My personal history and that of this project are inextricably intertwined, much as I wish they weren’t.
I started medical school at the University of La Laguna (Tenerife, Spain) in the fall of 1974. Because classes were taught in Spanish, I took an intensive course in the language at the Universidad de Menéndez Pelayo that summer in Santander, which is located on the northern Atlantic coast of Spain, one of the few bearable temperate places in the otherwise sweltering Iberian summers. Early in my studies, I realized I had less compassion than one rightly expects of a doctor and thus gravitated to pathology, a field in which people skills can quietly atrophy. Biomedical information fascinated me and I amassed drawerfuls of 3X5 cards about cutting edge medicine which, to be fair, wasn’t particularly cutting edge in the 1970s.
And I bore easily, one of the many downsides of a supposedly high IQ.
So I made a faustian bargain with the gods; I wanted to know everything; the work that pretends to provide all of the medical information is a dictionary. What a profound disappointment. They contain no new information, or what is “new” appears in a watered-down form 5 or more years after the data was first published in a peer-reviewed journal. And the traditional (classic) information, if you can find it, is so anemic as to be useless to the medical student or physician. I still have the ’75 edition of the Dorland’s Illustrated Medical Dictionary, and shake my head in wonder that enough copies get sold from one edition to the next for their publisher to keep producing such rubbish.
I finished medical school in 1980 after a three-semester stint in Klinikum Steglitz (now, Klinikum Benjamin Franklin in Berlin-Steglitz, and yes, it was taught in German). I returned to the States and began my residency in pathology. Histopathology in the US is not as intellectually challenging as it is in the UK and by 1984, I decided that re-writing a medical dictionary from the ground up offered me a worthy challenge.
How I rue the day when I embarked on this journey.
In reference to writing a book, Winston Churchill said it more eloquently than I ever could, it begins as a toy, then becomes an amusement, one’s mistress, master and finally a tyrant (paraphrased). I now feel guilty if more than a few hours pass without me sitting down at the laptop and slaving away under the tyrant’s thumb. This project has cost me three jobs, a marriage, two of my three children, over a hundred thousand dollars in hard- and software and hired expertise, and millions in lost wages.*
*But it’s time to cut losses. I’ve decided that if nothing substantial comes of this by year’s end, it will be time to seek another plane of existence. Let’s hope it doesn’t come to that.
This was first published in 1992 by the Parthenon Group, a UK publisher, as The Dictionary of Modern Medicine. The company’s managing director, a David Bloom, took my then wife aside and told her that I shouldn’t believe that I would ever make enough money to feed a family from the revenue. Nothing could convince me of this fact. It is now 2017 and short of a massive reversal of fortunes, I have, to my profound chagrin, proven him right.
The Dictionary was very well received and got stellar reviews. At the time, the project had 12,000 entries (compared to the Dorland’s Illustrated Medical Dictionary, which in the early 1990s had about 110,000 entries). Then, both works were text-based, which in simplistic terms, means that both were essentially very large MS Word files.
I continued to expand the project and was able to move the publishing rights over to Simon & Schuster’s (S&S) medical division (Appleton & Lange, A&L) and published the second edition with 18,000 terms in 1995 with the title Current Medtalk. The work’s final foray into paper publishing was in 2005 as The Concise Dictionary of Modern Medicine, this time with McGraw-Hill (which had bought A&L from S&S) with 23,000 terms, culled from a pool of perhaps 70,000 terms.
I’d just moved to the UK, where I thought I would finish my days as a pathologist and retire gracefully to northern Italy, which beckoned since my first extended period in Europe. I dropped anchor at Hereford Hospital, a small hospital trust just east of Wales. The agreement with the hospital was that I’d stay if they were happy with me and I with them after a six-month honeymoon. How could I not be happy, I was practicing real medicine for the first time in my life.
In the US, I’d get biopsies of essentially normal tissue for which I diagnosed “mild non-specific inflammation” in 90% of cases, wording which allowed the endoscopist to unnecessarily rebiopsy the patient year after year. In my experience in the States, your colleagues didn’t like to see the word “normal” too often on a report. It implied that they were “trigger happy” and ‘scoping patients more often than necessary and might lead to denial of coverage (non-payment) for the procedure. Such waste goes a long way to explain why health care in the US costs nearly double what it does in the UK.
In the UK, your clinical colleagues want to know if something is normal, because if it is, then they can discharge the patient and won’t have to see him/her for another 3 to 5 years.
The 6 month trial period came and went uneventfully and I settled in, which I now know was the worst of all the bad decisions I’ve ever made. Shortly afterward a colleague came from Bromley, an acute hospital trust in southeast London. Had I known then what I know now, I’d have weighed anchor and fled. Getting hired by a hospital in the UK is a huge deal and a lifetime commitment. If you take a post as a consultant, you’re there until you get the gold watch. So here was this female pathologist uprooting her family after 8 years in the same place. My guess is that her abrasiveness and arrogance hadn’t endeared her to her colleagues in Bromley and she was eventually persuaded to leave.
Five minutes after she walked in the door, she concluded I was “dangerously incompetent” (as she alleged were the next three pathologists who followed me). I’d never before met a bully, so the experience was new to me, but in retrospect, that’s what my new colleague was. I thought the hospital had my back. It didn’t; nor did it matter in the end, the bully won and I got sacked. It’s no consolation that those close to my situation said that I’d been “treated shabbily,” a British euphemism for screwed. How does that knowledge help me? Did knowing that somehow make the time I spent in a detention centre in the UK or my recent year and a half of homelessness less demeaning?
This is so difficult to relive, but the long and short of it is that the Royal College of Pathologists says that the expected serious error rate for a pathologist is 1% to 2%. The hospital had the cases I’d diagnosed reviewed and found I had a 1.54% serious error rate…and trust me, they put their finger on the meat scale; a fair number of the cases they called errors were not. These cases were then reviewed by Professor Sir Nicholas Wright who found I had a 0.56% error. I have relived these statistics every waking minute since.
The General Medical Council weighed in and found no issues and said simply, pass the FRCPath exam and you get your life back. I took and passed Part 1. I took Part 2 twice and failed. My visa expired, I was picked up by the Home Office, put in a detention centre and a week later (February 2012) put on a plane to the US, where I have been since, licking wounds that won’t heal, too embarrassed to approach another pathologist for any sort of job, cutting ties with friends and family due to the unbearable shame, shrinking from most human contact, not daring tell strangers I’m a doctor. The pain is more than flesh and blood can bear
To give the reader an inkling of my ongoing despair, I occasionally drive a taxi to supplement the pittance I get from Social Security. Two years ago, I was held up at gunpoint by three young men who assumed I valued my life more than the money they thought they were going to get. I yelled at the top of my lungs, “Start Shooting”. The bastards ran off; the only way they were going to get the $84 I’d earned between starting that evening and 2 am that morning was to pry it from my cold dead fingers.
The police caught the “perps” within a few minutes and they’re now doing time in prison. The assistant D.A. at the grand jury called me the most badass person he’d ever met…and he was pals with cops who had some hair on their chests. How could he have known that I wasn’t Bruce Willis, but rather the end result of bullying by a colleague?
O Death! Where is thy sting?
But I’m getting sidetracked…sorry. There are more stories, but none are happy…and we all like happy.
Since returning to the States, I’ve been working virtually nonstop on the dictionary/database and now have close to 200,000 entries