• Mount Sinai Myeloma Specialists Bart Barlogie & Sundar Jagannath Get Th

    From benmears2016@gmail.com@21:1/5 to All on Mon Feb 8 17:44:54 2016
    For Mount Sinai's Bart Barlogie & Sundar Jagannath, A Dose of Their Own Medicine


    Version 2.0 "A Call to Belay the Beatification of Bart Barlogie"

    SYNOPSIS: "Clinical informatics specialist contends that after luring him to Mount Sinai with statements like 'It's you or it's nobody,' oncologists Sundar Jagannath, Ajai Chari, and Samir Parekh played out a termination scheme when 3 planned events they
    deemed more likely than not came to fruition: (1) when world-renowned myeloma specialist and former colleague Dr. Barlogie came out of retirement to join their staff, (2) when the 71-year-old Barlogie won legal rights to a database he co-created at the
    site of his previous employment in Arkansas, and (3) when Dr. Barlogie's septuagenarian friend and database co-creator Dr. John Crowley confirmed his availability to re-create the Arkansas database for Mount Sinai's Multiple Myeloma program."

    I. Gave Up So Much

    I gave up so much to come here.

    I started a job in California just before the Mount Sinai Myeloma team reached out by phone to begin the courtship. The California job was not ideal in that I would have had to move my family cross-country and I only recently learned that a case of
    cancer in my family had taken a turn for the worse. But I was unemployed for quite some time before that, and if you want to know what unemployment of that length can do to a person's portfolio, reputation, and relationships, all you need to do is look
    at me. But the Mount Sinai position offered me the first-ever opportunity to do what I believe I was put on this earth to do and to make the kind of contribution I believe I could make -- AND began making with my doctoral dissertation in 1997 and my
    design of the Comprehensive Oncology Data Engine (CODE) for a hospital in 2006. Most importantly, it was a hospital, so there was a sense this could be the kind of place where I could drop anchor.

    My wife, a 22-year veteran of the United States government, resigned her guaranteed Federal employment with superior health and retirement benefits so that her husband could work again. (I know -- ouch!).

    So many of my jobs since the start of this economically and politically tumultuous millennium ended with some change in status to my employer. (Who can forget the NASDAQ Crash of 2000, hanging chads, 9/11, wars in Iraq and Afghanistan, the Great
    Recession, $5 a gallon gasoline, and a 5-year budget impasse on Capitol Hill leading to a government shutdown and sequestration). I also have a son with special needs, and we finally had a network of professionals in place in Virginia to develop and
    mainstream him when I uprooted my family for my job here in New York.

    Did I mention I signed a 12-month lease?

    I. Prologue

    I wish to apologize in advance for being indelicate and breaking with convention in sharing the circumstances of my separation from the Mount Sinai Health System. Given the egregious nature and impact of the miscarriage, I feel compelled to avail myself
    of higher principles in bringing this to your attention.

    Over the years I have witnessed some fairly despicable acts across the domains of corporate, academic, and Federal employment. I am alarmed every time I learn a skilled and educated worker has lost a job for reasons that have nothing to do with him (or
    her) or with his (or her) performance.

    This one happened to me.

    II. "It's You or It's Nobody" -- Sundar Jagannath

    It all began with a May 6 phone call from Andrew Randall, administrative assistant to Dr. Samir Parekh, representing three oncologists specializing in Multiple Myeloma within the Mount Sinai Health System (i.e., Icahn School of Medicine / Tisch Cancer
    Institute). The Multiple Myeloma program needs someone to design a research database. Having designed the Comprehensive Oncology Data Engine (CODE) serving research, business intelligence, and clinical decision making for a hospital in North Carolina, I
    appeared an attractive option. After a phone interview with Dr. Parekh and Dr. Ajai Chari, I was summoned for an in-person interview in New York, where the two physicians were joined by the head of their program, 64-year-old Sundar Jagannath. His
    decision to hire me, marked by the proclamation "It's you or it's nobody," launched an onerous screening and onboarding process that did not conclude until an official date of hire on September 7 and an official start date of September 21. (I was
    processed through two separate and redundant screening protocols, one for the Multiple Myeloma physician group and the other for Human Resources). Over that period, I was required to make a second visit to the hospital just to meet with Natalie Lewis-
    Ross, an operations analyst for the Tisch Cancer Institute who serves as part of the hospital's Human Resources function. This meeting would become notable for some additional misrepresentations I will discuss later.

    III. Best of the Best

    Mount Sinai was in the midst of a binge hiring period, onboarding an average of 100 workers a week. The I/O psychologist who addressed my orientation group informed the room of 94 that we should feel good about having been selected from among the average
    10,000 applicants for each of our positions.

    "They'll make your work for it," he added. "Only the best of the best are hired at Mount Sinai."

    It was here when the first of many omens emerged. After being the first of the 94 to sign into the orientation session, there was considerable confusion raised about the lack of my signature for the afternoon session.

    Apparently, after the break for lunch, during which I scurried to have my ID photo taken and to present my I-9 documentation to some office across the street (both of which involved waiting in considerably long lines), I returned to orientation not
    knowing I was required to present a second "afternoon session" signature. Until I presented some evidence I attended that session, they thought I played hooky. (Maybe they thought I took in the Broadway musical adaptation of American Psycho). They tell
    me this had nothing to do with the bizarre disappearance of my data from the Payroll Department computers. And I believe them, considering a couple other staff members tell me that it happened to them as well and even cost them a paycheck. "I hate when
    that happens," reported one administrative assistant within the cancer center.

    I guess it's just a shining example of Mount Sinai being the "best of the best."

    And between September 21 and my date of separation January 12, I did work for it. I commuted two hours each way, arriving at my "desk" (more on that later) at 7:45 AM and after my wife fell asleep between 10 and 11 PM, I was working remotely until 2 or 3
    in the morning.

    But my work habits were not motivated by some imagined standard ("best of the best"), when in fact evidence of substandard work was everywhere at Mount Sinai. I worked as feverishly as I did on my analytics strategy and my analytics tool out of fear that
    a shocking development in the Multiple Myeloma program could render my position unnecessary.

    IV. Septuagenarians Rule the Day

    You see, during my interview when Sundar Jagannath was announcing to me and the other 2 oncologists that "it's you or it's nobody," there was a fourth oncologist, officially onboarded just two days after me, who was already determined to run me out of
    town. But for reasons I cannot as yet fathom, the fact of his existence was hidden from me. You'd think the oncologists would mention that the "world-renowned" (according to Sinai press release) 71-year-old Bart Barlogie was coming out of retirement. No
    one told me that in addition to practicing as a staff medical oncologist he would also hold the title of Director of Research. And no one told me that for the past 40 years he was proud to have presided over a proprietary database he co-created at the
    site of his former employer in Arkansas.

    Fast forward to October. Office of Dr. Sundar Jagannath. I am poised to present my vision for a research database. This is what the meeting is all about. This is what I was hired to do. This is why I am here and why I might remain here for the rest of my
    career. This is why I relocated my family from Virginia. Why I allowed this group to lure me out of my brand new job in Brea, CA (my first opportunity in 3 years). Why my wife grudgingly left her 22-year career with the Federal government (yes, ouch!).
    Nothing I am disclosing to you now within the confines of this paragraph was not also known to Drs. Sundar Jagannath, Ajai Chari, and Samir Parekh.

    Everyone is here. Some more fashionably late than others. But they're doctors. Last in the room is Dr. Bart Barlogie. Last in the room, but first to speak. And he didn't stop speaking. In fact, I didn't get to begin my presentation until minute 20. And
    by the time I received permission to address the room, every word out of my mouth was rendered all but academic. And not the good kind of academic. I mean utterly, irreparably, and irrevocably moot.

    V. The Meeting

    "The database is out of litigation." - Bart Barlogie

    From that moment on, the revelations were delivered like bullets to my chest. He insisted that his old database from The University of Arkansas for Medical Sciences Myeloma Institute (UAMS) should be the database of record for the Multiple Myeloma
    program at Mount Sinai. He intended to have his old database transplanted from Arkansas and he insisted his old friend, the vaunted (and equally venerable) 70-year-old Dr. John James Crowley, should manage the implementation. (Crowley is listed as the
    Chief of Strategic Alliances for Cancer Research And Biostatistics, or CRAB, something akin to my Comprehensive Oncology Data Engine, or CODE).

    This bares repeating. There would be no database design. And the implementation would be managed by someone other than the person these oncologists just hired to implement the database. And just in case the oncologists might object to superseding their
    new hire, Barlogie delivered his final bullet. This one right between my eyes. He announced that he would fund his friend's multi-million dollar consulting services out of his own pocket.

    Time of death. 4:14.

    Make no mistake. There was no way Dr. Bart Barlogie wasn't getting exactly what he wanted. He was nothing short of a blow-hard and a bully. I may not have known at the time that he was world-renowned, but he knows it. And in a few short days, he acquired
    a reputation for being a verbally aggressive if not pugnacious browbeater who likes to suppress speech and push people around. "Outspoken" or "opinionated" or even "nervy" doesn't fit the bill here. You can only get away with behavior like that when you'
    re world-renowned, 71-years old, and bloviating within the borders of New York.

    And when you claim to have cured some people of their multiple myeloma. In a Myeloma 101 presentation to the new staff, the presenter mentioned that while Barlogie boasts a cure rate, none of the physicians at Sinai have to her knowledge cured a single
    patient. From my review of the data dumps from EPIC, I personally believe some patients have been cured by Sinai physicians not named Barlogie, but you can see why the hospital let alone the whole world has not heard about it.

    VI. Dr. John James Crowley and the Irrepressible Human Impulse to Cronyism

    At first I assumed the association between the 70-year-old Dr. Crowley and 71-year-old Dr. Barlogie ran no deeper than the one database project, that is, until I did something probably not even Crony's mother and proofreader have ever done -- read his
    entire CV. We're talking 421 publication credits spanning 28 pages. He recorded his first publication four years after I was born but more remarkably published at a rate of 10 papers a year for 40 years. I've seen the CVs of heavy-hitters and
    whippersnappers like him, and I always wondered how someone can accomplish a CV like that. I tell you what. Let's come back to that. There's the more interesting question of with whom he published -- when -- and how often. Truth be told, he's been co-
    publishing with Bart Barlogie since 1991, since which time they've collaborated on a mind-boggling 98 projects. Ninety-eight. I was also surprised by another familiar collaborator. Sundar Jagannath. Jagannath appears in Crony's publication list 20 times.
    The Mount Sinai press release announcing Barlogie had un-retired to join the Myeloma program, dated two days after my start date, revealed that Barlogie and Jagannath had been colleagues over 20 years ago.

    VII. What Did I Walk Into

    I have no doubt that I was actually second choice all along. But the oncologists of Mount Sinai's Multiple Myeloma program led me to believe I was their first and only choice while certain questions (as yet unknown to me) surrounded the availability of
    Dr. Barlogie, his database, and Dr. Crowley. I find it curious the blogs of some of Barlogie's former Arkansas patients (among whom he has been elevated to the status of a Deity) hint at some prolonged period during which his whereabouts and fate were
    unknown. Once these questions were resolved, my fate was sealed.

    I can only imagine that the Mount Sinai doctors, who've probably never known a day of unemployment in their lives and have never been short on money (Barlogie himself founded an entire institute in Arkansas with a $10 million grant), are surprised by the
    way I've responded to my termination. For physicians supposedly concerned with the well-being of patients, they had absolutely zero interest in the human aspect of their decision to dismiss me. The phrase "turning a blind eye" doesn't do justice to what
    they did. They were aware of where I came from and what I gave up to come here. I had not seen hyde or hair of any of them in the weeks prior to my termination, and Human Resources took the unprecedented move of allowing me to submit timesheets that did
    not carry any of their signatures. To her credit, Natalie Lewis-Ross reported some measure of frustration with the group, telling me at one time that "the doctors do not always follow the rules" and indicating that it was not acceptable that the
    physicians did not designate someone to provide direct managerial/administrative oversight over my position. The whole arrangement struck her and other administrative directors as odd, specifically for the jaw-dropping lack of planning and for failing to
    make other members of the team aware of my impending hire. The physicians decided to terminate my employment without seeking any information from me or about my work. Not one quantum of energy was expended to explore my value to the facility once John
    Crowley had been added to the mix. And as you have surmised, the physicians afforded me zero hint of dissatisfaction, let alone that a termination was an option, and none of them was designated to deliver the news of my termination personally. That
    unpleasant task was assigned to Natalie Lewis-Ross. And when she delivered the news, she acknowledged she had not been given insight into the grounds for the decision. Nothing beyond the obscure if not obfuscatory statement, "Ryan does not fit the need
    of the Multiple Myeloma program." I was led to believe that the physicians were pressed for details, but would not waiver from this line, which gave Natalie Lewis-Ross the vague impression there was something I was asked to do that I did not do. In a
    further act of estrangement, she informed me that because I was terminated during the probationary period, the physicians were prohibited by Mount Sinai policy from providing employment references for me. No doubt the physicians were aware of the policy
    when they availed themselves of the convenient probationary termination. Less work for them. And nothing to remind them one of their former employees needs a job.

    VIII. Science and the Herd Instinct

    Having been ousted for John James Crony, I felt compelled to review his CV; because at first glance, a bloated 28-page 421-credit CV has the power to hypnotize. His previous titles include "Program Head," "President and Chief Executive Officer," "
    Professor," "Board Chair," and "Chief," and his affiliations include the Fred Hutchinson Cancer Center, Stanford University, the University of Washington, and University of Wisconsin-Madison. But if you look beneath the surface -- beneath the cosmetic
    sheen -- and actually read the list of publications, a number of striking facts about science as a social enterprise begin to emerge. Publishing in science, which is the primary and arguably sole mechanism through which professional identities,
    reputations, and careers are created, is less about the intrinsic worth of the science performed and more about -- what else? -- networking. I began compiling statistics on each of Crowley's publications, recording the number of co-authors, Crowley's
    rank-order in the list, size of paper published, and when and how often Dr. Barlogie appears as a co-author. I mean it's general knowledge within these academic disciplines that the life of the scientific researcher involves a lot of outreach of the "hey,
    can I join your team" variety so that you end up as the 6th author on a lot of 4-page publications. That's the game. Maximum credit for minimal work. That's how careers and legends like that of Dr. Crowley are created and reinforced. Then they take
    their research to the national symposium where they address an auditorium of five from a panel of six. And it's a zero sum game. Your job, employability, and earning potential is determined by your rate of publication. Problem is there are only so many
    journals and so much space available within any journal. So science is all about safety. It's about joining a project with a large number of co-authors to confirm some binary, highly circumscribed hypothesis for which you fully expect a positive result.
    Even if the research is uninspired, as long as you have one author on the team with an established pedigree and reputation, or some -- ahem -- "connection" to someone on the 3-20 member editorial review committee for the journal in which you seek
    publication, you're as good as published. So science is about seeking safety in numbers (and boxing out the lesser known lone wolves).

    Crowley's CV does not exactly buck this trend. I examined one stretch of 67 publications where he boasts an average 10.4 co-authors per project, over which time his average rank order is 7.2. I found a number of projects that involved over 20 co-authors -
    - and one involving over 30 co-authors. Once he found his niche within the crony network, he would know for the rest of his career (and beyond if you accept retirement age as 65) that his next publication credit was just a month away and that within just
    a few short years he would have the kind of CV that would blow people away (and blow up the careers of people like me just as they're getting off the ground). After all, I'm sure none of the 20 co-authors on which he collaborated on his last project
    would object if he asked to join him or her on their next project. That's how you turn one publication into 20. It's just something my conscience won't permit me to do. There's nothing wrong with it. In fact, it's encouraged within the scientific "
    community," but I feel like I need a shower every time I agree to something like that. And I also happen to think as a social psychologist that it promotes groupthink. Is it any wonder these academic fields have adopted such a leaden Procrustean
    framework? And is it any wonder we think we need a larger scientific workforce to learn truths to which we were blinded by -- you guessed it -- a large scientific workforce? Take Barnes-Jewish Hospital in St. Louis. Despite employing well over 200 staff
    devoted to process improvement -- dozens of informaticians, healthcare researchers, epidemiologists, and Six Sigma black belts in the field of business transformation -- they turned to me because they couldn't raise their patient satisfaction scores.
    Sometimes the perspective needed for the seemingly insoluble problem is the one precluded by the community bias.

    Now I've met some whippersnappers and heavy-hitters throughout the years, including the heads of some hospital Bioinformatics units and I can tell you that you cannot measure a mind by the size of that CV. Over 10 publications a year? Either this is
    research of modest-to-marginal significance, or -- OR -- his link to/role in these projects is somewhat tenuous. I have been involved in just one major research project in my life (when I immersed myself in a methodology of my own invention to probe an
    age-old mystery), and I believe wholeheartedly that what I learned about dreams during this project-of-unprecedented-scope is more significant than what was learned over 40 years of academic research in psychology on the subject. Bold claim, I know.
    Maybe even mind-boggling. But I'm willing to back that up. All this CV padding and networking and name-dropping and title-primping creates a Bubble on the same order of magnitude as the ones responsible for the Great Recession.

    This isn't the first time something like this happened to me. Take the U.S. Department of Health & Human Services where I was ostensibly hired as a contract employee on the strength of my Social Psych PhD to provide management consulting. While I was
    being assigned onerous technical writing tasks (i.e., something they called routine socialization into the department for all new hires), the Director persuaded some maven who published multiple books and who consulted with many reputable institutions to
    add HHS to her consulting circuit. For her trouble she walked away with a staggering paycheck and consulting credit, and I ended up remaining a glorified secretary and over-worked, underpaid note-taker for meetings of subject matter experts (i.e., "
    working groups"). Despite repeated promises of more significant roles (and even Federalization), I was laid off when the 5-year budget crisis on Capitol Hill (remember for years the President and Congress could not put together a budget) led to an era of
    fiscal austerity, scarce resources, and re-prioritization, introducing into the public lexicon terms only square haircuts inside the Beltway should know: continuing resolutions, debt ceilings, threats of government shutdowns, an actual government
    shutdown, and sequestration.

    IX: Life after "Death"

    I probably should have started looking for a new job the moment the proverbial gavel fell on that October meeting. Maybe sooner. But I knew that even if Dr. Barlogie's wishes came to fruition (and how can anyone not acquiesce to him), I imagined there
    was still a role for me in the Multiple Myeloma program. I even imagined there was still a role for me on the database project. *I* could imagine it. So they must too. Right? A project likes this takes months and from all indications, Dr. Barlogie's
    crony was not going to move to New York and work every day at the facility. They needed someone on site to coordinate the crony's vision and manage the boots on the ground. I have executed a project like this myself for a hospital in North Carolina, and
    you can't imagine how complex it is. Of course it gets exponentially less complex when you are foisting a pre-packaged vision on a facility, which is exactly what Dr. Barlogie was doing. There's no requirements analysis. No meeting with physicians to
    discuss what they would like to see in an end product. This is what "Dr. Barlogie" wants and what has already been designed and implemented by 40-year veteran of the Biostatistics trade Dr. John Crowley. Just a few weeks after the meeting, I received the
    copy of the data dictionary and the structure and content of all the tables that comprise the database.

    But I digress.

    There would be no work toward the database until January. John Crowley and his D.B.A. Keith Goodman were not available until early January for an on site visit. But they arrived with fanfare and an itinerary that included all the major players -- all the
    stakeholders, end users, subject matter experts. Participants included the Director of the Tisch Cancer Institute, Steven Burakoff; Vice-Chair of Molecular Pathology & Genetics, Janina Longtine; Director of Oncology Pharmacy, Talaat Aggour; Director of
    Hematopathology, Julie Teruya-Feldstein; Oncology Investigational Drug Pharmacist, Kendra Yum; Administrative Director of the Bone Marrow Transplantation Team, Zachary Galitzeck; Multiple Myeloma Research Manager, Lisa La; Senior Director of Clinical
    Data and Analytics, Ken McCardle; and Director of Cancer Clinical Programs, Luis Isola.

    I informed the Multiple Myeloma team when I was hired that I would need to organize such a series of meetings, but none of them followed through for me.

    Now life at Mount Sinai did go on for me into the month of January. A $100 pre-paid gift card, A Holiday gift from the doctors, came with a curiously foreboding note of "thanks for all your help." It had a ring of finality to it. But from the October
    meeting forward, I was relieved of my broad database responsibilities and assigned, yes, you got it, onerous work of minor significance. I was reconciling large lists of patients and referral sources stored on multiple Word and Excel documents maintained
    by the physician's administrative assistants, past and present. Not that the work wasn't necessary. Three oncologists on that referral list have been deceased for over 6 years and one was recently arrested outside a cancer conference for failure to pay
    child support. But this was my new present and made me worry for my future.

    I tried to take control of my fate by designing an analytics tool for the database. (Regardless of how the database is designed, an export of the data into my analytics tool would prove a major force multiplier in understanding both any individual
    patient and the patient population). For 3 months I worked night and day on my Tool. By January 6, the Tool was finished. And not too soon. For this was the day of Dr. Crowley's visit to Mount Sinai. His itinerary was regal. He was scheduled to present
    to multiple meetings of clinical, analytics, and I.T. administrators across the facility. Why this was not arranged for me, especially after my suggestion early in my tenure, boggles my mind. This is how I launched my own version of a database for a
    hospital in North Carolina, something I called CODE (Comprehensive Oncology Data Engine). And I could tell you from experience that this requires the support of a lot of professionals representing multiple disciplines and information systems. Even after
    Dr. Crowley was anointed as the lead for this project, I was surprised I was not assigned a supporting role in the vein of project manager, requirements analyst, and for lack of a better word, "sales rep." Even within their own ranks the Multiple Myeloma
    team has no consensus vision of what they want this thing to do. And such a system is more than just a static repository of data. For the data to be actionable, it needs a graphic user interface (i.e., dashboards) to enter data and order analyses, a tool
    to integrate and analyze the data, and a reporting capability. From what I gathered from my one meeting with Dr. Crowley (and mind you, I was assigned only to the very last meeting of the day lacking all the key stakeholders and principals), they do not
    appear to have such a broad interpretation of the enterprise functionality.

    During the meeting, I did in fact discuss my analytics strategy, as I intended for the purposes of underscoring my value to the project and a number of possible roles. Unfortunately, none of the physicians from the Multiple Myeloma team were in my
    meeting group while I was making my case and outlining a few possible roles within the program moving forward. Three days later, I was fired.

    "Ryan does not fit the need of the Multiple Myeloma program."

    That was the reason for my dismissal, delivered by Human Resources Operations Analyst Natalie Lewis-Ross.

    X. The Termination

    There were more humane options than termination. They could have found another role for me within the project, within the program, or within the hospital. They could have phased out my position over a few months. Or they could have put together a
    severance package for me. Any one of these would have been fair. But no. Bart Barlogie needed me out. John Crowley and his Cancer Research and Biostatistics (CRAB) needed me out. And Mount Sinai needed me out. And they all need me out *yesterday*. Only a
    giant can of RAID could have killed me faster.

    I guess they got their "blood" database after all.

    As you know, it's customary when terminating an employee to rescind his access to company property and equipment prior to delivering the bad news. The method employed by Mount Sinai was particularly artful. They used a two-step process to distance me
    from my PC. Had they been successful -- had Mount Sinai had it's way -- I would have been deprived not only of references, but samples of my own work. I would have nothing to show for my time there. Here's how it worked. Research Manager Lisa La, who is
    usually the one who informs me when I need to vacate my PC for a monitor, tells me she needs my PC and that she's booked the large conference room for me for the day.

    Now there were a number of clues to my fate in this maneuver. First, I was displaced mid-day and with no notice. Usually I have at least one day's notice and I am informed at the beginning or end of the day. Secondly, no conference room, let alone the
    large conference room, is ever available for the day. You'd have a hard enough time booking the thing for an hour let alone a whole day. The third clue was in the canary-eating Cheshire cat grin on Lisa's face. She knew what this all about. And it meant
    she'd never have to fight me for that primitive PC again. So in 60 seconds of nervous paranoia I copied the contents of the PC onto my flash drive.

    I wasn't in the conference room for more than 15 minutes before Zachary Galitzeck arrived to tell me Natalie was waiting for me in his office. I don't know if you've ever seen the Coen Brother's film, Burn after Reading, but Natalie is the equivalent of
    the cryptic agent "Olsen" who is known only by reputation and who's present for all termination meetings. John Malkovich delivers one of the funniest lines in the film when his character -- a Senior Analyst with the State Department -- laments "Palmer,
    with all due respect, what the ^%!$ are you talking about? And why is Olson here?"

    I never saw any of the physicians again. Actually, I had not seen any of the physicians in the weeks leading up to the termination. I will repeat what I am about to say, but it's something that bears repeating. None of the Multiple Myeloma program
    oncologists ever met with me to assess my workload. None of them ever met with me to explore my role or value to the program in the John Crowley Era. Ms. Ross was somewhat confused by the circumstances surrounding my dismissal. The physicians were stingy
    with their explanation and seemed determined not to reveal the circumstances under which I was phased out of the program. All she said she could get out of them was, "Ryan does not fit the need of the Multiple Myeloma program." It was also important that
    I know that since I was inside the 6 month probationary period, it was designated a "probationary termination." I endure this 3 1/2 month gauntlet of interviewing, screening, and onboarding, and my reward is 6 months of probation?

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