COMMENTARY: Seeing clearly in muddy waters

August 4, 2006

I found Dimitri in the Moccasin Bar, an iced glass of Red Bull grasped firmly in both hands, his eyes focused on the thin red straw radiating from the yellowish green liquid. Dimitri had sworn off alcohol for the duration of his search for answers, but I could tell that at the moment he was having second thoughts.

SCANman is on a Kerouac-like quest this week, traveling the back roads of Wisconsin, searching for truth and the American way. In this, the second of a two-part series, the connection to medical imaging is inescapable, just as it was in the first.

I found Dimitri in the Moccasin Bar, an iced glass of Red Bull grasped firmly in both hands, his eyes focused on the thin red straw radiating from the yellowish green liquid. Dimitri had sworn off alcohol for the duration of his search for answers, but I could tell that at the moment he was having second thoughts.

The Moccasin Bar underscored the uncertainty that was driving him, a realization that Dimitri made clear to me through staccato sentences punctuated by finger jabs into the refrigerated air that kept bar patrons in Hayward, WI, insulated from the worst heat wave they had experienced in recent history. There, against the far wall, bathed in ceiling-suspended lights and festooned with documentation more than adequate for the local citizenry, was the stuffed and glazed remnant of the largest muskie ever caught.

It was not, as Dimitri had expected, three blocks away - where it should have been - at the National Freshwater Fishing Hall of Fame, a 143-foot model of a leaping muskie which houses other muskie memorabilia. Nor, he learned, was it the only muskie whose owners laid claim to its being the world's largest.

Seventeen miles east of the city, at the Dun Rovin' Lodge, were the remains of a muskie that weighed in at 70 pounds - several ounces more than the one at the Moccasin Bar. The scale used to weigh the one at the lodge, however, had long ago been called into question. The fact that this fish, unlike the one at the Moccasin Bar, was not caught in Hayward, the self-proclaimed muskie capital of the world, made the boast even less palatable, at least to Haywardites. But Dimitri, being the scientist he is, looked objectively at the claims for both fish and found an even greater flaw in those accompanying the muskie that hung in the Moccasin Bar.

"It's a fake," he blurted, an assertion that did not sit well with the local sitting next to him.

"It's not a fake," said the man, whose reach into the pickled egg jar had been halted by Dimitri's vile accusation. "It's a replica. The original was lost in a fire back in the 60s."

Dimitri had gone searching for a benchmark of certainty in muddy waters and now, quite simply, had sunk into the muck.

Claims and counterclaims, Dmitri feared or, worst of all - iterative advances, one advance a smidge better than the last - would forever diminish whatever he could concoct. The scribbling in the notebook beside him, drawings and notes for a new imaging modality, would ultimately be discredited, he said.

"If something as simple as a fish cannot be documented..." Dimitri said, his voice trailing off.

Several weeks ago, in a surge of creativity, Dimitri had imagined a new kind of medical imaging, one that uses beams of helium atoms whose speckle diffraction pattern would exactly characterize human tissue at a submolecular level. A catheter-based system might feed a helium "nozzle" to a coronary lesion, he speculated, allowing the differentiation of plaques.

"Who knows what other applications might be discovered?" Dimitri asked rhetorically, in a manic fit of satisfaction.

But now Dimitri had swung the other way, concluding that no matter what he developed and no matter how relevant it became, it would fall short of his goal of being truly creative.

Helium imaging had been inspired by work aimed at the physical sciences. This automatically impugned his creativity, he said. I disagreed.

"What about MR? It developed from nuclear magnetic resonance, a laboratory technique," I said.

Dimitri was not convinced.

"Name another," he demanded.

"Ultrasound and SONAR," I said.

"Another," he asked, more pleading than commanding.

"Nuclear medicine and ..."

"High energy physics," Lem chimed in, striding through the doorway of the Moccasin Bar.

Dimitri's assistant had tracked us down, his research in Seymour complete.

"Even the hamburger had predecessors going back centuries," he said. "The Mongols ate flat lamb patties 800 years ago. One person..."

"Builds on the work ..." I said.

"Of those who came before," Dimitri said, leaping to his feet.

Improving on earlier developments was the most basic expression of creativity, we decided. And, on this consensus, Dimitri ended his quest. He did so; it turned out, none too soon.

In the hours spent mulling the inconsistencies of muskellunge record-keeping, Dimitri had rung up a $12 bar bill, all from Red Bull. My friend needed an outlet for all that energy, and now he would have one, thanks to an epiphany, itself an act of creativity and a testament to the power of teamwork.