"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