Friday, January 21, 2022

Pancytokeratin and Purple Balloons

     The supply chain is compromised, and you never know what's going to be in short supply. You know if you've been to the grocery store - it's not pretty. Random things are depleted. Rick from histology called me in the middle of the week. We are having trouble getting pancytokeratin. What do you want me to do. Pancytokeratin? That's a staple in my world. We have never been out of that. Just run a low molecular weight Ck and a high molecular weight ck. They did, and it worked, and luckily the next day we had our supplies replenished. 

    Laurie's birthday is this week, and she reserved the private room at Sauced tomorrow night and invited a select few. I'm excited. Laurie had a rough year a few years back, and she is finally becoming herself again. She said no gifts on the Evite, but she didn't know who she was dealing with. Melody wanted us all to go in on a gift. Jessica told her she was longing for a classy understated string of pearls. Melody found one, and we all chipped in. I got a bunch of charms from Rad Girl Creations - I was introduced to them last week in Pathology Mom's Group on FB. The stickers and charms are edgy and pathology related and super cool. Emptied them onto my floor this week, shut the door, and invited Jessica over to help me pick out some for Shelby and Savannah and Laurie and Bob and Joe. 

    Laurie's favorite color is purple, I've known this since even before my time at PLA. Jessica and I ordered some purple decorations off of Amazon (I know, shouldn't support Bezos, but it's so fast) and I told her I would get balloons from Party City, which is right across the street. Turns out they are out of everything purple. Balloons, decorations, and candy. WTF. Planning to stop into Fresh Market tomorrow after work to try to find something festive and purple. 

    Cecelia called me last night and asked if she and her friend Blakely could spend the night tomorrow night. Hell yes! I was so excited I bought Boulevard pimento and cookies. Mike and Rachel are going to host a brunch on Sunday morning. Can I wear my pajamas? I asked Rach in text. What can I bring? Something fruit tray related. Easy. Done. They are coming to support their friend and go to the mom's funeral at 2pm at Wildwood. I had only suggested she live stream it I didn't want to stress her out but I still remember seeing Marcie Lewis' face at my grandfather's funeral in high school and feeling so supported so I am super proud they are making the trek back here. She's going through a lot, I told C, but she will remember this for the rest of her life. I'm so proud of you for making the effort.

    I've had two 7am meetings back to back this week - CARTI general tumor board (Joe Beck is a hoot) and BHEC QC (Bob Searcy is even more of a hoot). Long story short Admin cuts off their nose to spite their face. The head nurse waxed eloquent about division support and market analyses to try to determine why we were losing money all of a sudden. Keep up with the times. Pay the senior staff better so we don't lose them. Travel nurses have no investment into long term care, and they are more expensive. Bob was like speak English to me. Give me a name, not a nameless department. I'll give my recommendations. 

    Problem is, Admin has blown up over 300% since the mid-seventies. And they are making money decisions that don't bear fruit. I'm not trying to alienate myself from the powers that be. I want to influence them - I'm Chief now - and I have my first med exec committee next Monday. I saw a statistic that there are now ten admins for every doctor. And they make helluva lot more than we do. But we are on the frontlines, and there is a shortage of medical workers, so we are as much in a state of disarray as the rest of the world. 

    I was problem solving a health issue Lucy was having last week - hadn't talked to her in months. She's one of a kind. She told me a few months ago that astrologists have been looking at this time for hundreds of years. We are not close to being out of the dark, she said. It's going to be a few years of hell. Five, maybe more. So take a breath and get ready. That calms me, when I get stressed. My GI issues are thankfully abating. I'm having more energy to work out - also catching up on QA I have let linger for the past year. But when you open the news and read about all the voting and abortion restrictions it's hard to have hope.

    Easy peasy call week so far Jess and I were marveling this afternoon. It's so quiet, we had better not talk about it too much or we will jinx ourselves. Oh the hand! I forgot to talk about the hand. I got a hand today, five digits really. Amputated for wet gangrene, which I embarrassingly had to google today bc we only see the dried mummified version of gangrene on the feet. Since we so rarely get hands, I deep dived into the chart.

    Patient on ECMO. Got Covid in November. Vaccination status unknown. Supportive family. Wet gangrene is the kind with active bacterial infection. So pus, wounds, blisters, chance for sepsis. I had a little PTSD reading the charts, bc I remember when my dad was on ECMO. The machine doesn't take care of you as well as your heart, so the extremeties get cold and blue. We had around the clock family care - my little bro took the night shifts, because you really need a patient advocate no matter who you are. We constantly asked for heating pads - they have the fancy twist activated ones but if you aren't in attendance they will fall off and no CVICU nurse, as amazing as they all were, will watch out for your hands and feet as well as someone who loves you. Thanks to us, dad still has all of his digits. My next plane flight is to see them in February and their new house. Can't wait.

    Happy Friday. Much love, Elizabeth

Tuesday, January 18, 2022

Shit for Brains

      I wandered into the gross room at a quarter to four to check on possible late frozens. After the holidays and the deductibles things tend to slow down a bit, and we are just now seeing this. Jessica still had a pile of placentas but the more critical specimen table looked good, not overflowing like it has been for the past couple of months. I think the OR is winding down, Jess said. I'll go check, I told her. After I looked at the board I told her the only one that concerns me is the retrosigmoid approach to a craniotomy by Conner? What the hell? How do you go behind the sigmoid colon to get to the brain? Seems a little circuitous to me. She laughed. I already looked that one up. It's some artery microdissection. Not our concern. But I've seen that occasionally before. Not sure - is there a part of the brain called the sigmoid?

    Not that I remember. I'll have to google that, I said. Jess yelled it's shit for brains! Lol. Still haven't googled, but oh well. I got a text today from my Dad's Apple watch at 10:38 that scared the shit out of me and made me sweaty and shaky. Rick Nestrud has had a hard fall. You are receiving this because you are an emergency contact. Here is his location on maps. WTF? I called Mom and sure enough they were in downtown Port St. Joe waiting on an ambulance. Long story short, he's ok, he had a nasal fracture and a radial fracture - both non-dislocating, but he's got a lot of cuts and bruises and is in horrible pain. When I called Stephan and Christie to tell them they both said, I guess it's genetic. 

    When we finally ascertained in group text with sibs and Aunt Sue and Uncle Chuck that he was going to be ok, just a little battered and bruised, I said someone needs to start researching walking assistance for me, Mom, and Dad. Mom had a compound fracture in the Spring which required external hardware and much OT - we have been commiserating. Also a fall. I said I want a cool staff that makes me look like a witch or a wizard not an unsteady mess in disguise. Matt found something on Amazon that lights up! Bonus for nighttime. 

    In a flurry of oh shit I'm falling apart again I have had four dr. appointments in the past two weeks. Good news. Mammogram is clear as a bell. What are you doing? New breast rad - daughter of chief of ED who I have worked with on the phone but never met was incredulous. Look at last one there is tons of fibrocystic disease are you taking Vitamin E (well now I am) or hormones? Nope. When I called Amanda Ferrell to bitch about aforementioned surgeon she said that she's seen that happen during menopause, but it took her about a decade to recognize the pattern. 

    Also good repeat fasting labs were COMPLETELY NORMAL hallelujah no organ transplants in my near future I almost cried when I got the phone call Wednesday. Blood pressure is good as well no need to add anything to the beta blocker and with regular exercise I can probably get off of that too. Checked in with new gyno Amy - she is Cindy's BFF and I needed to see her since I haven't seen anyone since Cindy moved to Santa Fe earlier this year. She is hilarious I'm excited to be her friend and invited her to book club when Covid finally ends (if. Sigh.).

    I sound boring and old. Can't remember if I told you Cecelia's new mission in life is to become a sexual wellness doc. She wants to write a book and become famous and revolutionize the industry. Feminist me is super proud even though mom me cringes a bit at her candid discussion but that is what our kids do right? Bring us forward. She predicted her National Merit Finalist and President of Central when she was a Freshman so I've got no qualms that she cannot do what she sets out to do. 

    One of her new BFF's at Fville was the mom that tragically and inexplicably died while paddle boarding last week. So I've been plugging in a lot with her lately. How to support friends who are grieving. Hell I melted down thinking about it on Sunday. When C discovered she was missing on Wednesday night through her friends Insta she frantically and full of empathy told me I was never allowed to paddle board again. Well, I said, I'm pretty sure my OT would agree with you. Tongue in cheek, that was, but watching the fallout since then, from the police boats we could see from our window Wednesday night to the discovery Sunday has been holy hell. 

    Dad is good. A little embarrassed I kept receiving texts from his phone during head CT, etc. I just talked to him and was like hell no I want that info. Turns out if you go unconscious and don't disable something your Apple Watch will dial 911 and share your location. Melody said all of her and David's parents have one. Also picked up my dad's A.Fib a few years back. So good investment for a loved one, especially if they are on their own. Happy Tuesday, much love, Elizabeth

Monday, January 10, 2022

NastyGram

     I got fired on Friday, by a belligerent surgeon. Of course it was relayed to me by a partner - this person is borderline as hell. You do everything the same, 99.9% of the time you are right, but that .01% that you cannot predict all hell breaks loose. Did you defend me, I said? Stand up for me? What's there to defend. You did everything right. They probably made a promise to a patient, that they were trying to uphold. Well I don't stand over them in the OR and tell them how to do surgery. I'm nothing but professional. 

    I called a fellow doc to vent Friday night. You are preaching to the choir, she said. I get a nastygram every two years saying what a stupid doctor I am. And now that their notes are in Epic? They are throwing everyone under the bus. It's like a bad boyfriend you cannot predict or break up with, I said. They are the bane of our existence, she lamented. I love my job, very much, but this is a stick in my craw. 

    I want a New Year's makeover. And I tried - postponed my plans while Jack was in quarantine but Christy tested positive for Covid on Sunday after I spent Saturday with her and S is sick as a dog. He tested negative by PCR this afternoon. So maybe bad flu? Who the hell knows. I called employee health this morning - the same department that required a negative antigen test before I returned to work last week after coming into contact with Jack. No we are not testing anymore, she said. Just wear a mask, even if your husband comes up positive, we won't test you. That is new, I said, different from last week. Yes, the rules changed last Wednesday? Maybe Thursday. Just stay masked and don't eat with anyone this week - no unmasking at work. I LOL'd. So this is why there are so many CDC memes on Facebook. You are throwing us to the wolves. She laughed, and said just don't forget to mask up. If you need testing for peace of mind, do it elsewhere. If you become symptomatic we will test you.

    There is an Omicron update from Mandee that I didn't watch today - I plan to tomorrow. But anyone with access to the news can see that this is a huge shit show. Are they altering their plans for the good of the community? Or the good of the hospital business. I think the latter. I'm just going to lay down low and N95 it up and keep working. Christy dropped by some home testing kits today and was wondering about my results. Well, I decided not to test. It was recommended by employee health, and if I do test positive, it will wreak havoc among my group. A false positive would be a death sentence. We are all spread so thin, and this would put us into a spiral. 

    There are highlights of the new year. Figuring out hard cases. I had a gallbladder cancer in an early 40's patient last week. I have only had two other gallbladder cancers in my career and both were consults. About 50% of them are incidental findings - they think, as in this case, that they are just gallstones. This was not subtle, it was ugly as hell and all over the margins. I called the surgeon's nurse. Oh hell, she said. Can I give him your cell phone. Of course, I said, if he has any questions tell him to call me. This has a horrendous prognosis - 5% ten year survival maybe I looked it up last week but there has been a weekend since then. 

    So I still want a do-over. Sent Woody and Cecelia to my mom and dad's for a long weekend they had a blast. I'm a little jelly C saw their house before my planned trip in February but since she plans the summer in Spain this was a good thing. Other good? Ack not sure. Station 11 is still captivating and we just cheezed out to the fourth season of Cobra Kai. I hear that Euphoria and Righteous Gemstones just dropped new seasons too so there is no lack of content. Planning to finish Samantha Power's autobiography soon, it's fascinating. No more days off until February so there's nothing to do but work. Happy Monday, thank God it's almost over, Much love, Elizabeth

    Speaking of Gods, there are no Gods in medicine. There is only teamwork. Some clinicians fail to understand this. Well, we are entering a new era. Time to hold the Godheads accountable. 

    

Sunday, January 2, 2022

Covid Cats

     It's funny how you can be over the moon and something comes along and knocks you on your ass. In this instance, it was a phone call the day before Christmas Eve informing me of some wacky labs. I don't know why, maybe it's my job, but I go from skewed labs to multi-organ system failure and brain infarct in the blink of an eye. My labs were the first I'd done in three years, and I wasn't fasting, so I go again in a couple of weeks to make sure they were real. Nothing can make you feel more vulnerable and human than feeling out of control. Meantime I course correct (after I beat myself up for being a terrible person). There is more than one reason for getting on the treadmill and if I fixed my blood pressure and borderline high cholesterol once maybe I can do it again? Curves be damned I want to live as long if not longer than Betty White.

    Jack is finally out of quarantine today after testing positive on a home antigen test at Mike's last Wednesday night. I'm glad I've missed him. It threw our house into chaos for a few days but everyone else tested negative - M, R, and S by PCR, me, C and Joelle by rapid Ag. I took one look at that PCR line at Baptist on Friday morning and said screw this I'm on call. Went to the front lab desk and tested Ag negative in 15 minutes. I know PCR is gold standard, but I told Joelle and C if we get symptomatic we will do PCR but since we are not this is good enough for now. Just mask up and stay away from Jack and Noah.

    Noah ultimately tested negative yesterday by PCR (his brothers and sisters were pos) even though he was symptomatic, which made us wonder if Jack was one of the 1/100 false positives on the Ag test. Rachel's friend Whysper caught it - she had to get it from somewhere and Jack is the likely culprit since they all went to RKS together. It is so strange how indiscriminate the virus is. Jack and I wondered aloud if maybe Noah had extra ammunition on board since he was the only one who had the original Covid before he was vaccinated. Who knows. Jack ultimately decided he'd rather not spend the last couple of days of his break getting a PCR test. I agree.

    Happy New Year! It was pretty uneventful around here. The most exciting thing was spraying the cats off of the couch with bottled water in the evenings (they bed downstairs in the Covid lair). Jack was kind of happy to have an excuse to cancel his NYEve plans. I told him he could have six kids bc I was on call, and even if I wasn't, I don't want the house to turn into a wild party for 16 yos. He was getting lots of pressure from his friends to increase the numbers and it was stressing him out. Jack is not wild, he is quite the opposite. He's not an early thrill seeker like C was (the apple doesn't fall far) he is into his health and natural weight lifting (I'm all natty for my health, he says). He eschews drinking and vaping, he's tried the former but isn't impressed. He schedules lunches with his favorite teachers on break and gifts them books. He hasn't had a serious girlfriend since he was about 10, and we know that even if your emotions get carried away then it's kind of just a tip of the iceberg thing.

    Jack's friend Izzy stayed here for a couple of weeks in December while her parents were getting situated to move back to Little Rock from a Vermont experiment that failed after 6 months. I asked her one night about Jack. Told her I knew he had some vague interests but some new discovery about the person always led him to keep his distance. Not that I'm judging, Mom, he says, that's just not the person I want to date. Izzy said Jack is picky. He watches his friends get all giddy and then it turns into a train wreck and he congratulates himself for not going down that road. Not that it's been all roses for him. He is highly sought after, which has led to some very awkward situations that he's learning to get out of more smoothly as he goes along. 

    C was laughing about one of those situations recently. He's so heartfelt, I said, he doesn't want to hurt anyone's feelings but the poor girls are probably mortified the more he tries to explain and mollify. He such a good kid too. You probably wouldn't have hung out with him in high school, he's not wild enough. You are right, Mom, but he is so good. He's going to be a great catch someday. I told C I'm just glad he's old enough to start going to concerts with you. He's a great protector. I'll sleep better. Happy Sunday, much love, Elizabeth

Wednesday, December 22, 2021

The Mythical Elizabeth

     S started his job in February before the pandemic. As you know, Christmas parties were cancelled last year, but we had one last night in the party room at Samantha's Tap Room. There weren't over 20 people, it felt safe. We cancelled the PLA Christmas party this year bc with over 50 employees, it didn't feel safe. So I had never met the principals Tim and David or the draftsmen Dick and Riley or their lovely wives. Last night we all remedied that over food and drinks and it was a blast. I was surprised that they all thought I was a myth, since they hadn't met me before. I got super quizzed over Covid and that was a softball. 

    Another strange thing happened last week I didn't tell you about. I got a gross only report on a penile discharge/penile foreign object. I'm not even a guy, but I cringed. What the holy hell. We get a lot of rectal foreign objects but never penile? Was this person sane I wondered? I looked at the age. Four. I wandered into the gross room and asked about it. Savanna, our mouse in the house sex toy expert, said it looked like an apple stem. I LOL'd. I guess if something can come out of it something might go in. Savanna said he probably hoped he could shoot it out. Hahaha. Like I gun, I said. The stem was a bullet. Those little men start early with their dreams of projectiles. 

    My intake is so much less than my output lately I'm amazed that I'm not stick skinny. But I love the curves and that's the way of the world lately right? Moving into a curvy future. Tipton and Hurst at Baptist went the way of many stores during the pandemic but they are putting in a new scrub store and it's exciting watching it go up. The inventory is all there it looks like it will open soon and none too late. I'm through with trying to fit into my small tall scrubs it's not in the stars I decided. Certainly the tops will never fit no much how exercise I do. Time to explore medium, maybe large even. I'm pretty tall. 

    I had to go to the family doc this week (it's been three years!) bc when I was in the ED a few weeks ago they picked up incidental hypertension. It's returned. Sigh. Back on daily beta blockers and I bought a new sphygmomanometer at Walgreen's to chart my blood pressure, which was 167 over 115 on Monday after a restful non-eventful day (it was 206 over 120 after the traffic arm fell on me). That's pretty crazy high. This does not run in my family not sure where it came from. My family doc Kent Covert (he's highly recommended Melody uses him too) LOL'd when I told him the story of the ED trip. He said he always worried about it falling on his car but never imagined it falling on a head. I told him Staggs was so alarmed it happened to me twice he wondered aloud that I should not tell anyone that it's kind of embarrassing. Much? 

    Having a relaxing week I got a massage today and had lunch with Christy. Trio's requires vaccine cards I fing love that. I heard from Maddy when I got my hair done yesterday that 42 and the Rep require them too. I need to get out more. Monday shopping with Jack and Rennie was fun at Belle and Blush but scary as fuck in Gearhead Outfitters and Big Orange there were way too many people and no one is masking what are they thinking? Batshit crazy. Who knows what the next possible mutation will bring. Ebola nastiness? I wanted to scream get your Vax. But the world is crazy, so response to the pandemic is not surprising.

    Best ever show Bo Burnham Inside on Netflix. I died laughing at White Women Instagram and Sexting and empathized to the point of tears when he was talking panic attacks. I have about one a decade since my twenties - to the point of physical terror - and it happened last Thursday out of the blue. Shaking, perioral numbness, phalangeal numbness, you name it. 0 to 100 in a second it scared the holy shit outta me prompting a visit to Yousef yesterday for the first time in nine months. Turns out one a decade isn't really that bad. I'm gonna be ok. Interstate travel might be dicey for a little bit but it's a small sacrifice for sanity.

    Got a big grocery trip planned for the am our Christmas Eve potluck looms. S is cooking the beef chili and Jack wrestled the turkey chili from me so after I shop I'm home free just hosting. C gave me a list so long I think I'm going to be shopping for her whole spring semester so I'm hoping I can limit it all to one cart. Sunday we are leaving for Nashville to see Rainbow Kitten Surprise. LOL I'm on call Monday and am covering frozens I realized and turfed that to Shaver last Friday. I'll get up early and play catch up in the afternoon. Merry Christmas! Much love, Elizabeth

Friday, December 17, 2021

Hand Presentation

     I had two interesting placenta's this week, which is saying a lot, because I rarely get one a year. They are junk surgicals. Back in residency I cut my hand on a placenta. Unfortunately the histo director Marty saw me and made me initiate the reporting of it to workman's comp and HR. About thirty minutes into that process I could tell it was going to take a long time so I was like fuck this and went back to gross. Took a deep dive into the charts and Mom didn't seem high risk. When I was planning my first pregnancy I told my OB Cindy to check for all the things, AIDS, whatnot. I can handle putting myself in harm's way but not a kid. It was all negative, thank goodness.

    Anyway, the first one had chorioamnionitis. This is the most common placental problem but the requisition was what piqued my interest. It said hand presentation. I normally don't open Epic for a placenta but I did. Mom was of the young age that the prerequisite effort for her current predicament was possibly criminal and not recreational. She had no idea she was pregnant and called 911 bc there was a hand protruding from her vagina. I think I would have had a coronary before I was able to call 911. But she did, and delivered a viable 25 week old female infant in the ED. What a way to enter the world, I marveled. Maybe this chick will be president someday.

    The second one was today. We document the amount of placental villous infarct - it is estimated grossly - and they are usually under 5% which is normal. This one was 85% infarcted, which I've never seen. Mom had asymptomatic Covid, she was in town from a small town bc hubs was on ECMO with Covid. A closer examination of the req showed the baby was IUFD - intrauterine fetal demise. 33 weeks. I learned there are case reports out there that show that having Covid can cause massive fetal malperfusion and placental infarct. So it can bypass Mom and be terminal to fetus. Melody and I marveled - I printed out a case report for us to read.

    Mandee Novack did a Covid update for us last night and I watched the video today. The Omicron variant, which is plaguing South Africa and Europe, is just hitting the US and Mandee thinks it will cause massive problems in January (after my Christmas Eve party thank goodness). It's more transmissible than Delta and OG Covid but less virulent. Meaning vax boosted people will probably be ok. She showed lots of charts and graphs and where the other two VOC - variants of concern - were like a steady climb Omicron is like a straight up peak. 

    We had a plateau in April but there was no plateau after Delta there was just a nadir and we are on the rise again. Omicron is definitely here, if not yet detected. She got all sciency and nerdy in a good way but the gist is that Omicron has never before been seen molecular variants on it's spike protein. It has S dropout, and we have Thermofisher which is the only machine in the state to record S dropout so she's been charting it since Thanksgiving. No big spikes it that yet, but it's coming. BioFire and Thermofisher have the ability to identify the Omicron variant in the pipeline - it's coming soon. 

    Mandee predicts that while it may not be as virulent or cause as much problems as Delta it will be a crisis, if a more abbreviated one. It will wreak havoc on staffing - those L&D nurses who throw baby showers and have breakfast after a night shift could catch it and wipe out 40% of a department for 10 days. Whereas Delta and OG have a transmission rate of one it has a transmission rate of 5 so that might cause, and already is in Europe, exponential disaster. If one person infects 5 and they go onto infect five more it's a real problem.

    There will be testing issues and shortages. At the peak of Delta we were testing 500 a day in the drive through and this is worse. We have shortages on monoclonal antibodies and that's bad too. Our ICU's have remained full through Delta's waning and if there are asymptomatic people transmitting it to already sick patients they won't do well. Child care will be a big issue - Omicron doesn't care if you are vaccinated, although you will probably be ok you will still be a problem and there will be lots of shut downs of day care units. She illustrated the transmissibility with an article about a person from South Africa staying on the same floor as a person from Canada. Camera footage showed they never even passed in the hallway but the person from Canada got it anyway. So it can go through walls and HVAC units. Delta and OG could not do that.

    Cecelia came home today - I got two tubs of pimento to celebrate and she is happily diving into one with Ruffles. Jack excitedly texted that he got all A's this semester - I'm proud of his hard work. I've had a rough week physically but I'm excited to be off for a whole week. Got lots of boring doc appointments and OT but that's ok. Boring is better than exciting sometimes. Hope you are well, much love, Elizabeth

Thursday, December 9, 2021

Snake Oil

     Well Jack is better. He's over at his dad and stepmom's this week so I haven't heard from him but no news is good news. He was prescribed a new antiviral for the flu - Effluvox I think? That cost about 200 bucks insurance did not cover. It was interesting watching the cyclic nature of the virus. One minute he was eating and wanting to watch Merlin, a couple of hours later he had a blinding headache and was breaking out in new hives. He texted me at 2am Friday morning saying he wouldn't wish this on his worst enemy. So we filled the script Friday morning, and two hours later after a hard sleep he was right as rain. Worth every penny. He got the first dose Baptist gave this year.

    This week has been my week to suffer - I had such horrible dry heaves Monday and puked a bunch. Kimberly had to drive me home at noon. Tuesday was a little better but similar. Luckily the week has been slowing down a bit and my GI system has been somewhat normalizing. I was super pissed to see a flyer in my box Wednesday morning from a molecular rep asking me to go to Arthur's and view a lecture. I did a double take - the name was the same as the one who invited us to an Afirma dinner about four or five years ago. 

    Pam and I went - she is the head of cytology. It was in a private back room and the food and wine was abundant and lovely. The lecturer was from Dallas - she looked like she belonged to an affluent country club. ENT surgeon specializing in thyroids. About three fourths of the way through the lecture she showed pics of her pathology thyroid team and marketed our work out. I side-eyed Pam. WTF. At this stage in my career I would have stood up and called her out and left but I was still trying to be polite.

    Dr. Kirsch was there from Conway. A very vocal ENT, I met him first at Laura Lamps' house when I was a resident helping her host an international famous GI crew. He is tough to get off of a conversation with, I learned, and have continued to on the phone over the years. But he's sweet. He defended us. We like our pathology, we don't need to farm it out. As we were walking out, he was dissing her. Why do you need to be a thyroid expert if you are an ENT anyone can do that? I said, yeah, most of our general surgeons do the thyroids. She's moving backwards, and pretending that she is moving forwards. They aren't tough, surgically or pathologically. Most of them, 98%, are benign colloid nodules. It's not rocket science, it's job security. She's a slave to who she's crawled in bed with.

    A couple of weeks later Pam and I were doing a bronch for Cidney and she was there marketing lung technology. Passing out fliers for another dinner at Arthur's. She apologized to us for her guest speaker. I didn't know she was going to do that, I'm so sorry. She walked away. Sorry not sorry, I said to Pam, screw her and her dinners. Cidney said that lung molecular is like snake oil right now I wouldn't go if she paid me. He threw the flier in the trash. I laughed. I did the same thing this week. Tossed that bullshit.

    I started Heart of a Dog last night and am about 3/4 of the way through it is so good. Amanda is going to drive me to book club Saturday night I told her my night driving was sketchy right now. I was laughing so hard today when the dog was morphing into a human I had to put the book down to breathe and dry my eyes. Can't wait to see Natalya's home. Other than that it's just finishing unboxing and putting up and starting to wrap for Christmas. Can't wait for a weekend - I'm not on call again until New Year's week.

    Cecelia is doing good - she nailed an interview with a doc to work in a lab called TEMPT and she is so excited. Also got some travel abroad honor award. I was worried about her bc she called in agony on Monday in the midst of my physical distress. Sometimes a girl's gotta cry to her momma and it makes everything better. S is excited there is some retired hedge fund guy who researched water for 10 years and is building a plant in Hot Springs. Also restoring a dilapidated barn as a visitor center for lectures and museum. He wants to enter it in magazines and make a splash and win awards. He loves S's design. 

    We have some exciting things brewing in our company that are too early to talk about but I'm vibrating with possibility. Pathology is moving into some amazing new technology and we are trying to be proactive so we don't become obsolete. I think we are on the forefront. Rex and Dianne both heard about it at the party and said they are glad they are retired but I'm happy to be a part of it. Hope you are having a good week. Much love, Elizabeth