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March/April Issue of vein specialist

The Science of Veins: A World Without Boundaries

Table of Contents

Message from the Editor

Steve Elias, MD

Editor-in-Chief, Vein Specialist

Umbrageous Brutalism


Frederick Law Olmsted and Calvert Vaux designed many public spaces: Delaware Park in Buffalo, Parc du Mont-Royal, UC Berkeley, and, of course, New York’s Central Park. The beautiful sidewalks encircling the perimeter of Central Park are deteriorating. Someone needs to fix them. Stones are set in beautiful herringbone and basket weave patterns and patchwork asphalt. As Olmsted himself said, “The sidewalks are there to ensure the umbrageous horizon line.” What does this mean?

Well, let’s start with “umbrageous.” I did. I’d never heard the word. I read it in an article in Artdaily entitled “Smoothing the path to green, block by block” (which originally appeared in the New York Times entitled “Fixing Central Park’s Bumpy Sidewalks ”). When one encounters a word they don’t know, one can either move on or stop. I stopped. Umbrageous: “filled with shade.” Olmsted had the sidewalks constructed “for the purpose of concealing the houses on the opposite side of the street from the park and ensure an umbrageous horizon line.” He added the intricate patterns of the sidewalks so the denizens of NYC felt they were somewhere else when walking on them. Experience another mindset, another point of view. Isn’t that what we do every day when we care for patients. And isn’t that what we strive for every year at our annual meeting. Our society is a forum to exchange ideas and different points of view without brutalism. More on the brutalism later. Now, how about our annual meeting?

This issue provides highlights and analyses of our best-attended meeting ever. If you weren’t there, you missed a lot of info and a lot of fun. New things were instituted. Read about “The Day of Service” by Misaki Kiguchi. It’s a great concept to help the public who don’t know much about vein disease. Rob Attaran summarizes the deep venous session. Our keynote speaker was longtime-and-very-involved member BK Lal. His enthusiasm and commitment regarding high-quality data were evident. There are also many articles not necessarily annual meeting related: cybersecurity, AI, Medicare reimbursement, etc. Finally, our new president, Ruth Bush, and our outgoing president, Glenn Jacobowitz, are both highlighted for different reasons. But without brutalism.

Brutalism is a misunderstood term. Most think it is about being nasty and brutal. Not so. The concept started out as an architectural style. Think concrete, brick, monochromatic. Institutional and egalitarian. Begun in the UK in the 1950’s as a reaction to the ornate architecture of the 1940’s and before. WW II does that to a country. It then became very popular in Eastern Europe. It implied equality, workers united, and socialist principles. Bare, exposed bricks, beams, etc. Nothing fancy. Many public buildings were erected in the brutalist style: FBI Headquarters, Alumni Memorial Hall at the Illinois Institute of Technology in Chicago by Mies van der Rohe, Unite d’Habitation in Marseille by Le Corbusier, and other 1950’s institutional buildings.

AVF does not educate us or have an annual meeting that is brutal, basic, or bland. Brutalism is more than an architectural style. It is a concept. It strives for a simple, honest, and functional approach to life. And that’s what we do when we care for vein patients. We try to be honest, straightforward, and help them back to living their lives. We aren’t brutal, but maybe we adhere to some of the principles of brutalism. We don’t sit in the shade and be umbrageous. We look at vein disease in a bright, direct light. VENOUS 2024 definitely accomplished this.

Introducing Ruth Bush:
A Leader with a Vision for the Future

John Forbes, MD

Executive Director, American Venous Forum

Allie Sherrill

AVF Staff

The American Venous Forum is delighted to welcome its new president, Ruth L. Bush, MD, JD, MPH, a distinguished leader in vascular surgery with a passion for education and a vision for the future of the AVF.

Ruth L. Bush, MD, JD, MPH

Ruth was born in Radford, Virginia. After she and her brother were adopted, they grew up in North Carolina; she was  one of four children in her family. Ruth attended high school in Winston-Salem, where she worked hard and spent a lot of time reading. Ruth had never been north of Radford, VA, until she took a road trip with her mother during her senior year of high school, when she visited Cornell University on a beautiful sunny day.

Leaving the familiarity of her Southern roots, Ruth decided to attend Cornell University. She thoroughly enjoyed college, studying biology and women’s studies and joining the Kappa Alpha Theta sorority. Ruth applied to one medical school – University of North Carolina (UNC) – where she was accepted. Her first class at the UNC School of Medicine was anatomy, after which she was hooked! She earned her medical degree from the UNCSchool of Medicine, her juris doctor from William Taft Law School, and her Master of Public Health from UNC Gillings School of Global Public Health. Ruth then completed her general surgery residency at UC Davis Medical Center in Sacramento, California followed by a vascular surgery fellowship at Emory in Atlanta.

Ruth’s professional journey includes a diverse range of experiences from private practice in Tallahassee, Florida, to academic roles at esteemed institutions including Baylor College of Medicine and Texas A & M University. She practiced in the VA healthcare system for 18 years and recently retired from federal service. Her academic journey eventually brought her to Houston, where she has served an integral part of the Dean’s office since 2012. Her dedication is further evidenced by her role as the Editor-in-Chief of the Journal of Vascular Surgery: Venous and Lymphatic Disorders.

Young Ruth

Dean’s photo taken at the 2023 UTMB Medical School Graduation. Ruth L. Bush is on the right in UNC blue.

Ruth in Colombia with LATAM leaders.

Ruth in clinic with three first-year medical students.

Ruth met her husband Bill Fife on a blind date when she first moved to Houston in early 2003. In 2006, they eloped in Florence, Italy. Ruth and Bill share a love for Scottish terriers and wine tasting. Some of Ruth’s other hobbies include cooking, knitting, and binge-watching television crime series. Ruth’s sister lives in North Carolina and her brother on St Thomas, Virgin Islands.  A DNA test revealed a paternal half-brother, Bob Posiy, whom she connected with in 2020.

Ruth and Bill’s wedding photo in Florence, Italy, in 2006.

Ruth and Bill at a Texans game.

Ruth and Bill in Cortona, Italy.

Ruth with half-brother, Bob, after connecting in 2020.

Ruth with her sister, Francie

Ruth Bush and Kathleen Ozsvath at the European Venous Forum (EVF) in Berlin, Germany.

Ruth’s involvement with the AVF began when she won the American Venous Foundation Research Award in 2004. When Ruth attended one of her first AVF meetings, she was struck by the comradery of the organization when Dr Elna Masuda invited Ruth to sit at her gala table. Ruth’s involvement in the AVF has brought her great relationships with vein specialists from around the world. Throughout the years, Ruth has served on a number of AVF committees, including the Membership Committee and National Venous Screening Committee, and eventually serving on the AVF Board of Directors as Secretary, followed by Vice President in 2023.

As she assumes the role of AVF President, Ruth envisions a future that nurtures leaders, fosters a sense of belonging, and embraces diversity. Her commitment to providing opportunities for the younger generation aligns with her role in medical education, ensuring a more inclusive and impactful AVF community.

Ruth L. Bush with Cassius Iyad Ochoa Chaar (Program Chair for VENOUS2025) at the VENOUS2024 Gala in Tampa, FL.

Dr Ruth L. Bush brings not only a wealth of experience but also a genuine enthusiasm for medicine and education to the AVF. As she leads the organization into a new chapter, members can anticipate a visionary and inclusive approach that shapes the landscape of the AVF for years to come.

“I want to create a sense of belonging, starting at the top. This comes down to giving people a hope for the future and in themselves and giving younger people the opportunity to make an impact and get involved.” – Ruth

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