Tuesday, April 25, 2017

Gross Room

3:30 pm.

Me: I told him that I was 80% sure it was parathyroid. He's sending more. Guess I'll wait. He gives me less than the brain surgeons! What does he expect - Sorcery? Witchcraft?

Jessica: I'll freeze it. Hey, did you ever hear anything back from that neurosurgeon that did the Sunday elective? Is he still doing that?

Me: No! We've got admin backup. But I don't think I need it. Strange, I've never met him, he's been here 1.5 years, but I've seen him four times in the last few weeks. First time, in the front hallway, he studiously ignored my attempt at eye contact. Second time was in the parking garage stairwell. I said, "Good morning!" and he replied kindly. A couple of days later I saw him in the doctor's lounge, and he said hello to me. He must have checked my creds and run the situation by with other doc's and realized I wasn't just messing with him. We really, not just us, also OR, are not prepared for Sunday electives.

Jessica: Great! I know right? It's not like this is UAMS.

Me: Right! We are civilized here. We don't respond to crazy egos wanting frozens in the middle of the night. Cardiothoracic surgeons cannot have sex in the stairwell with their nurses. Chairmans cannot screw their business admins in the wee morning hours and get caught by janitors, only to be the butt of every joke on campus except from those in power protecting their bad behavior. We don't bring that stuff to work. We don't do elective surgeries on Sunday. That's family day. (Well, there was the incident with the sink being ripped from the wall, but we all talked and laughed about that, we didn't just brush it under the rug as normalcy.)

Evans (ponytailed motorcycle head of gross room - well, not head anymore, I took over last week as the lead pathologist over the gross room and my first move was to make it a triumvirate with Jessica and Laurie. Everyone is happier. I told them not to fight about who gets to be Julius Caesar, or Pompey, or that other one Crassus that no one remembers, just divvy up the duties to their satisfaction): It didn't used to be that way.

Me: Really? Nefarious things in the past? Do tell.

Evans: Certain people forgot to lock the doors when they were doing things they shouldn't at work. That didn't last long. They got exposed.

Me: Good. That shouldn't happen here. In my experience, when crazy stuff flares, it gets quieted by the reasonable members of our hospital. I hope they keep it that way.

Jessica: Weren't you wearing something different when I saw you this morning?

Me: Yes, I went home and changed. Forgot it was our head cytotech's family member's funeral today and I really wanted to attend, and not look like I was going to a dance party. It was at St. Mark's on 12th street.

It was amazing. He was incredible. Largest and possibly best funeral service I ever attended. Glowing tributes from best friend and brother. Beautiful sermon. Live music so good I got goose bumps. I sat next to the youngest daughter's best friend. I watched her eyes well up, and told her she was so strong and supportive to be here for her friend, who will be needing her. She smiled. I was glad, as I headed back to work, that I didn't know what an amazing good person he was when I did the post last week. I would have been incredibly intimidated, and probably screwed something up. The service made me want to book a flight to Mayo to make sure everything we needed was done right.

Jessica: Here's the other frozen.

Me: It's smaller than the other one. It's just fat, adipose tissue. I'll call and tell him.

Jessica: Is he sending another?

Me: He didn't say, so I'm going to bet no and head back to my work. Thanks a bunch.

Monday, April 24, 2017

Dinner Conversation

It was just me and J. C was coming home late from a track meet and I was trying to nourish him before the annual Spring Chorale concert at the school - he loves the choir. I cooked last night, but tonight was just mac and cheese and hot dogs and watermelon. Comfort food.

"There's this girl, she's definitely the nerd of the grade. She works really hard, always does the extra worksheets."

"She's super cute. I know her parents, they are both docs like yours. She will probably go far. Who's the boy nerd?"

"Definitely me. There are other ones, but I'm a nerd. I mean, I'm the only one who always has my nose in a book. All the time. But I'm smart, I don't do the extra work she does. I don't have to study. But I think all her extra studying might come from her parents? I'm not sure. She's really smart."

His nose in book constancy is the subject of parent-teacher conferences. He even has his nose in a book over recess. "The not having to study part will probably change. But I was a nerd too. The apple doesn't fall far from the tree. You remember, we tried you out in all the sports. You always had your head in the clouds. That was me. I'm glad you and C have finally found some individual sports that you like. And you have a best friend! He's awesome. Popularity isn't everything."

"So if you could choose between flying and telepathy, what would it be?"

"Definitely flying. Telepathy is for the birds."

Friday, April 21, 2017

Tumor Board

The Nightingale: So I've got a proposal. Pharm wants to come to our tumor board, and bring food. I'm reluctant. What do you all think?

Rad, Path (me), Rad/Onc: No.

The Nightingale: I agree. It's a safe space, for us docs and our patients. As soon as they come along, it will become about them. Let's keep it this way.

Me: Did you meet Dr. Kahn?

He's the Cyd Vicious of pancreatic pathology. He does EUS, and he's really good, and I'm so excited he's here. I'm pulling my pancreas book out and dusting off the muck (I was GI path so I knew it well way back when), and he's unearthing pancreas pathology that we haven't seen here in the past ten years. He's also ordering studies I've seen at conferences but haven't yet made it to Little Rock. Until now.

The Nightingale: Yes.

Me: Good. Oh hi!!

Big hug to St. Vincent pathologist friend.

B: Wow this is beautiful. I haven't been here before.

Me: Welcome. Glad you all are here. Can I introduce you to oncologists?

B: Yes, I've only met them over the phone. Please do.

Cyd: I think the pathologists are dominating today. They will soon take over.

Me: Lol yes. Ratio is 2:1 pathologist vs. other docs. There have never been so many here. That's how it should be.

The Nightingale: 7:00 a.m. Let's go. Can I take the first case? I've got someone who can really use our help.


Wednesday, April 19, 2017

Friday, April 14, 2017

Rate Limiting Factor

the slowest, therefore rate-limiting, step in a process or reaction involving several steps.

Today my rate limiting factor was my shoes. They reminded me of a hang up in an organic chemistry experiment. I bought them last Saturday, and after wearing them to Sunday School I knew they weren't practical. But they looked so good (confirmed by random stranger in the hall today) and matched my dress so I went for it. "What could go wrong?" my mind rationalized against my senses. "You'll maybe have two frozens. It will be ok, you sit at your scope most of the day."

I was sitting at a stoplight this morning at 8:02. I'm on call, I should be at work at 7:30 a.m. to cover the OR, but I've learned to push the envelope, and 99% of the time it works out. My phone rang. "We've got a frozen."

"Ok, I'll be there in five minutes."

The interminable stoplight finally changed to green. When I got on the interstate I gunned the accelerator to 90. Stepped out of my car in the parking lot and realized my dilemma. I could not run in these shoes. My normal walk is faster than the average female jog - I'm not a superhero, I've just got long legs. But these shoes rub and elevate me to an awkward stance - I've got to slow down to the average human speed. I finally reached the gross room three minutes past my estimate. I internally cringed when I realized the head of the gross room had not even started the frozen. But he had a good reason.

"Seasoned OB wants to freeze the cervical cone."

"What? What OR is he in? I need to call him. We never do that." My purse was dangling on my arm.

"I knew you would want me to wait. Here's the number."

Call seasoned OB, get him on the phone. "Can you tell me what you want? I haven't done this but once in ten years. She wanted to know if it was invasive cancer to do a surgery."

"That's what I want to know."

"Freezing tissue compromises the specimen. We cannot evaluate for dysplasia. Your specimen is huge. It will take us 45 minutes to an hour to freeze this tissue. Can I freeze a representative section? We cannot identify microinvasion grossly, so there are no guarantees."

"Ok, yeah, sure, one section is fine."

Fifteen minutes later. "No cancer."

"Thank you."

I was called to the gross room an hour later. "What? Breast surgeon is freezing the breast? Why are we freezing cervical cones and breasts today? Has the world flipped upside down?"

Fifteen minutes later. "You've got everything on this slide. DCIS, invasive cancer."

"Thanks so much."

Luckily no more frozens, but busy day. Double surgical load (with double reimbursement to boot) and call duties. Plus I was reminded scrolling through FB on a short break at 2 it was National PA (physician assistant - that is, all the people in the gross room) Day. Crap. The walk to Tipton and Hurst to buy gifts to bring to the gross room normally seems short, but with these shoes it was like 10 miles. But I did it. I took over the gross room from our chief last week, and am already orchestrating many changes behind the scenes. I'm so excited - micro and the gross room. My two fave departments. I feel like I'm on top of the world. But the cost of staring Dr. Music right in the eyes (I told you I would find the shoes that I could look down on you someday soon) is steep. No pun intended.

Preview shows unintended highlights. I've got to get up early and I'm in no mood to problem solve this issue, so enjoy.


Edited to add pic of shoes per Maren's request. They do look pretty badass, right? From now on, only for limited walking like out to dinner. 

Tuesday, April 11, 2017

Doctor's Lounge

To be fair, I was an eavesdropper, not an interlocutor. I was just getting some afternoon coffee.

ED doc: I was a senior in college. She was a freshman. She agreed to a date; I was on top of the world. We were in my car, I was playing Beach Boys and singing along. She asked me, "Who is this singing?" I was so proud to know the answer, and to explain it to her. "It's the Beach Boys." I kept singing. She said, "Can we just leave it to them?" Man I was crushed. My whole world exploded.

Me: LOL! Mean, but you've got to give it to her. I never think of clever things to say in the moment until a couple of hours later.

ED doc: Yeah, I've got to hand it to her. Here I am 30 years later, still thinking of that. She took me down a notch, that's for sure. I can't forget it.

Friday, April 7, 2017

In Case You Were in Doubt



I've got my hands in my pocket, and I'm waiting for the day to come.