Closing the Loop

The picture is of a colleague named Paul Loveday. I met Paul in 2007 at a conference in San Francisco. He was the founder and CEO of ClinStar, a CRO in Russia. At 6'10" Paul, a former NBA basketball player, was hard to miss in any room. During a coffee break on the first day of the conference, he loped up to where I was sitting, dropped to one knee (he was still tall even when kneeling) and said "Should I know you?"

There was no earthly reason why he should have. I said, "Do you mean in the metaphysical sense?", he laughed and from there an easy acquaintanceship was struck. I believe I only saw Paul 3 times during the 17 months that I knew him, yet I felt as though I knew him quite well - well enough to ask him to guest lecture twice to my UC class on emerging markets, by phone, all the way from Moscow at 6 AM his time, for 90 minutes at a stretch. Paul had a presence that made whoever he was speaking to feel as though they were the only person in the room. I would not be surprised if there were literally hundreds of people who only met him 3 times, and yet felt they knew him and he them.

The last time I saw Paul was in July of 2008. I was about to speak at a conference on emerging markets in Washington DC - the same conference where I had met Paul the year before - and he said he was planning to heckle me during my talk. I said "Bring it, Paul, bring the heat" and he laughed. His colleague had invited me to go with them for dinner the previous evening but I had declined in favor of previous plans.

The last time I heard Paul's voice was on November 10th, 2008. He called into my class on emerging markets from his office in Moscow and held forth on the benefits and challenges of doing clinical trials in Russia and Ukraine - preferably using his CRO - and somehow managed to make each student in the class feel as though he was standing in the room talking instead of thousands of miles away over a phone line.

In January as I was planning speakers for the spring offering of the emerging markets course and wondering if asking Paul to lecture again was going to the well too many times, I received an email out of the blue from his business development colleague Erin, with whom I had also become friendly. She wrote me that Paul had died suddenly in St Petersburg, 17 days after I last heard his voice.

The loop finally closed when I saw Erin at a two day meeting in San Francisco a couple of weeks ago. Together with the new president of ClinStar, Erin and I mourned. She told me that during the time she worked with Paul, she had often spent long stretches of time with him doing business development, broken by long stretches of time that she did not see him at all when he was in Russia running the business. She said she hadn't really accepted that he is gone, she just thought of him as still in Russia. She kept referring to him in the present tense; we both did. We talked about how their business would go on. We talked about dreading the next summer emerging markets conference without Paul. Erin told me that her sense was that Paul was getting ready to take on his next great challenge - she wasn't sure what it was but now we will never know.

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While I was still at this same meeting, I got a call from my mother with the news that my father has severe aortic stenosis with a not very good prognosis due to his age and other factors. He is not a good candidate for surgical valve replacement, which gives him a life expectancy of months, not years. He may be a candidate for a clinical trial, in which case the way I have spent my adult life earning a living may actually let me help my parents out by cutting through some of the barriers. My mother has a vague mistrust of experimental therapy (despite my careful explanations - what is that saying about a prophet not being welcome in her own hometown?); my father is all in for any reasonable chance to go on living as long as he can. I am walking a fine line of gathering information and pushing to keep the doors open and trying to keep the ball rolling for the trial which is very complicated, while still respecting my parents' autonomy. I take a deep breath whenever my phone rings and I see my mother's caller ID, wondering which call will be the one I'm dreading.

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I met with an old acquaintance this week whom I had not seen for several years after a falling out. It was surprisingly easy to make the small talk, but difficult to broach the subject of the disagreement. Once I had finally said my piece, she said "Fair enough. Water under the bridge?"

That was all. And it occurs to me that yes, the water is long gone under the bridge, but the bridge is no longer there either.

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Finally I am off to Germany next week to close another loop long left open. No doubt that trip will generate future blogging. Another day.

Focuses for the Upcoming Term

This tide marsh is located behind the building I where I work Monday through Thursday, on the east side of the San Francisco bay. It is close enough to walk to, and it has long flat dirt paths to run on when I feel energetic. On a clear day, such as we had this week, you can identify individual buildings in the downtown San Francisco skyline. Most days there is a haze on the water that precludes even seeing the mountains of the peninsula on the other side. I like to go out there during the day to clear my head or to think. Sometimes if I don't have early morning calls I stop by the marsh before heading into the office to watch the great white herons, snowy egrets, mallard ducks and other shorebirds make their living. I find the movement of the tides calming. The water of the bay has a different personality every day; sometimes calm, flat and glassy, sometimes grey and choppy. But the water in the marsh, seen here at high tide, is always smooth and tranquil.

The focus of this week has been building my network of experts in the field of clinical trials in emerging markets. I'm starting to do some research into the area of informed consent in emerging markets: what does signing a form mean to the patient, why are we shoving 15+ page consents down people's throats, and why do the ethics committees let us? I will be contacting my Indian, Eastern European and other connections in the developing world (although they don't know it yet) in the coming weeks to get their perspectives for the next iteration of the emerging markets course, to be offered in the spring term.

The winter term at UC Santa Cruz starts for me next week. It's been about an 8 week break since the fall term ended. Good Clinical Practices, my flagship class, begins Wednesday evening Jan 21 from 6-9pm, and runs for 10 weeks. I've improved (I hope) the curriculum for this term, updating some older information and including references to recent events in the NY Times, NPR, and other sources.