Thursday, April 15, 2021

Dr. Askhole

     I decided that was what I was going to call him today (he often asks for us to come up for frozens), because he had five cases in Conway and makes us sit there and often doesn't even use us. I looked at two uteri with EIN (endometrial intraepithelial neoplasia) that was diagnosed on biopsy and one looked normal but one looked ugly cancerous it makes a difference what he does in the operation and CARTI loves him. He came and looked himself Jessica could have opened without me because his assessment was as good as mine but I made sure to charge for a gross only. I'd never met him even though he's been there for a few years - he primarily works in Fayetteville I think (googled him a long time ago) but comes down to operate so he can check in on aging parents. And he was so nice and grateful I doubted my moniker. I'll shift the anger to the people who decided to build that hospital that still seems like a ghost town and doesn't have enough business for us to place someone full time there. One of the ovaries was enlarged on the grossly cancerous uterus. I warned him to stand back while J pierced it with her scalpel. Sure enough a bunch of serous fluid popped out into the sink looked benign, we both agreed.

    But I've never been up there with Jessica while I was waiting for the 10:00 courier we had so much fun talking and listening to music I told her we need to make this happen more often. We got on the subject of horses - my Barrington country club equestrian cousins and aunt and uncle used to try to get me to like them when I visited I wanted  nothing to do with it and they sensed my terror and tried to help me overcome it. To this day I remember sitting atop some giant horse (of course the biggest one was the calmest) at age 7 or 8 - his name was Gentle Ben I think? Or Ben? and using all my concentration not to pee in my pants I was so terrified. 

    Then she told me a horse story that has had me dying laughing every time I think about it all day. Her friend had a Shetland pony - size of a large dog she said - and they would saddle up and ride it at age nine. One time the saddle started listing to the side - she demonstrated this by leaning over, and suddenly they found themselves on the underbelly of the horse. Although their heads were probably only two inches from the ground they had no idea what to do so they were holding on for dear life (the pony was standing still) until an adult happened upon them and said, "Dear God what are you girls doing? Just drop on the ground!" They were so relieved.

    I told her my aunt used to try to teach me how to feed the horses with apples and carrots she said hold your hand flat so they don't accidentally bite a finger off. I was mortified, even as a small child. That's not really a risk I want to take in life. Jess agreed. Horses are too scary. We were both scarred as young children. I told her about the horse at the dude ranch that dropped to the ground and rolled - I narrowly missed breaking my leg - I had to scramble. I'm sure there are horse whisperers out there but I'm not one of them. 

    So happy it's almost Friday this week has stretched on forever. Highly recommend the turkey burger at Baptist Conway it's incredible. And Flight Attendant. I think we have one episode left. One more full week of no call work next week and then a two day work week with colonoscopy (fun!) then long weekend in Eureka. Happy Thursday, Much love, Elizabeth

Tuesday, April 13, 2021

LIbra Rising

     Lucy told me this was a lot more important than my sun sign. So after an hour and a half I marinated it. She is new at charting, it must be in her genes - she picked up on it in four months I told her I watched the Leo King for years and never understood it. She could honestly be an internet celebrity she identifies as LGBTQ she's amazing. She told me she was so jealous of my chart and thought I was only 30 when I told her I was 47 she about blew a gasket. Courtney Love is a Libra rising I learned on the internet I love that.

    I was at Boulevard today and bumped into my hospitalist neighbor Q he invited me to his poker night tonight. I went to just be charitable - he told me he doesn't socialize with other work docs these were outside friends. I met a guy named Jose, he is from Puerto Rico he has a girlfriend who is a physical therapist a ACH guess what her name is. Elizabeth. He tried to get her to come to Q's house it was mostly a guy poker night. I told him to bring her next time I'd love to meet her. He just signed on to Baptist to be a physiatrist (FIZZY!) I told him Baptist Rehab is one of the best in the nation they really helped my Dad. We talked shop and docs looking forward to seeing him around the hospital. 

    Lots of GI issues still but I'm getting stronger I walked another 4 miles tonight after work I did the same route on Saturday. Watched Promising Young Woman Carey Mulligan hosted SNL on Saturday she is getting a lot of Oscar nods. It was triggering, I cried a few times, but I loved it. Want to watch it again. 

    Made for Love is also wonderful it's on HBO. So artsy and wacky. Short blog. I'm tired. I was up from 1:30 to 5:00 am. Day went well but there's much change in the near future it's overwhelming. I'm going to wind down to music and TV. Much love, Elizabeth.

Saturday, April 10, 2021

Not Call Weekend

     I want to write but there's nothing much to say? I've already gotten enough sleep for a whole night but hoping to get more in a few. 

    Mallory, a new hire in the pharmacy, is adorable. She has glasses and dresses cute kinda librarian/pharmacy assistant with a millennial flair. She blends in, but stands out. She's pretty quiet and I don't need drugs much but Jack and Cecelia and myself had some things filled this week so I found myself talking to her more than usual. Turns out her birthday is Monday she turns 21. She said can you believe I turn 21 in a pandemic. I was like yeah that sucks no bar hopping I guess? She told me that she and her friends were planning a picnic after work. I said so you are an Aries girl? I've read a lot about Aries guys my ex was one but not much about Aries girls what's that like? She laughed and said we are really chaotic. Funny, bc she looks like the picture of calm in a storm. I laughed and said that sounds like my ex, told her we get along a lot better now that we aren't married. I think I'm going to buy her a festive drink for her picnic this weekend - maybe a bottle of champagne or Prosecco. 

    Something else happened since prom is canceled one of the mom's at Central is planning a masked event for those comfortable attending April 24. It's at Windsong in Maumelle - my partner Michelle and her husband Darius said it's a nice venue. So C wants 23 of her friends, she sent me the invite list, to come to our backyard for pics and dinner from 6-7:30 before it starts. We discussed catering something easy like Chic Fil A or Taziki's - I told her pizza might be dangerous to fancy dresses. I know parents will want to be there, so I started a group text with 8 moms I knew and told them the low key plan and told them to invite other parents I didn't know. Said it will be a masked event - I've held small gatherings with vaccinated people indoors since CDC approved and lots of people are vaccinated but this could be upwards of 50-60 people. 

    But eating and drinking are maskless activities and so I told them I'd have seating available for small groups so people could gather at their comfort level. Hosting during a pandemic is so challenging. I told the mom's I'd have some appetizers and wine but if each of them brought something to drink and an appetizer that should cover the adults with little cost and effort. Then I started freaking out and calling Kricia yesterday while signing out cytology bc that's a lot of people and do I have enough seating and chairs? I told her I want to use the dog run to serve, especially since we have no dogs or dog shit there, and she thought that was a great idea. She said PartyTimeRentals is cheap right across from Sauced go there and get two long tables and maybe get a couple of simple floral arrangements bc your view is the main attraction you don't need much else. I like the idea of leaving the pool area clear for photos. And Cecelia agreed an hour and a half is perfect - the shorter the better - less likely for kids (ack adults) to smuggle alcohol.

    C asked me for one thing for her bday - a mom and daughter shopping trip. She was texting me at work last week pics of new spring floral prints from Lulu. She works at All Aboard all day tomorrow, but she is off Sunday so we plan to do at least Lulu and Belle and Blush they texted me a coupon Friday I can't wait to use. So happy for a beautiful weekend off, hope to get some sun in tomorrow afternoon. Hope you have a wonderful weekend. Much love, Elizabeth

Tuesday, April 6, 2021

Astrology Chart

     I was hunting for my birth certificate a few years back because I have always wanted this done and couldn't find it. Deidre's friend does these; it's not in Lisa's wheelhouse. You need your time of birth and while your date is easily accessible (for most) this is hard to access without the permanent record. I called my dad and he no longer had my birth certificate on file so I gave up. Fast forward to needing passport to go to Costa Rica and I dug it out of a box under the stairs I've probably been lugging around for over 20 years after two hours of looking. Made sure to file it in my locked cabinet at work with the kid's. 

    So when I learned that Kimberly's replacement at Boulevard (since I poached her everyone loves her as much as I do and she's been a wonderful add to our work family) did astrology charts I was ecstatic. Wrote down that I was born at 9:53 am on August 20, 1973 and planned to get her to do one for me. Her name is Lucy, and as she was getting trained and up to speed I learned that she won even Brian over with her projections. Shelby was raving and Sean said she was very good. I asked her to do mine and asked her how much she charged. She said she never thought of charging, maybe 10 or 15 bucks?

    LOL that's crazy even Lisa charges a lot more than that and she's half of Yousef. I gave her a 20 Friday afternoon  and told her I'm in no rush, I have studied the cycles at BV for years I knew she had to break down for the week and transport still viable baked goods and food to the locations that were open on the weekends. She said give me your cell and I watched her write it in permanent black marker on the inside of her arm. 

    This made me think of two things. First, Eddie Vedder's MTV unplugged performance where he wrote pro choice or something like that on the inside of his arm atop a barstool and then fell over (I watched that so many times it's ridiculous). I'll bet Lucy's way too young to remember that but some of you out there might. Second, of a local doc who committed suicide a few years back - my chair knew about the note that became incoherent as the stuff kicked in and how he wrote NO AUTOPSY on his arm. Well, guess what. You don't get to decide that when you are gone. Rules are rules.

    So Lucy told me today that she would do my chart on her day off tomorrow and we could meet about it Saturday. She asked if I was familiar with Zoom. It took all my strength not to laugh out loud I just said Zoom, yes I know Zoom, that's fine. I mean who doesn't know Zoom??? She would probably laugh with me but I don't know her well enough yet to know that so I erred on the side of caution. In the meantime I texted Deidre and asked her how much her friend charged for charting so I could get a feel for what it costs and let Lucy know - she seemed incredulous at the idea of charging. I may actually be her first paying customer.

    Nice to have the kids back over here Jack did virtual yesterday and even though I had a gagillion needles it was fun to have him around talking about parallelograms and Hosseini's A Thousand Splendid Suns (of course you've read it Mother, no spoiler alerts please). He talks as fast as I dictate so when he was plotting to use me as an excuse not to go to a basketball game things got screwy. He said I'm going to tell my friends you can't drive me because you've got dinner plans but mask so I thought he said implants and we both got a good laugh about that. I told him he could use me as an excuse anytime but make sure that his excuse is escape proof bc any friend could say I or mom or dad could be happy to pick you up and then you are in another pickle. He laughs at my old timey expressions. 

    And OMG he's a fantastic shopper we tackled Kroger yesterday together and got it all done in a half hour it was amazing - this kid who has so much crap on his floor you can't see it and doesn't know how to find the dishwasher thank god there's hope. Planning a double batch of meatballs tomorrow. He's so excited. 

    On the way out today Tony cytotech brought me a case full of fungus. My friend Jason Holder did the bronch lavage yesterday. They were worried about an atypical infection bc it was multiple cavitary lung lesions in a 78 yo on Methotrexate (immunosuppressant). I noticed her crypto ag was pos and her crypto titers were high mycology was gone for the day but I showed it to Hal and he agreed we need to order a mucicarmine for tomorrow. Cryptococcus has this encapsulated mucoid shell and a mucin stain will light up the polysaccharide cell wall. I called Jason and he was working with the infectious disease doc they are on the side of belief and are doing a CSF tomorrow the stain there is India Ink they do that in the mycology lab. I'll touch base with Tommy in mycology first thing in the morning to brief him and give him a heads up. This is kinda rare. If the pics are good, I'll share. LOL cringe. Happy Tuesday. Hope you are having a good week. Much love, Elizabeth

Wednesday, March 31, 2021

Gross Room

     I was watching a taped version of Mandee Novack's talk on CLABSIs, you know central line associated blood stream infections, this morning around 10 am while waiting for slides. They have these physician metrics that you have to meet every year and they tie it to reimbursement somehow and it's always really boring for us pathologists because nothing is very pertinent it's all for clinical docs not lab docs. But all my partners have been talking about how great it was. This is her second one, and I just texted her and said girl you gotta stop knocking it out of the ballpark or they will make you do every one. She is seriously engaging and entertaining and has the ability to summarize massive amounts of data into useful information that's super rare in my experience. She said aww thanks I was glad to get that one over with the subject of CLABSIs is about as boring as watching paint dry. Not if you tell interesting stories to make it meaningful and have lots of gut churning pics (for a pathologist anyway - give me parts and dead bodies over live patients any day) as examples of bad insertion site maintenance. 

    I paused it when I got paged to go to the gross room for frozens. It was Muesse, a pleural rind, and I couldn't find anything malignant. I looked real hard because last time he was so incredulous there was no malignancy I looked again and found a tiny focus of probably cancer and called the OR back. The next day I was sweating bullets bc it got cut away on permanents but luckily he sent more pleura for parts B and C and it finally showed up in C. I showed it to Hal and he was like wow! You got so lucky! I cannot believe you called that flat out on frozen but you are right it's there so subtle. 

    While I was waiting on Jessica to stain - he sent two frozens so I decided to hang out and chat in between, I noticed Laurie grossing in a large leg. It looked kinda good so I wondered aloud why they cut it off. They had done multiple revisions of an ankle fracture and she was still in pain. I said that's a lot of leg for ankle. Laurie cursed when she could not get around a metal rod and Jessica from the stain line wondered if a bone saw might help.  I wandered over to Jessica and she said there was a blue light special on legs this week, everyone is doing legs. I looked in the glass front fridge and saw a big pile of legs - they put them in red plastic bags and tape them up. Lotsa legs.

    Jessica told me one guy came into the ED and had a history of a remote motorcycle accident with lots of surgeries on his tibia; his whole foot was red and swollen they took it off. She said oh my gosh most of his tibia was eaten up and hollowed out like a tree trunk someone had sawed into and I'm surprised he was still upright I would have thought he would have keeled over. Here I got a pic I've never seen anything like it. I looked and think cross section of a leg but not very clean there's ragged skin and lots of bloody meat and in the center the tibia looked like 4/5ths necrotic dark brown goo I have no idea how it was bearing the weight of a human without snapping like a twig. She said another guy must have been sitting home alone for a year the leg was so rotten. Anything else? I wondered.

    Oh we got an apple from the anus! I was like what???!! I laughed incredulously and said I sure hope it was a crabapple! She said no it was not and she eyeballed it grossly for measurements and description she did not touch it or look for a grocery store sticker but her guess was a large Mt. Fuji. I commiserated, not sure I'd want to touch that even with a glove. People are sure interesting. Happy Wednesday. Much love, Elizabeth

Edited to add I picked Pele today. The awakening. Very cool meditation sequence it reminds me of my last one with Lisa in Colorado a bit. I'll have to try it.

Monday, March 29, 2021

Call Monday

     Ugh it was a doozy. When I came in this morning Tina handed me a stack of cases to take pictures for for ENT tumor board tomorrow. I said I think it's Staggs' turn? Unless that changed last week? Sure enough he took off last minute. I just finished editing necrotizing granulomatous tonsillitis pics with Histo on the GMS and diffuse large B cell lymphoma of the thyroid. I told Trip Mishra last week on text I would help him get to CARTI tumor board this week too, even though I'm not assigned - he was texting early Thursday morning that he was lost. Two extra tumor boards. Oh well. 

    Then since cases were coming out slow and I thankfully had no frozens I set out to do my quarterly ABP test, which takes about an hour or so, and is a complete waste of my time. So much so I have frequently considered just guessing and not googling and trying to find the answers but I'm too competitive for that. We have cumulative stats and as of today I'm nine percent above my peer average, at 89%. And I'm not sure how I went up a percentage point today because I missed a lot of questions, including the first three of 25 which gave me chest pain. Luckily the next two were softballs and many easily googleable but I missed a lot. I'm pretty sure I've never picked peds path in my assessment design but I had three pedi path questions including one on congenital epulis of the newborn give me a freaking break! And one question asked about what an ED doc would do with these labs and another what category does this oncologist ethical question fall in and they were intuitive but left me thinking what kind of crazy lab rat am I for whose freaking study on my work time. One question near the end was a repeat of one I missed and I was like how stupid do you think I am. They are measuring repetitive learning in questions completely irrelevant to my practice. Give me a lit review of something pertinent to read and ask me questions about it any day - this is pure hell. It's due Wednesday. They overly frequently remind you to do it early in the quarter but I always procrastinate.

    Then I'm on this e-mail thread with a CAP inspection officer and NLR lab director and our hire to travel and assure lab compliance Mary and two docs in DeSoto Mississippi whose inspection was due last August (we were supposed to inspect them) but then Covid. In March CAP officer said let's pick a date and I said I'm the new CLIA director for Conway and our inspection window is May 10-August 9 so after August we could do it I need to be here we've already sent blackout dates. The docs in DeSoto said we have CLIA coming in August and it's our first CAP inspection and we need it done before August. Dilemma. CAP said (today!!) OK Dr. Seng can you plan it for April. I almost blew a gasket. I emailed back to the group that I have done many inspections, and had always had a six month window to plan and expected no less during a pandemic. I sent a respectful but assertive email, but honestly you'd think she was asking me to perform magic or something. I said it takes a month even to assemble a team and we have med tech shortages in NLR and med techs on medical leave and a pathologist shortage and call and work schedule to work around so not a possibility. We are donating our time here. Required work comes first. CAP officer sent me a sweet private email requesting a phone call at my convenience to discuss possibilities and I said sure ASAP on a day much less busy than today I'd let her know when it works for me. 

    I won't even touch on my friend I'm helping in a lawsuit or my daughter's college issues today it's too much I'm ready to wind down. I got home from work and I'm not sure if it's a physical issue (EGD and colonoscopy should resolve that at the end of April fun vacay plans) or a psychological one (Yousef thinks so it always happens at the end of a hard day at work) or ascension sickness (that's my own theory I googled it a few months back) but I puked my guts up right before this blog. For the first time in a while. Turns out, corn lasts the longest from a lunch of chicken tortilla soup the rest was just bits and pieces of what I like to imagine, as I'm hurling my guts up uncontrollably in the kitchen sink, is ancient soil. Hope your Monday went better than mine. You have to laugh, though. Much love, Elizabeth

Friday, March 26, 2021

Seller's Market

     Did I mention I sold my house? And we signed a full price back up offer this week if the first full price offer falls through. So different from last year. I have read that it's a seller's market but we really experienced it when we put our house on the market and had 7 showings the next day. So grateful for good renters who have been taking care of it and are dealing with all of this so we don't have too.

    I think I'm finally acclimating to the altitude on the day before we leave lol. My body sure told me, in more ways than one, that this is not an active vacation for me I've been on the couch reading. I've had Angels & Insects on my bookshelf for years and finally started it I'm a little ways into the first novella and it is fascinating. The story and the protagonist, anyway, when the guys start pontificating about religion I get a little glassy. The protagonist is a naturalist, and I just love that. He gets lost in beautiful descriptions of ants and butterflies. Looking forward to reading more on the 12 hour drive to OK City tomorrow.

    The girls and I have a spa afternoon planned so excited. We booked massages and have the use of all the spa amenities throughout the afternoon. I've been to Elevation Spa before and can't remember their exact amenities but I'm sure it's luxurious. It's Mary Margaret's first massage so excited for her. C hasn't had many either. Planning in town Ryce for dinner it's one of our faves. My third venture out of the condo this week lol.

    Susi Jeffus texted me this morning and was wondering if we were still looking for a pathologist (yes dying for one) her chair interviewed a guy and made an offer his wife is finishing fellowships hemepath and cytopath trained (!! As Kelsey Forcum would say Yay say Yay) and would we tackle Visa issues? I told her to pass the info along we are definitely looking and would love to interview her. I texted my partners and everyone is cautiously optimistic. Susi said as soon as her chair and the guy they made the offer to come to a decision she will share her CV. 

    So despite the fact that every aspect of my physical body seems to be betraying me things are looking up. About to pick a card from The Goddess Oracle deck and book set Lisa recommended I bought it a few months ago but stalled out after I picked Kali. She recommends daily which I vow to do - yesterday I chose an Irish goddess Maeve. All about grounding and responsibility and authenticity which I need to gravitate toward right now. The meditations are a little too intense but it's fun reading about the goddesses. 

    Lisa taught me a grounding meditation yesterday about pretending your feet are roots connecting to Mother Earth. Well my roots shot directly to the molten lava core of the planet and despite the fact I hadn't plan to journey - was only getting Reiki - I traveled to the Underworld on a pterodactyl's back to prehistoric Earth. We flew over bubbling volcanoes and lush Amazonian jungles it was amazing. Who needs acid when you've got Lisa. Hope you have a wonderful weekend. Much love, Elizabeth

Edited to add I picked Bast. Love her.