Tuesday, August 23, 2016

Picture Perfect Words



One of my Facebook friends, breast surgeon I think - maybe he is distantly related to her, posted this at the beginning of the summer. I listened, and I'm addicted. He's pretty prolific, and he's from Arkansas! All the songs are good, but I think this one is my favorite.

Ironically, my daughter loves bro country. It's what I'm subjected to whenever she is in the car. She loves good country too - but it's the current radio that she is most addicted to. So I listen. And am marveled that singers like Blake Shelton and all the others I don't know the names of are topping the charts and this guy has less than a thousand hits on Spotify; because his songs are amazing. I encourage you to listen to all of his albums. If he's not going places, this country is on crack.

Monday, August 22, 2016

Chinese God Factory

At the culmination of a weekend full of debauchery I headed to my friend's mother's house in Harrison, AR for shrimp and grits and cornbread waffles with butter and syrup and chocolate waffles with local blueberry compost and cream. I have great friends. Med school and having kids derailed this. It's nice to rekindle the friendships.

Her dad died suddenly of a heart attack in March. So devastating. He was a staunch Democrat - spent his life in public service. So nice to see the pics of them attending two Clinton inaugurations and an Obama one on the wall of his well preserved office.


Both Hillary and Bill Clinton called to express their condolences.


Yes this was going on in the office. While I'm indulging in hangover food. But the thing that really intrigued me was this.


Chinese war gods, from a Chinese war god factory. Here's a factory pic. They had them shipped from China, and had to hire movers to get them into the house.



The factory belittles it, doesn't it? A little. They had a wonderful life. Although I didn't know him well, this is  a blunted testament to his soul. For Christie.

Friday, August 12, 2016

Tumor Board

I walked in 5 minutes late. The Nightingale patted a seat beside her at the front of the room, beckoning me to join.

I sat down after getting breakfast (greek yogurt, almonds, blueberries, water, coffee) amidst the din of cases being presented. Feeling guilty for being late.

As I settled in I noticed Cid Vicious. Decided to text him.

"I woke up at 6:50." My alarm originally went off at 5:30, but I fell back asleep. When I woke up I startled and got ready in 10 minutes. Skirt. Blouse. Wash face. Drive to CARTI.

He texted back. "I woke up at 4 - I have seen 11 ICU patients, put in 3 central lines, intubated and bronched so far this AM. I am going to Chicago at noon and have to get outta here."

"Are you calling me a slacker? What's in Chicago?"

"Nothing in particular. Just going up there for baseball, eating, drinking, etc."

"At least I'll get EBUS relief." Amid more talk of patients.

"You call non diluted cases with the peacock relief?"

He had a poker face. I could not. Kept silently laughing from the front of the room. I was jealous.

"Aren't you taking her with you?"

"Yeah, we usually travel together, my wife thinks it's weird but we really enjoy each other's company."

I've met his wife, in the Kroger parking lot. Super sweet and adorable.

"Traveling with the peacock would make a really good SNL skit."

Then I presented. It went over pretty well. I even had the hard nosed thoracic surgeon engaged. Can't wait to present next week.

I was trying all day to think of texts that might have broken Cid's poker face.

"It's a good thing my leg hair is blond because I've got two days growth going on."

"My ponytailed look is not styled by product. It's grease from lack of showering."

I'll have to try harder next time. Good to have goals.

My partner at work who missed tumor board was incredulous that I didn't have time to shower. "It looks like you took an hour to get ready."


This is a granular cell tumor. It was in the arytenoid cartilage. 30 ish year old. Very subtle on frozen section, but I called it. Looks like macrophages. Never seen it in the larynx. Has a 3 (or .3?) percent malignant rate - most are B9. The clinicians were fascinated, gave lots of good advice. I've only seen it malignant once, in Conway, in the soft tissues of the buttocks. I think this one is B9, but local recurrence is a concern. The hard nosed surgeon wants a full laryngeal resection. None of the radiation oncologists had any idea of what it's response to radiation therapy might be, it's so rare. I'm not so sure I agree with resection, but it's not my granular cell tumor.

Saturday, August 6, 2016

Absorbing

I fell today, on a walk. It wasn't raining when I left the house, but a steady rain accompanied me as soon as I got going so I decided to cut it short, thirty minutes instead of forty-five. The road back to my house is steep. In retrospect I should have taken a different route. I debated taking my walking shoes off, but decided to trust them. I lost my footing about thirty seconds later. Skinned the hell out of my knee.

It bled. All the way back to my house blood and rain mixed in rivulets down my leg. I laughed at my situation (who falls on a walk?) but as soon as I got to the house the adrenaline that propelled me there exited my system and I got woozy - saw stars. First sat in a chair, then laid on the carpet. Still, it bled.

When I was finally coherent enough to move, I was surprised it was still bleeding. I've never had a cut bleed for more that a half hour. It bled while I changed the laundry. It bled while I had a whiskey to beat back the pain. It bled while I read a book. It bled while I took an hour and a half nap on the couch; it stained the couch. It was still bleeding while I finished the book. I cringed while I showered to get ready for my Uncle's 70th birthday party.

I catalogue the wounds of the dead - they don't bleed. So I am unfamiliar with live blood. I applied gauze and band-aids because it was still bleeding five hours after the injury. Not profusely, just oozing. And dripping. Must have been pretty deep. Wonder I made it home.

I used baby wipes to absorb the blood. I also finished a body of work that has interrupted my planned summer reading. It was a lot to absorb. Enjoyable, but sometimes when you read you learn something about yourself that precipitates a psychic crisis. But no matter the shock, somehow your soul absorbs, and you continue.

So I continue with new knowledge. Hopefully there will be no more bloodletting. I tread carefully. Trepidatiously. Fool me once, shame on you. Fool me twice, shame on me.


Wednesday, August 3, 2016

Reading in Reverse

Something funny happened today.

Have you ever walked into a lecture mid-way through and have been a little confused? Like, damn I wish I had seen the beginning so I could understand what the hell he/she is talking about. But you are a trooper, a hard worker; you puzzle and struggle through it anyway and it is rewarding nonetheless.

The book I finished yesterday felt like that. So imagine my surprise when I opened a new book today and discovered the same characters! A prequel. Relieving and comical at the same time. "Now I get to learn what I should have known all along. All the inside jokes." By the way that was a helluva good book. Caught a few typos though. Maybe I was an editor in my previous life.

You have to take your shoes off. Feet grounded to the Earth. Trust yourself. Don't be in a hurry; you have plenty of time. Let me look at you, OH! You are a . . . "

I was going to the bathroom today, sitting on the toilet, and something sticking out of the tampon dispenser distracted me. An empty package of beef jerky. I suppose beef jerky can pass the time as well as anything else (books, Facebook, but really? Beef jerky?). I have always professed my hate of beef jerky but truth is, I've never tried it. They say you can't really judge something you've never tried.

9:30 a.m. 8/3/2016

"Can I come into your office?"

Who asks? No one. So much so that I've taken to locking my door at lunch, for a short reprieve. "No, please don't." Half joking, but only half. I had a tray of placentas I wanted to finish before I worked on my Q/A.

"So I heard you had a possible autopsy last week, when I (head gross room PA, former defense lawyer) was on vacation." Long silver hair. Pony tail. He was perusing my bulletin board. I felt a little invaded, probably because I just wanted to get some work done. This is the time to acquiesce, because it's not about me. I turned to him and smiled.

"Yeah, but I beat it back. No worries."

"What would you have done? I'm the only deaner. It was a staycation, I could have come in."

"Well, John (morgue assistant - last name Horn - such a smooth voice I made excuses to call him again and again - could hear Gunsmoke re-runs in the background) and I decided that we would muddle through it if we had to. I've never performed the deaner job before, but I've seen plenty. He's seen more. Fortunately we didn't have to test ourselves. If we did, we might have pissed off a funeral home, but that's secondary right?"

"How did you get out of it?"

"It took about ten phone calls, but eventually I did. Wasn't even ordered by a doc. Was a screwy EMR mix up. On some social worker form."

"Wow, that's crazy. Did they ever fix that other problem in the EMR? With mandatory autopsy request by nurses?"

"Yeah, we nipped that in the bud. Don't worry about it."





Friday, July 29, 2016

Case of the Week (COW)

More like case of the century. I've never seen one.

I was headed into the gross room around 9 am. J, the gross room PA, said, "I need you to look at a specimen after you do the frozen."

Another brain, ugh. I had a two hour brain frozen the day before. Was praying this was an easy metastatic carcinoma but no. I had to call Dr. Bell again, for the second time in one week. Feed the megalomaniac. Luckily I like him, and his wisdom and experience more than make up for the humiliation of needing help.

"Ok, J, finally done. What do you have?"

"It's a didelphic, diduph, di-what? Help. It's a double uterus."

"What? I've never seen or heard of that."

"Me neither. Help more experienced gross room PA?"

"It's a didelphys uterus."

I walked over to the stainless steel table to look, and was amazed. Two uteri, divided by a septum.

"Why did they take it out?" A chronic condition, one that's not too serious, but if it festers it can become dangerous. I assessed the situation visually. Two cervices. Two uterine cavities. One much larger than the other.

"There's no way this can bear children, is there?"

"Well, I saw something like this on a Steve Harvey episode."

"Who is Steve Harvey?"

"Kind of like a Jerry Springer. Afternoon talk show. She was pregnant in her bifid uterus by two different fathers. One pregnancy was farther along than the other."

Well, I guess that's plausible. I suppose one could be 9 months along, the other 5. One could deliver before the other. Later on in my office, while I was studying my cases and stewing over this, my dad walked in. I eagerly shared the case.

"Yes, that can happen. Pretty rare. The danger is that if one is growing in the smaller uterus, it can be squashed. I've heard stories about Vietnam prostitutes (human trafficking victims! - some, anyway) being pregnant with twins. One uterus, but two different fathers. Happened in the same day."

You think you know it all, but you are constantly surprised. I was excited to get that case the next day. She had borne children. Wow. Both endometriums were in the same phase - proliferative. The surgeon who removed the uterus had a late case that night. I called him on his cell.

"This is really selfish, but my dad's birthday is in two days and I am taking him out for dinner tonight. Do you need me? Late? I'm happy to stay just let me know and I'll reschedule the dinner."

"No you go. Have a big time. Tell him happy birthday from me. I don't need to know anything tonight that will change what I do during surgery."

I was grateful, had just finished a lung frozen. Was exhausted from the day.

"Can I thank you by texting you a pic of the uterus from yesterday?"

"I'd love to see it."


Kind of looks like an octopus doesn't it?All the girls in PMG pathology are as amazed as I was. That's an ariel view of the fundus. I wish I would have thought to take it in panoramic mode. To the right and left are the individual uterine cavities, opened up.



Tuesday, July 26, 2016

Girl's Night Out

Girl 1: We need to plan a trip to Eureka before your wedding this fall. A bachelorette? There's a great lingerie shop up there. Not like Dillard's - a true sex shop with lots of other fun things to look at.

Girl 2: We went there together not too long ago - it was great. We shared a couple of bottles of wine over lunch, left the kids in the magic shop nearby. I was a little nervous, but she just plowed right in. I heard an oof from the dressing room and queried in alarm, but she said the shop girl was just tightening her corset. We ended up getting outfits that kind of matched.

Girl 3: Y'all were in a different kind of magic shop.

Girl 2: Oh, and I also tried the tightening cream.

Girl 1: I wasn't really into trying the tightening cream.

Girl 4: What? There is a tightening cream? I thought only surgery could do that!

Girl 2: Yes. It really works, it's amazing. You apply it by rubbing the cream on the inside, and by the time you are done with that part you are already halfway there ;)

Girl 4: So how does it come? Like in a toothpaste tube? I've never heard of it.

Girl 2: You find it in the corner of the store. It comes in a fuck's worth.

Girl 4: What did you say?

Girl 2: A fuck's worth.

Girl 4: That is the denomination? So I guess you want to buy more than one.

Girl 5: Does it work on the guy too?