Wednesday, May 24, 2017

Uterus Unicornus

Dr. Music: Rebecca? I think this is a hard case. Soft tissue mass in the ascending aorta. Is it luminal or adventitial?

Mary Pickford

He's been calling me Rebecca of Sunnybrook Farms today, on account of my dress. One I found last week on Amazon for 28 bucks. I told him I thought of it as more poodle skirt with a modern print. I've fielded more compliments, catcalls from phlebotomy, and requests for where I bought it than any other dress I've worn in history. I think the petticoat I bought online leads to a more vintage appealing look. I took a terrible selfie for Style MD that doesn't do it justice. I stopped a handsome yard guy at the wine store in his tracks. "I can't help but admire your dress, it's amazing." I replied, "Thank you, I've been hearing that all day! It's so comfy too. I ordered four different patterns - solid too - in the same dress this morning."


Terrible selfies

Me: That's a good question, I'll call cardiothoracic surgeon. I didn't think to ask. I thought the site was wrong, I felt for sure it was an atrial myxoma, but op note says it's in the ascending aorta. You know this week has been a treasure trove of unusual cases. Did you know I have a freaking uterus unicornus? I had to google that I've never heard of it.

Dr. Music: Me neither. I've heard it's a myth.

Me: No! Google it it's a true rare thing! I can't wait to call gross room and tell them about it. They thought the surgeon missed the uterus and got the cornu. But it's a true horn. Apparently an extremely rare congenital uterus anomaly is to have a banana shaped uterus and a horn. There are different variations. Mine has endometrium and myometrium.



Dr. Music: That was supposed to be a joke. Based on the uni . . .

Me: Oh duh. Ok I get it. But seriously, you can't top that can you?

Dr. Music: No. But back to the aortic mass.

Me: I know. I only found one case report from 1974 about a myxoma in the ascending aorta. She died. Not too encouraging. But this patient is fine.

Dr. Music: You did better than me. I found nothing. I'd send that to Jesse.

Me: I was thinking the same thing. Rare things have different rules. Ones best left to the experts. I'll send it to Cleveland Clinic tomorrow. After I find out exactly where it was growing.

It was growing in the pericardial space on the adventitia of the ascending aorta. I can't wait to see what Jesse thinks.

Tuesday, May 23, 2017

Blues Traveler - 100 Years


The best Blues Traveler song ever. Chris Cornell died, and that sucks, but I can't help thinking about John Popper. 

Monday, May 22, 2017

Ovary Frozen

"Ugh. An ovary frozen? On top of breast cases and interstitial lung disease and a full caseload on a Saturday? When does it end? Can you please look up the history?"

"I've got it pulled up right here."

"It's so confusing. She was diagnosed with cancer almost 15 years ago. So did she already get a hysterectomy? Why do we have the ovary?"

"Capsule looks intact. But it's huge. Gotta be cancer."

"The sections you took are necrotic. Let's take it over to the grossing station and breadloaf it - there must be viable tumor somewhere."

"Well, he (gyn/onc surgeon) would know if there is still a uterus."

"I'll ask him." Dial batphone. "Is there a history of endometrial cancer?"

OR help answers. "I'll ask him. No, there is no history of endometriosis."

"???!!!"

"Evans, she just told me there was no history of endometriosis. That's not what I asked her to ask him. I'm frustrated."

"Hello? Is there someone who knows medicine in there?"

"Right, calling all medicine help. Hello? Screw it. Just take this section and freeze it, it looks viable."

"OR. I've got malignant tumor. Not sure what kind. Do you still have the uterus? We will need to do stains."

"He's taking the uterus next."

"That's a big help. Thanks."


Sunday, May 21, 2017

Living the Spicy Life

So my kids are making all kinds of new friends so quickly it's making my head spin. Cecelia hangs with mostly public school kids now (she's dying to go all of a sudden, maybe 10th grade I tell her - convince your father - I've already put down a deposit for next year), and I've met a couple of new moms and girls in the last month. Jack has an online friend from his video games that he apparently knows from 2nd grade maybe? He's been begging to get together with him for weeks. They reunited at a friend's house Friday night for a sleepover. Today he desperately wanted an afternoon playdate and despite my exhaustion from work I knew I'd be missing the hell out of him all next weekend so I acquiesced.

Jack finally found Russ online at 1:30 p.m. to set it up, and interrupted my walk texting me the number to call his mom. She didn't answer. Back at the house, Jack said no she's in bed sick. Call his uncle. Uncle answered the phone, "You have 30 seconds I'm on a bike ride." I said, "I want to pick up your nephew and take him for a treat with my son, his online friend, but I don't know where he lives" all the while thinking how bizarre this was. He gave me more than 30 seconds and found Stepdad's number.

Stepdad answered, "Yes, his Uncle told me you would be calling. I'll bet he would love that. Is this the Jack on Woodlawn?"

"No, we are in Foxcroft, they are online friends. I haven't met y'all yet, but I spoke with your wife on the phone to get her e-mail for Jack's birthday party. I'm just going to take them to get some ice cream and back to my house to play. I'll be there at three and I'll drop him back by six or so. Jack told me your address, thank goodness you are only 5 minutes away. Does that work?"

"Sounds great. I'm the contact now. Not mom or uncle. So funny how these boys get these ideas and everything gets messed up. I was right upstairs."

"Yes I've contacted three of Russ' family members to set this up. I hope they have fun."

I drove to the house with Jack and Russ ran out of the garage. I got out of the car and shook his hand, introducing myself. "So do I need to meet an adult? Or are they ok for us to go?"

"Oh, we can just go. I haven't had lunch, can we do that before treat?"

"Do you like Subway? My stomach is growling I need something too before yoga. Then we can go to Baskin Robbins." I brought my book so I could give them privacy and found a great table outdoors between the two restaurants.

"I love Subway!"

Jack had eaten lunch, so I told Russ to order what he wanted. After he ordered a foot long sandwich, politely asking if it was ok, I ordered a cup of jalapenos to go with the Sun Chips I picked out. He turned to me, looked up, and said with a straight face, "So, you are living the spicy life?"

You could have knocked me over with a feather. My kids friends don't address me quite so candidly, especially new ones. I was excited, and decided to hide my surprise and engage. "Yes, I live the spicy life. Do you live the spicy life?"

"Well, I used to live the spicy life. Then I ate this pepper, it was so hot, it hurt me. I had to give up the spicy life."

"Entirely? You gave it up for good?"

"Yes. I haven't had anything spicy in a while."

"You know, when I was your age, I ate some really spicy hot sauce at a Mexican restaurant at the Epcot Center in Disney and I spent about 30 minutes at a water fountain before I felt like I wasn't going to die. It scared me away from the spicy life. But eventually I got back to it, and I have no regrets. So I would encourage you to keep it open - you might enjoy the spicy life again someday. Now I'm going to go outside it's freezing in here. Enjoy your sandwich and come find me at Baskin Robbins when you are ready for ice cream."

I tucked Jack into bed tonight. I told him I really liked his new friend. "He gave me a new identity. I've irrevocably changed. Up until now, I was just Gizabeth. Now I'm living the spicy life. I can't wait to have him over again. Now I'll sign all my Instagram posts hashtag living the spicy life."

"No mom, please don't."

"Just kidding - I've never hashtagged. I'm above that. Or below it. Or off to the side maybe. Not a hashtagger. So did y'all have fun?"

"Yes, he was really scared when that song he played for you on Spotify had a cuss word in it."

"I noticed him whispering to you frantically in the back seat. I didn't mind."

"Yeah, I told him it was ok. No worries."

"There are worse things in life than cuss words. Just don't cuss at your teachers and you will be ok."

"Yeah mom, I know."

"I know you know. Good night, love you."

"Love you more."

Saturday, May 20, 2017

Gout

Dr. Music barged into my office at 2pm.

"What is all this stuff you have written down. Pseudogout? Tumoral calcinosis? This is just gout."

I'm staring down the scope at the slide I am working up, but turn to look at him.

"Those were just ideas. Because, how can this be gout? It's so damn ugly."

"It's just gout."

"Are you sure? When I polarize it, it looks like crap. Like no gout I've ever seen. Like gout's red-headed stepchild."

"What do you mean?"

"I love gout. It's gorgeous. This is not like any gout I've ever seen."

"But it does polarize. There are crystals."

"Yes, few and far between. I'm a big fan of gout. I always take pictures."

"Show me."

"I'm not sure if I could find it on my phone. I only see it once every year or so. This gout is not picture worthy, if it is indeed gout. I'm not taking a picture of this. Gout usually takes my breath away. Not this one."

"Gout takes your breath away? That's crazy. Gout has never taken my breath away. Marie Osmond, in those weight commercials, she takes my breath away."

"Marie Osmond? And you watch TV that has commercials? Where does that still exist?"

"What, you only watch Netflix? And Marie Osmond has never looked better."

"Well, that and other TV with no commercials. I'll google her. She came to Baptist a few years ago, for Bolo Bash. Did you know that? Radiologist was bragging that she was at his house for a dinner. I didn't realize she was a thing. Wow, yes she's pretty hot, I'll give you that. But she can't hold a candle to a good gout."

"Just sign it out descriptively. Crystalline soft tissue deposits with giant cell reaction, favor gout; clinical correlation recommended."

"Sounds perfect. Thanks a bunch."


This is good gout. I cribbed it from the web. 

Friday, May 19, 2017

Conquer Me




I love this song so much. Watched the video over and over. Bought a striped shirt at Banana Republic in solidarity. Only it didn't bare my midriff. I wasn't that brave.

Thursday, May 18, 2017

Fireflies

Pinpoints of bright light
Draw children streaming through dew
Longing for magic

Wednesday, May 17, 2017

Nature's Image

Thoughts today while signing out a ridiculous number of complex cases on call.

Feathers = fern leaves = muscular striations

Heart = caverns

Lung = trees and root systems

Pulmonary parenchyma = honeycomb of bees

Cracked dry Earth = pulmonary and liver fibrosis

Arteries = Rivers and tributaries

Thyroid micro = creeks with cobblestones

Brain and electrical synapses = stars, Universe, higher conciousness, a spider's web

Our bodies parallel nature. There is no ego. There is no one. There is only collective.

And when it goes haywire, I'm there to diagnose disease. As a placeholder. I'm not unique - others have done it before me, and others will do it after me. I'm just here for the duration, doing the best I can in my brief moment on Earth.

Monday, May 15, 2017

IT: 8:30 am

IT: You are having problems with your keyboard?

Me: This always happens, when I'm gone for a week. Something crazy with my computer. Not to mention the dust bunnies in my office. It's not working. The blue tooth light is on, which makes me think it isn't the batteries, but I can't log in to try to reconnect it. Because it won't work to put in my password.

IT (Incredulous): Do you know about Trojan? Did you know what happened over the weekend? Did you even read the news? Do you realize we have more important problems?

Me: Um, no I didn't. I was at a music festival with my brother in Atlanta.

IT: So you were partying?

Me: Yes, I was. But apparently I missed the IT Armageddon. What happened?

IT: We were getting messages all weekend. Texts. They are all in meetings all day. I'm on my way to one now. This ransomware, Trojan, infiltrated hospital systems through e-mail. Two of our units are shut down. It incapacitated the NLR hospital. Apparently entire hospitals were affected in Europe. And there are more dangerous ones on the horizon.

Me: Dangerous what? Is that a virus?

I was thinking, isn't that a condom? Or a wooden horse?

IT: It's a type of virus yes. Don't open your e-mail unless you trust it.

Me: So what should I not trust?

IT: Anyone who normally contacts you by another medium, suddenly does thorough e-mail. Don't open it. They are using your contacts.

Me: So chief normally texts me. If I get an e-mail from him, suspicious?

IT: Yes. Very. Delete. And go and get me some batteries from transcription.

Twenty minutes later.

IT: We got it working! We had to do something, something, something.

Me: Well I'm glad my keyboard is working. Thanks so much. Good luck with um, Trojan. So what happens, if you are affected? Just so I know.

IT: You get a blank slate. Try to get in the EMR, and nothing.

Me: That sounds pretty bad. Hope it doesn't happen to path.

Sunday, May 14, 2017

Airport: 1:30 pm

Me: I'm running really late because I accidentally called Uberpool? Who knew there was such a thing. I paid the Uber girl $20 to kick two girls out of the car and get me to the airport as quick as possible. So anyway, my plane is boarding and I'm too late to check my bag and I want to see my kids for Mother's Day and I've got a bunch of liquids - where can I get rid of them?

Security: Over there. Get rid of whatever you need to.

Me: In the interest of time, I'll toss it all. ($350 dollars worth of beauty and bath products. Ugh.)

Security: No worries, happens all the time.


Made it.

So do you think they troll those trash cans looking for stuff? Because if they did today - Big time score.

Wednesday, May 10, 2017

Wheelchairs

Airport 10am

Hematology head tech: I'm so excited about the new wheelchairs!!

Lab director: I know me too. We get our first shipment soon. It will be so good for the hospital to get those wheelchairs.

Me: What new wheelchairs? 

Lab director: They are going to be so great. They are stackable, kind of like grocery store carts. And they will be color coded. For example, OB has pink, so if you see a pink wheelchair that isn't on OB, it will stick out like a sore thumb. 

Me: How is this good for the hospital?

Lab director: They have no way to drive, only push. So the person in them can't maneuver it. They can't steal the wheelchair.

Me: I didn't know that stealing wheelchairs was a problem.

Lab director (with other techs chiming in): Yes. Huge problem. Patients check out, and they steal anything that isn't nailed to the floor. You name it: wheelchairs, oxygen tanks, bed sheets, etc. Look! It's kind of like that airport one. That's stackable, and the person in it cannot drive.

Me: So the airports beat the hospital.

Lab director: Yes, they did. Wish I'd have thought of it. That's a billion dollar idea.

Tuesday, May 9, 2017

Hate?



Stirs slowly, in an effervescent stew.

The opposite of feeling is indifference.

Of which I'm an expert.


Monday, May 8, 2017

Words

Your words are a scorn
Ones I attempt to eschew
From the depths of my soul





Saturday, May 6, 2017

Cryptococcus neoformans

Me: Cancer,  active esophagitis, all can be turfed until Monday. I'm passing the cases out like candy. I'm flying out early Monday morning for a lab inspection. I won't be available for the fallout. But this, this is a medical emergency. I've got to do some carpooling around noon - get my daughter and her friends from volunteering to lunch to Heights, so please do the special stain and I will be back in an hour and a half.

Mycology tech (after inconclusive India Inks and mucicarmines): I'd go suspicious. I found a single colony on the plate. Too young for stains. I will follow up on Monday. It's a fast grower. 24-48 hours.

Me: This is a rare bug. I need to call ID, and make sure it is covered.

ID: Thanks so much for calling me. We aren't currently covered for that fungus. I'll add an extra anti-fungal, and make sure she is covered until Monday.

Me: I'm flying out early Monday morning. But the tech will call you with the results. Thanks for adding coverage; this is highly suspicious  - I think you are being prudent.

Isn't that halo breathtaking? India ink and mucicarmine positive, in a perfect world. But we have to wait.

Friday, May 5, 2017

Thursday, May 4, 2017

Musings

So I've decided not to lose the last few pounds. I'm enjoying the cleavage. It turns me on in yoga, during down dog. My own cleavage. And I can eat more. Finally indulge in what I've been denying my whole life.

I was at LuLu Lemon with my daughter last month. She was trying on a cute bralette, and I asked the clerk if I could try one on too.

"Um, no. Those are only for A and B cups. You are at least a C cup. You need to be looking in the C and D section. Over here."

I've never been guided to the C and D section. Seems like a milestone. One that I'll gladly take.


Wednesday, May 3, 2017

Gross Room

2:30 p.m.

Me: What? Who the heck is freezing testicle? I've never heard of such a thing.

Lin: I know. It's hard to freeze and gross, it's super fresh, I found a small lesion. Come look.

We normally fix testicles in formalin for a long time before we gross them. They are very squishy.

Me: That's so small. At least it seems clear of the margins. But a frozen? These tumors are so hard - we need stains to figure them out. Frozens ruins the tissue. At least we have the other half for permanents.

I looked through the microscope. Testicular tumors are so rare - we always need to pull out a book. I called Dr. Music for backup, and did just that - found the 1963 issue of male GU fascicle on the shelf and started to peruse. My best guess on first look was Leydig Cell tumor with extensive hyalinized stroma. But to call that on frozen? Pretty ballsy.

Dr. Music: I agree, this one is hard. But I think you love throwing the word testicle around.

Me: Isn't it fun? We get all the parts. Can you imagine a urologist throwing around the word breast, or vagina? They would be ostracized. But we can chant cervix, breast, penis, all day long.

Dr. Music: We can build a whole person. We can talk about every part. We look at it all. I agree. Suspicious for neoplasm, but we need stains.

Me: Thanks for your help. That's exactly where I was. I'll call the doc.

Of course the gross tech brings me his cell, because he has already left the OR. I'm a little incensed about the waste of the tissue for frozen. I explain to him nicely over the phone that we don't like to freeze these, because we need the tissue for immunostains. I think the message was lost.

Urologist: So it wasn't normal testes?

Me: Um, no. Not normal. I'm really worried about it. We need to do studies on the permanent sections to determine what it is.

I walked out of the reading room into the gross room. Told the techs if anyone ever decides to freeze a testicular mass they need to call me first, so I can try to talk them out of it.

Tuesday, May 2, 2017

Beetles and Wine

I stomp furiously to redirect the encroaching beetles. They persist.

The wine glass in my hand is jarred. Sweet wine drips down my calf.

People gather. Energy is garnered. Roots. Nets. Webs. Light. Earth. Divine.

It is time.

Monday, May 1, 2017

Diarrhea of the Mouth - Law and Order Version

It's close to midnight, and I'm up too late as usual, even though I've been up since 4am, and I'm talking too much (I do that sometimes, don't I?).

I had a unique experience today. I was a witness, not an expert witness, but a friend witness in a post divorce trial. Not sure of the outcome yet, but it was intense. What was supposed to be a half hour turned into 4 hours of an already busy call Monday. It was so toxic I was ready to pitch a tent for my friend. I've never been to the Pulaski County Courthouse, except to obtain marriage degrees.

Despite a dose of beta blockers I was nervous as hell. Sitting outside waiting, talking to other witnesses. At one point I learned my testimony might be blocked by the opposing counsel. They tried for over an hour, to no avail. I think they thought they could stall long enough that I would exasperatedly return to work. They thought wrong. I was strengthened by their determination to silence me.

The lunch in the basement of the courtroom was primitive. Ham or turkey sandwich, or choose from a variety of junk food. I found a Nature Valley oats and honey granola bar, and a large bottle of cold water. The plainclothes detective with handcuffs emerging from his back pocket moved aside so I could pay. I approached the counter. "Do you take a card? Check?"

"No, only cash. But I'll take your purse."

"Ha, I get lots of compliments. I'm keeping the purse. But I've got to go get some cash from my friends."

"I'll buy your lunch." This, from the detective. I thanked him profusely. Small courtesies in a long hard day seem overly gratuitous, and my appreciation swelled to astronomical heights.

When I was finally called I was so exhausted from lack of decent lunch and afternoon coffee I was ready for anything. I swore in, settled on the stand, and fielded questions through the microphone from both counsel. It was like a TV show - but I've never much preferred lawyer/court TV shows so I felt at a disadvantage. Maybe that played well for my friend. I hope so. She deserves it.

Despite objections and overrulings I think I got my point across. I could go into way more detail but I value confidence. Last question:

"So you don't think it was too much for her to ask where her son was."

"I'm a mother. I like to know where my kids are."


Saturday, April 29, 2017

Rainy Weekend

I holed up in a cottage in Eureka Springs. Re-reading an old trilogy. Just finished book one. And I must say, someone needs a medical editor. Human beings cannot pass gallstones, only kidney stones. Other than that it was as good as I remember.

Time for a glass of wine.

Hope everyone is having as blissful a weekend as I am.

Tuesday, April 25, 2017

Gross Room

3:30 pm.

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

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

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

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

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

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

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

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

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

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

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

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

Jessica: Here's the other frozen.

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

Jessica: Is he sending another?

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

Monday, April 24, 2017

Dinner Conversation

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

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

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

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

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

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

"Definitely flying. Telepathy is for the birds."

Friday, April 21, 2017

Tumor Board

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

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

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

Me: Did you meet Dr. Kahn?

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

The Nightingale: Yes.

Me: Good. Oh hi!!

Big hug to St. Vincent pathologist friend.

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

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

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

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

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

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


Wednesday, April 19, 2017

Friday, April 14, 2017

Rate Limiting Factor

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

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

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

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

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

"Seasoned OB wants to freeze the cervical cone."

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

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

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

"That's what I want to know."

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

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

Fifteen minutes later. "No cancer."

"Thank you."

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

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

"Thanks so much."

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

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


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

Tuesday, April 11, 2017

Doctor's Lounge

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

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

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

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

Friday, April 7, 2017

In Case You Were in Doubt



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

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.