The Life and Times of Michael C. McGoodwin
Radiology Practice Years
in Seattle Washington, 1978 – 1994
Part I

The World was all before them, where to choose
Their place of rest, and Providence their guide ...
(Of Adam and Eve in John Milton's Paradise Lost, 1667)


Christie, Rebecca, Michael, Wendy in Seattle December 1985
Christie, Rebecca, Michael, Wendy in Seattle December 1985


Topics Discussed On This Page

Moving to Seattle January 1978

Becky, Christie, Wendy, David and Mary Cardiff in our Seattle home August 1980
Becky, Christie, Wendy, David and Mary Cardiff in our Seattle home
August 1980
Christie and Wendy in our Seattle home front yard April 1985
Christie and Wendy in our Seattle home front yard
April 1985

Our Neighborhood:  We moved from Bellingham to Seattle about January 9, not an ideal time of the year to move in the Northwest.  We had purchased a home in the View Ridge – Bryant neighborhood a few blocks from where we had rented previously, and only a little further from the View Ridge Playfield.  The quiet aspects of the neighborhood seemed even more attractive to us as a place to raise our children.  Moving back to our old neighborhood was a little unimaginative—it seemed like putting back on a comfortable pair of slippers—but our familiarity with the neighborhood meant we could concentrate on other interests and the pressing matters at hand. 

Our New Home:  It was a rather plain but serviceable Northwest contemporary home, not fancy and having no view, but roomy enough with three bedrooms in the upstairs (the NW of which I used for a den), a spacious family room to the east of the kitchen and breakfast area, and a sunny dining room.  The basement, which connected to the two-car garage, was fully finished and had a recreation room (formerly holding a massive pool table), hot tub, sauna, and two person large shower (none of which we made much use of), as well as a spare bedroom.  This was only the second home we have owned.  Although there were trees and shrubs in front, the back yard and parking strip were grass without landscaping (aside from a single deciduous magnolia).  We therefore enjoyed for the first time learning about larger scale landscaping, adding several new trees over the years we lived there (1978 – 1985): a Magnolia grandiflora, apple, walnut, 'Crimson King' Norway maple, dogwood, several Austrian pines, and two akebono cherry trees, etc. (not all of which survived).  At various times out back, we had a vegetable garden, a swing set, a jungle gym, a cedar picnic table, a plastic wading pool and water slide, and other fun accessories for our children.  It was a nice back yard to hold birthday parties in.

Wendy and Christie on Hawaii Island January 1978
Wendy and Christie on Hawaii Island
January 1978
Michael with family on Hawaii Island January 1978
Mike with family on Hawaii Island
January 1978

Hawaii Trip 1978:  Before I started to work, and responding to the gloom and rain that we made this move in, we treated ourselves on short notice to a very pleasing week-long trip to Hawaii, our first there.  We traveled to Hawai'i (the "Big Island") on January 23, and stayed in Kailua Kona at the overly large King Kamehameha Hotel (now King Kamehameha's Kona Beach Hotel).  A nice Japanese couple at the airport gave our kids their lovely leis to enjoy—helping to set the gracious tone of this visit.  We enjoyed learning about some of the local food specialties, including for the first time fresh tuna (ahi) and Japanese eggplants at the adjacent Kona Galley restaurant (it was open-air upstairs and one dined in  the wafting balmy breezes).  We also took a glass-bottomed boat ride; explored tide pools at the City of Refuge; tried out the beaches at Spencer Beach Park and Punaluu black sand beach, etc.; visited Hawaii Volcanoes NP (viewing Kilauea Caldera, Thurston Lava tube, and hiking the Devastation Trail); stopping at the Waipio Valley Lookout and Akaka Falls State park; etc.  This trip provided much-needed relief from the efforts I had made to line up a new job and the trepidation we felt in moving, and was the first of several great trips we have really enjoyed to one or more of the Hawaii islands.  (Neither Becky nor I have ever wanted to spend much time simply lounging around at the beach, but the Big Island offers much to interest the snorkler, amateur geologist, botanist, birdwatcher, professional astronomer, or student of Polynesian and Oceanian cultures.)

The Education, Entertainment, Careers, and Interests of Our Children 1978 – 2009

This is a large set of topics—a full description, like much else about the lives of my children, will have to await their writing their own memoirs.  I have grouped the years of my Seattle practice and retirement together here.

Public Schooling and Busing:  When we returned to Seattle in 1978, Wendy continued in first grade in the public View Ridge Elementary School located near our house.  We began to encounter the problems that Seattle parents were wrestling with in those days (and in fact getting her into and keeping her in this local neighborhood school involved some considerable contortions and effort on our part).  We began to feel the societal upheaval involving schools; the neighborhood disruptions caused by racially based busing (begun in 1972); the confusion over the goals of elementary education in the Seattle schools; etc.  (For a good reference on some of the controversies in busing and schooling then, see below.)  As parents of very young and small daughters, we were faced with the choice of keeping them in the neighborhood in what proved to be a somewhat uninspiring school experience, or having them bused to a magnet school in the central district (near where I worked), far from our home and in a tough neighborhood.  Wendy stayed on in public school in first through third grades.  But half-way through her third grade (1979 – 1980), we decided, after facing constant frustrations and bureaucratic indifference, that we had had enough struggling to secure a good, safe, and nearby education for her.  I was particularly bothered by the philosophy, endemic in the non-magnet public schools at the time, that a bright child like Wendy should receive little if any encouragement to excel or go beyond the basics—the emphasis seemed to be entirely on "performing at grade", and children who were capable of going well beyond this rather modest expectation were expected simply to play quietly in the back while the others did their work. 

Private Schooling at Seattle Country Day School:  Although we had always been advocates for the democratizing effects of public school education (and both Becky and I were the products of public primary and secondary educations), we reluctantly made the major decision to send Wendy, beginning at the start of her fourth grade in 1980, to a private school.  Initially, this was Seattle Country Day School or SCDS (aimed they said at gifted children, and to which the parents now had to carpool).  Despite the transportation hassles and considerable expense, we breathed a great sigh of relief as we saw how enriched the learning environment was, how the academic expectations were high but reasonable, how much individual attention the kids received, how the school encouraged acquiring the widest range of new skills, and how much they cultivated and genuinely valued good relations with parents.  This school was founded and first directed by the very capable Lucile Beckman (director from 1964 to 1986).  Facing busing and other school concerns, we had stayed in Seattle rather than moving to the suburbs as many parents did for similar concerns, but opted for private school.  Although we perhaps fell into the statistical category of "white flight" (in our case, to a private school), our reasons were primarily academic in choosing this move (though safety and the recurring issue of busing were also in the back of our minds).  We also enrolled Christie at SCDS at the same time (beginning in fall 1980) for the start of her first grade.  (She had attended kindergarten 1979 – 1980 at View Ridge Elementary School.)  The kids made great progress in this private school, and we were proud of their achievements.

Private Schooling at Lakeside Middle and High School:  When Wendy was ready in 1983 to begin seventh grade, she transferred to the middle school at Lakeside School—Christie did the same in 1986.  (Lakeside now begins as early as the 5th grade, and probably did then.)  They both continued on to Lakeside High School, Wendy in 1985 – 1989 and Christie in 1988 – 1991.  I cannot say enough good things about the Lakeside learning environment.  Dan Ayrault (Arthur Delancey Ayrault, Jr., 1935 – 1990) was a former Olympics rowing champion and the outstanding headmaster from 1969 until his untimely death in 1990.  It was an attractive campus and was academically rigorous, yet very nurturing.  I enjoyed getting to know many of the fine teachers Wendy and Christie were privileged to have.  The kids also learned many non-academic skills that enhanced their social development, outdoor capabilities, versatility, and self-confidence.  Wendy graduated from Lakeside in 1989—Becky's parents attended the ceremony.  Christie found the high school a little cliquey, but this is probably impossible to prevent.  Before beginning her senior year in fall 1991, Christie decided she wanted to try somewhere different, and attended the public Roosevelt High School during her senior year, graduating in 1992.  (Becky's parents came for a visit soon thereafter—we had a nice excursion to La Conner.)

(I have felt more than a few pangs of envy and regret, wishing I had myself been able to attend such a fine school as Lakeside, one which might have done much more to nurture my personal growth and learning.  They offered a genuine orchestra with strings, which I would have surely enjoyed playing in.)

Wendy at Princeton Graduation June 1993
Wendy at Princeton Graduation
June 1993
Christie at her graduation from Whitman with Mike, Becky, and her parents May 1996
Christie at her graduation from Whitman with Mike, Becky, and Becky's  parents
May 1996

Wendy's College Education, Medical Education, and Career: Wendy went on to attend Princeton University in 1989 to 1993, graduating June 8, 1993 with a B. A. in anthropology and awarded membership in Phi Beta Kappa.  On a trip there in March 1989 after Wendy had been accepted, Becky helped her look over Princeton, and Wendy made numerous round trips from Seattle to Newark in conjunction with her East Coast education.  We both visited with Wendy there in April 1993, and Becky returned to Princeton along with her mother for Wendy's graduation in June 1993. 

She worked five and a half years (1993 – 1998) with a nonprofit organization called the Council for Responsible Genetics located in Cambridge, Massachusetts, rising to the position of Executive Director. 

She then took premedical courses for two years, in Boston (1998 – 1999) and in Seattle (1999 – 2000), and attended the University of Washington School of Medicine (2000 – 2004), earning her M.D. degree in June 2004.  She continued on in internal medicine residency also at the University of Washington (2004 – 2007). 

Upon graduation in 2007, Wendy joined the Internal Medicine faculty of the University of Washington School of Medicine and, as of 2009, continues in this position.

Christie's College Education, Further Education, and CareerChristie attended Whitman College in Walla Walla (located in the SE corner of Washington) in 1992 – 1996.  We had made an enjoyable college reconnaissance trip to visit Whitman as well as Willamette in Salem Oregon (in November 1991), and returned to drop her off to begin her freshman year in August 1992.  With her and Wendy at college, we became empty nesters, which we somehow survived.  We enjoyed several trips driving to and from Walla Walla in 1992 to 1996, giving us the opportunity to get to know better this lovely land of rolling wheat fields and spacious skies.  She graduated with a B. A. in Spanish on May 19, 1996—we attended her graduation accompanied by Becky's parents.  She joined the retail workforce for a few years, working particularly at Seattle's REI

When she decided to further her interest in teaching, she attended Seattle Pacific University with our assistance (September 1999 to c. spring 2001) in order to get her teaching certificate, which she earned in 2001.  After this, she worked first at substitute teaching, and eventually taught math and other subjects to middle schoolers full-time for two years at a nearby parochial school.  Becky and I enjoyed volunteering a little at that school—Becky by helping with the flower and ornamental beds on the grounds, and I by teaching some "enrichment" class sessions for Christie in Earth Science.  Subsequently, Christie took up working in development office jobs beginning in summer 2003 and continuing to the present (2009).  Her work entails applying special training and skills in managing a complex database used for fundraising, initially for the Catholic Archdiocese, and subsequently for a Seattle area Catholic high school.

Wendy and Christie at Halloween October 1980
Wendy and Christie at Halloween
October 1980
Wendy competing at soccer Seattle October 1983
Wendy competing at soccer in Seattle
October 1983
Our cat Skittles February 1985
Skittles in repose
February 1985
Christie competing at soccer Seattle October 1985
Christie competing at soccer in Seattle
October 1985

Entertainments and Educational Diversions:  Even excluding the many essentials of life, it would be nearly impossible (as for most devoted parents) to list all the many enrichments we provided and extracurricular activities we facilitated for our children.  However I present the following list for my reader's amusement, and for sober contemplation of what can be involved in raising middle-class kids. 

Activities included: Suzuki and non-Suzuki piano lessons and recitals; rhythm band; preschool; arts and crafts classes; dance and tumbling classes; swim lessons; gymnastics; creative dramatics; plays (at what is now called Seattle Children's Theater) and musical concerts; birthday parties complete with clowns or magicians; Pacific Science Center visits; stays at Camp Sealth (1980, 1981,1982); tending gerbils (beginning in 1980); Y-Princesses (for Christie; 1980 and beyond, including fun visits to the cabins of the Wyckoffs (see below), the Ericksons (see below), and other parents); Blue Birds and Camp Fire Girls (for Wendy and Christie, c. 1980, 1982, and Campfire Day Camp in 1983); soccer and soccer camp (multiple years); hundreds of books; pottery (1981, 1982); ski and other outdoor outfits and trips (see below); a tropical aquarium; a cat Skittles that we all loved (1982 - January 1992); science gizmos and educational toys; jazz dance (1983); break dancing (1984); accompanying parents on medical meeting trips (e.g., Wendy in Vancouver 1984); violin rentals and eventual purchase, and violin lessons for Wendy; Hidden Valley Camp (Wendy probably 1984 and 1985, Christie c. 1985 and 1986); Self-defense courses (1984); swim team; Camp Nor'wester (Christie only, c. 1987 and 1988); a summer typing course (1985); track (1985); crew racing (1986); Northwest Girlchoir (1986 – 1992, including a tour in 1990 to New York); tennis lessons (1986); dollhouses; formal dances; school picnics; lacrosse; singing lessons; guitar purchase and a lesson or two; bikes; driving lessons and cars; long-distance running gear and events; college expenses and major trips on their own; etc.

One time in about 1981, I thought I would entertain and instruct Christie's school class and allow them to visit in the Radiology department of Providence Medical Center (probably on a weekend).  I gave them a demo of how I could fluoroscope our two gerbils as they ran around in a box.  Unfortunately, one of the gerbils woke up dead the next morning, and I have always felt guilty that the stress of the outing and all the attention they received might have been what did him in—surely it was not the radiation!  (We quickly buried the hapless victim—in the classic manner by which doctors are said to handle their mistakes—and hurriedly bought a replacement.  Chastened and humbled, I never again examined any or our pets with radiology techniques.)

Summing Up:  We are pleased that both of our children have grown into mature, independent, fully employed, and accomplished adults. As adults, both have enjoyed reading, hiking, backpacking, a variety of musical and performance forms, and travel including Central and South America.  Wendy has also been attracted to mountaineering, Telemark skiing, quilting and gardening, while Christie enjoys sewing and sea kayaking.

Resort, Athletic, and Outdoor-Oriented Recreational Activities

We continued a significant focus on active outdoor-oriented activities, and I have listed these in considerable detail for personal and family purposes:

Exercise

Cycling:  We all had bikes eventually, and my nuclear family enjoyed making nice outings to Matthew's Beach Park, the University area, the Burke-Gilman trail, Point Defiance Park in Tacoma, Lincoln Park and Seward Park in Seattle, and other outings in the Seattle area.  We tried a few longer family bike excursions in the country c. 1983, including trips on Lopez Island (June 1983), the Lower Stillaguamish Valley (January 1983), Whidbey Island and the Deception Pass area (March 1983), the Snohomish River area (May 1983), and Point Defiance Park (April 1984).  However, I found this often a little too dangerous for my family due to traffic, angry dogs, and rabid rednecks.

Swim and Tennis Clubs:  In 1979, we joined the View Ridge Swim and Tennis Club, and enjoyed using the tennis courts (including playing in the tennis flights in the 1980s) and the pool for lap swimming and picnics.  This pool was managed during our early years of membership by a very capable ex-military man named Tom Evans, whom I respected. 

In 1980, we joined the Central Park Tennis Club in Kirkland, which resembled a country club but was strictly for tennis.  (We were introduced to this club by Paul Paulson, and joined him there on the courts several times.)  It is an attractive facility located a little too far away from us, requiring driving across the Evergreen Point floating bridge which spans Lake Washington.  The members were cordial, we made a number of friends, Becky took some useful tennis lessons and played regularly with a nice regular foursome, and I enjoyed some great tennis especially on men's night and with Becky at mixed doubles.  Regretfully we felt we had to give it up in spring 1990 due my increasing medical limitations and Becky's new career as a sonographer.

Downhill and Cross-Country Ski Trips

We also continued to enjoy downhill and cross-country (XC) skiing trips, both day excursions (mostly to Alpental at the Snoqualmie Pass area) and overnight trips.  Notable ski outings and trips included: Crystal Mountain (Alpine Inn without kids December 1978, Silver Ski Chalet without kids March 1979, and Silver Ski Chalet with kids February 1983); Sun Valley without kids (February 1982, for which we drove our snappy new 1981 front-wheel-drive Honda Accord); XC to Hurricane Ridge and Obstruction Point with John Burkhardt (February 1983); Schweitzer Idaho including our kids and the Warrens for downhill and XC (March 1984); Whistler Mountain ski trip with our kids and the Warren family (January 1985); Mt. Bachelor and Bend Oregon with our kids and the Warren family (March 1986, a trip on which I did not downhill ski); a family visit to a ski cabin near Lake Kachess that was owned by our hosts the McDermotts (December 1986); Bend and Mt. Bachelor Oregon, again with our kids and the Warren family (March 1987); and a pleasant stay with the Warrens at a Snowater Resort condominium in the Mt. Baker area, during which neither Becky nor I skied (December 1993).

Autos 1978 to 1994

We purchased a new 1981 front-wheel-drive Honda Accord in 1981.  With our active outdoors lifestyle and need for better traction, we decided to purchase a blue 1986 four-wheel-drive (4WD) Chevrolet Suburban in June 1986, a generous gift from Becky's parents, adding a third car to our 1977 yellow Volvo wagon and our 1981 Honda.  The Suburban proved useful for driving the family over treacherous mountain passes in snow and ice, and for improving the safety and comfort of our long-distance family road trips to Colorado, Montana, California, Canada, etc.

We purchased a used cream-colored 1978 Volvo wagon 1986, after our original 1977 Volvo was totaled by Becky in a freeway pileup, fortunately with no injuries.

Our first all-wheel-drive (AWD) cars, a nimble blue 1990 Subaru Legacy station wagon purchased in July 1990, also proved useful for negotiating snowy mountain passes, but was especially handy for driving Seattle's dangerously hilly streets on the rare occasions when snow or ice persisted.  With all four of us driving, we were for a while a four-car family (1978 Volvo, 1981 Honda, 1986 Suburban, and 1990 Subaru) until we sold our 1978 Volvo wagon in 1993. 

Mike sittin' tall in the saddle Jasper NP June 1979
Mike sittin' tall in the saddle in Jasper NP
June 1979
Wendy and Christie at sand dunes on Oregon coast September 1980
Wendy and Christie at sand dunes on Oregon coast
September 1980
Russ with Becky and our kids in Mt. Rainier NP July 1981
Russ with Becky and our kids hiking in Mt. Rainier NP
July 1981
Becky and Mike XC skiing Schweitzer ID March 1984
Becky and Mike XC skiing Schweitzer Mountain ID
March 1984
Becky with kids across from Athabasca Glacier in Jasper NP August 1984
Becky with our kids across from Athabasca Glacier in Jasper NP
August 1984
Becky and Mike at Upper Enchantment Basin July 1986
Becky and Mike at Upper Enchantment Basin in WA
July 1986
Mike and Russ with sea kayaks April 1988
Mike and Russ in sea kayaks April 1988

Christie and Becky on hike to Iceberg Lake in Glacier NP August 1991
Christie and Becky on hike to Iceberg Lake in Glacier NP
August 1991

Backpacking Trips

We continued to enjoy hiking and camping on numerous occasions and made some memorable backpacking trips during these years, some of which included our kids as they became more tolerant of longer hikes, and some of which were just for Becky and me.

Backpacking trips included a backpack with the kids and 3 of the Hashke family to Trout Lake (May 1979); backpack with kids to Esmeralda Basin (August 1979); Surprise Lake Backpack probably without kids (July 1980); a backpack to Summerland in Mount Rainier National Park (MRNP) with Becky's brother David and his wife Mary (August 1980); a backpack without kids to the High Divide in the Olympic NP, one of our favorite backpacks, complete with a full moon, great views, and herds of Roosevelt elk (September 1981); a backpack with kids at Snowgrass Flat near Mt. Adams soon, still ash-laden 2 years after the Mt. St. Helens eruption (July 1982); a backpack with Wendy and her friends to Lake Dorothy (July 1983); a backpack with the kids and the Warrens to Morovitz Meadow on Mt. Baker (August 1983); a spectacular backpacking trip without kids to another of our favorite destinations, Snow Lake and the Enchantment Lakes including Viviane, Perfection, and Inspiration Lakes as well as Aasgard Pass (July and August 1986, apparently our last backpacking trip).

Day Hiking, Camping, and Other Outdoors-oriented or National Park-style Trips

Trips of this type included: 

1978:  Car camping with our kids at Whidbey Island and Deception Pass in May 1978; camping with our kids at La Wis Wis near Mt. Rainier NP (MRNP) with our friends the Warrens in July 1978; camping with our kids on the Olympic Peninsula in July 1978; a hike with our kids to Flapjack Lakes (July 1978) and without our kids to Ingall's Lake (August 1978).

1979:  A hike with the kids to Lake Dorothy in June 1979; camping with kids at Deception Pass and Lopez Island Trip (March 1979); a camping and hiking trip without kids to Jasper and Banff NP (June 1979); a hike with kids around Naches Peak Loop Hike (July 1979); a hike without kids to Burroughs Mountain on Mt. Rainier (September 1979); camping with the kids along Icicle Creek area (October 1979).

1980: A car camping trip with our kids to Silver Lake near Mt. St. Helens (May 1980), only 14 days before the cataclysmic eruption 18 May 1980; hiking with kids on Naches Wagon Trail (May 1980); camping and hiking with our kids at Baker Lake area (May 1980); a hike without kids to Cascade Pass and Sahale Arm (August 1980); an Oregon Coast camping trip with kids, trying out a rented VW camper (September 1980); camping with Wendy and her Bluebirds at Wiley Creek (October 1980); and hikes without kids to Gobbler's Knob in MRNP and to Ridge/Gravel Lake/Commonwealth Basin near Snoqualmie Pass (October 1980). 

1981:  A hike probably without kids to Lake Serene (June 1981);  hiking with Christie and her Y-Princesses at Snoquera Falls, Palisades and Flats while staying at the Erickson's cabin (June 1981); a hike with kids on Skyline Trail to Panorama Point in MRNP (July 1981); a hike without kids on Tumac Mountain (July 1981); a Glacier National Park Trip with kids (August 1981); and a hike with Wendy and Bluebird Adventure girls to Tonga Ridge (October 1981).

1982:  A hike with kids to Annette Lake Hike in June 1982.

1983:  Family hiking and horseback riding in the Pasayten Wilderness (July 1983).

1984:  A family trip for hiking and swimming in Mt. Robson, Jasper and Banff National Parks (July – August 1984); a hike with kids, Tina, and Pat Burkhardt with her kids at Deer Park area of Olympic NP (August 1984); and a hike without kids to Spray Park in MRNP (September 1984)

1985:  A hike without kids at Lennox Creek (September 1985)

1986: A hike without kids to Norse Peak (June 1986); a hike without kids to Squire Creek Pass (July 1986).

1987:  A hike to Snow Lake past Alpental by just Mike and Christie (July 1987); a family car-camping and hiking trip, one of our last of this type, to Mt. Rainier NP including Glacier Basin hike and a hike to the summit of Second Burroughs Mountain at 7400 ft, and the Mt. St. Helens areas including the log-jammed Spirit Lake, the blowdown area, and Lava Cave (July 1987)

1989:  A solo hike by myself to Klapatche Park in Mt. Rainier NP in October 1989 "so I wouldn't go a summer without a hike"

1991:  A nice trip with Becky and Christie to Glacier National Park (July 1991); a return hike without kids to Burroughs Mountain in Mt. Rainier NP (September 1991).

1992:  A hike on Tonga Ridge with just Mike and Wendy (June 1992)

1993:  A trip to Jasper and Banff National Parks which included Wendy but not Christie in July 1993; and a hike without kids to Glacier Vista at Mt. Rainier NP (September 1993).

Further camping and hiking trips that included extended family are mentioned below.

Resort, Auto Touring, Cabin Oriented, Boating, and Urban Trips

Trips of this type made with our kids included: A stay at the Sunriver Resort for fall swimming and some day hiking (September 1979); Beach Haven at Orcas Island (August 1978); the Beachwood Resort on the south coast of the Olympic Peninsula near Copalis Beach, with our "gourmet" group (April 1979); visit by 4 to cabin of Nordfors at Vashon Island (August 1980); a visit with kids and the Warrens to an ash-laden cabin we were considering buying near Packwood and Randle Trip (February 1981); the Big Island of Hawaii, our second trip there again with the kids, at which time we visited the NASA infrared telescope on Mauna Kea (February 1981); the Beachwood Resort with our kids and "gourmet" group (March 1981); Sinclair Island at the Akers cabin in May 1981; the Big Island of Hawaii, including Christie but not Wendy (April 1982); a sailboat excursion with the Hepworths to Agate Pass (May 1982); Victoria BC with the kids (June 1982); Alice and Anderson Lakes BC cabin (July 1982); Priest Lake Idaho (August 1982 and August 1983, both times staying at Paul Paulson's recently built cabin, where me met the Thompson);  Kihei on Maui (March 1983); visit with Christie and her Y-Princesses to cabin of Wyckoffs at Seabeck (April 1983);  the Beachwood Resort at Ocean Shores with our "gourmet" group (May 1984); Lake Chelan for a visit with the Roberts at their cabin (August 1984); sailing with the Warrens on their sailboat (September 1987); visit with our kids to the Colbecks cabin at Big Lake (July 1988); boating for Christie with the Wyckoffs from our cabin (September 1988); and a family auto and camping trip to southern Oregon including Crater Lake, and Northern California including Lassen NP, Mt. Shasta, and the coast (June 1989).  

Becky and I also made the following trips of this type without the kids: San Juan Island at the Griffins cabin (in 1979 and 1982); trip with gourmet group at Sudden Valley and La Conner (1982); Orcas Island at the Beach Haven with "gourmet" friends (April 1983); Ashland and Jacksonville Oregon (September 1984); Oahu and the Big Island in Hawaii (January 1986); Kalaloch on the Olympic Peninsula (September 1990); Vancouver, in part to attend Phantom of the Opera (September 1991); Sun Valley (July – August 1992); Big Island of Hawaii (January 1993); Ashland OR (September 1993); and Kalaloch on the Olympic Peninsula (January 1994).

Further trips of this type that included extended family are mentioned to follow.

Other Travel, Cabin, and Extended Families

Becky, kids, and Mike's parents in Texas September 1978
Becky, our kids, and Mike's parents in Texas
September 1978
Becky with kids, Mike's mother and father Jim, Orcas Island July 1979
Becky, our kids, and Mike's parents, Orcas Island WA
July 1979
Mike with father, mother, and kids in San Antonio December 1979
Russ, Mike, our kids and Mike's parents in San Antonio TX
December 1979
Becky's grandmother and our kids, Katy TX December 1979
Becky's grandmother and our kids in her Katy TX home
December 1979
Jim with Tina, their sons, Becky, and grandchildren in San Antonio December 1979 & February 1980 (montage)
Mike's parents, Russ, Scott, and our kids in San Antonio TX
December 1979 & February 1980 (photomontage)
Becky with parents and kids on boat of Art and M. L. Griffin July 1980
Becky with her parents, our kids, and Art and M. L. Griffin on their boat near Sucia Island WA
July 1980
Becky with kids, parents, and brothers' families, Mike's mother, Karen, Brian, & Erika Haschke at Lake Buchanan TX April 1982
Becky's parents and the families of their descendents, Tina, Karen, Brian, & Erika Haschke at Lake Buchanan TX
April 1982
Becky, Christie, Mike's mother, Wendy in Seattle December 1982
Becky, her kids, and Tina in Seattle
December 1982
Mike with Becky's parents and their children and grandchildren, Lake Buchanan TX June 1983
Becky's parents and the families of their descendants, Lake Buchanan TX
 June 1983
Mike with Becky's father and brothers and striped bass Lake Buchanan June 1983
Mike with Becky's father and brothers holding striped bass, Lake Buchanan TX
June 1983
Tina, Mike's family and brothers, and Cardiff families at Rainbow Lake CO July 1985
Tina with her sons, Becky's parents with the families of their descendants at Rainbow Lake CO
July 1985
Cardiffs and Mike's families, Lake Buchanan TX June 1986
Becky's parents and the families of their descendants, Lake Buchanan TX
June 1986
Cardiffs and Mike's families at Rainbow Lake CO July 1988
Becky's parents and the families of their descendants at Rainbow Lake CO
July 1988
Scott and Tracy with Becky Cottonwood Pass CO July 1988
Scott, Tracy, Becky at Cottonwood Pass CO
July 1988
Becky, Tracy, Scott, James at Telluride CO July 1990
Becky, Tracy, Scott, James at Telluride CO
July 1990
Cardiffs and Mike's families Katy TX April 1991
Becky's parents and the families of their descendants Katy TX
April 1991
Mike's family with Becky's parents and descendents Katy TX March 1994
Becky's parents and the families of their descendants Katy Texas 
March 1994

Extended Families

Seeing our extended families has always been of great importance to me, Becky, and my children, and I have listed our visits with them as well as some major events in the extended families.  The following list also includes several major trips that did not involve extended family.

Texas Trips 1978 to 1994:  We made a visit with our kids to see our extended families in Texas at least once and sometimes twice a year through 1994 (and continued beyond, during my retirement years).  In September 1978, we visited at Becky's parents' Buchanan Lake house, and also went to Canyon Lake with my parents (photos above).  In San Antonio, we often went to Los Patios.  While in Texas, In addition to seeing the extended family members we would often try to visit with Marie Morris and the Spaws in Houston, and Richard and Jeannie Gonzalez in Austin.  I probably have not listed all of the numerous Texas trips we made.

Visits by My Parents to Seattle Prior to 1980: My parents came to visit in July 1978, at which time we took them with our kids hiking at Paradise on the Nisqually Glacier Vista Hike in MRNP.  At Christmas 1978, my parents returned and we made a memorable though very cold excursion to Whidbey Island and Deception Pass (where I built a much needed fire).  My father's last visit to Seattle was in July 1979, at which time we took both of my parents to Orcas Island and the Beach Haven resort.  During that visit, we also made the hike with them and our kids on Tonga Ridge (July 1979).  My father took great delight in seeing his only grandchildren.

Visits by Becky's Parents to Seattle Prior to 1980: Her parents came to visit in May 1978 and August 1979 (at which time they brought MaMa, her last visit to our home).

New Condo for Mike's Parents 1979:  Becky and I bought a condominium in San Antonio for my parents in November 1979, in order to make it more feasible for them to reunite under one roof and to provide aid for my father's declining spirits.  My father was especially thrilled with this.  

Texas and Hawaii Trip 1979 – 1980:  I was glad to have traveled with my family to see my parents in their new condo at Christmas 1979, just a month before my father died and the last time I saw him or MaMa in person.  Russ was also there for that Christmas visit.  After visiting with our extended families in Texas at Christmas 1979, we joined Becky's family including David and Mary on a trip from Texas to visit Kauai and Maui (December 1979 – January 1980).

The Death in 1980 of My Father and of MaMa:  Sadly, my father died in January 1980, as I have discussed elsewhere—this was a great loss to me.  Becky's grandmother MaMa, also a great favorite of mine, died soon thereafter in February 1980.  We all returned to Texas in late January 1980 to attend my father's funeral, and also attended MaMa's funeral later on that trip.

Visits by My Mother to Seattle 1980 to 1994:  After my father's death, my mother continued to visit us in Seattle at least once a year, usually in the summer, and sometimes also at Christmas (e.g., 1983, 1985, and others), until she could no longer travel safely.  We took her on a hike to Lennox Creek (July 1980) and to Point No Point for a picnic (August 1980), and we took her hiking near Deer Park in Olympic NP (August 1984).  She last traveled to Seattle in 2001, but not thereafter due to health limitations.

Visits by Becky's Parents to Seattle 1980 to 1994: Becky's parents came to see us in June 1980 (at which time we and the kids took them on the Pete Lake hike, to the Beach Haven at Orcas Island, and to Sucia Island with the Griffins on their boat); in August 1982 (when we went to Whidbey Island); in January or February 1984 (to see our new cabin), in February 1985 (we all again visited at our cabin); in February 1986 (when we took them to Snoqualmie Falls Lodge); in June 1989 (when Becky took them and Christie to Butchart Gardens Victoria); and in June 1992 (when we took them to La Conner with our kids).  In September 1993, Becky's father underwent major heart surgery, and after this, he and his wife felt less able to come to Seattle (but did return in 1996).

Visits by My Brother Russ to Seattle 1981 and 1988:  Russ came to see us in June – July 1981, and we took him and our kids on the Polallie Ridge hike and the Van Trump Park and Panorama Point hikes, as well as camping at Cougar Rock CG in Mt. Rainier NP.  He returned to visit in March – April 1988, at which time we visited Steilacoom (where he had lived prior to shipping off to Vietnam).  We also tried some limited sea kayaking at our cabin, though I was limited by weakness by at this point.  

My Brother Russ's Growing Family:  Russ remarried in 1991.  In late 1992, a daughter Megan was born to Russ and his wife Yashka.  Her son Nathaniel ("Nat") from an earlier marriage was born in early 1987 and was adopted by Russ.  Additional visits with them are mentioned in Colorado trips below.

My Brother Scott's Growing Family:  Scott and Tracy Cameron married January 23, 1989.  A son James T. was born in late 1989, and their daughter Katherine B. ("Kate") in fall 1992.  Visits with them are mentioned in Colorado trips below.

Visit by Robert Waite to Seattle 1989:  Robert and Judy Waite came to visit my family in May 1989—he had attended Princeton and enjoyed reminiscing about Princeton with Wendy, who would be starting there in the fall 1989.  (See below regarding our first visit to meet him.)

My Mother Marries Milo Jordan 1992:  We met my mother's future second husband Captain Milo A. Jordan in San Antonio in April 1991 and again in Seattle in December 1991.  They married in August 1992, and afterwards he accompanied her on several visits to see us in Seattle until his death in 2000. 

Becky's Brother Charles and His Family:  Becky's nephew Charles C. Cardiff, III ("Chaz") was born in summer 1978 to her brother Charles C. Cardiff and his wife Linda.  Their second daughter Catherine Cardiff was born in spring 1980.  Becky's niece Cayla Cardiff came to visit us in June 1993 after her high school graduation.

Becky's Brother David and His Family:  Becky's nephew Jared Cardiff was born to David and Mary in early 1982, and their daughter Holly in early 1986.  David and his family came again to visit with us in Seattle in May 1982, in August 1989, and in August 1992. 

Beach Cabin

We had a Salish Sea beach cabin built in 1983 on land that we bought in May 1981 (in an area we had first visited in 1978, when we stayed at a nearby resort).  Getting there requires a ferry ride, which is enjoyable (unless the lines are long) because one feels transported to another land.  I have not attempted to detail the many trips we have made to this cabin.

It has been a nice retreat for us where I have been able to get a lot of work done, free of big city woes and distractions, a place of serenity (like Shakespeare's Belmont).  Becky and I tend to be landlubbers at heart and mostly keep our feet firmly anchored on the ground, and so this cabin has to satisfy our Sea-Fever.  (We do get plenty of windy days, white clouds flying, flung spray, blown spume, and sea-gulls crying there.)  The birds are still plentiful (including osprey, bald eagles, Brant geese, great blue herons, and kingfishers), deer and sea otters come to visit, the quiet is noticeable (when the winds are not blowing), and the pace of life is comfortably slow.  Our boats there initially consisted of a small rubber raft for the kids and a 15 foot Tripper Old Town canoe bought used in 1984.  (Where at all possible, and consistent with our environmentalist–conservationist ethic, we have always tried to emphasize self-propelled forms of outdoor recreation, such as hiking, XC skiing, and paddling sports.  Of course, this ideal is observed more in the breach when using a car or plane to travel to a recreational destination, and downhill skiing was always an especially energy-intensive exception as well.) 

Dauntless madrona tree by beach November 1978
Dauntless madrona tree by beach
November 1978
Becky and her father with still undaunted madrona January 1984
Becky and her father with still undaunted madrona
January 1984
Tina, Mike, Wendy, and Christie at beach August 1986
Tina, Mike, Wendy, and Christie at beach
August 1986
Mike armed for combat at beach September 1987 (photo by K. Haschke)
Mike armed for combat at beach
September 1987
Mike's family at beach November 1987
Mike's family at beach
 November 1987

Landscaping and Gardening:  The cabin, of course, brought new responsibilities to furnish, landscape, and maintain it, and still requires a fair amount of our time.  In 1983, with the land overgrown with 10-foot high Scotch broom and presenting a dangerous 30 foot ledge to our young kids, we had to start from scratch (in an environmentally friendly way): erecting a bulkhead of uncemented stone riprap to stabilize the eroding bank, and recontouring the abrupt and dangerous cliff behind the bulkhead to slope more gently toward it.  We planted grasses to further help stabilize the new slope, along with trees in the open spaces such as shore (coast or contorta) pines and Japanese black pines, and closer to the cabin, vine maples, a Japanese maple, an arborvitae, and a flowering ash.  

Planning, acquiring, planting, and tending the many new plants we have subsequently added there since 1983 has been a labor of love for us.  Becky has done the lion's share of the gardening and served as the overall horticulturalist (with a special focus on the shrubs, perennials, and annuals), while I have participated mostly as the larger-scale arborist and weed whacker.  Nurturing and seeing all the lovely new plants grow and flourish has brought great pleasure and the deepest satisfaction to us both.  Over the years, we have added several bearing trees: apples, a pear, and an English walnut (plus several others that did not survive the dry and windy environment).  The nuts and fruits from these trees have mainly fed the ravenous wildlife, and almost nothing has been left for us to consume.  (This is not a big problem though—we have been happy to help out our fellow creatures.)  Becky has developed a Mediterranean-style garden on the south-facing bank (adding Cistus, Euphorbia, rosemary, Genista, Ceanothus, rugosa roses, lavender, sumacs, etc.)  We have also worked to develop a woodland garden nestled among the already present native trees.  The natives include Douglas-firs, western redcedars, Pacific madronas or madrones, bigleaf maples, red alders, and Pacific and other willows.  The trees we have successfully added there include a dogwood, paper birches, Japanese maples, a Cornus mas, an Alaska cedar, Western and Eastern (Canadian) hemlocks, a grand fir, Fraser firs, Garry oaks, a Pacific yew, and an Amur maple.  The ferns we added to those already present have been mostly sword, deer, maidenhair, and lady ferns.   The native shrubs are mostly salals, Oregon grapes, elderberries, snowberries, flowering currants, ocean spray, mock orange, and Indian plums.  To these we have added rhododendrons, fuchsias, hydrangeas, buddleias, English hollies, viburnums, roses, cotoneasters, and escalonias among others.  Becky has also planted many smaller flowering plants including columbines, trilliums (the flower selected for our logo), foxgloves, native irises, Vancouverias, hellebores, and forget-me-nots.  (To view a list in PDF format of the principal plants currently at our cabin location, click on this List 2.) 

Other Cabin Projects:  I enjoyed reactivating my modest woodworking and carpentry skills for the cabin by making two more sets of bunk beds, a queen bed, a roofed firewood rack, various other racks, and a large workbench.  I also assembled some sturdy basic furniture kits from Wood Classics.  One of the most interesting creations I made is a grilling rack worthy of Rube Goldberg—it is made of pipe and stainless steel rods and we use it to slow-broil salmon, lamb or chicken kebabs, and vegetables, etc. over a California Grill.

Neighbors:  We have made some nice friends among our neighbors there, and for many years enjoyed annual summer gatherings held at various homes along our beach. Sadly some of these neighbors have passed away, including Glen and Edith G.  Edith was a nice friend and fine gardener, and generously contributed several of the plants to Becky that we still have growing.

Local Sea Kayaking and Snorkeling:  We obtained wet suits and began snorkeling at our cabin in 1986.  In 1987, we took up sea kayaking on a small scale, again mostly near our cabin, and made some pleasant if occasionally hair-raising outings on Puget Sound, the Nisqually Delta region and Harstene Island area (April 1990), and Hood Canal.  (I soon had to cut way back on this pleasurable activity because of diminished stamina, but continued for many years to enjoy sea kayaking vicariously even in the remotest parts of the world through the fascinating Sea Kayaker magazine.)  Especially in the early years, we tried our hand at snorkeling for crab and fish such as flounders with very modest success, certainly nothing like I experienced with the crab fishermen of King Cove Alaska.  (In fact, some of the waters in our area seem sadly to be much reduced in sea life even since we first began snorkeling there in about 1983.)

Colorado Trips With Extended Family 1984 to 1990

New Mexico, Colorado, and Texas 1984:  Becky and I also took Wendy to Santa Fe in June 1984—Christie went on to Texas, and Wendy flew to Texas in a few days.  We enjoyed meeting up with a favorite but long lost relative on my mother's side, Robert Waite and his wife Fausta.  (He was my second cousin once removed.)  We also visited our Alaska friends the Duncans in Albuquerque, and my brother Scott and his wife Tracy in Colorado (in Eagle, Aspen, Maroon Bells, and Independence Pass), and stayed by ourselves for the first time at the Rainbow Lake Resort near Buena Vista CO.  We flew on to Texas to join up with Christie, to see the remainder of the Texas families, and to celebrate Mary Cardiff's new PhD.

Rainbow Lake Colorado 1985:  My family joined a grand extended family reunion at Rainbow Lake Resort near Buena Vista Colorado in July 1985 (photo above).  This included Becky's parents and their children's families, as well as my mother, both brothers, and Tracy. We also drove to the top of Pikes Peak.

Rainbow Lake Colorado and Utah 1988:  My nuclear family, Scott and his girlfriend Tracy, and the Cardiff clan again met up in June – July 1988 in Colorado.  On the way to Colorado, we visited the Mormon temple and grounds in Salt Lake City and Dinosaur National Monument in NE Utah, drove over Trail Ridge Road in Rocky Mountain NP, and visited my brothers and the University of Colorado in Boulder.  At the Rainbow Lake Resort near Buena Vista, Colorado, we stayed in cabins and hiked at Cottonwood Pass—Scott and Tracy joined us there.  On that trip, we also went with the Cardiffs further west over Cottonwood Pass to the dude ranch, Harmels Ranch Resort near Almont.

Durango and Telluride Colorado 1990:  My nuclear family joined the Cardiff family reunion in Colorado in June – July 1990 at Durango, Silverton, and Telluride (passing through Ouray on the way).  In Telluride, Scott came with his wife Tracy, giving us the first opportunity to meet my new nephew, James, who was born in fall 1989, but we missed Russ. 

More Trips Without Extended Family 1980 to 1987

Becky and Mike, Vince and Diane Nordfors, Tom and Sue Cooper at Carmona parador Spain May 1980
Becky and Mike, Diane and Vince Nordfors, Tom and Sue Cooper at Carmona Parador Spain
May 1980

Mike by Monasterboice High Cross, Ireland September 1986
Mike by Monasterboice High Cross, Ireland
September 1986
Becky and Mike at Trinity College in Dublin Ireland September 1986
Becky and Mike at Trinity College in Dublin Ireland
September 1986

Spain Trip 1980:  In April 1980, Becky and I made a memorable driving trip in Spain with our friends the Coopers and Nordfors.  The trip, my second to Europe, was enriched by staying at several scenic and historical paradores.  We visited Carmona, Sevilla, Jerez, Rota, Arcos de la Frontera, Málaga, Granada, Toledo, Ávila, Salamanca, Segovia, and Madrid, and had a great time.  

Mike and Christie at Disneyland May 1984
Mike and Christie at Disneyland
May 1984

Disneyland 1984:  Recalling fond memories of having quality time to myself with my father, and wanting to celebrate her tenth birthday in a special way, I took Christie alone to Disneyland in May 1984, the first time I had been back there since the summer it opened in 1955.  We had a great time. 

Ireland, Wales, and England Trip 1986:  Becky and I had another fine European driving trip in Ireland, Wales, and England, in September and early October 1986.  (To our mutual regret, this was my last trip to Europe as of 2013.)  Driving on the "wrong" side of the road was frightening, especially when we entered our first heavily trafficked roundabout close to the airport where we rented the car.  For a number of days, we had a meteorological rarity—the high pressure over Ireland was the highest on record and the skies correspondingly cloudless!  We visited Irish sites in Dublin (including Trinity College); Cashel; Clonmel; the Waterford Factory (closed in 2009); Tramore (where a swimming site on the Atlantic had a sign "For Men Only"); the Ring of Kerry and Valencia Island; Waterville; Lough Currane; Derrynane Historic Park; Killarney and the Muckross estate; the Dingle Peninsula and Dingle; Galway; the Cliffs of Moher; Dun Aengus on Inishmore (the largest of the Aran Islands); Oughterard; Connemara; Joyce's Country; Ashford Castle; Sligo; the "Lost Isle" of Innisfree; County Donegal; Dunfanaghy; and back to Dublin (including a brief but nerve-wracking drive through Northern Island, past machine-gun toting guards, and a stop back in the Republic of Ireland at the 3000 BC Neolithic site at Newgrange.  In Wales, we visited Caernarfon Castle, Mt. Snowdon and Snowdonia National Park, and Betus-Y-Coed; in England, we went to Chester, Jodrell Bank radio astronomy observatory, and Oxford.

East Coast Trip 1987:  My nuclear family made an exceptionally educational and inspiring trip back east in June 1987, including:  Washington, D.C.; Lancaster and Gettysburg, Pennsylvania; Monticello, Jamestown, and Williamsburg Virginia; Harper's Ferry, West Virginia and Shenandoah National Park; Roanoke Island and Nags Head in N. Carolina; Delaware; Chesapeake Bay and St. Michael's in Maryland; and many other points of interest.  We toured all the D.C. area governmental sites and monuments of significance, the Smithsonian, the FBI building, the American Museum of Natural History, the National Archives, the Library of Congress, the National Air and Space Museum, the National Art Gallery, Mt. Vernon, pandas at the National Zoo, the National Cathedral, etc.  We had a somber visit to the Vietnam Memorial, where we found no familiar names from Katy or San Antonio on the list of 58,000 names.  We also enjoyed a mini-Rice reunion with old friends at the home of Elizabeth Vickery and Jan Lodal, enjoying the full-throated chorus of 17-year cicadas that had emerged.

Domestic, Cultural and Esthetic Life in Seattle and Environs

Arts: We have led a very satisfying and highly diverse cultural life while living and working in Seattle.  I have described our extensive participation in the musical scene elsewhere.  Aside from musical events including symphony, concerts, opera, and ballet, we have continued to enjoy occasional plays at Intiman and at Seattle Repertory Theater.  Although I seem to reserve contemplation of visual arts mostly for trips to museums in Europe, we have made a few trips to the Asian Art Museum and the Seattle Art Museum.  (I have a limited affinity for graphical arts.  In addition to my difficulty seeing images in my mind's eye and my lack of drawing or painting skills, I have always been bothered that only one person or museum can own any particular original painting, and that they seem to be massively overpriced these days due to supply versus demand.  In contrast, anyone can attend a concert or own a CD presenting the greatest of classical music masterpieces for typically only a modest expense.)

Movies: We attended a Herzog German film series in fall 1980 at the UW, which included his Aguirre: The Wrath Of God (1972); Kaspar Hauser (1974); Stroszek (1977) and Nosferatu (1979)—we did not enjoy these as much as the Japanese series we had attended a few years earlier.  We also attended a Coppola film series in 1985 at the UW.  Movies I especially enjoyed during 1976 through 1994 included Star Wars (1977); Jesus Of Nazareth (1977); The Last Wave (1977); Coming Home (1978); Alien (1978); Apocalypse Now (1979); Body Heat (1981); Blade Runner (1982); Gandhi (1982); The Right Stuff (1983); Tender Mercies (1983); Amadeus (1984); This Is Spinal Tap (1984); Ran (1985); Room With A View (1986); Children Of A Lesser God (1986); Ferris Bueller's Day Off (1986); Aliens (1986); Moonstruck (1987); Rain Man (1988); Cyrano de Bergerac (1990); Dances With Wolves (1990); Terminator 2 (1991); Howards End (1992); Strictly Ballroom (1992); Schindler's List (1993); Il Postino (The Postman, 1994); To Live (1994); and Forrest Gump (1994).

Television and Media: We were bitten by the PBS television Masterpiece Theater bug probably starting in the mid-1970s, and have especially enjoyed a number of the great multi-part series, including for the 1978 – 1994 time period: Anna Karenina (1977 – 78); I, Claudius (1977 – 78); The Mayor Of Casterbridge (1978 – 79); Crime and Punishment (1980 – 81); Pride and Prejudice (1980 – 81); The Jewel In The Crown (1984 – 85); Bleak House (1985 – 86); By The Sword Divided (1985 – 86); The Last Place On Earth (1985 – 86); Silas Marner (1986 – 87); Summer's Lease (1990 – 91); The Secret Agent (1992 – 93); and Middlemarch (1993 – 94).  I have also received great benefit and instruction from Nova, Frontline, and the absolutely indispensable MacNeil/Lehrer NewsHour.  We continued to get our print news also from Time or Newsweek and the Seattle Times.

Coursework for Pleasure: We continued to take a number of non-credit courses together during my practice years in Seattle.  These included courses on the following subjects during 1978 to 1994: a geography course on the English Landscape (UW, 1978); opera courses at the UW (see Music); Financial Planning (UW, 1978); Minor Russian Novelists (UW, 1980, taught by James West, including reading of The Musk Ox and A Russian Gentleman); Astronomy (UW,1981); Northern Italy (UW, 1982); Computerizing Investments (UW, 1984, Mike only); The Tale of Genji (UW, 1984, a classic medieval Japanese novel); Systematic Training for Effective Parenting/Teen (1984, also called STEP/Teen, an invaluable course dealing with management of parent-teen conflicts by use of family meetings, controlling anger, defining reasonable expectations, etc.); Exploring Greece and Yugoslavia (UW, spring 1984); and The Brothers Karamazov (UW, fall 1987, taught by the colorfully flamboyant Professor Willis Konick, a course which we took with Wendy in the only course I have ever taken jointly with her).  Becky and I stopped taking courses together during 1988 – 1994 due to my illness limitations, but resumed after I retired in 1994.

Becky also took some non-credit courses on her own during during 1978 to 1994: French Conversation (UW, 1978, 1980, 1988), the Age of Don Quixote (UW, 1979); Spanish for Travelers (UW, 1979 – 80), and Italian conversation (UW, 1982).   She also toyed with graduate work in French at the UW in fall 1987, taking a graduate level course on classical French plays (Molière, Beaumarchais, etc.), but did not find pursuing a Master's readily feasible, and stopped after completing the one semester.  She reactivated her interest in piano by taking piano lessons for three years in 1982 – 1985.  I have discussed her return to college and training beginning in 1988 to be a sonographer elsewhere.  This brought an end to her taking non-credit courses for a while, but in 1993 she resumed attending lectures and workshops on horticultural topics (orchids, hellebores, etc.)  We both learned about fruit tree pruning in a short course given by PlantAmnesty taken in February 1994.

Restaurants: In addition to old standbys from my residency days already mentioned, our favorite affordable Seattle-area restaurants have included some of the following (some of which have closed by 2009):  Surrogate Hostess (defunct), China North (Northern Chinese, once unexcelled but unfortunately now a mere shadow of its former self), the House of Hong (excellent International District Chinese food), the Sahara (middle eastern, now defunct), the India House, the Tandoor (also Indian), the Ho-Ho (Chinese seafood), the Four Seas (dim sum especially), numerous Pho restaurants (for good low-fat Vietnamese lunches), the Santa Fe Cafe (regrettably by 2009 located only on Phinney Ave.), the Union Bay Cafe (the most expensive restaurant on this list, we reserved it for anniversaries, sadly now closed), and the Marlai Thai Restaurant (never a bad meal there yet).

New Home: We moved in June 1985 into our current home in Seattle—a larger and more comfortable house in the Hawthorne Hills neighborhood near where we lived before.  It offered a partial view toward Lake Washington and plenty of room for my family of four plus cat to spread out in.  We put it through a fairly extensive remodel at the time, primarily the kitchen and bathrooms.  I was pleased to have a large bedroom that could be used for my study and house my books and office-like activities.  

Landscaping and Gardening: Becky applied her remarkably honed skills in horticulture toward landscaping this home during 1985 to 1994 and beyond—my role has been largely confined to pruning.  We had some decent trees and shrubs to start with:  vine maples, a limber pine, blue spruces, a cutleaf Japanese maple, photinia hedges, some lodgepole pines, thundercloud red plum, Western redcedars, and a native dogwood.  Over the years, we have added the following trees:  a Chanticleer pear, a coral bark Japanese maple, apple and cherry trees, a star Magnolia (Magnolia stellata), Styrax japonicus (Japanese Snowbell), pink dogwood, Italian plums, and a Stewartia koreana.  We have also added many ornamental shrubs, including roses, camellias, viburnums, nandinas, rhododendrons, a buddleia, sarcococcas, kerrias, hydrangeas, fuchsias, a shrubby honeysuckle, smoke bushes, aucubas, daphnes, an American witchhazel, and an bay laurel.  Becky has shown great planning, assuring that we enjoy flowers and nice foliage colors year-round, along with a variety of interesting bark textures, contrasting leaf sizes and shapes, groundcovers, and other varied garden features.  The flowers are well coordinated so that clashing colors are not juxtaposed.  The various garden sections include an herb garden, perennial borders lining a wandering pathway, a bird feeding station, a small vegetable plot, a shade garden, an attractive cedar wood composting station, and a bench on a deck nestled in the trees in a far corner and covered overhead by a cedar shake roof—my mother liked to call this our Shinto shrine.  (To view a list in PDF format of the principal plants at this location, click on List 1.)

In about 1983, Becky joined Unit IV of the Lake Washington Garden Club, an affiliation which has been a great source of pleasure, camaraderie, and education for her.  (She is still active in it as of 2009.)

Donations and Contributions:  See here.

Politics and Environmental Issues: Despite my vote to re-elect the somewhat ineffective President James E. "Jimmy" Carter (1977 – 1981), in 1980 we instead elected the first overtly anti-environmentalist American president: President Ronald W. Reagan (1981 – 1989).  I was greatly disappointed at this turn of events, and watched in dismay as he cheerfully gutted the much-needed environmental (and social) protective mechanisms so carefully built up over the previous 10 to 20 years. 

The disastrous explosion and fire in the Number Four reactor at Chernobyl occurred in 1986 during his watch, though admittedly half way around the world.  It gave us an ironic new word, biorobots (used to designate the doomed humans who courageously worked in place of robots, of which there was a shortage, to seal off the deadly radiation environment). 

I was also sorry to see President George H. W. Bush (1989 – 1993)—admittedly a decent and intelligent man—elected president in 1988.  During his regime, the woefully ill-equipped and irresponsibly commanded Exxon Valdez spilled its oily guts in March 1989 into the waters of the pristine Prince William Sound, a region that I had found so beautiful in the 1970s. 

In 1992, I voted to elect William Jefferson "Bill" Clinton to his first term as president (1993 – 1997).  See here for more on politics and the environment since 1992.

Puget Sound Radiology Group Practice and Dynamics

Why I Accepted This Job:  I chose to accept this job in Seattle based on a number of factors, professional as well as personal.  From a professional point of view, I felt this was a diversified and prestigious downtown radiology practice in Seattle that offered me the greatest opportunities for professional growth and satisfaction.  Unlike some more narrowly subspecialized positions that I had been offered earlier, this group practice encompassed the full range of radiology—not just my own subspecialties of nuclear medicine (NM) and ultrasound (US), but also CAT scanning, sophisticated vascular radiology, and the remaining rich array of diagnostic radiology procedures.  The practice was well respected and regarded as innovative, having recently acquired the first whole body CT scanner in the Pacific Northwest, and its primary hospital seemed to be thriving.

Puget Sound Radiology (PSR) Partners, Name, and Incorporation:  The group practice I joined in early February 1978 was still a partnership, and at the time went by the somewhat cumbersome name of its seven partners.  They were Drs. Arthur Russell "Art" Griffin (the head partner of the group when I joined; b. 1929, d. 2015), John C. "Pete" McMillan, Paul Sherman Paulson (director of radiology services and vascular radiology at PMC; b. 1929, d. 2016), Claud I. Hepworth, J. Trenholme "Tren" Griffin (director of NM and radiation therapy; b. 1929), Gerold Frank "Gerry" Garrett (a pioneer in CT at PMC; b. 1933; d. 2007), and Harold E. "Hal" Olsson.  The name of the group was therefore "Drs. Griffin, McMillan, Paulson, Hepworth, Griffin, Garrett, and Olsson".  (I suggested in 1982 that the name be changed, and in about 1983 we decided on the name "Puget Sound Radiology Partnership"—or PSR—an improvement, as we no longer had to order new stationery with each new hire.)  I also eventually favored the conversion of the partnership into a professional corporation, which occurred May 1, 1989, at which time we became "Puget Sound Radiology, PC".  This was important in order to provide certain favorable tax handling and insurance benefits, but especially to shelter our personal assets from liability and malpractice lawsuits.   I'll refer hereafter to both the partnership and the corporation as PSR.  (Following further mergers since I left the practice, the group is now called Radia Medical Imaging and, in 2009, is said to number more than 70 physicians.)  

Early Group History: The partnership was said to be the oldest group radiology practice in the Northwest.  I have an anonymous history on file, the accuracy of which I cannot vouch for, but which serves as a partial source of information for this paragraph. (It is remarkable how silent Web resources are on much of this, even in 2009.)  The group began in Spokane in 1918 with Drs. Charles B. Ward and Arthur Betts forming a partnership, which Dr. Milo Harris joined in 1931.  Dr. Charles Ward moved to Seattle in the early 1930s to found the Tumor Institute at Swedish Hospital, and subsequently opened an office for diagnostic and therapeutic radiology in the Medical Dental building in 1935, moving to the Cobb Building in c. 1936.  After Dr. Betts died, Dr. Addington joined, followed by Dr. Bracher in 1940.  WWII caused some disruptions, mixing, and matching.  Dr. Ward died in 1943, and more radiologists were hired.  In 1958, the Spokane and Seattle parts of the practice disaffiliated.  In 1960, Drs. Templeton, Nelson, and Bracher all withdrew from the Seattle partnership, and Dr. Addington died in 1964.  Dr. David Christie became the senior partner until his withdrawal in 1972.  Art Griffin and Pete McMillan joined in 1963, somewhat thereafter Paul Paulson, Claud Hepworth (1969), Tren Griffin, and Gerry Garrett (1972). 

When I joined the group in 1978, Hal Olsson was the most recently acquired partner, having arrived in c. 1976. The radiologist preceding Hal had apparently not met the needs of the practice and was asked to leave—a sobering reminder that entry into the inner sanctum was by no means guaranteed. 

Subsequent Radiologists Hired or Acquired by Merger (1978 – 1994):  Later additions through hiring (while I was in practice up to 1994, and with approximate dates in our practice) included Drs. Michael T. "Mike" Ricci (1982  – 1989), James V. "Jim" Rogers III (late 1983), Bonnie J. Witrak (1985, the first woman in the group practice), William M. "Bill" Marks (July 1987), Gerald R. May (March 1988 – October 1992), Joel D. Blumhagen (July 1988 – died October 1993), Deborah M. Lecky/Graham (January 1989), Marie E. Lee (August 1989 – June 1990), Christine E. WIlliamson (Fall 1989 – 1994), Philip J. "Phil" Vogelzang (July 1992), Jeffrey D. "Jeff" Robinson (July 1992), Andrew "Andy" Gyorke (July 1993), and Sanjiv R. Parikh (July 1993).  Several additional radiologists also became affiliated with our group for a while when Pacific Medical Center hospital closed in 1987: Drs. Frederic H. Gerber, William E. "Bill" Greiner, Ken S. Heilbrunn, and Burley J Packwood, as well as nuclear medicine mentor, Dr. Robert S. Griep.  Through a merger in early 1989 with the Evergreen Hospital group in Kirkland, Drs. Kennan H. "Ken" Hollingsworth (1989), John W. Y. Li (1989), and Richard E. Miller (1989) joined our group. 

Tren Griffin left our group in 1982.  At the time I retired in 1994, the group had grown to 16 radiologists.  (In some parts of this narrative, especially when dealing with touchy subjects or adverse behaviors, I have omitted specific partner names.  This makes for blander reading, but I am not writing an exposé—many of them are still alive, and some would probably object to the unaccustomed publicity.)

Institutions and Office Practices:  The group when I joined covered Providence Medical Center (PMC, the group's  flagship hospital, now in 2009 called Swedish/Cherry Hill), as well as office practices in the Medical-Dental building downtown (next to Frederick and Nelson, the premier department store in Seattle), one at 1001 Broadway (on "Pill Hill", near Swedish Hospital), and one on the PMC campus (opened in 1978).  They also contracted to provide radiology services at the Polyclinic (a multi-specialty clinic located near the Broadway office).  During my years of practice, we went on to cover at various times the radiology services at First Medical Imaging (FMI), the West Seattle Community Hospital (WSCH), the office practice established originally by Dr. Olsson in Bellevue, an office practice in Redmond, the Evergreen Hospital Medical Center (EHMC), some smaller locations we contracted with, and probably others that I have forgotten about.  

Humor in PSR:  There were often moments of humor in PSR, especially provided by Art Griffin and the devilish practical joker, Gerry Garrett.  Gerry sent out a memo once to the office staff advising that the phone lines needed to be "cleaned out" and asked them at a certain time of the day to place the phone handset in the trash can to receive the dust—we had high compliance on this assignment.  Another advisory he left behind (I think) was a paper notice placed on an unusually dusty table where we worked in the hospital, asking housekeeping not to clean up the dust as it was part of an important ongoing mycological experiment.  He also placed a non-functional but realistic pushbutton on the PMC X-ray film developing unit with a label indicating that, by pressing it, the X-ray films would emerge quicker.  We got a chuckle out of seeing the impatient neurosurgeon, Dr. Stuntz, repeatedly pressing this button to hasten delivery of his myelogram films.  Gerry had a special ability to gab with patients and reduce them to a fit of laughter, often excellent medicine in anticipation of an anxiety-provoking examination.  (We each received a rotting fish in the mail once, but Gerry insisted he had nothing to do with this.)  I was sorry to learn of Gerry's death in 2007.

Group Social Dynamics:  There were some interesting dynamics in this group practice, many of which were like those in many other radiology group practices, such as I have discussed elsewhere.  Despite the humor and light-hearted moments, our work environment was usually a fairly high pressure one, in which there were often impossibly competing needs and some considerable animosities or frictions between certain of the radiologists, for instance clashes between the titular head of the group and the head of hospital radiology.  Not all the members seemed happy with belonging to this group, and the group as a whole only rarely organized a purely social dinner that included our spouses.  (One of our radiologists once asserted that he would rather dine with the KGB than have a non-business couples dinner with his fellow partners.)  The lack of consistent social cohesiveness was a disappointment to me.  Though most of us hosted a partnership affair at least once, and my wife and I exchanged a dinner each with many of the partners, some partners—mainly Art, Paul, Claud, and Jim—did hold repeated summer swim parties, picnics, or Christmas parties at their homes, or took my family boating, etc., which we appreciated. 

Group Meetings and Frictions:  There were frictions not just over professional issues but also over our diverse political views and even the varying religions (or lack thereof) among the group members.  Perhaps the relative lack of camaraderie and esprit de corps accounts for the unfortunate fact that there was never a group photograph made of the PSR partners, at least during my years with them.  I was shocked to see, at the very first partnership meeting that I attended (at Canlis, no less), that one partner demanded another to head out to the parking lot for the purpose of duking it out, in order to resolve his anger and frustrations.  Fortunately cooler heads and the threat of a lawsuit helped to defuse the situation and deter this means of conflict resolution, and such a potentially violent confrontation never again occurred.  Some of our group meetings seemed uncomfortably like scenes from The Godfather, especially when we met in the dimly lit wine cellar at El Gaucho Restaurant.  Eventually, my group concluded that meetings at expensive restaurants were no longer affordable or efficient (especially when alcohol flowed freely), and we began to meet in a hospital conference room, munching on spartan sandwiches and moderating the libations.

Making Waves in My First Year:  I found myself stepping on eggshells during my first year with the group (six months as a salaried employee, six more as a provisional partner).  The group had a reasonable provision that all newly hired physicians such as myself were effectively on probation for a year, but also had the draconian provision that any single partner could block his joining or remaining in the partnership prior to the year's end, thereby causing his termination.  Even during this first probationary year, it was apparent to me that an urgent need existed for improvements involving my subspecialty areas, particularly in nuclear medicine (NM).  In spearheading the complex development of the previously non-existent nuclear cardiology service (including the acquisition of a new portable gamma camera and a Medical Data Systems NM computer, both obtained in c. 1978), and trying to get some other vital changes and improvements made (including a new fixed gamma camera), I ruffled some feathers, found myself under-scheduled in NM and US, and at one point was put on notice that my job might be in jeopardy.  Fortunately, this disheartening threat blew over, and the conflict was ultimately resolved when I was promoted to director of nuclear medicine in 1979 (and director of ultrasound a few months earlier).  Thereafter, I felt more supported in implementing needed nuclear medicine and ultrasound reforms and upgrades.  (It was at about this time that I probably ground down the remaining rough edges in my professional approach to physician colleagues—at least my kids eventually came to think of me as exhibiting masterful diplomacy and tact.)

Typical Group Practice Issues:  Over the years, we wrestled with numerous recurring or one-time practice concerns involving personnel, medical, technical, logistical, and economic issues, many of which were not unique to our practice and could have been encountered in any large business (see also general discussion here).  I'll list a few of these issues, many of which I was intimately involved with—perhaps this will help to impart some of the flavor of what it is like to be in a complex private radiology practice: 

Group Leadership:  The group also wrestled with how to structure its leadership: initially, should the most senior partner automatically be the head of the group?—or should the group elect an administrative partner based on merit or rotation?  The decision to change to an elected managing partner (who eventually became the corporate president of the board of directors) led to the selection of Pete McMillan in c. 1981, and Gerry Garrett in 1987 for this position.  I did not have the opportunity to assume this role.  Though I was considered to be the heir-apparent to take it on, and had earlier been encouraged to do so, I had no choice but to decline when asked to take the position due to increasing illness, and Dr. Rogers became the president of the now incorporated group in April 1991, and remained so until well after I departed.

Partnership Agreement and Bylaws:  It was soon apparent to me and most of my colleagues that the structure of our partnership agreement—the all-important governing document of our association—was in many respects archaic and much in need of updating.  I was never one to shy away from tackling difficult tasks of critical importance to the practice.  Beginning in 1982, I volunteered my word-processing skills (since for several years I had the only personal computer or PC among my partners) to undertake, with the advice and consent of the group, our attorney, and our accountant, a massive revision of this agreement.  This protracted effort ultimately led to a 50 page document which in my opinion was successful in clarifying and making explicit what we could agree on, including such difficult subjects as how to account for the partnership's real and intangible assets for partners joining or leaving the practice, the firing of partners, disability, and practice dissolution.  I was proud of what I accomplished in this largely behind-the-scenes task that took so much of my time (including the many revisions and amendments I was involved with over several years to follow), though I sometimes wondered if it would have been better for me personally to have spent this time on direct medical care that might have been more visible to my partners.  The partnership agreement morphed into our corporate bylaws in 1989.

Turf Battles:  There were also numerous turf battles to deal with in the hospital practice.  One of the more difficult was between cardiology and radiology regarding the interpretation of coronary arteriograms (resolved finally in favor of the cardiologists).  Another was between myself and cardiologists regarding interpretation of nuclear cardiac studies—for the innovative resolution, see here.  Others were between emergency room physicians and radiologists regarding interpretation of emergency exams; between various clinicians and radiologists regarding ultrasound-guided needle procedures;  between endocrinologists and myself regarding radioiodine therapy; between radiation therapy and myself regarding strontium-89 therapy; etc.

Michael at work in PMC radiology August 1981 (photo by J. R. McGoodwin)
Michael doing radiology at PMC 
August 1981
Michael photo by KCMS July 1989
Michael,
photo by KCMS
July 1989

Scheduling, Subspecialization, and Staffing Controversies:  Surprisingly, I found that it was often a struggle for me to get adequate time to practice my chosen subspecialties (US and NM) in our hospital practice at PMC.  In the first of several complex practice analyses I performed for PSR over the years, I calculated that, in the first eight months of 1980, less than a quarter of my time was in fact spent working on NM and US, though I was the chief or director of these two important sections of radiology.  If nothing else, this put me (and ultimately my group) at a competitive disadvantage compared to other institutions where NM and US were more consistently covered by dedicated subspecialists (such as at Swedish, Virginia Mason, and University Hospitals).  The de facto philosophy of our group, established before I arrived in earlier years essentially by the generalist radiologists, was to try to make almost every radiologist function the same, rotating each through all the sites of the practice, and pretty much attempting to fit all in the same Procrustean mold.  (Exceptions had been made, such as for complex angiography—Paul Paulson had already appropriately campaigned for some degree of restrictive subspecialization in this area.) 

I had to fight repeatedly to be assigned substantially more in the hospital and to the US and NM services, in order to establish, build, and maintain excellence in these sections that I was in charge of, for which my motivation was high.  I thought it somewhat crazy that, early in the practice, I was not allowed to do this more.  It seemed that among some of my partners there was some kind of unstated fear regarding individuals acquiring power or undue respect with referring physicians, thus acquiring their own "fiefdoms".  However, there were also real logistical and other practical issues driving this aversion to subspecialization, including the problem of providing on-call coverage (i.e., if I were the only one who knew how to do or interpret a particular procedure, what would be done when the procedure was needed and I was not available?) 

"Productivity" Analysis of Hospital versus Office Sites:  The problem was also compounded by the fact that we were often, in my estimation, significantly understaffed with radiologists at PMC, and that I was therefore often over-scheduled.  Obviously, opinions could and did differ on this assessment, especially among those individuals who felt more comfortable and less pressed by the practice demands.  This quandary led me to present to the group another complex analysis (in March 1982, one of the first I created using a personal computer-based spreadsheet program) which compared the assigned hours of our radiologists, by practice site, to the net income generated at those sites.  My enlightened self-interest in performing this analysis derived primarily from my perception that we needed more radiologists at PMC, and only secondarily in any interest I might have had in enhancing overall practice income.  This "productivity" analysis (as I called it), which proved to be somewhat shocking, documented high productivity at our hospital, and helped the practice determine which of our non-hospital office sites were the most and which were the least productive.  (I recommended that we close the Medical Dental Building office, which was done in 1984.)  It also helped demonstrate whether the allocation of radiologists was being fairly made at the hospital in terms of the work load performed.   

Subspecialization Prevails:  By the mid-1980s, the recognition of subspecialists within the group had gradually increased after the acquisition of other radiologists with subspecialty skills such as Drs. Ricci, Rogers, and Witrak, and in response to the relentless competition from outside institutions such as Swedish Medical Center and from non-radiologist competitors.  The question of whether the practice should encourage subspecialization had been resolved once and for all.  Ironically, it was only after I went part-time in late 1990 that the group finally allowed me to work mostly at PMC and primarily within my subspecialty areas.  

Body and Head CT Scanning:  Initially especially, I also wanted to be at the hospital also because it provided me the opportunity to become adept at managing and interpreting CT scans.  PMC was the first hospital in the Pacific Northwest to acquire a "whole body" CAT scanner (in c. 1976 and made by Ohio Nuclear), and this was one of the main attractions I felt when deciding to join this innovative Seattle practice.  After my arrival, I scrambled to learn as much as I could about this brand new and all-important technology, for which I had had virtually no training in residency (other than the modest exposure to cerebral scanning at Virginia Mason).  We received referrals from as far away as British Columbia and Alaska for these studies until other hospitals gradually obtained body CT scanners of their own.  The process of obtaining CT scanners was made much more difficult by the regulatory requirement to obtain a "Certificate of Need", which could take years.  The competing manufacturers included GE and Searle, and our group in 1978 was already considering upgrading to the GE 8800 versus an improved Ohio Nuclear "2020" model.  The latter model was eventually chosen.  Even cardiac electron beam computed tomography scanning was under discussion at the time, though general availability was thought to be several years away.  Eventually, CT body scanners became commonplace and were found at several of our practice sites as well as at our competitor's facilities, and most radiologists had occasion to perform and interpret at least some categories of CT exams (particularly, those that did not involve complex neuroradiology)..

Magnetic Resonance Imaging MRI:  By 1985 – 1986, we plunged ahead by obtaining a mobile MRI scanner in a truck, to be operated adjacent to the professional office building on the PMC campus.  This brought a further escalation of complexity to the practice, and again forced me and others to scramble for training in this complex and fascinating new modality.  (I spent a week in San Francisco in November 1986 taking a course, and also a week at the UW radiology department training with Dr. William "Bill" Shuman in March 1987 to accomplish this.)  Although I tried reasonably hard to add MRI to my list of skills, the pressure was rising in the group to limit MRI interpretation to a small number of neuroradiology-oriented subspecialists, and my own responsibilities in US and NM as well as my many other ongoing job commitments (including serving as the chairman of radiology) made it difficult to give the amount of attention that MRI demanded.  It seemed that the time had unequivocally come when it simply was no longer feasible for every radiologist to attempt to participate in every major diagnostic modality in the practice, even such an important new development as MRI.  I therefore reluctantly gave up participating in MRI in 1987, conceding it to those with the most intense interest and highest skill level.  My decision was further influenced by the growing awareness, by 1987, that I was encountering some physical limitations due to a slowly increasing but undiagnosed illness.  By mid-1988, I was also relieved of the requirement to perform angiography and other "special procedures", since special procedures by now frequently involved high-risk interventional (therapeutic) procedures in which I had no training and little hope of ever mastering.  The era of subpecialization in radiology was fully upon us.

Radiology Leadership Tasks, Positions, Staff and Administrators

Director of NM and US at PMC:  I took over from Dr. Olsson as Director or Chief of Diagnostic Ultrasound at PMC beginning in May 1979.  I kept this position until mid-1988, when I handed over the reins to Bill Marks, who was well qualified to assume the role.  In December 1979, I became Chief of Nuclear Medicine (NM) at PMC, a position which I held until my retirement in 1994. 

Major Equipment Acquisitions at PMC:  In addition to supervising and interpreting many of the US and NM examinations, I made a number of improvements over the years, trying to keep procedure protocols current, appropriate, and efficient of the use of our expensive machines and personnel.  I spent substantial time evaluating new imaging equipment, and took the lead in promoting and shepherding their acquisition when I was convinced they were needed.  New equipment included:  B-mode sector US scanners; real-time ultrasound scanners (beginning in c. 1980); portable gamma cameras (we acquired a GE Datacamera probably in late 1978); stationary gamma cameras (such as a GE 15-inch-crystal device acquired in c. 1979); NM computers (such as the MDS computer purchased probably in 1978, and a Technicare/Ohio Nuclear 560 computer acquired in 1980 ); an exercise table for gated cardiac NM studies (acquired 1981), a SPECT camera (we acquired our Siemens LFOV Diacam SPECT camera in mid-1991); Macintosh-based physician workstations (1991), etc.

Chairman of Radiology at PMC:  In 1986 – 1988, I also served as Chairman of Radiology at PMC, a position that despite its impressive title entailed primarily promoting quality assurance in the physician performance of radiology procedures and interpretations, mostly of course done by radiologists.  (Paul Paulson, as the ongoing "Director of Radiology Services", remained in charge of spearheading technical radiology equipment decisions and overall departmental supervision.)  As Chairman of Radiology, I was instrumental (in 1986) in establishing the Radiology Quality Assurance Committee and an innovative reporting mechanism for handling potential incidents and errors.  The committee met monthly and caused considerable anguish and irritation in some of my radiologist colleagues, but was heartily endorsed by the PMC medical director and by our group's leadership.  The chairmanship also placed me on the hospital Executive Committee, which held long evening meetings. 

Radiation Safety Roles and Other Committees at PMC: As the head of nuclear medicine, it was also logical for me to take the position of Radiation Safety Officer and to chair the Radiation Safety Committee (both of which dealt with the hazards of radioactive materials such as the radiopharmaceuticals we used in NM).  I did this for four years, 1983 – 1986, until I passed these roles to Dr. Sharon Cole, a radiation oncologist.  Of course there were a variety of other non-radiology committees that I also served on at PMC over the years, such as Medical Quality Assurance Committee and the Human Research Committee.

Executive Committee of PSR:  In an effort to attempt to streamline the increasingly cumbersome management of our group (in part resulting from the merger with the Evergreen Associated Physicians group), we formed a managing or executive committee in February 1989, and I was privileged to serve on this important committee from May 1989 to April 1991.  This committee served an important function during a time of great change, and I was sorry to have to step down from it due to growing disability.

Neal Wilson at work in PMC November 1991
Neal Wilson at work in PMC
c. October 1991
Michael's PMC ultrasound and nuclear medicine "family" at my home July 1994
My PMC ultrasound and nuclear medicine "family" at my home. 
Front: Rebecca, Jamie, Mary, Nancy, and Cassie.  Rear: Cliff, Pat, Sue Ellen, Mary Lee, Anita, Stephanie, Michael
July 1994

Outstanding Staff:  I was truly privileged to serve with numerous fine nuclear medicine technologists, radiologic technologists, medical sonographers (i.e., ultrasound technologists), and other key individuals at PMC, at other hospitals, and in our office practices.  I cannot begin to name all the fine persons and unsung heroes I worked with—including Nicki Ewing (died 2009), Georgia Hitzke, Anne Thomas, Beverly Biggs, ... The list could go on and on, and I would not know how to draw the line.  I'll therefore only single out a few others here by name.  The level of professionalism was generally quite high, and I respected and found much to admire and enjoy in the vast majority of these hard working people.  (I have often thought that it was a shame that PMC Radiology and PSR did not periodically gather their radiology employees together for departmental group photos, such as I enjoyed from my time at M. D. Anderson Hospital.) 

Neal L. Wilson, P.A.:  Paul Paulson had been instrumental in promoting the advanced training and hiring of Neal L. Wilson by PSR as one of the few radiologic physician's assistants in the Northwest.  (Neal also served as the administrative director of the PMC radiology department, thus wearing two somewhat incompatible hats, since he was employed both by us and the hospital.)  Neal was totally dedicated in his work, probably the most valuable worker in our entire practice, and a person for whom I had the highest admiration.  He was like a friend as well as a trusted co-worker, and I deeply regretted seeing him leave our practice and Seattle in March 1994, after PMC demanded that he decide between being our employee or the hospital's.  This was a great loss to both PSR and the hospital, and his presence in the practice was especially important to me at the time.

My NM Technologists and US Sonographers:  The nuclear medicine technologists and sonographers—the PMC employees whom I directly supervised and worked with the most closely—were to me very much like a close-knit family.  I always tried to show my respect for them and to keep them happy while setting a high standard for the tasks we performed.  The lead NM technologists included Martin Daly, Jan Wilkinson, Mary Gagnon and Clifford Lee.  Some of my US leads as I recall included Pat Chamuler, Denise Coburn, Anita Hartley, Ann Kokesh, and Stephanie Nibler. (If I have inadvertently omitted any of my lead technologists and sonographers, please advise.)  I deeply regretted having to leave their company when I retired in 1994.

Other PMC and PSR Staff:  The remainder of the staff at PMC radiology and in our offices was also critical to the smooth functioning of the complex interactions taking place in a complex department in a complex institution, and with only a few minor exceptions I found the ancillary radiology staff nearly ideal to work with: transcriptionists, file persons, supervisors, etc. 

Medical Directors and Administrators:  Although our positions on opposite sides of the negotiating table could lead to inevitable strains, and I was not especially close to these persons, I generally enjoyed good relations during my practice years with the PMC medical directors, including Dr. Bruce Gilliland (died 2007), Dr. Brian Goodell, and Dr. William McKee.  I also found the PMC hospital administrators reasonable to work with, and especially admired Peter Bigelow (who came on board in c. 1979 and was one of the best hospital administrators that I was privileged to work with).  

Group Practice Administrators:  Our radiology group practice PSR had its own administrators or business managers during my years with them—initially Dorothy Anderson,  then Don B. in 1981.  I learned to my regret from participation in the search for a new business manager in 1981 that this process is fraught with pitfalls, and that radiologists such as myself were not automatically well suited to do it.  In mid-1982, finding ourselves somewhat overwhelmed with the many problems arising from the complexity and rapid changes taking place in our practice, we initiated an exhaustive practice review by an outside consultant, William Otway, leading to the hiring in August 1982 of the firm Medical Management, Inc.  They were based in Boise, and led by Jim Trounson, a good man with whom I enjoyed working.  They brought about the appointment in the fall 1982 of Roger Hoy as our administrator.  We hired Steve Jacobsen as the next administrator while I was still in full-time practice—he began in about May 1990.  I had known Steve as a hard-working radiology technologist at UW radiology, and during the time he worked for us, I found him to be a very energetic and highly capable business manager. 

Other Physician Colleagues:  It would be impossible to name all of the many outstanding physicians who (along with their patients) made our practice possible, and whom I enjoyed working with and interacting with during my Seattle practice years.  (Ok, a few could be real jerks, but the vast majority were competent decent physicians who wanted the best for their patients.)  I always had the highest admiration for physicians who were effective and demanding advocates for their patients, even if their demands added to the stress of my professional life.  Moreover, my years in the Indian Health Service, serving as a sort of family practitioner, had given me considerable empathy for the tasks of the primary care physician.

Professional Organizations, Journals, Meetings, Conferences, Education, and Teaching

Memberships in Professional Organizations: During my radiology practice years in Seattle (1978 – 1994), I found it appropriate to join or belong to a number of scientific organizations relating to medicine, radiology, and nuclear medicine.  These included the American College of Nuclear Physicians (ACNP, joined 1977), the American College of Radiology (ACR, joined 1977), the American Institute of Ultrasound in Medicine (AIUM, joined 1977), the King County Medical Society (KCMS, joined 1978), the Pacific Northwest Radiological Society (PNWRS), the Radiological Society of North America (RSNA, joined 1977), the Society of Nuclear Medicine (SNM, joined 1978), and the Washington State Medical Association (WSMA, joined via the KCMS in 1978).  I tried the American Medical Association (AMA) for a while, but decided they did not seem especially relevant to me, and I already carried too many memberships.  (After retirement, I was granted retired or emeritus status for most of these organizations.)  One could debate whether it was really necessary to belong to all these organizations, which were generally not free to belong to, but it was hard for me to decide what to omit, and each had potential direct relevance to my multiple areas of practice.

Professional Journals:  Several of these professional associations included a journal subscription that was highly significant to my practice, such as: the Journal of Nuclear Medicine (published by the SNM); the Journal of Ultrasound in Medicine (published by the AIUM); and Radiology (published by the RSNA).  Although I don't believe I joined the American Roentgen Ray Society, I did subscribe to their journal, the American Journal of Roentgenology during my practice years.  (Dr. Mel Figley, after his appointment as editor, transformed this journal from a humdrum radiology journal into a worthy competitor to Radiology.)  I finally let my subscription to Annals of Internal Medicine lapse, but I have continued my New England Journal of Medicine subscription to this day (2009).  I also subscribed to and read, while in practice, the Radiologic Clinics of North America, a number of the Seminars series (Seminars in Roentgenology, Seminars in Nuclear Medicine, Seminars in Ultrasound, CT, and MRI, etc.), and some of the Year Book series, etc.  The journals that were not hardbound were fair game for being read or scanned and then torn apart for their individual articles (which ended up in my massive article filing system).

Professional Meetings, Courses, and Continuing Medical Education:  I attended several of the national meetings of the national organizations: the SNM (1977), the RSNA (1976 and 1982), as well as the UCSF diagnostic radiology seminar (1978) and possibly the AIUM.  I did this especially in my early years in practice, but eventually concluded that most of the week-long meetings were simply too time consuming, too inefficient of my time, more aimed at researchers climbing the academic ladder than clinicians, and/or just too trying on my patience.  I gradually came to prefer well-organized clinical two- or three-day meetings, focused on a particular body region or imaging modality.  Some of the ideal meetings of this type which I attended included:

• the highly productive Western Regional Society of Nuclear Medicine (WRSNM) meetings, held in nice places like Monterey (October 1979 and October 1984), Los Angeles (October 1980), Palm Springs (October 1985), Phoenix (October 1992), San Diego (October 1982 and October 1987), San Francisco (1981), Seattle, and Vancouver (1978 and 1993);
• the Fleischner Society, dealing specifically with physiology and diseases of the Chest, held in Santa Fe (June 1984);
• the Pacific Northwest Chapter of the Society of Nuclear Medicine (PNWSNM) meetings, also held in attractive destinations in our neck of the woods like Orcas Island, Port Ludlow, Salishan (1979), Alderbrook Inn (1981, with our kids), and Vancouver (1980, 1983, and 1992);
• the International Skeletal Society, held in Vancouver (September 1986); and
• the Pacific Northwest Radiological Society (PNWRS) annual meetings, held in Seattle, Portland, Vancouver (1980 and 1992).

I also liked to go to course-like meetings aimed specifically at clinicians, especially again those focused on a particular imaging modality or region of the body, such as the following I attended:

• the UCSF CT/US course in San Francisco (1979);
• the Neuro-MRI course at UCSF in San Francisco (November 1986);
• the annual Spring Diagnostic Ultrasound Conference in Los Angeles (June 1980 and May 1986);
• the annual Pacific Northwest Diagnostic Ultrasound OB/GYN symposium, sponsored by the AIUM and Swedish Medical Center, held in Seattle (1991, 1992, 1993); and
• the Society of Computed Body Tomography and Magnetic Resonance (Seattle 1994).  

Of course there were numerous smaller-scale opportunities to keep abreast of new developments (and at the same time earn continuing medical education or CME credits, which are required to maintain medical licensure).  I have attended many hundreds of morning or evening mini-symposia, tumor boards, scan meetings, and hour-long lectures, many of which were given in our education-rich hospital, PMC.  Some of the lecture topics included AIDS, medical ethics, basic sciences, etc.

Teaching Attending Physicians, Physicians in Training, and Staff:  I also enjoyed following the Hippocratic dictum by organizing or participating in many hundreds of teaching conferences (some of which are named above) as a presenter of radiology and nuclear medicine subjects and patient findings to fellow physicians, medical students, and technologists.  The direct affiliation of our main hospital (PMC) as a teaching hospital for the University of Washington house staff and students, and the many hours I spent in teaching them, earned me titular membership on the UW clinical faculty.  This was a loose appointment to what was variously termed over the years the clinical, adjunct, or auxiliary faculty, and my title was given as clinical assistant professor.  I gave a few lectures at the UW radiology department and even participated a time or two in the practical examinations given to the radiology residents at the University of Washington (1983), but most of my teaching—undoubtedly many thousands of hours—was performed in my own hospital and entirely pro bono.  (I am pleased that at least in 2016 I am still appointed by the University of Washington Department of Radiology to this clinical faculty position, despite my suspension of practice since 1994.) 

I was honored to serve as the scientific program chairman and moderator as well as a presenter for two meetings: the Spring Pacific Northwest Chapter meeting of the Society of Nuclear Medicine (held in Vancouver in March 1980) and a one-day PMC symposium on Hepatobiliary Disorders (held in Seattle in January 1983). 

Education About the Business and Law of Medicine:  Though I had little intrinsic interest in the world of business and finance, and would have preferred to devote myself entirely to purely medical matters, I could not ignore that I was a partner and shareholder in a major business, and that that we very much needed all the expertise we could muster.  (In fact, I was often amazed how at times we made critical but non-medical decisions based on remarkably little knowledge.  We would often just muddle along and hope for the best outcome despite our profound ignorance.)  As I wanted to be an effective member of our medical enterprise, I tried during my practice years to improve my own knowledge of business and economic matters (in which I had absolutely no background), including going to lectures and reading the throwaway journal Medical Economics.  But most importantly, I read several important textbooks such as: a useful primer on accounting; Schall and Haley's Introduction to Financial Management; Corporate Finance by Ross et al; and Francis's Investments: Analysis and Management.  The abstruse mathematics and theory associated with economics and finance were intermittently interesting to me, and have provided ample opportunity for Nobel prizes (such as in capital assets pricing, portfolio theory, etc.).  Had I not been a physician, such studies might have provided a possible alternative career option (but would not have lured me away from astronomy and other favorite mathematical sciences). 

In general, I tried to apply my mathematical skills to become a sort of "quant" within the group practice.  I effectively mastered several computer spreadsheet programs, starting with the original and revolutionary VisiCalc in October 1981, working through the 3-D Boeing CALC, SuperCalc and Lotus 1-2-3, and finally ending up with the Dark Side's MS Excel.  (The powerful capability and sophistication of these remarkable programs have never failed to amaze me—I have often worked out scientific calculations and demonstrations with them, including here.) 

I also took an evening course in practical business law in 1985, dealing with such topics as torts and lawsuits, business associations, contracts, property, and lawyer-doctor relations.

Quantitative Obstetrical Ultrasonography and MOBUS

This is a rather technical section, so feel free to skip it.  However, it was an important and creative professional activity for me in which I took great pride.  It also provides some interesting early information technology history as I experienced it.

Clinical Need:  Diagnostic ultrasound (US) was a major part of my practice responsibility, and obstetrical ultrasound (OB US) comprised perhaps one half of the US caseload.  By the late 1970s, it had become apparent to me from a rising tide of published papers that fetal biometry (the making of measurements of the fetus for diagnostic purposes) was becoming an increasingly important modality that would have a significant impact on the performance of obstetrical US examinations.  The measurement of the fetal biparietal diameter (BPD, the widest transverse or right-to-left diameter of the skull) for the estimation of fetal age had been in use for some time, but newer measurements were being added, including the two abdominal diameters and calculated fetal abdominal circumference (AC), the three uterine dimensions and calculated total intrauterine volume (TIUV), and eventually numerous other measurement such as fetal femur length (FL), fetal occipital-frontal head diameter (OFD), calculated fetal head circumference (HC), fetal crown-rump length (CRL), etc.  However, despite the usefulness of the published papers on these subjects, there was when I took up the subject no convenient way to implement these measurements into an integrated evaluation during normal clinical exams.  

My Calculator Program OBUS: In 1980, I used my improving skills in operating a programmable calculator—the HP41CV, bought in 1979, equipped with a magnetic card reader, three extra memory modules, and a printer—to create a calculator program I named OBUS.  It would use the date of the patient's last menstrual period, the fetal BPD, the TIUV, etc., and generate a coherent printed report.  (This was before the era of widely available personal computers or PCs.)  We put this OB US calculator program into routine service at PMC US by the middle of 1980, and I let my partners know about its availability and how to use it.  I also demonstrated the program at the regional chapter meeting of the AIUM in Seattle, probably in the fall of 1980, and made the program freely available through the Hewlett-Packard User's Library beginning in November 1980.  I submitted an article on it to Radiology in January 1981 (rejected by the editor Dr. William Eyler due to its length), and resubmitted a shortened "Technical Note" version in June 1981, which was accepted in July 1981, and published in the September 1982 issue of Radiology.  (The same issue of Radiology had the first article that I am aware of about the use of an integrated commercial computer program to accomplish similar tasks—the author, RA Greenes, also named his program OBUS.)  My published paper represents the only time when I was the sole author on a scientific paper submitted to and accepted by a peer-reviewed medical journal.  I continued to upgrade this free calculator program, submitting new versions to the HP User's Library through September 1982, and using it without financial compensation in our US department until I replaced it with MOBUS.

Personally Owned Personal Computers:  I bought my first personal computer for home use, an Apple II, in September 1981—it included the Muse Super-Text word processor and the remarkable spreadsheet VisiCalc.  There were no personal computers available in Providence Medical Center at the time I created the calculator program OBUS in 1980.  I bought my first IBM PC (the first of many "IBM PC compatibles" and Windows-based PCs I have owned) in September 1982—it included DOS, the word processor WordStar and the excellent spreadsheet program SuperCalc.

My Computer Program MOBUS:  Interest in the topic of fetal biometry rapidly grew in the early 1980s, aided by the growing availability and use of larger computers, and papers appeared from numerous centers (which I will not attempt to credit here).  Some of the best publications on quantitative OB US came out of Baylor College of Medicine, my alma mater, written by Drs. Russell Deter and Frank Hadlock among others.  (The state of the art as of the mid-1980s was summarized in their excellent 1986 textbook.) 

I was eager to make maximal use of these published methods, which still were quite difficult to implement in ordinary clinical practice.  (US machines at that time did not incorporate any such calculations.)  Therefore, I decided to expand on my calculator project, and create a computer program.  Through laborious programming, I developed the first version of MOBUS beginning in late 1982 and extending through much of 1983.  This was a much improved version of my obstetrical ultrasound calculator program, and used the computer language BASIC implemented on an IBM PC running DOS.  Since Greenes had named his commercial program OBUS, I named my computer program MOBUS, signifying "McGoodwin Obstetrical Ultrasound", in order to differentiate the two programs. 

I was the first person to request, in 1983, the purchase of a PC system (an IBM PC XT) at Providence Medical Center, going out on a limb with the administration in making such an unusual equipment request for use with an unproven application.  I first put MOBUS into service at Providence Medical Center in 1983, and eventually it was also used in a community hospital, in our private radiology office, and in two local clinics where I rotated through in radiology and could provide maintenance. 

Details on Creating and Maintaining MOBUS:  I had taken a short course on BASIC programming in the fall of 1982 (and a course on Pascal programming in 1983, which I made no further use of), but had to teach myself most of the intricacies of programming in the BASIC environment.  When I was first developing MOBUS, I began with one of the early versions of Microsoft BASIC, probably MS GW-BASIC (released 1983).  This was an interpreted version of BASIC, not a compiled one, therefore slow in execution.

At some point, I tried unsuccessfully to expand the capability of MOBUS using the Borland Turbo BASIC compiler (apparently first released in 1987), finding to my regret that the Borland version available to me at the time had severe limitations when applied to such a large memory-hungry program, and would crash repeatedly without warning.  Like many computer projects done by early-adopters operating at the "bleeding edge", this was a dead end which wasted an amazing amount of my time.  

I also used the successor compiled Microsoft BASIC dialects for the IBM PC running DOS: MS QuickBASIC (in several versions, released from 1985 to 1988), and QuickBASIC's more sophisticated parent and advanced DOS product, MS BASIC Professional Development System (versions 7.0 released in 1989 and 7.1 released in 1990).  Within these MS BASIC products, I could also make use of various commercially purchased software component libraries (such as could be purchased from MicroHelp, probably Dan Appleman, and others).  These helpful products made available to the programmer ready-made tools for providing highly efficient and substantive capabilities without having to constantly reinvent the wheel.

Microsoft subsequently developed MS Visual Basic (VB), which evolved into an exclusively Windows program.  VB had adequately matured by version 3 (released 1993) for my potential use in my 1993 release of MOBUS4 (i.e., MOBUS version 4).  However, by then I felt I could not devote the substantial time and energy required to migrate MOBUS to a Windows environment, and I discontinued work on MOBUS when I discontinued practice in 1994. (See here for more on my experiences with MS Visual Basic.) 

The printout or final report of MOBUS was implemented on a dedicated Epson dot-matrix printer using the Epson printer language command set.  (At that time, there was no such thing as a universal printer interface, as was later incorporated into Windows programs, and programming a printer was a complex task.  The first genuinely popular version of MS Windows, version 3.0, did not come out until 1990.)  

I refined and improved MOBUS through frequent revisions and upgrades as newer and more sophisticated quantitative OB US methodologies became available in the published literature (and many of the revisions took several hundred hours of work).  Some of the features it included were: computation of fetal age by using a weighted averaging of estimates deriving from several measurements and techniques (BPD, FL, CRL, etc.); the estimation of fetal weight using as many as four concurrent measured parameters (BPD, HC, AC, FL) and comparison of estimated to expected weight for age; the assessment of whether each individual measurement was normal or outside the normal range for the estimated age; the evaluation of interval growth of the fetus between successive examinations (looking for signs of growth retardation); computation of the ratio of BPD/OFD (cephalic ratio) and other ratios having potential clinical usefulness; etc.  Exam data were stored on floppy disks for subsequent retrieval to facilitate comparison on up to 9 subsequent follow-up exams.  

Licensing MOBUS:  The program was operated under a license agreement that involved no up-front cost to the hospital or clinic, but only a nominal per-exam licensing fee charged to the patient.  The first version of MOBUS had taken more than 600 hours to write and develop.  (I would guess that it required altogether perhaps 1500 to 2000 hours of my time for programming and maintaining MOBUS in its various versions and revisions, and I had no difficulty justifying to myself the small fee I negotiated for its use in daily patient examinations.)  Lacking any supporting infrastructure or the time or inclination to pursue such a further escalation of the project on my own, I did not attempt to market this program outside the locations where I worked and could maintain it myself.  I had a few outside requests for it, but learned the hard way when I supplied it to a distant clinic in Alabama that there was no practical way to enforce payment for its use.

Presentations on MOBUS:  I gave a presentation entitled "Computer Implementation of Quantitative Obstetrical Ultrasound" at the regional chapter meeting of the AIUM in Seattle in May 1985, at which time I discussed primarily the underlying science, math, and statistics, and only alluded to my program MOBUS.  I made several presentations specifically about MOBUS in order to enhance its utility and interpretation among the clinicians, including a major presentation on MOBUS3 at our Quarterly OB/Radiology Conference given to the obstetricians in March 1992, complete with a detailed annotated bibliography.  I never attempted to publish anything about MOBUS in a medical journal—by 1985 there were several competing commercial programs offering various degrees of quantitative OB US, and soon some degree of quantitation capability was built directly into the ultrasound machines.

Final Versions and Demise of MOBUSMOBUS3 was prepared in 1988.  The final and best version, MOBUS4, was developed over several hundred hours in mid-1993—by this time I was seriously struggling, as a result of illness, to keep up with my professional work requirements.  But MOBUS was integral to our OB US service, and helped us to compete with nearby Swedish Medical Center, and I felt I could not defer updating the program any longer.  There were numerous tweaks, but the most significant improvement in this version was the incorporation of graphical plotting of HC, AC, FL, and fetal weight in the printout, so that a clinician could see at a glance which if any of these parameters were falling outside the age-related standard curves for normal fetuses.  This was still a DOS program, compiled in MS PDS Basic 7.1, and still printed out to a dot matrix printer, but the graphs looked nice to me.  MOBUS was in service at PMC until March 1995, when its use was discontinued.  I was no longer in practice by this point, I was not following new developments in the field, I would have had a hard time trying to make needed upgrades, and the new persons in charge of US appropriately chose to employ other solutions.  Its use at affiliated clinics and offices also faded away at about this time.

Summing Up MOBUSMOBUS had a very good run, being used continuously for about 12 years in its various evolving versions, not a bad lifespan for medical software used in a competitive and rapidly evolving environment.  Although it earned me some modest extra income, I regarded it primarily as a professional labor of love which made excellent use of what I was able to do best.  There was no original clinical research in MOBUS—its originality and uniqueness derived from the fact that it provided a coherent and effective pulling together of a complex, diverse, and intimidating body of knowledge into a highly organized and readily usable clinical implementation.  It was one of my proudest professional accomplishments, it contributed greatly to my own effectiveness as a radiologist practicing obstetrical ultrasound, and I believe it was also quite useful to my radiology and obstetrician colleagues and their patients.

Malpractice Matters

As with all other physicians in practice, the scrutiny that my medical actions were subjected to steadily became more intense over the years, in part due to increasing expectations on performance quality, and a rising requirement for active and structured quality assurance.  Patients were becoming much better educated, sophisticated, and demanding, and their expectations regarding our performance also steadily rose.  The Sword of Damocles hanging over the head of every practicing physician is the threat of a bad outcome and a resulting malpractice claim.  Although one's competence is always in question when these claims are filed, the threat and reality of a lawsuit exists even for the most competent physicians.  During my career, I had several preliminary inquiries that were dropped, and at least two actions taken against myself that led to settlements, each one handled with the help of my insurer.  These two cases are instructive, and help to illustrate why a radiologist can never relax or become complacent in conducting examinations, even ones that seem to bear a low risk, and also why malpractice insurance premiums have continued to skyrocket.

Sample Case I: The first claim, in 1981, was filed by a person with a chronic intestinal condition and who sustained a small rectal tear documented at the time of the barium enema I performed.  Although our technologist placed the enema tip, and might conceivably have caused the tear, she was one of the most highly skilled and experienced technologists we had, and I felt this was unlikely, nor did it seem that the enema balloon had been overinflated (another potential cause of perforation).  Moreover, he had undergone sigmoidoscopy without biopsy immediately prior to the barium enema (the physician performing the sigmoidoscopy later commented that he had observed a droplet of blood in the rectum at the time), and I also learned that the patient had self-administered an enema prior to the procedure (not part of our protocol), which caused him some pain.  Thus, one of these two preceding procedures seemed to me to be the more likely explanation for the rectal mucosal tear.  Nevertheless, the patient wanted to be compensated for time lost from work and medical costs, and my insurer did now want to contest this claim.  I acquiesced to this settlement (though certainly not accepting responsibility), and it was settled for a few thousand dollars.

Sample Case II: The second and far more serious claim, partially tried and finally settled in 1986, involved a patient who underwent radiation therapy to the head for what was presumed to be a brain tumor.  The radiation dosage may have been excessive, and the patient sustained significant and apparently radiation-induced brain damage.  Our hospital was named as a defendant, along with the radiation therapist, and seven of our diagnostic radiologists including myself, plus all of our wives (since we were a partnership at the time, and lacked the protective veil of incorporation).  In 1981, I had interpreted the first of many CT brain scans that the patient underwent.  I had identified the mass in the brain stem, implied I did not know what it was for sure, though I suggested it was likely a tumor, but offered a differential diagnosis listing several alternative possibilities including a vascular lesion such as an aneurysm or an infection.  Subsequent CT scans were apparently also interpreted in this manner.  (I no longer have those later reports to review.)  Unfortunately, based on its appearance on subsequent cerebral MRI (a technology that was not available to me in 1981), it was eventually concluded by an expert neuroradiologist from California that it was more likely a rare vascular lesion, a capillary telangiectasia type of arteriovenous malformation (AVM), rather than a growing brain tumor.  In my defense, I reviewed the commonly available radiology literature up to the time I interpreted this lesion in 1981, and found that there were virtually no comparable instances where published CT scans showed brain stem capillary telangiectasia AVMs appearing anything like this lesion.  (The outside expert neuroradiologist had a very powerful "retrospectoscope" and, armed with the benefit of rapidly advancing 1986 technology, critiqued our lack of skills back in 1981 with little regard to any sense of fairness regarding the actual timeline of history.)  This was all of little consolation to me, or to my other implicated colleagues, or to the patient, and the case was settled for several million dollars.  This case illustrates well how the seemingly routine practice of diagnostic radiology continually places the non-super-subspecialized radiologist at risk of lawsuit as a result of misinterpretation due to a lack of arcane or highly specialized knowledge.  There is no easy fix for this problem, other than perhaps to: (1) maintain a ready availability of suitably selected subspecialists in one's practice (or ready access to outside consulting subspecialists); (2) assign the subspecialists in the practice to the procedures most likely to generate a need for their skills; (3) assure they are willing to make themselves readily available to consult or take over on cases which come up with puzzling findings; and (4) assure that the subspecialists are willing to seek higher outside levels of consultation where needed.  (I am doubtful, however, whether any of these improved approaches would have made a significant difference in my 1981 interpretation.  Nowadays, the ready availability of abstruse information by Internet searching, the easy transmission of digital data for consultation, and the improved networking capability presumably even with super-subspecialists have surely improved the situation.)

Serving as an Expert Witness:  I was never comfortable with and did not enjoy courtroom medical dramas, either the one time when I was a potential defendant or when serving as a potential expert witness for a claimant.  Most physicians who don't become professional "hired guns" find it distasteful to testify against fellow physicians in court, and in addition, I just found the process too far removed from tending to patients and too stressful and arduous, especially after I became ill.  I thus accepted the role of providing expert courtroom testimony only once, in mid-1987, and declined numerous other requests from attorneys.  The case involved a fetus with possible growth retardation, in which the fetal measurements and estimated intrauterine fetal weight compared to gestational age played a major role.  Of course, I was quite familiar with this subject, having specialized more or less in quantitative OB US, but as a result of my own strong sense of fairness, I felt uncomfortable trying to state to what extent such specialized knowledge and capabilities had become the standard of practice to which the defendant's actions should be compared.  Thus I was not testifying "for the plaintiff" or "for the defense" (taking sides is the deprecated but most lucrative approach for serving as a professional hired gun), but simply to provide a balanced presentation of medical truth as I interpreted it in all its grayness and uncertainty.  

The Zenith of My Medical Career and Prosperity: 1985

Michael at Providence Medical Center August 1984
Michael at Providence Medical Center
August 1984
Michael with family November 1985
Michael with family
November 1985
Christie at our Seattle home December 1985
Christie at our new Seattle home
December 1985

If I were called upon to fix, like Gibbon, the period in my professional career, and life in general, during which I was the most happy, prosperous, and fulfilled, I would, without hesitation, name the year 1985.  (I have already mentioned earlier years, such as my senior year of college and my two Alaska years, in which I was very satisfied with life, though not especially prosperous.)  

Professional Satisfaction:  By this time, I was well established in my subspecialty areas of US and NM, and the sections of US and NM which I supervised at PMC were well-equipped and running fairly smoothly.  I had climbed the partnership ladder, had completed a reasonable practice buy-in (purchasing my share of the business assets), was now on an equal footing economically with the more senior partners, and was thereby well compensated for my professional efforts.  The workload remained very high, and the practice quite stressful, but I was devoted to medicine and to patient care, and had clearly come to derive my personal and professional identity from serving as a practicing physician.  I reasoned that, in choosing this complex downtown Seattle practice over simpler alternatives, I had chosen to play in the Major League, and did not seek as a primary goal a life of ease professionally.  (Alternatively, I mused that my job was like being a soloist for the Metropolitan Opera—you were constantly put to the ultimate test, and were "only as good as your last performance".  One did not take on such roles expecting to be relaxed, comfortable, or complacent, but only out of a striving to work at the highest levels of artistry—and medicine, as they say, is partly an art.) 

I had good relations with and the respect of almost all of my referring physicians and hospital personnel (or course, you can never please everyone), and things were mostly going quite well.  The PMC radiology department remodel had been completed several years earlier, which gave me well designed new rooms in which to conduct NM and US procedures, and I also had the benefit of having a convenient reading area interposed between NM and US, so that I could very closely supervise the ongoing procedures as I was interpreting others.  I also had been given the luxury of a reasonably spacious nearby office of my own, which at last gave me the opportunity to bring in and further expand my all-important collection of scientific/medical articles, which I made use of quite frequently throughout the work day.  The technologists and sonographers that I worked most closely with were of very high caliber, the radiologists were expanding and thereby adding needed additional subspecialization, and the quality of overall care that the group was rendering seemed to me, with some exceptions, to be of reasonably high quality. 

Adding up the professional hours I spent—in (1) direct patient care, (2) the many meetings and conferences I needed to attend, (3)  the behind-the-scenes projects I worked on for the partnership, (4) my efforts to keep up with continuing education needs, and (5) my various specialized professional interests such as quantitative OB US—my work was taking more than 80 intense hours per week on average.  It was hard, demanding work, and interpersonal conflicts could still be challenging and difficult to contend with at times (as one would expect at least to some degree in any complex enterprise involving many strong personalities), but overall I was grateful to have the job, and felt very fortunate that I had been able to find such a nearly ideal match for my skills, interests, and general preferences within my chosen profession. 

Looking ahead from that point, I thought I might eventually branch out a little more into teaching or research, or slow down eventually as I approached retirement, but I was not in any hurry to make any significant changes, and hoped to continue in clinical practice for at least 25 to 30 more years (until I was 70 years old or so), at which point I would become an elder statesman of radiology and tend to my grandchildren and garden.

Personal Satisfaction:  On the home front, we were comfortable in our new house.  Wendy was now a sharp and sassy 14, Christie a lively and delightful 11, and Becky was enjoying herself greatly.  I had a satisfactory amount of time off from work, which allowed me to pursue my other intellectual and recreational interests and to keep my family happy—life had been good to us and I had become something of a success object.  I certainly had no need for a mid-life crisis!

Health and Fitness:  My physical fitness in 1985 was high, I was quite athletic, and I seemed to be in good health.  I had had a few past episodes of plantar fasciitis (painful heel, in 1979 and 1985), as well as the previously mentioned annoyances of longstanding migraine and readily controlled reactive hypoglycemia.  In retrospect, however, I was already experiencing early but still minor manifestations of chronic fatigue syndrome and undifferentiated autoimmune syndrome, and the story of the eventual disabling impact of these evolving disorders will be told on another page.

References

(1) MC McGoodwin, "Use of an Alphanumeric Programmable Calculator for Obstetrical Ultrasound"  Radiology 144:935, September 1982.
(2) RL Deter, RB Harrist, JC Birnholz, FP Hadlock, Quantitative Obstetrical Ultrasound, John Wiley & Sons, 1986.
(3) Cassandra Tate, "Busing in Seattle: A Well-Intentioned Failure", September 07, 2002, http://www.historylink.org/essays/output.cfm?file_id=3939, accessed on August 30, 2005.
(4) John Masefield (1878 – 1967), Sea-Fever, http://www.bartleby.com/103/98.html