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. 

2 comments:

Maren said...

This post needs a pic of the shoes! :)

Liana said...

Wow! Those are high (and beautiful!)