Talk I gave at Grace Church and Toastmasters storytelling in December 2015

"One's destination is never a place, but a new way of seeing things."  - Henry Miller -     The late American writer

Where is one’s destination? Where is mine? Where is yours? The answer to these questions is simple. It is not a discussion needed to be had by great minds, great philosophers, great theologians. It does not require a great amount of pontification. The answer is simply “here and now“.

My name is Rudy Yanuck. I am a 48 year old retired pathologist, the 2010 Gateway Area  Chapter of the National Multiple Sclerosis Society’s Father of the Year, and a 21 year survivor of multiple sclerosis. Though my life with MS is full of opportunities to live in the here and now, MS presents challenges each day.   My family shares these struggles with me.  I know it is not easy for them and I am truly grateful.

So many people, myself included, focus their time and energy searching for, agonizing over, what their destiny in the future may hold. Where they feel they should be in five, 10, 15 years.  They fret over what could be, should be, might be, hope to be.  They forget about what is, the NOW. They forget to appreciate, cherish, love what is right HERE in front of them. The NOW.  Or worse yet, they only focus on the bad, and forget about the good. I wish I could say I've always lived in the here and now, but it wouldn't be true.Today I’d like to share with you some of those moments.

In the spring of my surgery internship at the Naval Hospital San Diego, in 1994, I felt as though I was on top of the world. Life could not get any better.  About to finish the professionally most challenging, physically taxing year of which over twenty years later I am still most proud, followed by three years of flight surgery, then orthopedic surgery residency and career as an orthopod.  This was my destiny!  

Then one day, “Lieutenant, tomorrow at O-800 you WILL report to staff sick call.  You WILL obtain your medical record and you WILL report to the ophthalmology clinic.  You have an O-830 appointment with the neuro-ophthalmologist.  You WILL receive an MRI.” the Chief of the Department of Urology, sternly ordered me.  Immediately, I stiffened in fear.  

I wasn’t to concerned about the ophthalmology appointment.  I had been evaluated by The neuro-ophthalmologist two months previously as part of my flight surgery application.  I had been selected and would not have had the orders in hand to report for flight surgery training that summer had I had not passed the eye exam.  It was the MRI I feared.  That test had the potential to discover, uncover, reveal, ruin… and save me.  

During my internship I was generally referred to as doctor.  So when a captain referred to me as lieutenant, I knew the only reply was “Yes Sir”.

From July 1, 1993 to July 1, 1994 I did a basic surgery internship at the Naval Hospital in San Diego. Early in July 1993 on my trauma service rotation, I began having some difficulties with touch sensation.  Feeling pulses in order to get blood for an arterial blood gas measurement was difficult for me, sometimes impossible.  It became the running joke of one of the staff surgeons.  At times I felt the tears wanting to erupt but I refused to show my true emotions, laughing along with him.

As the year progressed, I started noticing other difficulties.  I had more trouble than most with fine, and even some gross motor tasks.  As the rest of my team would glide rapidly down the staircases, their feet seemingly not even making contact, I would be left slogging behind.  On call nights when I stayed overnight in the hospital and was awakened, summoned to assess a patient, I found it difficult to begin the long trek from my call room to the patient wards, spending the first 20 yards or so bouncing off the walls for balance.  One day I asked a fellow surgery intern if he was tired.  He emphatically replied “HECK YEAH I’M TIRED!  I’VE BEEN UP FOR THE LAST 36 HOURS!”  So I tried to convince myself that it was just a hazard of the job.  But deep down I knew there was something more.

I had been a surgical intern on the urology service for the month of April 1994.  The interns rotated Fridays,  performing minor surgeries with the department chairman.  The previous Friday was my turn.  Apparently he had noticed something in my surgical technique that caused him enough concern to lead to our Monday morning meeting in his office, and warrant a mandatory ophthalmologic evaluation and MRI.

At the appointment, The neuro-ophthalmologist performed essentially the same exam he had performed two months previously.  This time he asked more directed questions focusing on my peripheral vision.  He was looking for signs of bitemporal hemianopsia, the classic symptoms of a pituitary Adenoma. A brain tumor that affects peripheral vision.  Untreated it could cause blindness, endocrine disturbances, and potentially death.  

My responses to all of his questions where “No”.  “Your exam is unchanged from the last time I examined you.  I don’t see a justification for an MRI.”  “Whew.” I thought, finally releasing the breath I was holding.  “Well”, he said, “actually I do. If the captain wants an MRI, the captain gets an MRI.

The month of May, I spent assigned to the pediatric surgery service at a private hospital in San Diego.  As an unlicensed physician, as most interns are, I had a very limited role in actual patient care at this hospital for liability reasons.   I primarily observed, not being allowed to write notes and orders in patient charts, cover inpatient call, not even allowed to “scrub in” on surgeries.  The relaxed pace was sometimes boring but a welcome reprieve from the frenetic pace of the rest of the year.   

Preoccupation over my upcoming MRI towards the end of the month blurred my memory of that rotation.   One event does, however, stand out.  I had been informed of a little boy who had received a gastric tube for feeding because of a congenital abnormality.  He was having difficulty breathing due to indigestion and bloating.  Later that evening, the father called me with the same complaints.  As instructed, I told him to “burp” the tube and go to the emergency room if his difficulties continued.  I went to bed.  

Early the next morning, around three am, the father called me back to inform me his son was dead.  I froze in panic.  “My God, what do I say?  What do I do?” I thought.  I had never been in a situation like this.  Medical school only prepared me to take care of the living, never teaching how to deal with this inevitable scenario.  

Previously, I had been a part of a team in these kind of situations.  The more experienced attending physicians handled this stuff and I stayed in the background with the rest of the surgical entourage.  This time I was alone having to talk with an acutely grieving parent. I expressed my condolences for his loss.  I hung up the phone with the unsettling feeling that I handled it all terribly wrong.  Eight months later, when my daughter died at 4 dAys old, I would learn that there was nothing I could have said to ease his pain, but to have said nothing would have been inexcusable.

The morning of Thursday, May 26 I went to the radiology clinic for my MRI.  The machine looked like all the other CT scanners and MRI scanners I had seen previously.    But this time, I was the patient lying on the table whose head the unseen magnets would rotate.

I lay supine on the table.  A cage was placed over my head.  I imagined I looked like a hockey goalie or baseball catcher.  The table slid into the scanner,  automatically positioning my head in the narrow opening.  “!-!-!” went the scanner, then silence.  Suddenly a loud “gnweuew”, followed by “dupt-dupt-dupt-dupt-dupt-dupt-dupt-dupt, blop-blop-blop-blop-blop-blop-blop-blop, doof-doof-doof-doof-doof-doof-doof-doof, rat-tat-tat-tat tat-tat-tat-tat.  The sound would have been deafening had it not been for the headphones placed over my ears.  Then silence.  A few seconds later  it started again.  This pattern continued for the next two hours.

The following afternoon I called the radiology department to get the results.  I spoke to the neuroradiology resident who was reluctant to discuss the preliminary results.  Radiologists generally don’t discuss results with patients, only doctors.  Dilemma, I was both.  He nervously stressed the results were only preliminary, not yet reviewed by his attending radiologist, not yet finalized.   he then delivered his preliminary findings, which were word for word of the eventual finalized report,with a shaky voice,not out of nervousness and insecurity in his interpretation, but out of concern for what his interpretation meant to the person on the other end of the phone line, me.  

I listened, hung up the phone, and steadily, with heart pounding, throat closing, and eyes welling, walked to the men’s room.  Once the latch clicked behind me, I collapsed to the floor against the corner, in a heap of wails and sobs.  I wept like I never wept before, and only thrice since.

My pituitary gland was fine.  The test uncovered severe bilateral demyelination of my periventricular white matter, ultimately resulting in a diagnosis of multiple sclerosis.  Just like that, my professional hopes and dreams, my destiny, vanished.  The Navy forced me into a field of medicine I had  never  enjoyed, never considered, and in fact, had felt not really a true clinical specialty, pathology.

I did my pathology residency at the University of California, Irvine, a prestigious program, with some prestigious names in the field of pathology.  I could not see that then.  I was too busy mourning the loss of what could’ve been, should’ve been. I was too busy being angry at multiple sclerosis for what it had taken from me professionally. I was too busy fighting accepting what was there in front of me, the here and now.  I did not see nor  appreciate the opportunities being given me.I wanted my destiny back!  

Anger prevented me from accepting the what is and fully engaging myself in my training. Had I done so, it would not have taken me the many attempts to pass the pathology specialty boards as it did. Life would’ve been so much easier for me and my family had I embraced the opportunities.

Following my residency, I did hematopathology fellowship training at the Armed Forces Institute of Pathology  in Washington DC, a very prestigious program, with many prestigious names in the field of pathology. It was during this training when I began to accept my destiny, embracing the here and now.  I started seeing it in a new way. Interestingly I began to enjoy my job, finding it less difficult than it had been. I began having fun.

After a 20 year career in pathology, my multiple sclerosis had progressed to the point even the low physical demands were becoming physically taxing.  After a three year battle to save my job, I took a forced federal disability retirement. Again, I failed to see the opportunities presented. I did not embrace my new destiny. Once I finally did, I began to enjoy my new life. I began having fun.

Today - my here and now - I am a full time at home dad to five kids, ages 4- 21, spending my days with my children and working on taking care of  my health. These are the moments I cherish. Life could not get any better.  THANK YOU

Almost Famous

“Guitar player wanted,” read the ad in The Harrisburg Patriot News classified section in early spring of 1985.  I had recently been kicked out of the band I was in after the one and only concert we played, an assembly at my high school in Mechanicsburg, PA, which I booked.  Suffering from mono at the time, no warning, discussion nor common courtesy was extended.  They just dropped off my guitar equipment after the show and that was it.  Determined to continue with my passion for the guitar, I searched for another outlet.  

Rick Ream answered when I called the number in the ad.  Rick, six years my senior, lived in the neighborhood adjoining mine.  He told me he and Bret Sychak had left their previous “cover” band, The Spectors, and were putting together a band that would only perform original material.  They intended to use the next six months to “get tight” then move to Los Angeles.  He asked my plans.

“College,” I replied.  I obviously was on a different trajectory.  After all, an education was in my near future and they had aspirations of becoming “starving artists”… or so I thought.

A few months later, Rick and Bret were at the high school passing out pink paper flyers containing four individuals photos, each occupying a quarter of the page, of Rikki Rockett, Bret Michaels, Bobby Dall, and Matt Smith.  The flyers announced that their band “Paris” would be the performers for that evening’s high school dance, although heavy metal is not really danceable music.

After school, the cafeteria was abuzz with students waiting for their buses to take them home, while “Paris roadies” fought the outbound current of kids, like salmon heading to their spawning grounds, bringing platforms, drums, amplifiers, and guitars into the cafeteria.  Rikki and Bobby entered confidently.  Rikki looked much the same as I had always known him to look.  Bobby strolled in looking nothing like I remembered.  

When we had met years earlier, he looked much like an MBA grad student with a preppy button down shirt, slacks, and a short cropped haircut.This day he wore a leather jacket, t-shirt, and torn jeans with long flowing locks of dark hair extending to his low back, the prototypical “bad boy of rock” look.

A few minutes later Bret sauntered in with the same look as Bobby, his usual style, with an air of what I interpreted at the time to be arrogance, but what I now see as calm self assuredness. Matt Smith, the guitar player whom I had never met before, frantically entered, almost on the brink of a nervous breakdown.  While loading his equipment for transport, he had dropped his Marshall 50 watt amplifier head, shattering its tubes that provide the patented Marshall sound.  Without them, the amp would not work.  He had neither the time nor the money to replace them on such short notice.

I had a Marshall 100 amplifier head that I  offered him for the show.  Back at my house, I strapped on my Kramer Voyager Imperial with Floyd Rose Locking Tremolo, my favorite “ax”, slang for guitar, to give him a quick tour of the amp head.  I started playing a riff that I had made up some weeks earlier.  Matt excitedly slung on the strap of my Les Paul Standard, another of my axes, and excitedly exclaimed, “Cool lick.”  “Teach it to me,” he requested.  So I did.

The fall of my sophomore year at Dickinson College in 1986 as I strolled through the bookstore, an album cover on an end cap caught my eye, stopping me in my tracks.  “No fucking way.” I murmured to myself in disbelief.  The album cover was almost exactly the same as the flyers being passed out years earlier, only the name of the band had changed and C. C. Deville’s picture sat in the quarter of the cover that used to be occupied by Matt’s in the flyer.

I purchased the album and went straight to my dorm room, placed the record on the turntable and the title track began.  “NO FUCKING WAY!” I screamed within the first four beats.  There it was.  My riff.  The title song.  I was floored and in shock.

No one believed me.  At least not until, while at home for break,  I went down to the basement where I had my “studio”, a portion of the basement my dad and I had “finished” years before.  I intended to learn the other songs on the album.  After all, I already knew the title track.  The first song began.  Within four measures, the basement door flew open.  My mom stood at the top of the stairs shouting, “Rudy, They’re playing your song!”

Alive

“Can I do anything to help?” came the woman's voice from behind me, over my shoulder. Not automatically assuming it was for me, I ignored the question and continued unloading my scooter from the back of my van in the Clayton Center gym parking lot on a mid morning in May 2015. Then, an extremely attractive woman wearing sweats, obviously just having worked out, appeared beside me and asked if there was anything she could do to help. I stood up, and with a big smile replied, "Yes, you can stand there and continue to look gorgeous. "

Just then, my three-year-old popped her head out over the backseat and said, " Hi ". With a tone of sarcasm, the woman commented, "Oh my, she looks nothing like you. She's absolutely beautiful." "She's not mine. " I retorted, “She came with the car. "

I introduced myself.  She responded in kind.  Resuming assemblage of my scooter, our conversation continued. She told me she had just finished teaching two fitness classes at the Clayton Center, was also a dance instructor, and had 3 kids, ages 16, 14, and 12.  Hearing the ages, I internally jumped for joy.  “She is about my age,” I thought to myself.

We parted ways,she to her home, me into the gym.  During my workout, I could not stop thinking about her.  She captivated me.  Before leaving the gym, I found out her work schedule.  Her next class would not be until Friday, four days away.  I’d have to wait to see her again.  Patience is not a virtue of mine.

It felt as though the days went by so slowly. Those four days seemed like an eternity . I found myself constantly thinking of her.  It was a nice reprieve from the loneliness and constantly thinking about my failed marriage. I noticed a lightness in my gait, a smile on my face again. I felt like a teenager all giddy with excitement and anticipation.Parts of me that were dormant, I thought dead, awoke. I felt alive .

Friday finally came. After getting Andrew, Liza, and Oscar off to school, I quickly got Abby dressed and hurried to the Clayton Center gym. I checked Abby into the childcare and scurried over to the aerobics room. Her class was still in session. Maybe it was my anxiety and excitement, or maybe the diuretic, I had to go to the bathroom.Thinking I still had time, I did. Upon returning, I found the lights off and the door locked. I missed my chance. I raced down to the front desk and was told she had not left yet. I sat in a chair by the door, hoping to catch her as she exited. I waited as people streamed in and out of the gym, 5 minutes...10 minutes…. 15 minutes….. finally after around 20 minutes of sitting, she appeared. I told her I had been waiting to see her.  With a big smile she sat down in the chair across from me.

For the next 40 minutes we talked. We talked about our backgrounds, what brought us to St. Louis, and our kids.There was an ease to the back-and-forth of the conversation. As we talked, I began to fear there was a husband, father of her kids , still in her picture. With a bit of anxiety, and a deep breath, I asked her if she was still married.

I motioned as to say, “shucks,” when she answered, “Yes.”

Called Out

“What the fuck’s wrong with you? “He barked, grabbing me by my shirt collar, pinning me against the wall as I exited the conference room.  Dr. Roman Sky had just given us pathology residents a lecture on some aspect of pediatric pathology, in the spring of 1996.  Stunned, shocked, and terrified, I stood there against the wall, frozen, wide-eyed, and speechless.  “You’re stumbling around, bumping into things, dropping stuff, and making a mess. Are you in drugs!?” he continued.  I just stood there, motionless, internally acknowledging the reality that I could no longer keep my secret, which I had been fighting desperately to keep, hidden.

I had been rotating in surgical pathology, my first rotation of my first year of residency, at a private hospital in Long Beach, California, since January 1 of that year.   As a resident on this rotation, I examined and processed surgical specimens ranging from skin biopsies, to colons, to breasts. Additionally, every four weeks I performed all of the autopsies requested. One reason I chose to go into the medical field of pathology is because it is mentally challenging, yet not physically taxing in nature.  Surgical pathology is the most physically demanding aspect of pathology.

What Dr. Sky had brought to light, showing me the reflection in my mirror, was true. I was stumbling around, bumping into things, dropping stuff, and making a mess. The nickname I had acquired during this rotation, ”Bloody mess”, was appropriate.  Though not for the reasons Dr. Sky thought.

A self-proclaimed  “big dumb Pollock,” Dr. Sky was by no means dumb. Polish, yes, big, yes, looking more like an NFL middle linebacker than a physician. Having successfully completed a pediatrics residency, a pathology residency, and a pediatric pathology fellowship, holding board certifications in pediatrics, anatomic and clinical pathology, and pediatric pathology, one could hardly question his intellect.

This encounter marked the beginning of an extremely meaningful and influential relationship during my residency. Dr. Sky, throughout my residency years, afforded me opportunities that had not been presented me by anyone else, such as presenting cases to the multidisciplinary tumor board on several occasions. These conferences, attended by the clinicians treating the patients being presented, were where decisions about treatment were made.  Over the four years of residency, he became like a father figure to me. One of the few things I miss about my residency years

.

The more I got to know Dr. Sky, the more I understood from where his words and actions during our first encounter came. They were not words of anger, contempt, or disgust. They were words of caring, kindness, and compassion. That encounter was his attempt, although clumsy and likely illegal, at a possible intervention rather than an act of accusation.

Accosting me like he did after that conference shook me and caught me off guard, as I think was his intention. I saw the reaction on his face and change in body language when I finally responded.  I could hear the ”thunk” of his dropped jaw hitting the floor as I finally answered his question, disclosing, ”I have multiple sclerosis.”

"Angels Ready"

"Angels ready?" I called over my shoulder to the trio of young women, a blond and two brunettes, on the jet ski, in reference to the recent movie, Charlie’s Angels, starring Cameron Diaz, Drew Barrymore, and Lucy Liu.  My “Angels” were the jumpers and deep water starters tasked with riding the wave runner jet ski as a “chase boat” to follow me as I skied at the wheelchair water ski clinic on a Saturday in July, 2009. The three ladies responded with a chorus of, "Ready, "  

After confirming that my  beach water starter was ready, I yelled, "Hit it."  The boat engine revved, yanking me and my partially submerged water ski from its resting position, tip of the ski extending from the water towards the sky, to an upright, horizontal position.  I began gliding and cutting back and forth atop the wake of water created by the speeding boat.

I’ve been attending the annual disabled water ski event at Creve Coeur Lake for well over a decade. I look forward to these outings all year. It is a rare chance for me to feel ”normal”, or at least as close to normal as I remember normal feeling,  if at least only for a few hours. The endorphin rush I get as I glide, balance, steer, and even sometimes jump across the water, wind in my face, water spraying over me, is much like the feelings I used to get while playing competitive sports, snow skiing, or performing music.  Even the “wipeouts”, though sometimes mildly uncomfortable, can be exhilarating.

The second most important person on the boat, most important being the boat driver, is the person working the pin.  Pulling the pin releases the ski rope from the boat.  The pin is pulled when the skier wipes out to prevent injury.  If the pin is pulled too late, the skier gets dragged behind the boat, flailing in the water.  If the pin is pulled too soon, or unnecessarily, the ski coasts to a stop, and sinks, with the skier still atop the ski.  Personally, I prefer the former.

Volunteers far outnumber athletes at this event. In addition to in-boat volunteers, boat drivers, pin pullers, and whomever else wants to ride along, there are countless volunteers on the beach preparing and carrying skis to and from the water, all to ensure we disabled skiers have a safe and fun time.  Lunch features a barbecue of hamburgers and hotdogs, cooked on-site by volunteers with the ever delicious, Mr. Lucido’s barbecued chicken the highlight of the meal. (Mr. Lucido is Vito, the organizer of the event’s father) Last but not least are the ladies who organize boats and skiers to ensure everybody has the opportunity to ski.

As soon as the words, “Angels ready?” left my mouth, a dread came over me.  “Was I inappropriate?”  “Did I offend or disrespect them?”  “Am I a dirty old man?” were some of my concerns.  After all, at the time, I was married.  These concerns continued to plague me while I skied, until my wipeout.  After getting me back on my ski, and themselves back onto their chase boat, I heard them quibbling amongst themselves, “I’m Lucy Liu.” “No, I’m Lucy Liu.”

"Psych"

“I'm not sure why they are requesting me to do this,” said Dr.Oliveri , the neuropsychologist hired to perform neuropsychiatric testing on me. "They want you to find me incompetent so they finally have a reason to fire me, " I replied.

I had been fighting a battle with the hospital administration to keep my job as a pathologist at the VA medical center St. Louis. More specifically the battle was with the new acting Chief of Staff (ACOS) since mid 2010. The hospital had been struggling with poor performance ratings and a reputation of being the worst VA hospital in the VA system.  Getting rid of as many of the existing physicians as possible and bringing in new staff, the ACOS felt, would change that performance rating and reputation. Unfortunately, whenever a new administration takes over a business, the first people to lose their jobs are the easy targets, the disabled. It was determined that my diagnostic error rate was higher than the other pathologists in the department. True, my rate was higher, however, it was nowhere near incompetent.  Excellent, no, it was a bit better-than-average.

Even still, my anatomic pathology hospital privileges were suspended. My appeal of this action resulted in a peer review panel of three physicians as judges, hearing testimony from hospital administration and coworkers regarding my performance and character.  This tribunal agreed that my error rate was not sufficient grounds to remove me from my position.  However, they did claim my lack of remorse and emotion through the proceedings (advice given me by my attorney) was of concern and a neuropsychiatric evaluation was warranted.  Basically, they said I was a bad person.

The evaluation began At 9:00 am on May 29, 2012.  A series of tests were administered.   The testing began evaluating my mental status by asking me simple questions, such as the date,  time, president, and other common knowledge facts, which I passed with flying colors. A complex drawing looking like a sideways rocket with squares, rectangles, and lines contained within, and complex antenna looking figures attached to its outside, was given me to copy on a blank sheet of paper.  Series of simple numbers were verbally given to me in at 3 second intervals in which I would add the last two numbers spoken to assess my arithmetic and concentration ability.  He said, “3...5.”  I said, “8.”  He said,”7.”  I said, “12.”   He said “2,” I said “9.”  He said “1.” I said “3.”  

Lists of words were spoken.  Then an additional list of words were spoken for me to determine which previous list the word was  in, if at all.  Pictures of faces and incomplete faces exhibiting differing expressions were shown me.  Then, much like the lists of words, I was shown another series of faces and was asked to determine which lists the faces were in, if at all.  As fatiguing as these tasks were,I actually found them somewhat enjoyable, Almost treating it like a game, all be it a very tiresome game.

Over the lunch break, I was able to rest my fatigued brain and strained eyes.  Dr. Olivari entered the room to tell me his “preliminary review of the data obtained thus far suggested I was performing very well."

After lunch,The whole series of tests were repeated, only this time with different numbers, words, and facial expressions.  During this round of facial expression recognition I realized there were only maybe four or five different faces being shown with differing expressions and zoom powers.  I mentioned this and got no response except for a slight upturn of the corner of his mouth.  When asked to recall three unrelated words told me at the beginning of the testing process several hours earlier, I successfully did.  He gave me a blank sheet of paper and asked me to redraw the complex figure I had been shown at the beginning of the testing.  With the exception of a one or two minor details, I did.

At the completion of testing, Dr. Oliveri told me I had performed exceedingly well, much better than he had been led to believe I would perform.  After having been pounded on, hounded, continuously placed under a looking glass and scrutinized, and told repeatedly how incompetent I had been, his words released an immense, 15 minute outpouring of emotion.  This proved nothing was wrong with me.  I actually am an okay person.  I am smart too.  Interestingly, the administration never gave me a copy of the results report.  Fortunately, a copy of the report was emailed me by Dr. Olivari.  The results were never mentioned by hospital administration.

My 2015 MS Evening of Hope talk

"One's destination is never a place, but a new way of seeing things."  - Henry Miller -     The late American writer

Where is one’s destination? Where is mine? Where is yours? The answer to these questions is simple. It is not a discussion needed to be had by great minds, great philosophers, great theologians. It does not require a great amount of pontification. The answer is simply “here and now“.

My name is Rudy Yanuck. I am a 48 year old retired pathologist, the 2010 Gateway Area  Chapter of the National Multiple Sclerosis Society’s Father of the Year, and a 21 year survivor of multiple sclerosis. Though my life with MS is full of opportunities to live in the here and now, MS presents challenges each day.   My family shares these struggles with me.  I know it is not easy for them and I am truly grateful.

So many people, myself included, focus their time and energy searching for, agonizing over, what their destiny in the future may hold. Where they feel they should be in five, 10, 15 years.  They fret over what could be, should be, might be, hope to be.  They forget about what is, the NOW. They forget to appreciate, cherish, love what is right HERE in front of them. The NOW.  Or worse yet, they only focus on the bad, and forget about the good. I wish I could say I've always lived in the here and now, but it wouldn't be true.Tonight I’d like to share with you some of those moments.

In the spring of my surgery internship at the Naval Hospital San Diego, in 1994, I felt as though I was on top of the world. Life could not get any better.  About to finish the professionally most challenging, physically taxing year of which over twenty years later I am still most proud, followed by three years of flight surgery, then orthopedic surgery residency and career as an orthopod.  This was my destiny!  

During an ophthalmologic examination, an incidental MRI finding uncovered severe bilateral demyelination of my periventricular white matter, ultimately resulting in a diagnosis of multiple sclerosis.  Just like that, my professional hopes and dreams, my destiny, vanished.  The Navy forced me into a field of medicine I had  never  enjoyed, never considered, and in fact, had felt not really a true clinical specialty, pathology.

I did my pathology residency at the University of California, Irvine, a prestigious program, with some prestigious names in the field of pathology.  I could not see that then.  I was too busy mourning the loss of what could’ve been, should’ve been. I was too busy being angry at multiple sclerosis for what it had taken from me professionally. I was too busy fighting accepting what was there in front of me, the here and now.  I did not see nor  appreciate the opportunities being given me.I wanted my destiny back!  

Anger prevented me from accepting the what is and fully engaging myself in my training. Had I done so, it would not have taken me the many attempts to pass the pathology specialty boards as it did. Life would’ve been so much easier for me and my family had I embraced the opportunities.

Following my residency, I did hematopathology fellowship training at the Armed Forces Institute of Pathology  in Washington DC, a very prestigious program, with many prestigious names in the field of pathology. It was during this training when I began to accept my destiny, embracing the here and now.  I started seeing it in a new way. Interestingly I began to enjoy my job, finding it less difficult than it had been. I began having fun.

After a 20 year career in pathology, my multiple sclerosis had progressed to the point even the low physical demands were becoming physically taxing.  After a three year battle to save my job, I took a forced federal disability retirement. Again, I failed to see the opportunities presented. I did not embrace my new destiny. Once I finally did, I began to enjoy my new life. I began having fun.

Today - my here and now - I am a full time at home dad to five kids, ages 3 ½ - 20, spending my days with my children and working on taking care of  my health. These are the moments I cherishing.  Life could not get any better.  THANK YOU

My 2014 MS Evening of Hope talk

Hope

As defined by Merriam-Webster

-To want something to happen or be true and think that it could happen or be true.

-To cherish a desire with anticipationhh.

-To desire with expectation of obtainment.

-To expect with confidence

-Trust

Hope is necessary. It is essential for survival, for living, for being.  Without it there is no reason for, or meaning of life. We all have so much for which to be hopeful.   It is each and every one of our responsibilities to define, discover, cherish, and maintain hope . Living with a chronic illness, such as multiple sclerosis, hope can easily be lost, or forgotten, or sometimes downright impossible. But we have so many more reasons for which to be hopeful than previous generations. Advances in understanding, diagnosing, treatments and medication, and research that has brought us that much closer to finding a cure are but a few.

My name is Rudy Yanuck. I am a 46 year old recently retired pathologist, the 2010 gateway area multiple sclerosis society chapter’s Father of the Year, and a 20 year survivor of multiple sclerosis. though my life with MS is full of moments of hope,, no doubt MS presents challenges each day.   My family shares these struggles with me and I know it is not easy.  For them, I am truly grateful.

I have so many of my own reasons for which to be thankful and maintain hope. Tonight I’d like to share with you my most precious.

My wife and I have had kids over three decades, two centuries, and two millenia.  How many couples can make that pronouncement?  I have her to thank for that and not only for the obvious reasons.The first five were premeditated.

Late winter 1994, during the last half of my surgery internship at the San Diego Naval Hospital,  my wife exclaimed, “I want a baby!”  “No,” I responded.  Starting a family was not on my short list of things to do.  I just received orders for flight surgery training in Pensacola following internship.  Six months that included education in aviation medicine and flight training, followed by what I envisioned as 2 years of a life much like the characters “Maverick” and “Goose”, the confident, cocky, envelope-pushing Navy fighter pilots from the 1986 movie “Top Gun.”   Those orders were never executed thanks to my diagnosis later that spring.

My wife was persuasive.  On December 19, 1994, we became parents of beautiful twin girls, Al .and Ca.  Al made our duo a trio at 10:36 pm, followed 15 minutes later by Ca, making our newly formed trio a quartet.  Our pure emotional bliss lasted less than 8 hours before tragedy struck.  Al became septic, requiring extreme modes of life support.  On Friday, December 23 - please take note of the date, 1994, Al took her last gasp of air as she kissed the three of us goodbye.  We were a trio again.  

Despite our grief and despair over Al, we chose the hope Ca brought us.

In 1996, my first year of pathology residency, in late winter, my wife exclaimed, “I want another baby!”  Again, I selfishly answered, “No.”  Later that year, on December 31, at 3:21pm, An entered the world, and our family.  A few months later his profound deafness was discovered.  At nine months he developed cataracts, and at 17 months, juvenile diabetes.  After an exhaustive genetic workup searching for a reason, the best answer we were given was, “The An syndrome, God just made him that way.”  A muscle biopsy was normal but “smelled like a mitochondrial abnormality,” according to Dr. Salvatore DiMauro, the World’s leading expert on mitochondrial diseases.  He discovered most of the mitochondrial disorders, literally writing the book.   Later An’s developmental delays became evident. He suffered a traumatic retinal detachment resulting in the loss of that eye, and most recently vision threatening glaucoma in his remaining eye.

More grief and despair, but ultimately we chose hope.

Early summer 2003, my wife, earned her  MSW degree with honors at Washington University, the nation’s top school for social work, My wife again exclaimed, “I want another baby!”  Once again my answer was,”No.”  After all, it would make more sense to put her newly earned graduate degree to good use, right?   On August 24, 2004, at 11:23pm, El was born, greeting us with smiles, bringing us hope.  My wife proved to me that being an amazing mother and a superstar therapist were not mutually exclusive.

In early 2008,  my wife proclaimed, “I’m going to be 40 soon.  This is my last chance.  I want another baby.”  She was only 36.  Initially, I responded with my consistent “No.”   Then, over the next few weeks, I began thinking about her desire to have another child.  I’ve heard older women say, a touch of regret in their voices, “I wish I would have had more kids.”  I have never heard anyone say, “Damn it! I had too many,”  I wanted to prevent her from having this regret.   At 12:12pm, October 13, 2008, Os, who looks like the love child of Paul Newman and Brad Pitt, completed our brood.  Our family was finalized...or so we thought.

“But dad, you’re a doctor.  You should know how to prevent this,” 16 year old Ca lamented when we told her my wife was pregnant in early summer 2011.  We were still in shock ourselves.  On mid morning Friday December 23, my wife spontaneously went into labor.  At 4:00pm Ab unequivocally completed our family filling our lives with more joy a hope than we could have imagined.  

Now days, in late spring 2014, when asked my kids’ ages, I reply, “19, 17, 9, 5, ...and 2.”  Preemptively answering the unasked questions, I continue.  “Same mom. No, we’re not Catholic.  And until recently, no, the middle names are not ‘Oops’... but it’s the best damn mistake I’ve ever made.”

Never lose hope.

Thank You

Evening of Hope 2014 blog (conclusion)

With the addition of a small suggestion from Michelle, I didn’t.

As I entered the venue for the Evening of Hope, Michelle hung a gift bag on my scooter containing an afghan, knitted by a cancer survivor, as a thank you.  She informed me I would be the third of three speakers.  My wife, eldest daughter, and I sat at a table next to my friend Pat, who had driven 2 hours from Columbia to hear my talk, and her grand - now THAT’S a good friend.

After the second speaker, Michelle began her introduction of the next speaker: me.  As I made my way towards the podium, a petite blonde woman, I believed to be one of the NMSS Chapter staff, clipped a lapel microphone to my collar and handed my wife a wireless battery pack to clip to my belt, prepping me for my talk.  I continued my trek to the podium, gave my talk - which went far better than I had hoped - and began the return trek to my seat.  On the way back, the same woman as before unprepped me, removing the devices placed ten minutes earlier, and told me how well I had done.  At my table, my wife told me that I did, “great, not a dry eye in the house”...including my own.

Michelle then began her presentation of a handmade quilt to the sponsor of the evening, another MS survivor, Brenda Snow, as a thank you not only for making our event possible, but also for all she has done for the MS community through her Snow Companies.  Brenda went to the podium to accept her gift and speak.  Much to my amazement, the woman I thought CHAPTER STAFF, MY PREPPER, walked to the podium!

At the conclusion of the evening, I had the opportunity to meet and mingle with a few of the attendees, both newly diagnosed, and “old salts” with regard to MS, like myself.  In the newly diagnosed, I saw myself 20 years ago- upright, walking, no external visible signs of the internal war their bodies are waging against themselves.  In the “old salts”, I saw myself now- long since able to keep secret the internal battles of war now visible, some still raging, others lost.

A Chapter volunteer and fellow MS survivor introduced herself to me.  She invited me to become an MS Ambassador.  As an Ambassador, I would have the opportunity to host a volunteer fair table, speak to a class of students, pass out pamphlets at fundraising events, and speak about MS at local organizations whenever the National MS Society is invited to do so.  This is just the kind of meaningful fun for which I have been looking.

Brenda walked towards me.  Passing by, she dropped her business card into the gift bag hanging on my scooter’s handlebars and said, “Shoot me an email tomorrow.  It may take me a while to get back to you, but I will. I could use you.”

Michelle had asked me to speak at the event about what gives me hope, to try to give hope to those who may be struggling.  Yet, I have no doubt, I left the event having just been given the most hope of anyone there.  Heading to my car, I noticed a feeling I had not had in quite a while.  I felt a “puff” in my chest, a confidence, the sense things could be, would be, great.

The next day, while reflecting on the event, I googled Brenda Snow.  Reading about her, her Snow Companies, and her trademarked Patient AmbassadorTM   model of direct-to-patient communications, empowering patients, giving voice to their disease, and sharing their personal inspiring stories, my eyes began to moisten.  Tears slowly trickled.  By the time I finished, tears were streaming down my face, my head echoing, “Could this be my life’s next chapter...”

Evening of Hope 2014 blog (part 1)

“Awesome!  I hope you will be able to speak at the event,”  replied Michelle in her email response.  She was referring to the YouTube link I sent of the short video of my family and me.  The Gateway Area Chapter of the National Multiple Sclerosis Society commissioned it when I had been honored with the 2010 Gateway Area Chapter of the National Multiple Sclerosis Society's Father of the Year award.  

Michelle Keating, a chapter board member and fellow multiple sclerosis survivor, contacted me at the suggestion of Rebecca Fehlig, Chapter President, whom I had met earlier that Spring at a fundraising event.  Michelle was organizing the 2014 MS Evening of Hope (the first ever event of its kind by the Chapter) and asked if I would be one of the speakers, sharing “what gives me hope.”  Many of the attendees would be newly diagnosed, most likely scared of what their futures might hold, now that they contain those two words, Multiple Sclerosis. They might likely feel pretty hopeless...

I jumped at the invitation, emphatically saying, “YES.”  This was exactly the kind of opportunity I had been hoping for, yet never expected.   Since my forced disability retirement from medicine, I had been searching, trying to figure out my life’s next chapter, especially as my children got older and my primary parental duties lessened.  

I knew that I did not want to return to pathology, an area of medicine not entered into by choice.  “Time to have fun,” I decided.  Reflecting on my education and training, personal struggles and triumphs, my gift for gab making a short story long,  and my passion for performing in my youth, I felt that public/ motivational speaking would be a great way for me to have fun meaningfully.  A ridiculous pipe dream, I know.

In fact, I had practically no public speaking experience, limited to fundraising events, thanking donors for their generosity, and telling them how their donations were helping the MS community.  I had only spoken about myself in the “Memoirs” class I’ve been taking over the past year at the Lifelong Learning Institute at Washington University .  There, I only spoke to at most ten people at a time. I call my classmates my “editorial board.”

Anguishing over what in my life could possibly give someone starting their new journey in, if not my shoes, ones that will most likely look awfully similar, I asked my friend and fellow MS survivor, Pat Sachs.  She immediately responded, “Creativity,” -- a story I recently wrote for class.  “What’s more hopeful than children?” she continued.  Modifying my story to the venue, I had my MS Evening of Hope talk.

The week before the event, when Michelle and I were arranging a time to meet and discuss the upcoming event, I informed her my talk was roughly nine minutes long.  “I’m sorry but you only have 5-7 minutes to talk.  You’ll need to cut it down,”  she responded.

“But where?” I thought.  I cut a few words, rearranged a few sentences, and actually added a few details. 

The weekend before the event, Michelle and I met to go over my talk.  As I began, she started her stopwatch.  Mid-way through, I noticed her turning off the stopwatch.  I finished my talk with tears streaming down my cheeks.  I looked up at Michelle, and with tears of her own, she said, “It’s perfect.  Don’t change a thing.”

- to be continued -