Wednesday, January 18, 2017

Ubeats

Worth every penny. Y'all. That bass.

Tuesday, January 17, 2017

Gunshot Wound to the Abdomen

I called Dr. Woods on the intercom.

Me: So I have this specimen full of hemorrhage: kidney and most of the colon and small bowel. Requisition says gunshot. I open the EMR for the clinical, thinking I would be seeing some street war story. Instead, this 40 something year old guy was taking sleeping pills, and shot himself in the abdomen. He doesn't remember, but it was self-inflicted. Apparently the wife was taking sleeping pills too, and doesn't remember anything either.

Dr. Woods: I think they were taking more than sleeping pills.

Me: Doesn't the story seem fishy to you?

Dr. Woods: It certainly could have been the wife.

Me: So was it a cover up? Would she have shot him and convinced him in his compromised state that he did it to himself? Was he defending her? Or was she pulling the wool over his eyes?

Dr. Woods: It was most certainly the wife. The wives are always fiendish.

Me: Fiendish wives almost always have a reason for their behavior.

Monday, January 16, 2017

Andalusian Horses

I was at a birthday party in the back room of Ciao Baci tonight, from 5:30-7. The party girl is an OB I know through my kids.

She repeatedly introduced us to each other, when a new girl entered the room. "She's my divorce guru." I'm a divorce guru, I guess. She's turning 37 - the same age I was when I got divorced. I remember, because I put my birthdate on Match.com and that's what turned up. I was honest, which is more that I can say for this one guy I met, who was about ten years beyond his stated age.

We had lunch at Pizza Cafe. He was obviously hung up on his ex. She raised Andalusian horses. He was a bronze Olympian medalist, swimming I think, in a former life. Now he was IT, working on his Master's degree. He had Allport's syndrome, so was very hard of hearing and had kidney issues. Was also sterile, so when his wife got pregnant, the marriage was over.

We had a few phone calls after the lunch, but things fizzled quickly. Once there was a tornado alarm and I was sheltering under the stairs. We talked. He was also hung up on another ex-girlfriend - a single mom with two girls. He had once rescued them from a tree falling on their house - he liked to tell the story. He seemed to want me to be afraid, and to want to be rescued.

"Aren't you scared? There's a tornado alarm. Do you need me to come over?"

"No, I'm not scared. I'm fine. If you need someone to rescue, you are knocking on the wrong door. Go back to your ex-girlfriend. It was nice talking to you."

I sat in between a beautiful ENT to my left and my friend's OB partner to my right. The OB announced, midway through cocktails and appetizers, "Just look at all the talent in this room. There is unlimited potential here. OB, psychologists, ENT, yoga instructors, cRNA's, we can get anything done with the people collected in this room. This is power!"

"I can do autopsies, when you all die."

Love pulling that party trick.

Sunday, January 15, 2017

Centering Prayer

The guest speaker at Sunday school was - let's just call it like it is - a freaking badass.

She has three kids under five. She went to Harvard and works at Stephen's. She has worked with refugees in Africa. She has studied in Indian ashrams. She knows my new orthopod friend from book club - we bonded over that before class started.

She told a little of her story. She studied hard, and got to her goal, only to realize that her goal sucked. So she learned about centering prayer. The Catholics dug it up, it's like Buddhist meditation, but the Episcopal's have been responsible for knocking it out of the ballpark lately. There's a place of silence on Chenal Valley Road, called the House of Prayer, inviting anyone from any faith to worship. She knows the people that started it. She shared a little of her own hardships in life - we all have them, and it gave her street cred. So when she asked us to meditate in silence for five minutes, we were all, albeit somewhat reluctantly, game.

"Here's what I do. I just meditate in silence. Once we start, sounds that are happening that we all aren't aware of will come into focus. The clock ticking. Someone walking by outside the door. Our job is to let all that go. I use a word - my word is Jesus. But it isn't like a chant. It's more like a word to ground me when my mind is wandering - thinking about the grocery list or what I'm going to do about dinner. It centers me."

We started. One of the founders of the group pulled out her mediation app and set if for five minutes. A gong went off, and there we went.

Last week, our guest speaker was a gritty divorce lawyer who was also a healer and a practitioner of Qigong. She was amazing. After everyone left, she told me I held all my stress in my lower back. So I told her about my premature pregnancy and having to find a chiropractor to move again. Then she looked me straight in the eye.

"You have had some major emotional trauma lately. Your lungs are fine, but you have pleuritis. What happened?"

I told her about New Year's Day. "It was one week ago to this hour. I'm walking a lot on the treadmill, doing as much yoga as I can, trying to open things up because I feel closed and shut down and sick. Monday and Tuesday were hell, but I feel like I'm back in the game."

"Can I tell you about a mediation that can help you? When you breathe in, breathe white light. Make it hot. Not so hot that it causes pain, but hot enough to burn that shit out. You've got to burn it, or it will never go away."

So when a gong sounded this week, and our five minutes were over, we shared about our experiences. Some said - "That five minutes seemed like thirty." Others said, "that was the hardest thing I've ever done in my life."

I said, "When I was a teenager, I had bad stomachaches. A counselor once told me when I got them I should lay down and breathe. Pretend I was breathing in white healing light, and target it to my stomach. Then breathe out the pain - make it a color. I chose red. It helped - the breathing, the color imagery. My five minutes seemed like one second. I used color imagery - used white light to target not physical but spiritual pain. It felt like it was working."

Guest speaker: I love that. It doesn't have to be a word - imagery can work too. I've heard of some people that use imagery in their centering prayer. It's been great to be here. I've never been asked to share, and speak about this before. This is a first for me, I hope not a last.


Saturday, January 14, 2017

Doc Mom Book Club

Oncologist's house, 2:30-5:00pm. I got the book pic, since I hosted the last one. A Man Called Ove. We were discussing how he stuck to his principles. Knew how to fix things. Breast radiologist raved about her grandparents, who grew up poor. They couldn't call an electrician or a plumber when something went wrong - so they figured out how to fix it. We were all getting worked up telling our stories.

Breast radiologist: And my son is going to learn how to drive a manual transmission! I've been looking for a car for two years, and finally bought one this week. Took peds to my right for a spin this week.

Peds: It was incredible.

Me: Ok, you've set the bar too high. No manual for me, I never even learned that.

Breast radiologist: I had very specific specifications. I wanted a manual, but also with heated seats and a back up mirror. I wanted a car made in America - that didn't exist two years ago. I test drove everything. The Subaru (something something) was nice but Car Talk says their (something) craps out at 40,000 miles. I didn't want that. I got a Ford Focus ST. Only 4,000 made.

Orthopedic Surgeon: OHH! What color? What horsepower?

The rest of us were watching in awe and amazement.

Breast rad: 350 horsepower. White.

Me: You are talking a language I don't speak.

My path partner: I'm pretty sure the Range Rover I bought my husband doesn't have that much horsepower.

Breast rad: My brothers turbo engines and build drones on the weekends. This is my lineage. Here, want to see a pic?

Orhopod: Look at those rims!!

Me: What are rims?

Breast rad: I got new tires since that pic. Ordered them on the internet, and my husband put them on last night. I don't have a pic with the new tires, but here is a pic of the tires I ordered.

Everyone: Oooh. Aaaah. Nice. Understated. Elegant.

Breast rad: So I was driving it yesterday, and a Subaru (something something - hell give me credit for memorizing the name of her car) pulled up next to me. He was looking over, I thought he was challenging me to a race. I'm like DUDE! No fair. I'm boxed in. No contest. Then I really looked, and he was giving me the sign.

She held up her hands with thumb and first finger in a circle, the last three fingers extending upwards. Universal sign, even underwater when scuba diving, for I'm ok. Or you are ok.

Breast rad: He knew how awesome my car was, and he approved! Y'ALL! I'm in the club!!!!

Orthopod (she has a two and a one year old. Irish twins. A tiny circle of hell. She's about ten years younger that the rest of us - from Chicago. Husband from the South Side - he's anesthesia. She regaled us with a hilarious story of a rented minivan and road trip to Chicago for Thanksgiving that ended with her flying back with the kids and her husband driving the minivan home alone. We all remembered those days): Can I tell you my recipe for lemon curd in a blender? It's divine. It's my grandmother's.

My path partner: You mean you don't use gelatin?

Orthopod: No, the butter does the trick. You don't need gelatin.


Friday, January 13, 2017

Narrow Misses, Part 5

Me: Here's the cases. The pleural fluid is full of signet ring cell gastric carcinoma. Mucicarmine lit up like a Christmas tree. After you look I'd like them back, to show the cytotechs.

I pull the earplugs from my ears to be able to hear her.

Me: Sorry, I forgot these were in. Drilling started around noon. Surprised me, it's been a few weeks. Driving me crazy. Luckily I got most of my work done before it started.

Dr. Earnest (I say this in the kindest light - I was Dr. Earnest my first five years here. I recognize myself in her, and she makes me happy): I know right? I hear this knocking, from this vent in the ceiling, every day. It's unpredictable, but it's daily. It's like there is someone living up there, constantly reminding me of their presence. Every once and a while a shower of dirt and dust will descend upon my desk from the vent. There's something going on in there. I'm convinced someone lives up there.

Me: I'm glad you alerted me of the gastric cancer. Signet ring cells look exactly like normal mesothelial cells, on cytology. A week ago he didn't have the diagnosis, and I just thought they looked a little atypical. I called the oncologist, and amended my report. Metastatic cancer will make a huge difference in staging, prognosis, and treatment.

Signet ring cell carcinoma is the sneakiest cancer of the lot. Everyone has a story to tell, of how they missed it. Dr. Earnest alerted me not only of my miss, but another seasoned pathologist missed it in an earlier gastric biopsy (1mm lit up on immunos. We all would have missed it on morphology). Luckily all of these specimens were taken within two weeks of each other. No harm to the patient.

Reminded me of myself, two years in, discovering a mesothelioma that three other senior pathologists had called negative. Again, normal time frame - no harm to the patient, but still. Gives you the shakes, knowing there are cancers out there that elude our routine evaluation. Still, we argue, it's not reasonable to stain every normal appearing tissue to look for something we will only come across once every five years. The money spent in stains would be a ridiculous waste to the system. It's a hard balance between being thorough and correct, and being judicious with the tools we have on hand. In my experience, as long as we are in good communication with our fellow clinicians, we will get the right diagnosis in time to start treatment, despite occasionally falling victim to the morphology that betrays us.

Thursday, January 12, 2017

Cold Moon

Bronch #1 - hilar nodes.

Me: Blood. Still blood. More blood.

Cyd Vicious: Fuck. I thought I could get it.

Me: This slide is still blood.

Cyd: I'm done.

Me: She seemed like a tough patient. Coughing, talking.

Cyd: That shouldn't have affected anything.

Bronch #2 - hilar nodes.

Me: Metastatic poorly diff adenocarcinoma. Doesn't look like colon, unless it is poorly diff. When colon goes to the lung, it usually retains it's architecture. Picket fence nuclei. Dirty necrosis. This is ugly and clean as a whistle.

Cyd: He doesn't just have colon cancer. There's lung too.

Me: Oh! I didn't know that. Could be ugly lung. Get a good cell block so I can stain it up.

Cyd to nurses: I need to get to the contralateral node and see what's going on.

My tech (not hearing about the contralateral node): Are you done with us?

Cyd: Sure, I'll just put the rest in cell block.

Me: Are you sure? I can stick around. It's 15 minutes until my lunch (garner guffaws from the nurses and respiratory therapists).

Cyd looks up from the procedure into my eyes.

Me: I'll stay. No problem. That's what I'm here for.

Cyd: Ok, sure. Sure.

Me: Lots of lymphs, heterogeneous, and no cancer. This is a great sample. I think the contralateral side is clean.

Cyd: Ok. That's what I thought. Makes a big difference. Thank you.

I walked out of the bronch lab, mind on Boulevard Soup. Vietnamese Hot Pot today, I discovered when I got there. It felt good, having my time valued by an esteemed colleague. Many lesser clinicians take three times as much of our time for granted. It made me feel light and ever willing to stay in the fight.

The Cold Moon is also called the Wolf Moon. It is one of the longest Full Moons, as nights in January are long and dark. It is both painful and transformative.