Wednesday, April 01, 2015

Last Mango In Paris

My primary goal for retirement was to hit the road with Mrs. Dalai and travel the world. I'm happy to report that we have begun our journey into journeying. Whilst I havent been writing prolifically about it, or anything else, we have averaged a trip out of the US every month for the preceding three: Curacao in January, and the Caribbean earlier this month. Right now I am typing away on a bus carrying us from Paris to Lyon, having just left a cruise of the Seine River, and headed to a second on the Rhone in southern France.

I have to tell you we made this trip with some trepidation.  The Charlie Hebdo and HyperCasher slaughters happened here all too recently, and as Jews we were quite concerned for our safety. But we did ultimately proceed, and I'm glad we did. 

Paris and the Normandy area are truly beautiful, and the French people are very warm and welcoming. Yes, you read that right, and the statement is not l'April Fools joke. We were prepared for the stereotypical nasty French treatment of Americans (which Mrs. Dalai experiened over years of French classes, explaining why she doesn't remember any of her French). But the reality was completely different. We saw absolutely no sign of the condescending, arrogant treatment so often attributed to Parisian waiters and so on. On the contrary, we were treated far better by every single Frenchman and woman we met than we were by the surly gate agents in Delta livery working the gate in Atlanta for our Delta code-share Air France flight over. (Air France, by the way, still believes in hiring young, happy, and energetic flight attendants, unlike Delta where an AARP card is mandatory for most of the cabin crew.) Most everyone here speaks English, although they all seem to appreciate our feeble attempts to communicate in French, and are kind enough to suppress their laughter at our horrific mangling of the language. 

Let me speak briefly of the Normandy Beach visit.

Today, the various little towns along the D-Day landing sites are placid and picturesque. You would never know of the terror and bloodshed that occurred here 71 years ago (could it really have happened that long ago?) on June 6, 1944. Thousands upon thousands of brave Allied soldiers stormed these beaches, knowing they would probably not survive the attempt. Thousands died, and many were laid to rest in the cemetary at Omaha Beach. Row upon row upon row of crosses, with the occasional Star of David, occupy this sacred patch of land. I cannot begin to convey the intensity of feeling inspired by the knowledge of how these ordinary men became heroes. In a very real sense, each and every one helped to save the world from tyranny. Without them, you might be speaking German, and I might not be here at all. Sadly, the understanding of what happened here has not penetrated to some politicians who have also stood on this hallowed ground, thinking it a photo-op and not a moment to reflect, but that's OK. We get it. And the heroes buried here, who certainly are looking down upon us, get it as well. I will thank them for the rest of my life.

At Versailles, we toured the amazing palace as best we could while being trampled by hordes of folks from China whose concept of personal space differs greatly from mine. 

Dalai at Versailles. It's good to be the king, but where's the pissboy?

Our guide gave us an alternative interpretation of the classic Marie Antoinette line, "Let them eat cake..." Some say she was attempting to distribute the contents of the royal storehouses to the starving. We will, of course, never know for sure, but it just goes to show that things you thought were etched in stone still deserve inquiry. 

But back to the future.

First connected by Aunt Minnie, I have been communicating for a while with a French radiologist named Denis, and he graciously invited me to visit his clinic near Notre Dame in central Paris. He picked me up at my hotel, and gracefully navigated the treacherous morning traffic, finding a parking space only two blocks from the hospital, a lucky break since there is no parking for physicians at the hospital itself. All morning, we discussed the state of French medicine in general, and radiology and PACS in particular. Things are different over here, as you might imagine.  As we see in many other nations, there is a mixture of private and public care, with heavy governmental regulation. There is a bit of a physician shortage in France, though, because the government in its infinite wisdom decided years ago that the way to save healthcare Euros was to cut back on the number of physicians. (Somehow that never happens with lawyers.) So it was mandated that doctors retire at age 62. And now there aren't enough doctors, surprise, surprise. The age of retirement has been raised to 72, which won't help much for a long time. It's so bad that in Provence, for example, where we are now headed, and to which Denis commutes to practice periodically, the only available ophthalmologist is a young physician from Morocco, who is flown in every two weeks. Right. Also, it had been declared that none of the nations's smaller hospitals would have radiologists. So much for getting a summer job on the Rivera.

Anyway, as is often the case with people of incredibly high calibre and capability, Denis, and his partner, Jean Noel, treated me as an equal, a colleague come to visit from afar. Indeed, I had no idea of the rarified air I was breathing. Denis mentioned almost in passing that he had been deeply involved with GE, and was responsible for parts of the Advantage Workstation ". . .which I hear the Dalai doesn't like! Ah, but this is OK, I agree with you!"  The more we talked, the more it became clear that Denis was a far more important figure in PACS and radiology than I had imagined. In fact, if I am the Dalai of PACS, Denis should be the Pope of PACS, and David Clunie could then be High Priest. (I'll stop with the religious allusions now before I get stoned.) Denis has had such a significant involvement with the development of PACS he said, without trace of regret, "Had I been in America, I would have been a millionaire by now, but I would far rather be in France." Denis keeps his hand in the business today, working with a smallish company that has captured much of the French PACS market, Global Imaging. I had the chance to see him use the product he has helped design in the production environment. It functioned well even on an older Windows workstation, with a better-than-average GUI that hid unnecessary buttons. Perhaps I'll get the chance to play with a demonstration version in the future.

I had to leave all too soon to get back to the hotel where Mrs. Dalai was waiting, but before I left, Jean Noel asked me to stop by his office to see the book he has co-authored. It turns out to be one of THE authorative texts on pelvic imaging. Again, I had no idea of the brilliance of these gentlemen who instantly accepted me as a friend from afar. Jean Noel is now working on the second edition. "I will try to do at least a little better than I did on the first version." I'm not sure that would be possible...the first edition is a masterpiece. 

One very interesting aspect of their practice is their direct involvement with the patients. Both Denis and Jean Noel speak with the patients presenting for MRI or CT before their exam, and then directly protocol each study. When the exam is finished and interpreted, they review the whole thing with the patient. As Jean Noel put it, "I can't make a report without seeing the patient." It is a very different paradigm than ours, and it has great merit.

Since I have limited broadband (and none on our bus now leaving Dijon en route to Lyon), I'm going to have to postpone the post about my discussion with Denis about server-side rendering and who owns what patents for it. More to come on that very interesting topic, which I think will literally dictate the future of PACS.

In the meantime, I raise my glass of local Chardonnay to my new friends in Paris, and to all of you, and wish you Bon Appetite! And yes, despite the date, I am really in France!


stacey said...

You know what they call a Quarter Pounder with Cheese in Paris, right?

A Doc 2 Be said...

I loved Paris; similarly found the people helpful, kind, and warm... even if my French was laughable.


stacey said...

Quarter Pounder in Paris: