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September, 2017

Wall of Words

By Michael J. Katin, MD

Later this month will be held the 59th Annual Meeting of ASTRO, the historically-but-still-awkwardly-initialed American Society for Radiation Oncology. For the first time since 2010, the session is being held in San Diego, California. It is somewhat unexpected that it has already been seven years since the Annual Meeting was held in one of the most desirable convention locations in the country since, after all, the main reason to have an organization in the first place is....well, actually, to give awards to each other, but almost as important is to be able to have big, exciting, expensive annual meetings! Sorry, Duluth, Minnesota, and Midland, Texas.

San Diego was shortchanged in the October, 2010, column since the meeting was held at the same time as the mid-term elections, but this is now an opportunity to pay appropriate tribute to the city and county of San Diego.

Due to ethnocentrism, the previous name of "San Diego" is not publicized but the European name, San Miguel, was given to the area by Juan Rodriguez Cabrillo, in 1542. Since at that time Facebook and Instagram were not yet in use, nobody paid attention that that name and yet another name was applied by Sebastian Vizcaino in 1602, when he sailed into Mission Bay on his flagship, the "San Diego." Presumably if it had been named the"Guppy," the ASTRO meeting would be being held in Guppy, California. His ship itself was named after Didacus of Alcala, known otherwise as St. Diego de San Nicolas, a Spanish missionary to the Canary Islands. A 15-inch-tall automaton of St Diego can be seen in the Smithsonian Institute, on the opposite side of the continent. This mechanical masterpiece, years ahead of its time and reportedly still in working order, was commissioned by the royal family of Spain after Crown Prince Don Carlos recovered after a severe head injury, reportedly by having the 100-year-old corpse of St. Diego placed next to him. There is no mention in the ASTRO meeting announcements about having the automaton brought to San Diego for the event, unfortunately, let alone the corpse of St. Diego.

It was not until 1769 that San Diego became the first permanent European settlement in the borders of what was to become the state of California. Mission San Diego de Alcala was founded by friars headed by Junipero Serra, and attendees of the ASTRO Annual Meeting will be able to visit the site of the Mission, located one mile east of Qualcomm Stadium (which was , reportedly, not there at the time of the original founding). Parenthetically, Junipero Serra was designated as the chief inquisitor for the Spanish Inquisition in California, the forerunner of oral board examinations. Unfortunately, by 1838 the population of San Diego had decreased markedly, down to fewer than 150, but people started to move in, drawn by such attractions as Sea World and Black's Beach, and by 1850, when California was admitted as the 31st state, San Diego was incorporated as a city and elected its first mayor, Joshua H. Bean, brother of the famous Judge Roy Bean, the only law West of the Pecos. Mayor Bean served only until 1851, having caused some disruption by selling City Hall and other public property to himself and his friend, Cave Couts. That original City Hall cannot be visited, but the next City Hall, built in 1873,, is available for viewing by ASTRO Annual Meeting participants. The first mayor to have an office in the "new" city hall, Edwin Capps, was a civil engineer responsible for major development of San Diego, including construction of the Spruce Street Suspension Bridge, dredging the harbor, and many other improvements, but possibly best known for hiring a rainmaker in 1915 after four years of drought, followed by the flood of 1916. It is unfortunate that attendees of the ASTRO Annual Meeting have just missed the centennial recognition of this event (but it may still be possible for the 61st Annual Meeting, location not yet announced, to be scheduled in Boston for the centennial of the Great Molasses Flood of 1919). Fort this, the rainmaker, Charles Hatfield, was not paid -- the contact had been vague and efforts were made to hold him responsible for $3,500,000 in damages Sometimes one can be too successful.

Throughout this period of time San Diego received attention as the site of the 1915 (despite the drought) Panama-California Exposition, which was the impetus for the final gentrification of Balboa Park, which previously had been home to colonies of smallpox victims, tobacco growing, and eccentrics such as Professor LeBatt, whose cave can still be visited by determined ASTRO members, some of whom are well-accustomed to working in low-lying isolated locations.

Although this meeting missed the centennials of both these major events, it coincides with the twentieth anniversary of the Heaven's Gate mass suicide in Rancho Santa Fe, a short distance from the meeting site. Unfortunately, it is not possible to tour the house where Marshall Applewhite and 38 others killed themselves with the expectation of getting to the next plane, but obsessed ASTRO members can at least see the lot where the house used to be, even though the people in the community changed the street name (hint: Paseo Victoria, although in reports the house number is listed as either 18239, 18241, or 18341). For those who become inspired, the Heaven's Gate Website can still be accessed, but Comet Hale-Bopp will not be by again until the year 4380.

Now that amends have been made to San Diego for 2010, there is one important characteristic of the city and county thate should be addressed since ASTRO may be able to contribute to solving a huge problem. Although Capps was a civil engineer who accomplished a great deal, he was an amateur compared to the drug cartels who have succeeded in creating a vast underground (literally) network to allow passage of product and persons unimpaired between Mexico and the United States. Their speed and accuracy makes Manhattan Construction look like amateurs. Amazing what the profit motive can accomplish.

Which brings us to what ASTRO can contribute. It would be worthwhile for the ASTRO attendees to check their hotel rooms and the floors of any restaurants they may patronize for the San Diego terminus of any tunnels, but, more importantly, to think about what we can do to provide obstruction for their efforts. The 59th Annual Meeting will have presentation of at least 600 oral presentations and ePosters, and it has to be assumed that, even in a "paperless" society, there have to be at least 20 to 30 pages generated in the compilation, submission, and acceptance of each of these. Add to these the number of copies of the daily newspaper handout and tons of literature from vendors and, from this year alone, there would probably be enough paper to obstruct every tunnel crossing the border. Then take all past issues of the International Journal of Radiation Oncology, Biology, and Physics, plus supplements, plus general oncology journals that are either complimentary or that we check to see what the medical oncologists are doing, and there will be enough to build a wall 30 feet tall from the ocean to Arizona, at least. Please be prepared to leave your papers and handouts at the door when you leave the San Diego Convention Center.

Plus, if that's not enough to deter illegal border crossing, threaten all those who are interdicted with having to master MACRA* and MIPS**.

*MAssively Complicated Resettlement Act
**Meaningless Indecipherable Permit System


Emanuel Countdown: Dr. Ezekiel Emanuel's biographies list his birth year as 1957 but, interestingly, do not list a birth date. He has expressed that he does not wish to live past his 75th birthday. Giving him every benefit of the doubt, he will have his 75th birthday no later than December 31, 2032. Including September 1, 2017, this leaves 5,601 days to his goal.