Podcast guest: People of Pathology, hosted by Dennis Strenk

Dr. Apple is the guest on a recent episode. Spotify, Google, and Apple Podcasts

What Dennis discusses with Dr Apple: How she became interested in writing. Her first two novels, and why she decided to write a nonfiction book. Her path to medical school and pathology, and why she chose breast pathology.

What “the Unseen Doctors” means to her. Why communication between pathologists and other doctors is so important. Why she wanted to help educate patients with this book. How she got into teaching, and why it is rewarding for her.

Who says you have cancer?

Only your pathologist determines the “final diagnosis” for a patient’s illness. This is the first medical book of its kind that describes pathology, the unseen doctors and workers who who are behind the scenes working for patients in every hospital. Dr. Apple donates all her book sale profits for those in need of a wheelchair through Joni and Friends, and those who lack access to food through the Valley Food Bank.

Available at Amazon

“Pathology is one of the most misunderstood fields of medicine. In Doctor Apple’s book, she makes it clear what pathologist do, the joys and rewards of practicing pathology, and why she choose to enter the field. This is a must-read for any medical student contemplating their choice of specialty, any physician trying to better understand their pathology colleagues, and any patient who may incur the services of a pathology laboratory.”Michael H. Kanter, MD, CPPS, Professor and Chair, Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine

Part IV: Martin’s Story

Chapter One

I am mad as hell! How dare they kill my daughter Julie! All the sons of bitches have to pay for this and I will make sure they pay a hefty price! Slowly but surely, I will torment and destroy them one by one starting with the lab doctor. How can the top hospital like Beverly Hills hire such an incompetent doctor who butchered up my daughter’s case? Who is this bitch? What does she look like? I just want to meet her and see her face to face. She should not be mucking around being a doctor but should just have children and a husband to attend to. And leave these matters and important job of medicine to men doctors. How could Dr. Kline, my trusted doctor, have done this to me, leaving such an important job to a woman doctor when I have been giving him a ton of money for his research? Not only that, but he also botches up my daughter’s care by not giving her radiation treatment in time. Now I regret giving him so much research money after he helped my wife deliver all three of us girls.

I thought he was my friend. Doctors are all the same, they protect each other when there is a lawsuit. And those two must have been hiding something and not telling me the truth. Well, it will all be revealed in the courtroom. My hired guns will reveal their secrets and display them in daylight. Let’s see how these doctors look when we put them on the stand and see if they can extricate themselves out of the situations. I will make sure my lawyers bite them like sharks. We’ll make them spit out all their mistakes with as much bleeding as possible. They will get a dose of their own medicine by the time I get through this lawsuit. The jury will see how vulnerable doctors really are and I will bring them down from their high and haughty white tower, prideful egos and put them to shame. Even so, I am not sure justice will be served. My Julie is still dead, and she will not be with us, forever. This pain of losing my child is so overwhelming and devastating. I can’t think about anything else but to be hyper-focused on revenge. I am her father, and I did not protect her. Feeling like a failure torments me. I have not been talking to my wife or Jane, my second daughter. Luckily, June, my first daughter is at college and there is my excuse to avoid talking. I do not have to see her every day. But Mary and Jane, I must see every day and I have no idea what to say to them. They keep distancing themselves from me, and from each other, too. Everyone goes to our own rooms, closing the doors behind. We no longer have family dinners. My wife does not want to see me anymore. She locks the master bedroom door, so I cannot even get in. She does not address me about the scene at a hotel, as if nothing happened. Sometimes I even wonder if she actually witnessed me standing with another woman in the elevator. I make several attempts to talk about this, but Mary won’t budge.

She avoids me and does not acknowledge I am in the house. Right after the elevator incident with my paralegal Beth, my wife decides to give me cold looks. She will not even talk to me. I cannot believe Mary followed me into the hotel! I almost kissed Beth in front of her. I saw Mary but it did not register I was seeing her right in front of me. I got caught. Guilty as hell. But I deny it, of course. And I will deny it all the way if Mary asks me. Sometimes women can overlook and overthink, and I can fool them to think otherwise. I still have my charm and smarts to get out of a sticky situation like this. Over time, Mary will think maybe she thought she saw things that were not really what appeared to be. I never cheated on her before this time, and we have a fantastic marriage. She will forget about all this because we have girls with us, a family. I have supported my family as a bread winner successfully. They have a beautiful house, private schools and many vacations all over the world with my company’s private plane.

We have a beautiful lake house in Lake Tahoe we enjoy every summer. I always provide for them spectacularly well. What more can anyone ask from me? I am more than a capable man and support my family in prolific abundance. Besides this little slip with the paralegal, I am a perfect husband and a good father. With Beth, it just happened so naturally. I spend a lot of time in the office, and still pull 70–80 hours a week as a senior partner. Making money can be a little addicting. As I make more and more money, I notice there is no limit to the amount that satisfies. If I make a half million dollars, then, I want to see if I can achieve three quarters of a million, then a million, and why not ten or hundred million? Sky is the limit. Nothing is more exciting than to know my capability to profit my company and earn a good living. What is wrong with that? Regarding Beth, it is momentary fire and flirtation I could have resisted, but I said to myself “why not?” Why would a capable man like me settle to have just one woman for life? Although I do not really believe women can be as capable as most men in my business, we are required to hire more attractive female attorneys and paralegals. Plus, they can be helpful in many of our cases. They somehow approach problems in different ways; shall I say more softer and at times manipulative ways, and some of our clients listen to their voices more than mine. We pay very competitively and can be choosy in selecting who will join our company. Stacks of applications pour into our place every year and we can be very selective, and what is wrong with selecting only the attractive ones? This applies to both females and males. After all, it is a fact that attractive people are more successful and they get what they want more easily. Beth is perhaps the most attractive lady in our company. She is a blond, blue eyes, tall, young and thin with figure. Her high heels make her body swing; her full buttocks, it is a killer especially with those long legs of hers crossing when she sits. She flaunts it because she knows she’s got the looks. Among senior partners, we bet who will get her first. Well, not actual money but in a joking manner. Competitive edge always serves me well. I never lose anything when I put my mind and priorities in place. When I begin sleeping with Beth I do not think through things or how it will affect my family. I’ve just got to have Beth. What does she look like naked? She addicts me. I’m willing to do just about anything when a competition is set in front of me. Being first is important, but I have to think about the consequences, unfortunately. I never think about getting caught, to be honest. Beth is becoming more demanding. “Why don’t you buy me this or that? How come I can’t see you in public? Why can’t we go to Hawaii for a vacation together?” Her annoying lists become long, and I am tiring of her whining voice, straining to fulfill her demands. We go to Hawaii, and I lie that it is a business trip to my wife.

At lunch I stop by Tiffany’s to find Beth something, open my wallet and there is not enough cash. My credit card works. Rushing back to the office, I realize Mary now pays the bills. I relinquished that responsibility to her just last month. Now I have to buy something else for Mary and cover up the first charge I just made for Beth. I forget it was from Tiffany’s in Beverly Hills and a couple days later I pick up a necklace from Nieman Marcus for my wife, not thinking whether or not it is packaged in a Tiffany blue box. On top of this, I totally forget about our wedding anniversary. I just took a Hawaii trip with Beth. 

“Oh, it’s not from Tiffany’s!” Mary screams.

I know I blew it, immediately. I have become an insensitive son-of-a-bitch to my wife. Why have I come this far? It is not fair for Mary. She has been a good wife and a good mother to my children. I feel remorse but she will not even face me, and I will tell her how sorry I am if I must. Maybe I have come too far to fool her to think I am not having an affair. My only hope is to show her how much I care about her and the family by winning this lawsuit case. That will show Mary and my family how great I am to take care of matters with my own hands. Not only do I pick five top-notch senior partners for my medical-legal team, I add five more associates who are aggressive, rising stars in our firm. I release hungry sharks to be free in the water for them to seek prey. They will have a field day as they destroy these doctors and that hospital.

Read the entire novel. 100% of profits from book sales are donated. Incidents in my new novel portray a female pathologist promoted to department chair. She encounters powerful forces of indoctrinated prejudice and in medicine and exposes false assumptions about medical-legal justice. Ultimately, the doctor presents a case to decontaminate the poisons in this world of unforgiveness. FORGIVE TO LIVE at Amazon and at Smashwords eBooks

Martin’s story

Chapter Two 

It is early November and finally Los Angles weather is consistently getting cooler. I work hard to get this case heard by pushing some judges, my old friends in the court system to get a prompt pretrial hearing. We get a fast-track date for early November, just two months after Julie’s death. It is good to know some people and use some muscle to shift things around in the legal realm. The day is upon us to meet all these doctors and defendant attorneys face to face. Of course, I know what this lab doctor looks like from her web page. I am mostly excited; and a little apprehensive to meet her and crush her. I never get accustomed to courtroom drama, how it makes me nervous, especially in the beginning. Butterflies in my stomach during my opening statements. Although I am not personally involved in this case, my nerves are jittery. In the preliminary hearing, the defense side only has two counsels, Mr. Harris and some young female attorney named Melissa Razi. The hospital always retains respectable liability firms, and today it is Harris and Sidman, LLC. Melissa Razi appears to be Persian, in her mid 30s, fairly attractive attorney with a slight Farsi accent. She will shrivel and cry, an easy target for the guys I hired. My attorneys will deliver sharp remarks and can be ruthless. Karl Harris is another matter. He gained some weight and more gray hair over the years. He is very experienced, skillful and a smart guy we previously encountered with the same hospital a number of years ago. The outcome was really bad for us; we lost the jury trial. The damn Harris group and idiot jurors put us to shame and we are still paying the price for our reputation. We still made a profit from the plaintiff, who had to pay all fees for every hour billed by our firm, as we rarely take on pro bono cases. In the end, we always win by gaining monetary rewards. Today is showtime. Our ten attorneys will crush Harris this time. He is stupid enough to show up with just one additional meek new attorney. Last night our side called Harris with a settlement amount which he should have agreed to pay. He should have accumulated more defense attorneys to at least take our side seriously and show us some respect. We carefully calculate the amount in every detail. If Julie were to live and become a trial attorney like myself, she would have earned so many millions of dollars, minus her education fees. If she were to be just a housewife. minus education fees, her life might be worth a particular amount of lesser dollars. We make sure the figure lies somewhere in the middle to be perceived as realistic. Suddenly, anger hits me. I am sure she would have been a star, wildly successful as a trial attorney, maybe even better than me, as I quickly recalculate her billings, bonuses, plus inflation. I am still not satisfied with the final amount, but I have to be reasonable. What I really want to do is ask for an obnoxious settlement amount that will push our case to a court trial, but my partners persuade me to be reasonable. Their interest, after all, is the money, not a jury trial. Usually, the plaintiff’s side requests pain and suffering be compensated, while the defense side wants their names to be cleared, and their attorneys are ultimately interested in money. This is what the system boils down to in the end.

In this case, plaintiff and attorneys are one, at least from my viewpoint. My partners still do not see it this way and are only interested in money. I am not one of the counsels at the table, for a change. I take a seat behind the players, next to my wife and Jane. June plans to come from Berkeley, probably the last day of deliberation or earlier if she has to testify for some odd reason. I try to protect her from interruptions during her college classes. Jane is somewhat thrilled and anxious, glad to skip her high school classes and witness every action in the courtroom and actually observe the outcome after her sister’s death. None of my daughters have ever seen me in courtroom action. I never take them to my playground where I thrive and play hardball. Too bad I am not a counsel contributing at the courtroom table. I want to impress my daughters and my wife how great I am. It starts. I watch all ten of my attorneys walk in, all in suits. Dark navy blue, gray and black. There are not enough seats for my side. Mr. Harris shakes hands with five of my guys, Jeff Grey the lead, Tony Spiro second in command, and three others. Mr. Harris introduces his partner, Ms. Razi. Next to her is Dr. Sara Choi and Dr. Kline. This is the first time I see Dr. Choi in person. She is tiny maybe five feet, four inches tall, shockingly attractive, Asian and appears very intelligent with her glasses, younger than her age. She looks to be in her mid-thirties, but Dr. Kline told me she is late 40s, almost 50 years old and chair of the department. Dr. Kline spoke very highly of her once when she read my daughter’s liver biopsy. He said she is a top-notch pathologist. There is something about her and why do I feel somewhat intimidated? She seems too smart for me. A coolness about her, perhaps an air of confidence I have never seen in any woman. Her hair is deep brown to black, a little curly and long and she wears it straight down covering her shoulders. Her deep navy pants suit is pristine, perfect with her starched white blouse which is not low cut. No jewelry except a sleek smartphone watch with a classic silver band. Choi’s black shoes have low heels, she’s comfortable but dressy. Indeterminate emotion on her face, probably good in poker games. Dr. Kline is next to her. They talk softly to one another, leaning in close and whispering into each other’s ears. Clearly friendly, they like each other. Well, they have to be one team, working together for this case at least. Inspecting Dr. Kline in his generic dark suit and necktie does not impress me or draw my attention. I do not care how he looks except to say he looks much more nervous than during our casual dinners at each other’s places many years ago. I certainly do not want to penalize him too much. Just answer the question, why did you delay radiation treatment to my daughter? I really am not out here to get his money or his reputation. If I had my wish, we would immediately drop our claim against him after hearing his answer. I am here to get Dr. Choi. I will pull her down so that she cannot practice pathology any longer and confiscate her medical license to prevent this damaging medical care of hers that delays diagnosis and treatment to other patients. This trial is about punitive damages. I am rather happy to have Virginia Chang, Esq. in my group, in case there are sympathetic jurors out there for Dr. Choi, an Asian descendant. Ms. Chang will slay her with one sentence and put her in misery. Chang’s sharp tongue and killer instinct has her disliked by every secretary in our group because of that nasty tongue and prideful attitude. I would hate to face Ms. Chang if she were not on my side. 

When everyone is situated somewhat, we stand to greet the judge. The judge walks in; I am flabbergasted. Elizabeth Wayne, an African American woman in her 60s, the only black judge in our district. What luck! Why do I have to get her! My mouth is wide open, and my eyes roll as I wonder if this is the reason why my partners never told me the judge’s name for this case. I personally requested a jury trial, made a deposit for it and requested judge Andrew Coulter. How could they switch judges at the last minute? My mouth quickly shuts as I get a text. It’s Mavis Hill, one of the attorneys in the front row. “We didn’t know!!! Maybe Coulter sick? Heart attack? Wayne a substitute…We’re in for a ride!” No! I cannot believe what is happening right in front of me. Did this judge even have time to read all the depositions and evidence we provided? Why is this happening to me now when I worked so hard with Judge Coulter and prepared him in advance? Our guys know Coulter disdains medical doctors with their pride. We benefit from Coulter on this case. “Please be seated,” Judge Wayne says. “We are here to begin the pretrial proceedings of Freedman vs. Beverly Hills Hospital and Drs. Sara Choi and Steven Kline. I read all the transcripts, depositions from both doctors and the depositions from experts. The defendant has filed an answer and a motion to dismiss the complaints. “The plaintiff filed a pretrial motion, and I am here to hold a hearing. Based on this case management conference, we can move this case to a jury trial today or set another date for a trial date. We have 90 people here on jury duty, enough to begin the process of jury trial. It is up to you, both, so, please proceed Mr. Grey and Mr. Harris, or have you come to settlement?” Mr. Grey begins, “No, your Honor, we have not agreed to settle. We are proceeding as planned.” With that, attorneys on both sides briefly present their case. Huddles of heads nod and whisper, and shortly after their huddle Judge Wayne proclaims jury selection will begin today. After 15 minutes, about 30 jurors walk in. Twelve of them sit in jury chairs, four are seated in alternate chairs. They’re nervous. The 12 seated in the jury chairs are variable in ages, seven are white, two Latino, two Asian and one African American. Eight are men and four are women. The judge says her welcome speech to all jurors and quickly begins her interviews. One by one, starting from juror number one she asks for name and occupation. The entire process is taking longer than one hour. Attorneys on both sides intently observe each juror and I am able to tell when each attorney formulates their impression of each juror. Most of the jurors have their subtle attitudes, and do not want to be here. Our side has an expert who reads out jurors accurately and I am glad Mrs. Tomoko is here today. She is like a fortune teller in reading out personal characteristics on people very precisely. Tomoko can predict each juror’s verdict by just looking at the person, listening to the voice. Her high salary for this is worth it. We always bring her to the courtroom during jury selection. This is definitely an advantage for us. Mr. Harris and his side do not have such a person. Time after time, I become a believer of Mrs. Tomoko and her ability to pick out the best jurors. Selecting the best jurors and alternates will take most of today and at least a part of tomorrow. I cannot emphasize enough how important this process is and why we need this time to read out each juror to benefit our side. We want no jurors in the medical field, and no health care providers, either themselves or their relatives who are likely sympathetic to their own professions. Next day, attendance in the courtroom is limited to our side and the defendant attorneys handling juror selection. The judge is here to observe and occasionally asks questions to the jurors. Fifteen more jurors are here today, in case we run out of potential jurors. I give body gestures and make eye contact with Ms. Tomoko constantly. Even though I sit in the passenger seat, I am the one who ultimately decides how this courtroom will look like. It is our best interest to also exclude Asians, and female jurors. They might be more sympathetic and empathetic to Dr. Choi. My target is to bring her down. After interviewing those selected jurors from yesterday, we decide to let go of jurors #1 and #7 because they already made up their minds and appear hostile toward our side which is obviously undesirable. Unfortunately, one of the alternates from yesterday is chosen to replace juror #1, a retired male doctor who used to be a pediatrician. My understanding is that we are not to have any health care workers in the jury but the defendant side argues that he is retired, and therefore, it does not fit the category of health care worker per se. The defendant’s side tries extremely hard to keep him. We lose that battle. We have a potential problem with this retired doctor. He’s likely very accustomed to being an influential leader and other jurors may give him that authority. Other jurors may become deferential to him in their thoughts and verdict. Thank goodness this is not a criminal case where everyone has to agree on a verdict. If we can just convince majority of the jurors, we can win the case. Ultimately, we end up with 12 jurors variable in age, ranging from the oldest, 72 and the youngest, 39 years old; eight whites, two Latinos, one Asian and one African American. Seven are men and five are women. It looks good and favorable to us, except for the retired doctor. The four alternate jurors are also chosen in case a juror is unable or disqualified to perform his or her duties at the time he or she is sworn in, especially important for a lengthy trial case like ours. It may extend up to two weeks. The trial will start tomorrow 9:00 a.m. sharp. It’s showtime!

Read the entire novel. 100% of profits from book sales are donated. Incidents in my new novel portray a female pathologist promoted to department chair. She encounters powerful forces of indoctrinated prejudice and in medicine and exposes false assumptions about medical-legal justice. Ultimately, the doctor presents a case to decontaminate the poisons in this world of unforgiveness. FORGIVE TO LIVE at Amazon and at Smashwords eBooks

Special thanks to pexels-vladislav-reshetnyak, and pexels-ekaterina-bolovtsova for their images.

The unspoken language

Amazing patients in my brief encounters taught me their view and philosophy in life.

One such patient lost almost half of her face due to head and neck cancer. She came to the FNA clinic because of a tumor regrowth in her scar site. She was severely disfigured and shocking to see. She wore a hat and wrapped half her face with a scarf. She lived in fear that people would look at her with disbelief and disgust. She was in pain and shame. The extent people prefer to stay living by paying such a costly price is astonishing. Life is indeed priceless. She hesitated to show the lump or allow me to procure samples. As she began unwrapping her face and revealing her scar, she was crying. It was difficult to disguise the horror in my body language. I held her hand. She knew that I had my own sets of physical limitations and knew I had gone through emotional and mental pain not too dissimilar to hers. (I have polio on my right leg). There was unspoken language of understanding and compassion with each other. We had a special bond at that moment and there was a mutual understanding of enormous burdens we each carried in our daily lives. This kind of human understanding needs no words and felt between people who go through certain amounts of pain. After the procedure, I hugged her without a word. This patient helped me realize why I must suffer from my own physical limitations. From my new book, “Who says you have cancer?” available on Amazon.

Images of cancer patients courtesy of pixels-shvets-production

Unnatural action: Forgive

Forgiveness and a metaphor from Italian medical history

Pacinian Corpuscle is a major tactile sensory mechanism in mammalian skin, discovered by Italian anatomist Filippo Pacini. It detects pressure changes and vibrations in the skin. When the external pressure such as touch is applied to the skin, it senses the vibration by deforming layers of lines until the nerve ending in the center processes the touch. The Pacinian corpuscle can be described as oval-cylindrical-shaped, 1 mm in length and consists of 20 to 60 concentric lamellae (like onion rings) connected by nerve endings at the center.

This microscopic image depicts the inner struggles we as humans experience via external stimuli, especially when it is negative. Natural reaction when the core of the structure is sensed as unfavorable is to recoil, retreat, shrink, flee, and finally fight if necessary.

Act of forgiveness, whether it is given or received, requires unnatural process of action. The power of the unnatural process of forgiveness is perhaps not possible by natural selection of human ability. God needs to intervene, so that humans can live peacefully with others and our own selves.

Photo of Florence by #Josh Hild