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.

Thursday, April 6, 2017

Tumor Board

The Tigress: I've got this patient. Two separate lung cancers. Small cell and adeno. Not sure what to do with her. She'll accept resection, but she's opposed to neoadjuvant therapy. Only the natural stuff. And, by the way, that includes cocaine.

The Nightingale: Oh, well, since chemo's out of the picture, let's do resection. And I'm not sure there are a lot of studies out there about cocaine and cancer? Maybe it will help? We can hope.

Ancient thoracic surgeon: Anyone who considers a surgeon's hands natural should maybe think twice.


Senior year pic I found in an office drawer today. Ack that sweater vest and those 90's earrings. And chunky chipmunk cheeks. This was obviously before my late 20's when I discovered how to use the three items of make-up I use today. But that hair! I'd kill to have it back. 

Wednesday, April 5, 2017

Fan Crush



Have you ever identified with a celebrity in a little overly familiar way?

For me it was Louis C.K.

Granted I learned about him from a rebound after my divorce. I was mostly reading books only, but after a few episodes of his show I became addicted. He's a single parent like me. His show cracks me up, and I need a little laugh in my misery. Um, can I just go out for pizza with him after he does comedy on a night without kids? I fantasized about commiserating with him. I sort of stalked him.

So I was super excited when it was announced that he would drop a Netfilx comedy show in April. But I was so damn busy yesterday that I didn't check my calendar and forgot. More damn busy today. No worries. Season ending of Walking Dead was suffice.

So I jumped on it tonight. Laughed so hard I worried my kids. I needed that. Shitty day. Laughter is the best medicine.

Tuesday, April 4, 2017

Alternative Facts

You know your day is going to be long when it starts the day before. I got a call from my chief carpooling my son home from after school activities.

"It's 6:30, I'm still here, this call already sucks. (Don't know if you remember, but the pathologist's motto is When the Clock Strikes Four - We Hit the Door). I need to tell you there's an autopsy tomorrow. It was ordered Saturday, but there was a problem with the EMR. We just found out about it at 4:30, you were already gone. I'm up, but since you are covering me tomorrow you will have to do it."

OK, I'm thinking, his call sucks and I have an autopsy tomorrow that was already ordered and supposed to be his? While I'm covering call duties and OR? "Have you called the physician? Maybe I can get rid of it."

"No I haven't. I think she died two hours after she got discharged. It's been chaos."

"An autopsy isn't an order, it's a consult. I'll call the physician in the morning, don't worry about it. Take care of your wife." She was having a minor medical procedure, and I was covering him so he could support her.

I called the cardiologist first thing in a.m. Explained our policy. "We do this pro bono for physician inquiries. We refer families to private autopsies. Do you have a question?"

"She's pretty young, I just want to know if there's a PE (pulmonary embolus)."

"OK, I can do that for you. No problem. This is just a big bomb into my already full day. Can we limit it to lungs and heart only?" I'd heard she was pretty big. I didn't feel like mucking around in guts all afternoon.

"Absolutely. Chest only."

I entered the gross room about 9 am to set it up with the deaner. He's the head of the gross room. Got a new motorcycle recently to match his long silver ponytail. An ex criminal defense lawyer. He's got two speeds - gruff and silent vs. entertaining and loquacious. This morning it was the latter. I perused the death note. "It says here she died in the hospital. I was told she died at home. Where the heck are we, Washington D.C.?"

"Propaganda. Smokescreen. Rumors. Alternative Facts."

"Yes! Alternative autopsy facts. We don't need that around here. Let's set it up for 12:45. That will give me time to eat lunch after covering morning frozens."

Thirty minutes later I get a call from a secretary. "They are ready for you in bronch lab."

"Um, I'm not covering EV this week. Where the heck is Palmer."

"He's at jury duty. If he doesn't get picked, he will be here around noon."

After covering bronch lab I send a text to chief. "WTF??"

"My fault, he told me but I didn't tell you. Autopsy chaos." My angst leaked over to my head transcriptionist. "Did you just cuss?" "Yes, I'm sorry, I'll try not too."  "No, I thought it was really cute. I've never heard you cuss." "Ok, I'll do it more often."

So I'm covering OR, bronch, and scheduling an autopsy. Unprecedented, in ten years. It was a helluva busy morning. I went to PMG pathology for support. Got lots. Someone made me a meme. God I love PMG pathology.



I called the morgue at 1:00. "Can you please call me when you are ready to open? I'm trying to get through my surgicals."

Head down the morgue about 1:30. Get lost (it's been almost a year and it's confusing down there). Get guided. I enter the morgue and there are 10 people, mostly young women, gloved and gowned and masked around the dead body and my deaner, who is clearly enjoying the audience. "I'm sorry, we used up all the gowns. There aren't any left."

"No worries, I'll just steer clear of the juicy parts. I will glove up though. I plan to stick around for the eval of the PE, then I'm headed back upstairs to work."

"These are all nursing students. Happened to bump into them and they helped me load the body on the table. It was hard."

"I know a tech at the VA who is still drawing a check from disability after dislocating her shoulder moving a 600 lb. man onto the table. This one's only half that size. Glad you could get help. I get the gowns, but why are they all masked? This scene looks crazy."

Nursing sup spoke up. "I'm their supervisor. I mandated it."

"No argument there. Students need the most protection."

The deaner started the Y-shaped incision, fueled by the nursing students surrounding him and asking questions in awe. I laughed internally at two of them earnestly holding the massive breasts that were now covering her face. As if it was helping. As if they were needed. Well, damn, we all need to feel needed. I told a few crime lab stories to add to the entertainment.

One girl couldn't handle it. "I see deer all the time, but this is too much. I'm going to go sit in the other room."

Others were manic. "Never seen deer here, but this is so cool!"

The deaner preened. "No no, she's the MD. I'm just a JD. Now look at how I can find the right junction between the cartilage and the ribs to use the scalpel. Oops, no, this is too hard."

I asked him, looking at my watch, "Can you just get the bone saw?"

"Oh, sorry, I know you have a 3:00 appointment."

"I'm just going to stick around for the evaluation for the PE. Then I'll leave you to your teaching exercise."

Finally the sternum and the ribs were excised. The heart, when pulled from the chest, seemed abnormally large. Unusual - large people have normal sized organs. There was no PE, deaner confirmed, after first accidentally searching for one in the aorta. I met his eye. "I was thinking that wall looked too thick to be a pulmonary artery. Let's fix the organs and finish at the end of the week. Thanks for your help."

Monday, April 3, 2017

15




1983 Oldsmobile Toronado convertible and this album - Don't Tell a Soul. It was a rallying cry. Camp Aldersgate, Senior year. How I discovered it I've no idea.

Doctor's Lounge

Admin: Did you happen to talk to new neurosurgeon?

Me: I did. I bumped into him in the hallway end of last week. Saw his name on his jacket, and introduced myself. He thanked me for doing the frozens. I explained to him that we don't do elective brain surgery on Sunday. I think I flustered him a little. I was very polite, but I'm worried I made my first enemy here. He said he would do his cases whenever he wanted and walked away.

Admin (former OB who delivered C): I never did elective surgeries on Sunday.

Me: No one does. It's for emergencies only. And he didn't even give me a heads up. I was yanked out of Sunday School, then a mother and daughter brunch downtown at South on Main. I finished my brunch and carpooled my daughter home, but still.

Admin: The OR is not equipped for those cases on Sunday.

Me: I know! They were more surprised and upset than me. They asked me to talk to someone for them. I promised them I would. Is that guy from around here? I mean, it's tradition, I've been here ten years. No electives on Sunday. I told him that. I think he got the message.

Admin: Well, somewhat. He's military. Moved around a lot. Let me know if that happens again. I'll have head of anesthesia talk to him.

Me: Thanks, I'll let you know.

Sunday, April 2, 2017

Sunday

I did a lot today. Baked muffins. Went to Sunday School. Read a not yet released entire book for a friend on MIM and reviewed on email. Hiked the hood. Went to yoga despite the fact that my arms were screaming in pain from doing push ups yesterday. My legs are super strong. My arms are super weak. I worked hard yesterday to hide that from the yoga watchers. Six push ups almost did me in. I feel like my arms today are going to fall off with any slight effort.

And I'm hyperkinetic. I can't relax. I spent an hour prepping a Blue Apron meal for tomorrow night. I've no idea what I'm covering tomorrow, because the schedule wasn't yet made out on Thursday afternoon, but I'm ready for whatever.




Shapeshifting



I've been shapeshifting this month. Metaphorically. On another plane. Have you ever read about the dragonfly? It can see 360 degrees and travel up to 45 miles an hour with minimal wingbeats compared to other insects. It's wildly efficient, and has been revered for centuries by many cultures.

It represents, among other things, resilience and metamorphosis.

I've got lots of dragonfly totems in my office. A bit of an obsession. And to inhabit? Pure bliss.

Saturday, April 1, 2017

Mutual Parasites

Did you ever need someone as much as they needed you? And do they even know it?

Sorry? For what?!!??

Friday, March 24, 2017

Firefighters

8:00 a.m.

Admin: Good morning! Dr. . . . how do you pronounce your new name?

Me: Dr. Sang, like I sang a song. I get Dr. Sing a lot though. Seng is German, if you can believe it, they dropped either the E or the UE at the end when they emigrated. Kind of like Nestrud had a dropped E. I guess the process of emigration was so chaotic a lot of last names got botched. This one is a little confusing, but it's definitely the easiest last name I've ever had.

Amin: I hope you don't have to work this weekend?

Me: Finishing two weeks in a row of call. Actually looking forward to Monday. It's been crazy quiet for Spring Break though, knock on wood.

Admin: That's a long time! I have admin call this weekend too.

Me: I didn't know admin's had call! What do you do?

Admin: We give a presence at the Little Rock and North Little Rock hospitals. Do rounds.

Me: Interesting. I guess you put out fires?

Admin: Yes. I'm headed to an emergency meeting now to do just that. You will probably read about it in the papers. Our head of pastoral care was arrested last night for soliciting prostitutes in Southwest Little Rock. We need to do a press release.

Me: (LOL) That's quite a fire!! Good luck with that.

I googled it when I got to my office and sure enough Fox News had already reported it. The mask of religion so often hides desires of the flesh - luckily I don't know that guy so I can find the humor.

Friday, March 17, 2017

Gross Room

8:15 a.m. - a phone rings in my office from the gross room PA.

"OB surgeon wants to do a frozen on a cervical cone. It's a tiny specimen, I could probably get it all on one slide. But freezing a cervical cone? What do you want me to do?"

"You are right, that's weird. I'll call the OB. What OR is she in?"

"OR 6."

"OB? Can you please tell me why we are freezing a cone?"

"I'm so sorry, I should have called you. I know this is unusual. I'm giving her a hysterectomy. I just need to know if there is cancer or not. It will change what I do."

She detailed the history, the previous procedures, and the decision making process that carried her to this point. She's an amazing surgeon.

"No problem, we are happy to do it."

I wander slowly to the gross room. It will take 15 minutes or so to freeze an entire cervical cone. I lament on the way there to a phlebotomist about the current construction that necessitates double the amount of walking. The worst of which is part of the way involves the main entrance hallway, where it is easy to get stuck behind patients or generally slow general visitor population. He empathizes with me, and tells me he hears it will be about three more weeks before the back way opens up again. At least I don't have to push a cart like he does, I think.

I finally enter the gross room full of five P.A.'s and look up at Jessica. "Oh! You look fantastic. I love your glittery hat and your shirt. I knew it was St. Patrick's Day all week, but I forgot this morning. Thank goodness Baptist Hospital color is green. It's on my name tag, my only green in my outfit. Your hat is amazing - love how it contrasts with your strawberry blond hair."

"Thank you! See - it says I'm a wee bit Irish. And it's a wee little hat. I found it at Kroger last week. No forgetting in my family - it's a National Holiday. In fact, I really should be carrying around a pint of Guinness all day long."

"Can I give you permission to do that? If so, I'll grant it." I move in closer to Jess and Laurie.  

"Look at this ring I got in Chinatown! Five bucks. I love the vintage look. I've been wearing it all week, and it hasn't turned my finger green yet - I take that as a good sign. I've never worn more than one ring on my ten fingers, I'm kind of liking it."

Jessica replied, "When I met Houston I wore a ring on every finger. I was crazy flashy. Now I only wear my wedding one."

"It's beautiful. Y'all did good. And I almost forgot to show you my new Swatch watch! Brand new series."

Laurie asked, "Do they still make Swatch?"

"There was a whole store!! The kids weren't very interested, so other mom took them to the next stop. I was there over a half hour, trying on every watch that fancied me. This glittery band series, it's super lightweight, had three colors - gold, silver, and rose gold. I was drawn to the rose gold, but when I put it on it disappeared. Seems my skin is rose gold."

"But that would have been kind of cool!" cried Jessica. "It would have looked like the watch was growing out of your skin."

"Yes and no. I chose the silver. Nice contrast."

Laurie looked up from the uterus she was grossing. "I had the Swatch with the white band and the red, blue, and yellow face. I loved that Swatch."

I looked at her incredulously. "That was my Swatch. I had the same one. I loved how when I got tan in the summer the white band contrasted with my skin like a beacon. You could have seen it from miles away."

Laurie and Jessica both laughed. Laurie is a dark haired alabaster skinned beauty, and Jessica is a pale fiery Irish redhead. Jessica said, "The one time I tried to tan I ended up in the ER with severe burns." Laurie concurred, "Tanning is not something I'm good at."

Steve H. interrupted our reminiscing. "Frozen is ready."

"Oh thanks. Man, wow. This is amazing. It looks like an H&E. You got great mucosa on every slice. It's clean as a whistle. No cancer. I'll call the OB."

The sigh of relief was palpable over the OR phone. "Thank you so much. I'll proceed now."


Incipient Murderess

I got a call from an endocrinologist early this week about an adrenal case I had signed out with Dr. Music in December. "The symptoms are coming back. Are you sure it's medullary hyperplasia? Are you positive it isn't an incipient pheochromocytoma?"

"Well, I trained with a chair who wrote the first adrenal fascicle, he's a world expert, but admittedly these cases are rare. I haven't seen a pheochromoctyma since I trained. Would you like me to send it off?"

"Yes please, where will you send it to? How long does it take?"

"I know a guy at Cleveland Clinic, Dr. Genius. I trained with him when I was a resident. I've never sent an adrenal out, but I'm sure he can handle it or show it to someone who can. He's the quickest turnaround I know."

"Thank you so much."

I told Dr. Music the plan, since his name is on the report. "Sounds good, yes send it to Dr. Genius."

I got an e-mail from Dr. Genius last night. "Family's great, thanks for asking, I'm traveling way too much for work. Your case just showed up on my desk. As expected, no tumor."

I bragged to Dr. Music in the hall this morning that as usual when we have a finalized case that gets sent out at the request of the clinician we were right.

"What the heck is an incipient pheochromocytoma anyway? Have you ever heard of that? By the way, incipient is my favorite word this week, thanks to that endocrinologist. I've decided this morning I'm an incipient murderess. The drilling has become so loud and incessant that I had to dig out my earplugs and wear them again, but they only dull the constant din. I'm not sure of my target yet, but when it happens it will be very spontaneous and chaotic. Watch out."

"I have never heard of an incipient pheochromocytoma either. Is that a thing? I haven't googled it yet. By the way, isn't this (he points to his arm) an incipient tumor? Aren't we all incipient tumors headed for the Grim Reaper?"

Turns out there is such a thing as incipient pheochromocytoma. This is the full blown malignant pheo.

Zellballen sheets of polygonal cells in a complex vascular network

The gross image is super disgusting so I'll leave it out of this very clean prim and proper blog.

Thursday, March 16, 2017

Musings

It was fun tonight, to see Phantom of the Opera. It was, if I understand correctly, the first time the Broadway production has come to Little Rock. I saw it over 20 years ago on Broadway. I still love some of the songs, but I had lost the context. I remember fidgeting and squirming through the second act when I was a teenager, but as an adult I got the psychological nuances parlayed through song that aided in character development. She wasn't just a victim of circumstance - Christine - she was a complex character that was searching for a father figure after the premature loss of her own. And the Phantom wasn't a monster but his circumstance created one - his disfigurement and confinement cut short a promising early bright start, warping his personality. I didn't get all that back then.

It's tough listening to a soundtrack without context. I struggled through Hamilton last summer, but after seeing it, and becoming surprised and enraptured in my daughter's enjoyment of it last week in San Francisco (tonight, it was my son - he loved Phantom), the music finally presented itself to be appreciated.

Warning: whining about to happen.

I lost my pager when I was on call Christmas week. I don't lose things, so I imagined it would turn up sooner or later, but it hasn't. I slowly started doling out my cell number to all the cytotechs and secretaries and gross assistants. I found it much easier to keep up with one thing instead of two, and much more efficient for everyone to just text when I had a frozen or needed to go to read a needle. So I told my business manager to cancel my pager service. I feel no longer stuck back in the 1980's. It's freeing.

10 years ago, when I joined my group, one of my partners approached me and asked if I would consider giving him some of my call for money. I was worried about what my other soon to be partners might think about my work ethic, so I told him I would be happy to pending approval by the board. They approved. I have given up half of my call - paring 10 or 12 weeks a year down to five or six, ever since. Refused to give up more, because I didn't want to lose my call skills. Our fiscal year starts in October. By January, I still had no takers. Seems my two partners who have been willing to take my AP call for the last few years are now in a position to value time over money. "I love going to the gym with my teenage son after work." "I don't really want to drive over from NLR more than I have to - it adds so much more work." Good for them, sucks for me. This is the first year I've had to take full call - I believe twelve or thirteen weeks. And this is the first time I've done a two week stretch in a row. Spring is the most concentrated time. Our chief graciously took my call tonight so I could go to Phantom. But I'm missing Spring Break with my kids, for the first time since I joined the group. Luckily with AP call the OR usually dies down at a certain hour, so I can enjoy some wine. I was a call teetotaler for many years of CP call. It's more common on that rotation to be bugged unexpectedly at 2am.

1.5 weeks to go. Doesn't seem nearly as daunting as it did a few years ago. I can do this. And the extra money in my paycheck will help pay for all the fun.

Monday, March 6, 2017

Giant Colon

"You've got to go see the colon. It's on tour, and it's hitting Conway this week. I'm busy - you go with Dr. Woods and Dr. NWA."

Conway is my place - I went to college there. I planned a trip with Stoby's cheese dip on the agenda. After all, I was super pregnant with C, I deserved it.

Me and Dr. Woods to my right (he looks so young!) and Dr. NWA to my left. The colon is behind us.

Dr. Woods, kind of sideways, inside the colon next to the internal hemorrhoids. Despite my preggo state, I crawled through the colon too.

I asked this tubular adenoma of the colon - mildly dysplastic polyp, to take a pic with me in the bathroom. Made me feel good. I'm pregnant, but she's way bigger than me.

Me and Dr. NWA with a Fleet's enema. My daughter turns 14 on Friday, so this is 15 years ago. As the old adage goes, time flies.

Friday, March 3, 2017

Rise

Sasha from SMD posted today about a struggle with a critic. An excerpt:

"It can wear you down to listen to your critics, can't it? But the fire is where iron is hardened and where we are molded and where strength arises. Where fortitude and character are built, and where your weaknesses are burned away. The fire is also where it is evident who has your back, and who will pick you up when you fall down.

You can't please everyone, and you can't listen to people who aren't in the same arena fighting with you. You can't take everyone to the top of the Ferris Wheel, and the biggest thing I learned, it's not YOUR JOB to figure out WHY you are too much for some people. That's their choice, not yours.

Pursuing your dream, living your life - this will be too much for others. The way you talk, dress, work, laugh, even smile, will offend someone, somewhere.

Be kind. Be respectful. But don't cave in the corner and stay silent or inactive bc you're "too much" for some person. Go forward humbly and live your dream."

Hundreds of comments. Someone reminded her of a Maya Angelou poem:

Still I Rise

You may write me down in history
With your bitter, twisted lies,
You may trod me in the very dirt
But still, like dust, I'll rise.

Does my sassiness upset you?
Why are you beset with gloom?
'Cause I walk like I've got oil wells
Pumping in my living room.

Just like moons and like suns,
With the certainty of tides,
Just like hopes springing high, 
Still I'll rise.

Did you want to see me broken?
Bowed head and lowered eyes?
Shoulders falling down like teardrops, 
Weakened by my soulful cries.

Does my haughtiness offend you?
Don't you take it awful hard
'Cause I laugh like I've got gold mines
Diggin' in my own back yard.

You may shoot me with your words,
You may cut me with your eyes,
You may kill me with your hatefulness,
But still, like air, I'll rise.

Does my sexiness upset you?
Does it come as a surprise
That I dance like I've got diamonds
At the meeting of my thighs?

Out of the huts of history's shame
I rise
Up from a past that's rooted in pain
I rise
I'm a black ocean, leaping and wide,
Welling and swelling I bear in the tide.
Leaving behind nights of terror and fear
I rise
Into a daybreak that's wondrously clear
I rise
Bringing the gifts that my ancestors gave,
I am the dream and the hope of a slave.
I rise
I rise
I rise.

Her post and this poem really hit home. Taking on other's negative opinions is like absorbing their problems into your own psyche. Many women have enough of a harsh inner critic that they don't need others to reinforce it. And many critical people are only projecting their own insecurities and misery onto those around them to try to make themselves feel better, which ultimately doesn't bear out. Seems my lesson this year is to learn to let go of other's negativity - it's hard, but I'm getting there. Time heals. 

Another commenter posted a famous quote by Theodore Roosevelt:

"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasm, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while DARING GREATLY . . ."

In between a boatload of needles and cases and running a meeting today I got to visit a mock up of a new bronch endoscopy suite. I felt like I had just walked into a space station. They had it set up in Shuffield Auditorium all week. We may even be able to project what we see under the scope into the procedure room in real time. Seems bronch lab might finally climb out of the basement.


When I was at my wit's end this morning because I hadn't had time to look at any of my cases due to procedure after procedure, I came into my office to find this. My eyes welled up. 



I found out later my cytotech, who is aware of my love of dark chocolate and almonds, left this by my scope. I thanked him. The day got easier. We are all in this together. When people like Tony and all the anonymous SMD sisters notice you are struggling and support you, rather than try to tear you down, it makes every effort and struggle and hard day worth it.


Tuesday, February 28, 2017

Interventional Radiology

9 a.m. I sit down at the scope, flanked by the radiologist, and my wingman cytotech.

Me: So what am I looking at.

Rad: Indiscrete mass in the lung. Maybe pneumonia. Why are you so dressed up.

Me: I've got a meeting at the school today, C's advisor. And tonight I'm going to a breast molecular update. Breast surgeon hosts these one or two times a year, usually at good restaurants. We get free food, and learn about the latest prognostic information. It's path, rad/onc, and onc.

Cytotech: I've never been invited.

Rad: Me neither. But I'm not a breast man.

Me: Really? You aren't a breast man?

Cytotech: He must be an Ass Man.

Rad: That's actually what is on my license plate. Ass Man.

Me: I was asking cause I was wondering. What man isn't a breast man.

Rad: It's not that I don't like breasts. It's just that it's a hobby, it's not my day job.

Me: I see macrophages. No big inflammation, no malignancy. Good news for the patient. It always feels good to hand out good news. No news is good news, right?

Rad: Sounds good to me. I'll get cultures. We've got a couple more cases for you after lunch.

Me: Good - bronch lab has two cases, but they should be done before lunch. See you later.

Friday, February 24, 2017

INFJ

I was lurking in a PMG Pathology thread the other day - they were talking about how they scored on the Myers Briggs personality scale. Many pathologists are INTJ's. I was a psych major, I took that test over 20 years ago, I'll never forget my type. INFJ. But I forgot what it meant, so I googled it today over lunch.

I found out I am a rare and complex personality type, shared by Eleanor Roosevelt. Gandhi. Umm, Nicole Kidman. Piers Morgan? Them's fighting words. Reading about who you are, based on a personality test, is indulgent. The ego is a necessary evil of human existence. Watering it seems trite, but is nevertheless satisfying. There are entire books, I learned, on Myers Briggs personality types, but a quick scour of the internet was enough for me. My ego is fine. Overly indulged last summer - like someone took my ego's mouth to a fire hose.

There are days when you are tasked to challenge your nature. Today was one of those. I had to show humility to a clinician I had unintentionally misled on a frozen. Separately, I had to (gulp, cough, spit) ask for help, something that is akin to torture for me. The volumes of challenging cases I had on call this week, some of which I hope to resolve tomorrow, set records in my ten years of practice.

I reminded my daughter today while I was carpooling her to her church retreat weekend that when we are faced with obstacles that seem insurmountable, ones that we hope to but cannot control, it's happening for a reason. Kind of like destiny. The challenges we face are tests to our ego, lessons that need to be learned. If you are impatient, there will be a test to challenge your patience. If you are overly confident, a missed call will humble you. If you think your diagnoses can help a clinician, there will be a difficult case that will stymie you and the patient will go downhill no matter what the morphology shows you. A blow to the ego necessitates a surrender to the divine. You duck and shield, you stand up, and you move forward. Experience, including mistakes, begets fresh revelation.

"It is better to light a candle than to curse the darkness." - Eleanor Roosevelt

Thursday, February 23, 2017

SMD

No, it doesn't stand for sadomasochist disorder, or even suck my dick, as Urban Dictionary purports.

At least not in this context.

Style MD. It has over 6,000 doc mom members on Facebook, although only a few hundred regularly participate. I'm mostly a voyeur, but try to post a selfie every other month, just to stay relevant. Selfies are hard, and my daughter has seen mine in the cloud somehow, and is highly critical. "Mom, you need to smile. Don't do that weird smirk thing." Well, that's what all my friends do, at my age, so she needs to accept that.


See, the arms are awkward. But it's a work in progress.

SMD has a Queen, her name is Sasha. She posts motivational messages on a daily basis. She's uber positive, crazy smart, and an amazing mom. She speaks all over the country about doctoring and empowering women. She's hosting the first ever SMD conference in her home state of Nebraska this fall, and I've already booked a hotel room. Convinced a good friend from residency to do the same. The final line up isn't announced yet, but there will be continuing medical education (CME) and yoga sessions and cocktail hours and pajama parties and pedicures. I can't think of a better way to spend my CME money. Sasha seems poised on the brink of stardom, at least in the doc mom world. Despite her white blond roots, she's very inclusive. Our cover photo is dark haired women from all nationalities. She's not on it. Beautiful and humble.


She's a curvy cornhusker beauty. She leaks these professional pics tantalizingly, teasing us of announcements to come. Her followers ask, A blog? A book? What are you planning? We wait in suspense.

She often posts from her gym early in the morning, after she has done her weights and cardio and is dressed for the day to come. Today she posted a pic of herself in a black tank top and leggings. She lamented forgetting her blazer and top, she was spending all day in a conference with admin. "I cannot wear this in front of the dean. What am I going to do?"

Many suggestions poured in:

Do you have a friend the same size you can call on?
White coat, it's so forgiving! No one will know you have a tank on underneath.
Blarf at the hospital gift shop?
Can your husband bail you out? Mine's a SAHD (Stay at Home Dad) - he always saves me.

Me: You look like Linda Hamilton in The Terminator - screw the white coat admin requires shades and a gun.


My pulmonologist friend from Philly: This will probably go down just fine where you live.

Me: That's how we regulate admin in AR baby

Philly: UAMS was so mild mannered compared to your place.

Me: You should see the Glock our business manager packs for insurance reimbursement negotiations. We know how to keep these guys in line. We aren't Pathology Labs of Arkansas we are Pathology Renegades of Arkansas (PRA). They are gonna pray when they see us coming.

Sasha: This is my fav EVER!

I think she liked being compared to the Terminator chick. We are all one pair of sunglasses and a gun away from being the Terminator chick these days. Medicine, like politics, is a battleground. It wears you down, but it's definitely worth fighting for. 

Wednesday, February 22, 2017

Ectopic Pregnancy

Life threatening, due to probable rupture and hemorrhage. A pregnancy in which the fertilized egg implants outside the uterus. Usually in the fallopian tube. We get these specimens not infrequently. It is unusual to see the placental villi intact inside the fallopian tube wall, it is usually ruptured and full of hemorrhage. So this is a rare pic. "Wow," says PMG pathology. "WTF" is what I know you are thinking. No fetal tissue here, though - just immature placental villi inside a fallopian tube.





I'm going to Shaky Knees in Atlanta. Just bought 2 VIP tix (Love you Matt). So I'm boning up on the lineup. Cage the Elephant headlines Friday night.



Tuesday, February 14, 2017

Happy Valentine's Day

I am Her Doctor, and Her Friend.

Read, over at MiM.

Monday, February 13, 2017

Accepting Limits

I remember the moment I decided to give up on skiing. Vividly - it was last year during Spring Break. One minute I was on the verge of a tiny snow hill, one long conquered by my kids and then boyfriend, heart beating rapidly. The next moment I was lying on the ground in the snow, my body in an awkward X shape like a dead body police mark, buried skis making it seem impossible to move without breaking a kneecap. I stared up at the sky. "This is actually relaxing," I thought. "I could stay here forever, and never have to try to run a blue to impress my kids." I didn't stay there forever, but it was a good 20 minutes before I even tried to move.

Nevertheless, I tried. The year before I ponied up for group lessons, to no avail. Last year I ponied up even ridiculously more for individual lessons. Still I couldn't stay the anxiety that kept me moving in slow horizontal terror down a vertical slope, kids smiling and racing in front of me, beating me to the mid-blue hill restaurant by almost a half hour. "But I can scuba dive," I wanted to scream. "I can name cancer on 5 cells. I'm a badass in other arenas." But not this. Maybe not ever.

It's calming, to relinquish the desire to achieve in areas your kids pressure you to. There are other activities to do in snowy weather. Today, I signed up for a two hour guided snowshoe tour - one that my Facebook path friend lauded. She was at this conference a few years ago, and was giving me tips on messenger. "I only do greens and easy blues. I take beta blockers."

"I've taken beta blockers for many situations, but never skiing. Good idea. But maybe next year - I'm taking a break this year. And I've gotta convince my kids that I'm never going to be as good as them, and they will have to accept that fact and let me be happy with my greens."

This conference starts at 6:30 am and is over by 11:00 am everyday, so everyone can hit the slopes. Not me. I'm hitting the salon for a pedi and massages, and snowshoe tours. Planning to go to Aspen one evening - ACES (Aspen Center for Environmental Studies) does free lectures on Naturalist Nights. There's one on Wednesday by a Professor at Colorado State University about energy development impacts on wildlife. They sponsor the 2 hour snowshoe tours in Snowmass, and I can hire a naturalist guide to do an even longer one later this week. That's about my speed.


Friday, February 10, 2017

Gross Room

Me: So what's up with this new hat everyone in the OR is wearing? It's so crazy. Tall skinny floral chef hat. Combined with the scrubs and the clogs, it's not good.

Female PA: I think they put their hair under it.

Me: They would need a helluva lot of hair to fill that hat. Who do they think they are? British soldiers gone Mad Hatter? What happened to the chill square version of the do-rag?

Female PA: And they are all so skinny, those nurse anesthetists. Don't they get cold back there in the OR?

Me: Yes. I was walking behind one, on my way here, and I was trying to find the contours of her butt through her skinny scrubs while she was walking. A personal challenge. No dice.

Female PA: We need to help them. Sweaters and cheeseburgers!!

Me: LOL! I agree. And a freaking stylist. So what are we doing?

Female PA: Ovarian cancer. Pretty obvious. I'm cutting now, will have it ready in a minute or so.

Male PA, working at another grossing station: Who would name their daughter Nympha?

Me: Really? That's her name?

Male PA: Well, it's spelled different, but still.

Me: How old is she?

Male PA: 40 ish.

Me: Well at least she made it that far.

Male PA #2: I'll bet she was invited to all the dances.

Me: I'm guessing she wasn't the wallflower.

Female PA: Frozen is ready.

Me: You were right. Ugly. I called, gyn/onc is sending the other ovary, he says it's the same but he's cool with no frozen. Thanks a bunch.


Thursday, February 9, 2017

BHEC QRC

Pronounced B-heck QRC. Affectionately. Stands for Baptist Health Extended Care Quality Review Committee. I've been on it for over a year. And I missed the last two, for kid stuff, so I needed to be there last night. We mostly talk about the long term patients, their CAUTI's and CLABSI's first: the infection nurse leads the meeting.

If you are feeling left behind with the acronyms you are not alone. When I first got on board I needed to get up to speed. Catheter associated urinary tract infections. Central line associated blood stream infections. The entire meeting is a check on the system; comparing it to national norms. They are earnestly trying, against all natural odds, to serve the patients as best as they can. They put more effort into it than I could imagine, and despite all the crazy standards they are held too, more often than not they succeed.

After infection control left last night - she leads then heads to her church group - we moved on to pharmacy. There were a lot of new procedures to approve. We got to one called "Unresolved Discrepancies."

ID doc: That sounds scandalous.

Pharm: It's just that when a controlled med goes missing, we can always track it. Figure out why. But not this time. We couldn't find the source of the problem. So we had to create a new policy to report missing meds that aren't accounted for.

Me: Sounds like an inside job.

Laughter.

Pharm: Yeah, you are probably right. I can think of a few people that might target the narcotic bin, especially late at night. Next policy.

Television monitor at the front of the room: Sedation Monitoring.

Admin: If I was a joking man I might make one about keeping you all awake during this review.

Pharm: Beats her fingers against the table in the universal culmination of a joke sound. Bah bum bum. No, this is about making sure the patients who are getting procedures get the right support.

ID doc: Not sure I understand. Explain.

GI doc: Like if you want to do a scope - GI, pulmonary, you need the right support. You can't just do it in any room. You can't have a nurse anesthetist monitor five rooms on the floor. There are only certain areas, with the right support staff, that are allowed to do those procedures.

Me: It's the Joan Rivers Rule.

ID doc gives delayed incredulous belly laugh. "Exactly!" I love inducing that.

Me: Motion to approve.

FP doc: I second.

Admin: Everyone in favor?

Collective: Aye.




Wednesday, February 8, 2017

The Quest

Mid-morning, while I'm reading my GI's I become determined to find someone else who hasn't heard of vodka tampons. I decide to call Dr. Music on the intercom.

Dr. Music (he can see who is calling): No one's home.

Me: Well that sucks, because I'm on the hunt.

Dr. Music: And I'm being hunted? Not sure if I like that or not.

Me: I'm looking for someone, besides me last week, who has never heard of vodka tampons.

Dr. Music: Vodka what?

Me: So you haven't? I finally get to explain it. (So I did).

Dr. Music: That sounds crazy. What if you don't have the right orifice?

Me: I hear from my friend that it works in the other one down there too.

Dr. Music: That doesn't make sense about the breathalyzer. Once it goes into your bloodstream, it would register on the breathalyzer.

Me: I don't know, I've never been breathalyzed so I don't know the technology. But I would think it would register less, not having been sitting in your stomach.

Dr. Music: Maybe they will make an assalyzer.

Me: I was thinking a vaginalyzer. Not too farfetched in our current political climate.

Dr. Music: Yeah I saw that pic on Facebook of you and your husband at the Woman's March. I can't believe you dragged him up there. Did you make him wear a pussyhat?

Me: Hell no. I hate them too, but you can't always choose the symbols of your movement, you've just got to run with it. There were 30-40% guys there, by the way. Way more than anticipated. And three of S's male colleagues called him to thank him for participating in the March.

Dr. Music: Well that's something.

Me: You aren't on Instagram, are you?

Dr. Music: No.

Me: I posted tons of pics. I didn't carry a sign, I just took pics of signs. I'll text spam you when I'm done with my GI's. I made a series on Instagram. I'll even send you some that I didn't post - because they were pretty salty and I know I've got a big following from C's friends. Your wife will love the pics.

Dr. Music: She will. I can't even have Trump or Trump news on the TV - she will run and attack the television.

Me: I'm trying to take it all in as entertainment. A necessary step to a better future. Helps me cope.

Dr. Music: Yes, I'm spinning it that way too.

Me: Except it's hard when people are held and detained at airports by misguided officials because of their religion. Then it's not so funny.

Dr. Music: Can't argue with that.






I took the first four, but I can't take credit for this last pic I cribbed it off of a Democratic facebook group I think? Not sure if it was in Washington or not. Ballsy chick, though.

Tuesday, February 7, 2017

Gross Room

PA: I'm cutting the frozen, it's almost ready.

Me: What is it?

PA: Pancreatic mass. Nothing in the computer.

Me: Ugh I hate pancreas. So my friend told me last week I'm the only one who hasn't heard of vodka tampons. I'm trying to prove her wrong.

PA: No luck here. Vodka tampons are all over the place. How could you have not heard of them?

Me: Living under a rock, I guess. You haven't tried that, have you?

PA: Hell no. Young girls are doing it, I hear. Helps to avoid the breathalyzer.

Me: But how do you regulate it? If you aren't sipping slowly. Wouldn't it be easier to OD? Where are the Vodka tampon rules and regulations?

PA: Yeah, it's supposed to absorb quickly; it's really vascular down there. I don't know. A new way to overdo it.

We both agreed that we certainly weren't the queens of abstinence in our younger years, method of delivery be damned.

Me: But still - tampons? Ewww.

PA: Can't disagree with you there. Here's the slide, it's ready.

Me to surgeon on bat phone: Long comment about frozen.

Surgeon: I can't hear a word you are saying on this intercom thing. Let me scrub out and get the phone.

Me: I know right? It's like Charlie Brown's teacher.

Surgeon: What do you think?

Me: Mostly chronically inflamed fibrosis. There isn't an epithelial wall per se, but some of the area that looks like lining is teeming with neutrophils. Could this be an old walled off abscess? I see atrophic acini, but no tumor.

Surgeon: So it might just be a pseudocyst? That's great news.

Me: Yeah that fits. We will look at the whole thing tomorrow to make sure.

Monday, February 6, 2017

Densus Church






This is the oldest church in Romania. I spent a chunk of the day riveted by it's limited online history (I favor the pagan theory) and that of the pagan Gods of Europe - Swedish, Norse, German, and Romanian. Much more fascinating than my morning frozens. A slow day, finally, thank God (Gods?). Last week was insane.

Sunday, February 5, 2017

AURORA

Aurora carries the Mother feeling of peace and love to all mankind. Hers is the assurance that always flows from a mother’s love—all is well, “the dawn is coming.”

Aurora is an archangel. Which makes me love this song even more. There's more to archangels than the Teenage Mutant Ninja Turtles. Raphael and Michael are my favorites. If you doubt me, google them. They are pretty impressive.

When I was in college, I had a silver foil tree. I decided to make a theme: it was angels. I still have many of the angel ornaments I gathered back then on my yearly live tree. I trolled arts and craft fairs looking for angels, with good results. 

I still look for angels. Humans are vessels for angels; they can make miracles.







I can't fix this font, no matter how hard I try. LOL.

Friday, February 3, 2017

Bronch Lab

11:00 a.m. My fifth procedure before noon. This was one of those days when your intelligence crackles from your fingers like lightning, because there is no way in hell you are going to get any rest.

Tech: It looks malignant.

Me: Well it looks like I showed up at the right time. You guys already have it all figured out. I agree.

The librarian (nurse who works with Cyd Vicious): Do you want to see a picture of the mass? It's in the mainstem bronchus.

Me: Yes, please.

Cyd Vicious to librarian: Give me my phone I need to show the patient's family.

Librarian raises her eyes in apology.

Me: No worries. I can wait.

Librarian: Want me to show you a funny video in the meantime?

I watch a video of an 11 month old boy in a sink reveling in water being sprayed on him from the kitchen sink sprayer (is there a more consolidated word for this?). He is lapping up the water like a dog.

Me: Who is that?

Librarian: That's my foster kid. I foster kids. He's getting his TPR on Monday.

Me: What's a TPR?

Librarian: A termination of parental rights.

Me: Let's back up here. Why do you foster kids?

Librarian: I had a hysterectomy at 27. I love kids. I applied to be a foster parent.

Me: So, you look 25. How did you have a hysterectomy 2 years into the future.

Librarian: I'm 29. Started fostering right after the surgery. That's why I love working with Cyd. He forgives the times I can't show up because I am being there for the kids. But this one, I'm really attached. I'm trying to adopt him.

Me: Why now? I mean, fostering kids must be hard. You have to build a wall, because you know they are going to leave.  Do you have a partner? A spouse?

Librarian: No it's just me. That's precisely why I'm adopting. I've built that wall. And it's not fair for the kids. They need unconditional love, and if you aren't prepared to give them that at such a crucial time in their lives, you are shorting them. The foster system sucks. It's rough. I get picked on all the time. I've been written up as a delinquent. Once, when I had bathroom cleaner on the floor next to my toilet. The child I was fostering was six weeks old. - there's no way he could have gotten into that bathroom cleaner. Made no freaking sense. And there's this other rule, that all knives have to be in the kitchen. I had a butter knife in the living room once, and voila. Another deficiency.

Me: So you are a single mom. Of foster kids. One of which you are trying to adopt. (Reeling) And they are picking on you? What about all the other foster parents leeching on the system, the ones I read about who take the money and ignore the kids?

Librarian: I'm still trying to figure out how foster parents make bank. I'm in the hole. I spend way more on the kids I foster than the $400 bucks a month I receive for what I do. Sorry I've got to take this call.

Cyd walks over, done with the procedure: So it's malignant.

Me: Yes. I hear you encountered a giant mass in the mainstem bronchus, and have a pic. Can I see?

Cyd: Sure. Here it is. We could debulk it, they would have ten years ago, but it's got more of a chance shrinking with chemo/rad. You see this, right (giant fungating mass), and want to take it out. But it's not the standard of care these days. I'll do it if it doesn't respond to treatment. But that's rare. She's got a good chance of responding.

Me: I'm going to go upstairs and try to get some work done. Call me when you need me.

Thursday, February 2, 2017

Rummi Bears and Tampons

Dinner with big time Girlfriend. After catching up on all the personal stuff, we moved on to more important things.

GF: We were going on a three day road trip. We weren't driving. I prepared with gummy bears - Rum and Vodka infused Vanilla.

Me: Wait. What? I have no idea what you are talking about.

GF: Well, you soak the gummy bears in alcohol. At room temperature. No longer than three days, or it will congeal into a large gummy mess - that works, but it isn't pretty. You have to get the good kind, the Hasbro.

Me: Yes, I know, we are gummy bear snobs. So you soak them? Or infuse them? I'm confused.

GF: You just soak them. But I like the idea of infusing. Could that be C or (her son) J's next science fair project? Soaking vs. infusing gummy bears with alcohol. How do you propose we measure that, besides weight?

Me: Maybe you could measure the blood alcohol content after a certain number of gummy bears, see which method makes it higher. Not sure that is a middle school/early high school project though.

GF: Of course you have heard of the vodka-infused tampons.

Me: No. You are joking.

GF: I'm not! I thought everyone had heard of them, until you. It's great - you've got no alcohol breath, you just insert and voila. I understand it's very vascular down there. After your first buzz, you just pull it out and replace another one. Of course I've never tried it, but it's out there. Lots of people are doing it.

Me: Unbelievable. You are putting me on. Wouldn't I have heard about this in medical school?

GF: No, it's just come out in the last few years. You don't have to settle for just one. You can do three or four at a time, especially if you use slender regular.

Me: What if you don't have the right, um, orifice?

GF: I hear it works just as well if you put it in the back door.

Me: No freaking way.  You are insane. Can I drive you to your car? We need to do this more often, I miss you.


Wednesday, February 1, 2017

Private Mortuary

My daughter, 13, independent of me, decided to read The Devil's Knot by Mara Leveritt and base her yearlong history Capstone project on it. She spoke to me excitedly a couple of months ago about the details of the case. I told her I was here, I lived it. "Do you want me to hook you up with an interview with a forensic pathologist at the Crime Lab? I know Frank Peretti."

"You do??!!? He was the bad pathologist, in the book."

I've bought the book, but I haven't read it. Of course I know about his persecution, reading blogs and articles. It's been 11 years since I rotated with him at the Crime Lab, but he's a nice intelligent guy.

"Careful C. Evidence always has a spin. Keep an open mind. I'll work on it."

After many e-mails with his assistant over the last few weeks, I finally secured an interview at 4:30 today. Her last e-mail instructed me to meet him not at the Crime Lab, but at his private mortuary off of an exit near the airport. I got covered, got off early, and picked up C at the school.

We arrived at the mortuary five minutes early, after trying to secure some bottled water at a closed up chained off gas station - the only one we could find off of the exit. We were greeted by two coroner vans in the parking lot - one of the coroners nicely directed us to his office. We played with an eager dog - not sure of the breed, but it was regal. The assistant entered the hallway from the mortuary.

"I can't believe I missed you coming here. I was supposed to put the dog up. I'll let him know you are here."

We waited on the couch. When he entered, he looked disheveled as always, and surprised. "I know you!" I guess his assistant didn't tell him.

"Yes, I rotated with you for a month at the Crime Lab. Great to see you." I got up and gave him a hug.

Cecelia gave and recorded a thoughtful and intelligent interview that lasted a half hour. I was impressed with her knowledge of the case; I stayed silent in awe and respect. He turned the popular media impression of the case of the West Memphis Three over on it's head. She was clearly enamored and partially mind blown. His facts flew at the celebrity opinion in the face. She had much project fodder and he concluded, in his Northern accent blunt way, one that was used to testifying cases in a courtroom, that his opinion was correct. As soon as I become unshackled, he assured her, when I retire, I'm going to write my own book.

I'll leave the details to her project.

When it was over I asked, "So what do you have over there? How many tables, one? Dr. Woods told me about your private mortuary, but I've never seen it."

"Do you want a tour? We've got three tables."

"I'd love one. What about you (Cecelia)? Do you want to see? There are dead bodies in there."

I watched my daughter steel herself and answer emphatically. "Yes."

I worried. I'm a mother, that's our job. Plus I've been there. I asked the assistant for some candy - sugar or carbs. She produced a fortune cookie out of her purse, and I encouraged C to eat it.

As we walked through the room entering the mortuary there were four dead bodies on gurneys. In the mortuary, two of three gurneys were occupied. One was a large male that hadn't yet been autopsied. The other was a female whose autopsy was complete. Two men were about to embalm her. I looked back at C to make sure she was ok.

"They don't look real, they look like wax figures."

"Good, keep that mentality. That will help you."

The woman had her face peeled backwards over her skull. Her organs had been removed, so her ribs and body cavity were prominent. There was a pool of blood in the body cavity. We were regaled with stories - of her death, of his, of other interesting deaths in the past week - one's that we promised not to tell. It was thrilling for me to finally have C interested in what I do.

Peretti and his crew were impressed with C's countenance. "Why don't you watch me do the autopsy of her organs and brain?"

She was game. She donned an apron and gloves and he walked through the anatomy of the healthy organs. I stood over them like a mother hen; her asking questions, he explaining. At one point, the embalming guy called us over to the woman whose organs we were dissecting. "Look. This is so exciting. I've injected the embalming fluid into her right carotid. Look at her face."

Half the face was pink red with life, the other half drained of color in death. I remarked, "I've never seen this. You could draw a line, right down the center of the face."

He said, "It's remarkable, what anatomy does. I've only injected into the right carotid. Look at the results."

C asked, "What's in embalming fluid?"

"Mostly alcohol, and a heavy dose of red dye to make the body appear as it was in life."

We wandered back and finished the autopsy - brain, cerebellum, brainstem, adrenals, lungs, spleen, liver, gallbladder, aorta, thyroid, esophagus, trachea, kidneys, and finally the heart. C was enraptured. I told her this would take me all day to do, but these guys are experts, they can do it much faster.

The humble Peretti told her that they are quick because they are experts, and these are healthy organs. The nature of her death made it go by fast. Homicides, he told her, can take hours. "Your mom does disease. We don't know disease. When we run into something we don't understand, we turf it to her."

As we were leaving I asked him if we could do a follow up interview, in a month or so, at his house. "I heard you are a turtle expert, that you have quite a live collection. Dr. Woods bragged about it. We would love to see it - her project isn't due until May. Can we come check it out?"

I hear he has a turtle exhibition dedicated to him at the Memphis Zoo. He has donated many rehabilitated turtles to zoos.

"Anytime. You have my number. I'm taking care of those turtles all weekend long, every weekend. Would love to see you."



Cecelia and Dr. Frank Peretti, status post her first autopsy.





Tuesday, January 31, 2017

Tumor Board

Oncologist: I have this guy. He had Diffuse Large B Cell Lymphoma in his spine. I treated it with CHOP. Now he has back pain. I called the insurance company, to get a PET. They said no. I told them emphatically that it was the standard of care. There was no beating around the bushes. They said, "We will not pay for that."

Thoracic surgeon: At least they were honest. They told you right away, instead of giving you a fifteen minute song and dance saying the same thing but all the while wasting the hell out of your time.

Oncologist: But still, where does that leave us? Luckily this is a man of means. We are working hard to find the least expensive pay out of pocket PET scan. We shouldn't be reduced to doing this. Any advice?

The silence was palpable. No wonder physician suicide rate is higher now than any other profession. I feel guilty - I get to hide behind my scope. I'm only accountable to the clinicians who hang on my diagnoses. They have to face the patients. And the patients, if not already screwed, are about to be royally fucked.

Monday, January 30, 2017

Sunday School

I led yesterday, tasked a few weeks before to speak about the Woman's March on Washington.

I started by reading a private essay I wrote last fall, a piece I am particularly proud of. I hadn't practiced, only hatched the idea, so I was unprepared for how much my voice shook in the beginning. But by the middle, I had gained my voice and finished strong. This was my tribe, this group of women - ones I only met last summer but would now walk through a raging fire to save each of their lives. Some I know better than others, but I'm confident that will change over time.

I spoke about the March - the hope and solidarity that for the first time filled a void that was created by the presidential election. I concluded by opening the floor to sharing. Some women spoke about being surrounded by white males in their jobs. By becoming slowly aware that the "locker room talk" that is taken for granted in our society is not normal, or respectful. When it is something you grow up in, something that is accepted by society, you tend to fall victim to it being the norm.

One woman spoke of her volunteer work for PATH. I asked, "What is PATH?"

"It stands for Partners Against Trafficking of Humans. There is an office in Little Rock, but there is no sign on the door, no identifier. I help women who have been trafficked by giving them financial counseling. Girls here in Arkansas."

Made sense. She started the bank account for our group, and takes up collections each week. She is one of the organizers. And she is a single mom to a handsome kindergartner. The pictures of his new beagle puppy she got him for Christmas lit up my Facebook like a Christmas tree. Single mom. Career woman. Volunteer. All of these women are rock stars.

"The frustrating thing is that the pimps get little to no punishment when they are caught by the law. They prey on high school students. They are trained to identify the girls that have low self esteem,  the one's without good family support. They shower them with attention, then plow them with drugs to introduce them into a life of prostitution. They also bring them in from Mexico. They are leaving the drug business in droves to do this. A drug is a commodity that can be sold only once. A girl can be sold over and over. It's basic economics. One girl I talked to spoke of being sold 60 times a day."

How is that possible, we wondered aloud. I calculated a twelve hour day would require being sold every 12 minutes. But if drugged, a girl could easily work 24 hours. And what's this business about building a wall? Let's just incarcerate these scumbags for life and that might solve some of our "supposed" inflow issues. Such a double standard. In many ways more than just this.

"The girl's lives are ruined. Their perps get a slap on the wrist. It's not fair. Only a small percentage get back into life and climb out. The vast majority confront financial problems, PTSD, and social ostracization. They go back to the only life they know - the only thing that obliterates the pain - drugs and prostitution." At least we have come far enough that the girls are being prosecuted less and less for the crime of prostitution, and finally seen as victims in the eyes of the law.

"I think we need to end the hour. I want to hear more about PATH, though. I think you" - I looked to my left - "said you would say the ending prayer for me?"

She led the prayer and we adjourned slowly. Many girls offered me much appreciated hugs and words of encouragement. One of the girls who came in late asked where she could read the essay she missed - I handed her my copy. Another wanted to know if she could have a copy to read to her son.

Today over lunch I found the website for PATH and listened to the video - my eyes welled up. I donated a couple hundred dollars immediately, and was thankful I knew someone on the inside who might present an opportunity to help in other ways.

Sunday, January 29, 2017

Narrow Misses, Part 6?

I listened to Sinead O'Conner's first album over and over senior year of high school. I had a friend ask me who that bald chic was I was listening too - it was before she went mainstream. I loved Mandinka, and Nothing Compares 2 U. But my favorite song was Last Day of Our Acquaintance - loved the arc of the song, how it started slow and ended in crescendo. Those lyrics. Little did I know it would serve me well 20 years later when I was getting divorced.

That same friend years later marveled when a singer I recommended to her, Alanis Morissette, blew up a few months after I introduced the music to her. "You always seem to know who is going to get big, before they get big. How do you do that?" There's plenty of stuff I liked that never got big, was my response.

Me and Kallie (different friend) used to spend summers after high school riding around in my Jeep, often clad in little more than bikini tops and cutoff jean shorts. By this time Sinead O'Conner was big, and Nothing Compares 2 U was played ad nauseum on the radio station. We penned an alternate version, which we sang at the top of our lungs whenever it came on. I'm thinking of it because when I was at the grocery store today (alt title box of food with cheezy 90's hits pumped into the background) I heard Nothing Compares 2 U for the first time in a while. I guess it's not on Spotify b/c it was written by Prince - I checked on the way home. But I'll never forget our version.

It's been 7 hours and 15 days
Since you took your dick away
I go out every night and sleep all day
Since you took your dick away
Since you've been gone I can fuck whoever I want
I can sleep with whomever I choose
I can eat my dick in a fancy restaurant
But nothing, no nothing can take away these blues
Cause no dick compares
No dick compares
To yours

It's been so lonely without your dick
Like a bird without a song
Nothing can stop these lonely tears from falling
Tell me baby, where did I go wrong
I can put my lips around every dick I see
But they only remind me of yours
I went to the doctor and guess what he told me guess what he told me
He said girl you better stop having fun no matter what you do
But he's a dick
Cause no dick compares, no dick compares to yours

All the flowers that you planted mama
In the backyard
All died and went away (we faltered here, I must admit)
I know that living with you baby was always hard
So I'm willing to give it another try
Cause no dick compares, no dick compares, to yours.

Crass and salty, I know. We were pretty young. Once we were in said Jeep and bikini tops - white wine zinfandel (cringe) in the cup holders, singing and laughing. The hard top and soft top were back in a garage. All of a sudden Kallie screamed.

"What happened?"

"This guy in the car next to us, he's jacking off."

"No. Gross. He wishes."

"I'm serious. Look."

I really didn't want to see. I saw his face only, he was about thirty something and staring straight at us, I took her on faith. I slammed on the brakes, and he slowed down too. I gunned the engine - it was a four lane highway, and he sped up to catch us.

I looked at Kallie. "Hold on, I'm going to lose him."

I've gotten one speeding ticket in my life - I was very pregnant with C going 55 in a 35 down Evergreen, according to the cop. On my way to work at UAMS. But I've been lucky. I remember going on off campus lunch senior year down Napa Valley to Andy's in my Oldsmobile Toronado convertible multiple times topping 80. I watched my Dad in his Jaguar heading to Florida for vacation topping 110 when I held the lucky front seat in the rotation. Like father like daughter. Despite being stopped a couple of times, I always managed to talk my way out of a ticket. I can play vapid blonde to my advantage - used that many times in different situations. I can't deny there are perks to being blonde.

I pushed the limits of my Jeep and managed to escape that pervert. Kallie and I laughed and sang when we lost the creep.



Thursday, January 26, 2017

Gross Room


I was called at about 11:30 a.m. "It's a peritoneal biopsy. Dr. Surgeon. She's got a history of cancer - had most of her bowel removed. I guess they are looking for more."

"Ok I'll come over." I walked to the gross room from my office.

"Here, the slide is already done."

"What type of cancer?"

"Not sure I'll look it up for you."

I look at the slide. Macrophages, no cancer. Unless - signet ring cell can masquerade as macrophages.

"Did you find a cancer type?"

"Mucinous adenocarcinoma."

Good. This isn't that. I called the surgeon on the bat phone. "No cancer. Looks like treatment related changes. Macrophages gather in infection, but based on the history, I favor the former. You can culture it of you like."

J: "We've got another frozen. Gyn/onc."

I walked over to look at the uterus.

"He already opened it."

"It looks benign. Easy case. I'll just hang out while you freeze it. Looks like you had fun in Nashville last weekend, J!"

I'd seen a pic of her and her four girlfriends standing on the bar at Coyote Ugly on Facebook.

"Ugh, too much fun. I'm having my New Year's resolution late. Calming down for a bit. It was really fun. We were in this one bar, and there was a girl perched up on a stool - she was overlooking the whole bar and just strumming her guitar and singing. It was so cool."

"That reminds me of the time I went to New Orleans for New Year's Eve. With a bunch of high school friends, but we were already in college. They were all 21, but I was still 19. Luckily the drinking age in NOLA at the time was 18. The streets were so crowded we had to hold hands moving from bar to bar, to avoid getting lost in the sea of people. We girls, about half of our crowd, decided to go to a strip bar. We had never been, and it took us some time to find a male strip bar. When we walked in, there were girls perched on platforms hung by chains over the bar. They were very scantily clad - tassels and thongs. We were shocked, but marched on through to the back of the bar where stripping men were promised. It was just one guy - he was in a snakeskin bikini - is that what you call it on men? I've no idea. Haven't been to a strip bar before or since. Except this one, but I'll tell you about that later. Anyway, he was skinny as shit. No muscles at all. Just dancing to this lame music, it was pathetic. We sat down and ordered a pitcher of beer just to see if anything better happened. It didn't."

"Was there anyone else in there?"

"No, well, maybe four or five people. Most of the tables were empty. Finally we decided to get out of there but took a group trip to the bathroom first. Oh. My slide is ready. I'll tell you the rest later."

Bat phone to gyn/onc OR. "Benign endometrial polyp."

J: "There is another frozen. Another peritoneal biopsy from that cancer case."

"I guess they want to hold me hostage until noon. Ok. So anyway, we went to the bathroom. There was this woman in there, super pudgy, she was bawling. Like the happy well adjusted empathic college kids we were, we surrounded her and hugged her. Asked her what was wrong. She told us that her husband was stripping out there, to make money. She hated that other women were ogling him. She was miserable that he had to do that for her and the baby. We were taken aback, but assured her that we were leaving the bar - we assured her emphatically and truthfully that we would not be ogling her husband - and told her that everything would be ok."

"That's crazy."

"I know right? It was like Jack Sprat the stripper on stage and his wife dejected in the bathroom. Put a damper on the college kids seeking the stripper experience. One good thing, though - my friend brought one of her college friends. She was blond, and resembled me a little. She had two driver's licenses for some reason, one was lost then found. So she gave me her ID to use as a fake - I had fake's all through college since I didn't turn 21 until after I graduated and this one lasted the longest. It was from Oklahoma. Her name was Cindy Cox - sounded like a stripper name to me. I was her for over a year in Arkansas, until I got lulled into complacency and one night a smart bouncer at Juanita's caught me tipsy and daydreaming and tripped me up on the address I had memorized by heart. He also looked into my eyes. Realized that mine were blue, and hers were green. No other bouncer ever bothered to check that. He confiscated that ID, and left me scrambling. Is that other slide ready?"

"Here it is."

I put it under the scope. Called the OR. "Recurrent metastatic mucinous adenocarcinoma."

Dr. Surgeon: "Really? Ok, thanks."

I walked back into the gross room from the scope room.

"Thanks for all your help guys. I'm going to get some soup."




This album was a fave of mine in high school. I wore it out. Was fascinated how it could run from synth pop to arresting ballads to creepy chants that when learned could transform into a droning lullaby; a backdrop to the drudgery of life. I never knew anyone else who listened to Yaz, until I read Rob Sheffield's Love is a Mix Tape about 7 years ago. It's a memoir about his first wife who died prematurely. I think they enjoyed this album as much as I did. And they were way more creative with Zima, I was super jealous.