experiences, a positive result would be far from the worst thing in the world.
     
    A warm thanks to everyone who wrote me or commented here. You don't know how much it means to me.
     
    The interim job's going great and everything's on track for my permanent job later this year. It's nice to be working again! I don't have nearly as much time for writing, but I still hope to have Legacy done before the end of the year, and Conversations With Myself shortly after that.
  2. Altimexis
    Wow! I can't believe it's been nearly two years since my last entry! Truth be told, I was never big in keeping a journal going, even when I was required to in school, and I've never been much interested in maintaining a blog. The last couple of years have not been kind to me. Caught up in across-the-board layoffs at the university where I worked, I took a job in another city and we moved there, only to be laid off a month later when they lost a major contract that accounted for more than half my income. I then went to work for a friend and colleague of mine, even though it meant a 2-hour commute each way every day. After several months, however, it became apparent that he just didn't have enough business to support both of us and my income wasn't even covering my commuting costs, let alone the mortgage. I therefore started looking for another job, and eventually found one nearby. That one lasted a little longer than the first, but then I was again laid off when a contract facility threatened to pull their business if I didn't alter my documentation to make them look good. I should have probably reported them to the state - they were taking on cases they were in no way equipped to handle - but they threatened to report me for a series of trumped-up ethics violations. In retrospect, I should have probably called their bluff, but I was too afraid of what they could do to keep me from getting another job. In reality we ended up using up most of our life savings anyway, as it took until now to find another job.
     
    As I said, it has not been a good couple of years.
     
    OK, so I have a new job that starts in a couple or three months and I have a temporary job that starts next week and will allow us to make our September mortgage payment in the interim. With permanent employment, I'll finally be able to refinance our mortgage, too, which will make a huge difference in our monthly payments. Life is good, right?
     
    Well as a requirement of the temporary job, I got a physical - it had been just about a year and so I was due, anyway. As part of the physical, my doctor checked my PSA. My PSA had always been low. Last year it was 0.8. This year it came back as 8.5. F--k! That was just two days ago.
     
    Since then, I've done some reading on my own and I spoke with the head of Urology at Memorial Sloan Kettering Hospital, who is himself a world expert on prostate cancer. The good news is that such a steep rise is not generally consistent with cancer. Prostate cancer is usually insidious and causes a much more gradual rise. There is absolutely no history of prostate cancer in my family and although my mother has breast cancer, she didn't get it until she was 88, which puts it in a very low risk category. No one else in my family has ever had cancer at all. However, the only other thing that could cause a jump in PSA like that is an infection called prostatitis, which usually causes symptoms. I have no symptoms.
     
    A week from today I will have a repeat PSA test done to make sure the increase in PSA is real and not some combination of lab error and other factors. Just to be sure, I've been asked to refrain from any sexual activity or bike riding the week before. If it comes back normal, I'll be able to breathe a big sigh of relief, at least until next year, but if it's still elevated, I'll have to undergo a thorough cancer work-up. In the meantime I'm nervous as hell.
     
    Just when everything finally seemed to falling into place in my life, this had to happen, but there's more. My new health insurance won't take effect for another three months and, even then, there will be a one-year exclusion of pre-existing conditions. My COBRA coverage will run out early next year, leaving me without coverage for this condition, should it prove to be real. The treatment could literally bankrupt us but, if I do indeed have cancer, forgoing treatment is not an option. On top of everything, I'm worried sick my new employer will find someway to break the contract if and when they find out. I'm screwed.
     
    I cannot fathom how so many people in the US can be so opposed to a national health program. What was so bad about the availability of a public option for those who need it? The current system is fragmented and inefficient, and it's all too easy to lose coverage. It can happen to anyone, as I've certainly seen first-hand.
  3. Altimexis
    I'm way overdue in making an entry, but I just had to say something on this history-making day - the day after America elected Barak Obama to be the 44th President of the United States. My wife and I were Obama supporters from the beginning. I usually don't go around making a big deal of my politics, but I strongly believe in the basic premise that government has an obligation to ensure a level playing field for humanity. That doesn't mean there needs to be a huge bureaucracy, but the lack of government oversight led to the complete and utter collapse of the world financial system in my grandparents' day, ultimately paving the way for the rise of fascism and Nazism, and it's sad to see our past mistakes so readily repeated. As they say, those who forget the mistakes of history are doomed to repeat them.
     
    I'm not sure when "liberal" became a dirty word, but I think we have learned some important lessons from our mistakes of the 60's and 70's - among them that government has its limitations and cannot be expected to fix all of societies ills. Still, we shouldn't throw out the baby with the bathwater, as they say. Just because the "knee-jerk" liberal notion to provide everyone with food and housing has led to generations of "welfare moms" with no incentive to work doesn't mean we should dismantle the entire safety net. Worse still, the conservative arm of the Republican Party has an unhealthy penchant for inserting itself into the American bedroom. Not only do they want to ban abortion, which should be a heart-wrenching, but personal choice, but they want to define the very nature of the American family, telling us who we can love, whom we can marry and to an extent, even whom we can worship. Never mind that their presidential candidate threw his first wife away. That, I suppose, is OK. That is not a threat to marriage, but heaven forbid, two men should try to marry, or two women.
     
    Yesterday, a few states passed legislation defining marriage as only being between a man and a woman, among them California, a state I called home for three years out of my young adult life. I'm very disappointed to say the least. Let us hope this is only a temporary setback. I am fortunate to currently live in a state that while not allowing gay marriage, accepts gay marriage performed in other states or countries where it is legal. Some of our good friends have gone to Canada or Massachusetts to be married and are now recognized as legally married where I live, which is a start. I myself am married to a woman whom I love and adore - it's a sad reflection on the way things were when I was growing up - but she is my soul mate and I wouldn't change a thing, and am greatful that she accepts me as I am.
     
    The truly amazing news out of the election is that the state where I grew up - the reddest state in the Midwest - Indiana, went for Obama. That was a true miracle! Hooray for the gay teens of Naptown, which BTW went for Obama by a 2:1 margin.
     
    In final news, to catch my readers up on my own situation, as of my last blog entry, I had started a new job in the NYC area. Unfortunately, with the downturn in the economy, I was laid off within weeks of starting that job, after having moved more than a thousand miles. They just didn't have enough business, and gave me a reasonable severance package under the terms of the contract, but it still wasn't enough. I ended up partnering with a long-term friend and colleague of mine who lives in the area. It means a very long commute and the income is less than steady, and there will be a long delay before I see any of it, but at least it will (hopefully) keep my head above water. Wish me luck!
  4. Altimexis
    Well, this is my very first entry in my very first blog. I better not set the expectations too high - posts will be few and far between, as I'm busy, busy, busy. . . .
     
    If any of you have read my story, The New Job, you know that I moved here after my department was consolidated into another. A colleague of mine, a "friend", or should we say former friend, offered me a position as more of a lifeline than anything else. Unfortunately, the thing is that if anyone should never have become a department chair, he's the one. Saying he has ADD is putting it mildly. :nuke: He can't resist micromanaging things and he doesn't give anything a chance to succeed before he makes changes. Further, we are an academic medical center and there are bound to be fluctuations in activity. Grants come and go and the patient census can be expected to rise and fall - that is the nature of things.
     
    I was here for scarcely a half-a-year when he removed me from my position as a division chief because I "reduced the efficiency of the division." Let's look at that for a minute. When I arrived, the inpatient census on the division was fifteen and the one physician caring for those patients was reaching a state of burnout. At the same time we had three physicians seeing outpatients, none of whom was particularly busy. It only made sense to split the inpatient service in half and rotate the outpatient physicians through the second inpatient service, while at the same time having the former inpatient physician also see some outpatients, too. This had the advantage of improving continuity of care for the patients, while making the inpatient service less "stagnant." Our residents also benefited from having a wider variety of teaching experiences. It was a win-win situation and a resounding success, and the inpatient census skyrocketed even higher, reaching a high of nearly thirty.
     
    But then the natural cycle asserted itself, temperatures cooled, fewer kids shot each other or for whatever reason and the census fell to around eight. Seeing this happen, I was prepared to do what obviously needed to be done - to temporarily suspend the second inpatient service until the census picked up again as it inevitably would (and did), but I was never given the opportunity. I was removed from the directorship person, my salary was cut by 25% and I was removed from the service, with most of my protected research time being eliminated as well. Now as to my having made the service more inefficient - the only way I did that was by the addition of my position - adding a fourth salary to the division budget. I thought I was brought in to create change, but they didn't want change. I later found out that I was brought in expressly to fire one of my colleagues in my division - it was assumed I would recognize the need to fire him right away. Although he certainly was not and is not pulling anything close to his weight, he has been here forever and knows how to use every provision of his union contract to protect himself, and I wasn't about to fire him without cause.
     
     
    So anyway, the long and short of it is that my lifeline of a job has turned into a bit of a nightmare. I've been shuttled into one situation after another without any regard to what I want to do or to what my strengths and abilities are. I also walked right into the middle of one of the worst political messes in any academic medical center that I've ever witnessed, in which the medical center and the medical school are literally at war with each other. The dean and the CEO hate each other's guts, and the fight has become very personal, without regard to the thousands of lives affected.
     
    A couple of weeks ago, I was called into my boss's office to be told that layoffs were being discussed. The CEO is withholding $1 million per month of money he claims the medical school is now getting from the state and no longer needs from him. That's total BS, and it's total BS that the medical school can't manage with $1 million less in a budget of billions if it has to. Of course the budget has to be balanced at the end of the day, but the dean has to do something to fight back and so he's grandstanding in the media. "If you don't give me my money, I'm going to have to fire some doctors and we won't be able to take care of the poor." Well, as the last hired in the department, I would be the first to be laid off. Never mind that I have a distinguished career spanning more than two decades. Never mind that I've been a department chair and a division chief. I've been unhappy in this job, practically since arriving here, and I've been looking, but everywhere I've interviewed, people have wanted to know why I want to change jobs so soon. At least now I have a reason.
     
    So I guess what I'm getting at is that my writing may have to slow down for a while. I plan to introduce Out on a Limb on schedule, but it may slide, particularly if I find myself involved in a move. I'm interviewing for a job next week. It's in a private practice setting with an academic affiliation - definitely not the sort of thing I envisioned myself doing when I finished school, but after having been burned in academia twice now, being away from the center of the firestorm doesn't seem like a bad idea.
  5. Altimexis
    Yikes!
     
    Just when I thought things were bad enough, I've been laid off! But don't worry, I've landed on my feet. More on that in a bit.
     
    OK, let me back up a bit. If you haven't read it already, go back and read my story, The New Job. This is not only the story of my coming out to my wife, but it chronicles the story of my career, too. Although the story is fictional, the scenario is close enough. After finishing university, graduate school and medical school, I did my residency out west, and that's when I met my wife. I then joined the National Institutes of Health, and eventually went into academic medicine, planning a career in medical research. I did very well, eventually becoming a department chair. Big mistake. After suffering through three, count 'em, three deans in five years, I wound up with a dean who knew nothing about my field, could have cared less about it and, in the end, decided we were too small and too much of a bother. He basically decided to consolidate our department with a much larger one, scrapping fiver years of hard work spent building a world-class program.
     
    Everything I wrote about in my story is true. When you step down as a department chair, even under these circumstances, everyone wonders why. Since no one is ever fired - they always "resign", there's no way to tell if they resigned because they quit out of disgust, they were eased out because of politics or they were fired because of incompetence. People ought to be given the benefit of the doubt, but it's human nature to steer clear of such people - to treat them as damaged goods. Some people have a natural charisma and manage to pick themselves up and move right on, securing an even better chairmanship, but I'm not one of those and, besides, I've had my fill of politics. I ended up taking a friend up on an offer to head up a division in an academic department in a city I would have never previously considered calling home. :wacko:
     
    I'm not going to name the city. It's in the Midwest, and it doesn't have the best of reputations. It's known for violent crime and for corruption in government. The good news is that it has affordable housing. My wife and I were able to buy a condo in a beautiful art deco building, right in the city, within walking distance of work. Of course just about everyone I know told me I should be packing a piece if I intend to actually walk to work. :2hands: Now that's a gross exaggeration - I've walked to work many times when the weather's nice and it's quite safe, but you do have to choose your route carefully or you will be stopped multiple times and asked for money. When I told my wife it was more a matter of when, not if, I would eventually be mugged, she told me in no uncertain terms that I shouldn't walk to work. OK, so maybe it's not completely safe. :sword:
     
    In any case, I've been here 2 1/2 years now, and absolutely hated it. My "friend" thought he was doing me a favor, but he was bringing me into a political mess in which I was expected to replace and ultimately fire an unproductive colleague who had been entrenched for years. I didn't really know that at the time and it only became apparent after I'd been here a while. The problem with entrenched academicians is, there's usually a reason they're entrenched, even if they don't have tenure. Either they know the system well enough that they can manipulate people to keep from being fired, or they have enough dirt on people to guarantee job security, or a combination of both. I'll tell you, when I even suggested to the colleague that he might want to complete his subspecialty boards while he could still be "grandfathered" in, I immediately received a long diatribe of an e-mail from one of the senior associate deans on the inappropriateness of anyone but the department chair dealing with career development issues. My boss quickly cleared things up by explaining on my behalf to the dean's office that subspecialty boards were a job requirement and I was only doing my job as the head of a clinical division, but this certainly showed me what was in store any time I attempted to do what I was hired to do.
     
    The long and short of it was that at the end of the day, there wasn't a single thing I could really do to fire the guy that was ethical and I wasn't about to become a target in my own right in the interest of making it easy on my boss, who was too chicken to pull the trigger on the guy himself. :wacko: When I failed to do what I was really hired to do, I was removed from my position as division chief, relegated to a low-level clinical position that someone just out of training might get, at a significant reduction in pay, I might add, and prevented from spending any time on research grants. Talk about punishment. To say this sucked big time is an understatement. I've been looking for a better job ever since, but now everyone's really suspicious. First I resigned as department chair, and then I resign as division chief after less than a year, and now I'm looking for a new job after only a couple of years? It certainly looks like I'm bad news, doesn't it? :wacko:
     
    Of course, there are always two sides to every story and there are a lot of crazy things that have been going on here besides the drama between myself and my colleague, and besides that between myself and my former friend, my boss. The CEO of the medical center is a former prosecutor who takes no prisoners, and he has his own agenda that is heavily at odds with that of the dean of the medical school. I would say it's fairly accurate to say the CEO and the dean are at war with each other. Recently, the CEO announced a retroactive cut in something called the DISH payment - payment his hospitals receive for taking care of the destitute - to the medical school. He's supposed to pass this money on since it's the physicians that actually render the care, but he's decided to hold on to it. The dean is crying foul and claiming he'll have to lay off physicians and stop serving the poor. Well, guess what - the dean's quietly circumventing union regulations for laying off faculty by simply pulling the plug on approving contract renewals, and guess whose contract was up for renewal on July 1.
     
    Does my life sound like a soap opera or what?
     
    I've had it with academia for the time being. Much as I'd like to help humanity, the politics in academic medicine just aren't worth it. If I had my life to do over again, I would have stayed at the NIH. Although you have to put up with the changing priorities of each presidential administration, once you rise though the ranks, you can pretty much do what you want and you don't have to compete to nearly the same extent for research funds. Now, however, I have to move on. I received a very good offer from a large private practice group on the East Coast and I've decided to take it. I won't be rich by any stretch of the imagination, particularly when one considers the cost of living where I'll be going. In fact, after factoring in the cost of housing, We'll be living in less space than most people would consider acceptable, so from that standpoint, I guess you could say that at best we'll be middle class. The most important thing is that I'll have freedom, and I'll actually have better opportunities to get back into medical research than I've had for the past five three years.
     
    And now an important announcement about my upcoming story, Out on a Limb. Because I have a major cross-country move coming, up, it will obviously be impossible to start posting the story as originally planned in mid-May. Only the first three chapters have been written and edited, but I can at least say that I'm very pleased with the way they've turned out and with the direction of the story so far. OoaL is a much darker story than LiaC, and much truer to life, but I think it will be very fulfilling and resonate with a much wider audience in the end. Something about it just resonates with me as I write it, much the way it did when I wrote The Un-Christmas, so I know it will turn out well. In the interest of doing it right, I'm postponing it's initial release date until the fall.
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