Friday, July 23, 2021

Variants

     So much happened today I don't know if there is a beginning or an end there were just endless cases. I worked my fing ass off. BHEC committee was underwhelming, I was ten minutes late; forgot it had moved from down by the Doctor's lounge to the Admin suite. I was talking with Ali afterwards - he was asking about my KT tape on my arm and I told him about my MRI fears and he said, don't worry - I fell asleep, it's not bad. GTK bc it's set up for next Wednesday at 6am. Lucy worked the kitchen at Baptist Boulevard today - hadn't seen her in too long - and we hugged and planned a girl's shopping trip next Thursday so excited. But that's an aside.

    As Ali and I were walking up the stairs after BHEC meeting we bumped into Wayne Lyle. He's an ED doc - I told Ali we went to med school together and we were blood draw lab partners. Told them I drew his blood fine but when he drew mine I passed out cold. Ali laughed and Wayne did too - said he didn't remember that until just now. Ali checked in on Wayne. How are y'all doing in the ED. With the delta variant. 

    Wayne said I've still got lots of compassion for my patients - that's my job, but I'm losing my compassion for the employees who won't vaccinate. I'm so angry and I try not to be but I am. I told him not all of our employees are vaccinated and some still don't believe that the unvaxxed are the root of the new variants - it angers me. Especially when so much of that movement, if you call it that, wants to blame the Hispanics, which Wayne and Melody assured my instincts today that the Hispanic population are not in the ED with Covid and are overwhelmingly vaccinated compared to our population. I learned that only 48% of our hospital employees are vaccinated, and it almost brought me to my knees. Physician vax rate is 95-98%, which makes the others even lower percentage wise. The floating reason for not requiring the vax is that we are so short of nursing staff that if we require it they bail and we are crippled. I kinda get that - there is talk of a coordinated effort to all require vax at the same time so there is no "safe hospital" for the unvaxxed but at the same time I just want to call bullshit like Emmanuel Macron.

    Went to huddle and was glad I did Amy did an amazing inservice on sequencing. There's not just Covid and a delta variant; we were looking at graphs and sequences of the entire evolution of the virus, which mutates daily, over the past year. I was supposed to be at the Zoom meeting Wednesday but call duties prevailed. The doctor in charge in Arkansas admits we are the 48th in the country for sequencing Covid cases (just like the vaccine, I joked with Olivia). When there was a geri psych outbreak last year at the beginning of Covid - I researched the contacts for admin - the sequences of the virus were all the same. B.1.1 maybe? I had Amy send me the Power Point but it's a little late to delve into that I've got to work tomorrow. Anyway, all the current infections - kids and adults - are overwhelmingly Delta. The bad news makes the news. If it bleeds, it leads. 

    Kids are going out of town next week - C to Mexico and Jack to camp. Already texting friends for plans - there are no triple surgicals or even pluses on the schedule next week (thank god) so hopefully work will be manageable. Happy Friday. Much love, Elizabeth

    

Thursday, July 22, 2021

Breast Care

     I walked into Staggs' office Monday morning to chat, whatever, I can't remember, it was before the onslaught of needles. We were catching up. Tara from histology brought some slides into his office. There was a red stamp on top of a requisition about a centimeter high in bold. It said breast care. I looked at Staggs incredulously. Do you mean breast case? I asked Tara, and she said yes as she receded down the hall. 

    WTH? I asked Staggs. Dunno, he said, I've never seen that before. I wondered aloud if it meant for us to do a self exam. Not that you really need to, I told him, but guys can get breast cancer too. Later I told the story to Melody, and she said that Tina had ordered a stamp last week from the business office announcing breast cases (these are time sensitive to some of our clinicians) and they had f'ed it up. LOL. 

    A day later I was getting cases announcing breast case (in capital red bold letters), so I guess they finally got it right. Yesterday Tina got a white sac package from the business office. "I'm scared of this," she said. I wandered into transcription. "Why? Open it." 

    It was another stamp that announced breast cases. But we've already got it right, she beleaguered. Why are they sending us another one? I guess I could stamp it on my breasts, she said, might be kinda sexy. I told her that breast care stamped across the chest would be even more sexy. Less clinical, I was thinking, and more of an invitation. She laughed. I headed to CT. Keep up. Happy Thursday. Much love, E.




Wednesday, July 21, 2021

Preaching to the Choir

     Monday after I read an EBUS for Cydney Tony and I were talking about Covid. Wondering why people don't get vaccinated. Today he rejoiced that one of his cousins got vaccinated when he signed up for a cruise and they told him if he didn't, he would be quarantined in his room all week. No dinners. No community. No excursions. It was a win win, but God the lengths we are going through to get people to get the shot in this strange climate is mind boggling. 

    I walked into the Dr. Lounge to get a water after I read the slides - it is right next to the pulmonology lab. I ran into Bob Searcy - a seasoned and highly opinionated pulmonologist. He used to intimidate the hell outta me but when I told him who my dad was a year ago he took a shine to me and always asks me about how my dad is doing. He told me that one of the SICU workers (he is in critical care pulmonology) who refused to get the vaccine was on a large outing last weekend and a bunch of them, including her, got Covid. He was livid and ranting. I don't want anyone unvaccinated taking care of my patients, they are already critical, and Covid would be a death sentence for most of them.

    I told him I heard a hospital in NW AR was requiring the vaccine for health care workers. These are murky waters - it's not yet FDA approved, but I agree, we need to mandate it, and so does he. This new variant is so much more virulent and Melody and I wondered this afternoon about the ethicality of even having a sore throat and coming to work without a test. As vaccinated asymptomatic or mildly symptomatic carriers we can wreak havoc to those who aren't protected. Yes, I'm frustrated but not entirely hostile to the community who disagrees with my point of view. But the children. They are succumbing much more rapidly to the delta variant, and haven't yet been approved for the vaccine. If that isn't argument enough to mask up, I don't know what is.

    Laurie and I got called to a late brain frozen in NLR today and I was explaining my angle - who wouldn't want to protect the children? She is cynical in a good way, often more so than me. "Well hell you know who it is. They don't want to do anything to help the children when they are outside of the womb." But that's a control issue, I said, entirely separate. But not really, I sheepishly admitted. It's such a shit show. Luckily it was an easy frozen and we were back at work to finish up and be home by the decent hour of 7pm.

    Shay is one of the workers in the Doctor's Lounge - we have gotten friendly since she started working there about a year ago. When Breezes opened back up Geisha had to go back and Shay was her replacement. A spunky lady in her late 50's or early 60's not sure but her colored hair and smooth skin belie her age. She has 34 grandchildren! She lost a great friend to Covid last week, was showing me pictures on Facebook as the automatic Starbucks coffee machine was brewing my morning mojo. The funeral is this weekend. I told her I've had close people contract the disease and suffer greatly but had not yet had a close casualty. I sympathized.

    But it's bound to happen soon. I read the lambda variant popped up in Texas the other day and what even is that? We are like a Petri dish; all of our misinformation brewing opportunists. And our blissfully unaware (or so they claim to be - machination vs. ignorance is tough to snuff out these days) legislators are touting the vaccine (finally, some of them at least) but it's too damn late for that. Melody sent the numbers tonight in our hospital system - they are rising as predicted. On July 14 it was 163 hospitalized 47 in ICU. Today it is 185 hospitalized 61 in ICU. According to Mandee, we are at the tip of a disaster.

    In micro huddle we plot and plan to decide which machines to use on which patients - vaccinated vs. unvaccinated, asymptomatic vs. symptomatic, exposed vs. unexposed. Trying to get the information to the clinicians in the most efficient and expedient way possible - some are batched, some are not, some add other PCR viral tests that may be of use to rule in or out Covid. I'm noticing when I look in the charts that a lot of Covid inpatients are overdue for their second vaccination. The hospitalists I bump into in the Dr. Lounge are more frazzled than they were in the winter. I hear our patient count is over the maximum bed capacity - we are at 614 (max 600) and we are now converting private Covid rooms to shared ones for patients with mild symptoms to accommodate everyone. 

    I escape from it all by looking at science articles on The Guardian over lunch - they first talked about pyrocumulonimbus clouds last week and now the NY Times has jumped on board. Dangerous but fascinating. Family dinner over meatballs tonight also helped. I find that if I just reason that everything, no matter how awful or contrary to what I wish, is happening (oh god I resist to say for a reason that is so fing cliche) but if it just is, and I just go with the flow, me and mine will be ok. Maybe fairy fantasy stuff, but if it helps you sleep at night, use it. Happy Wednesday. Keep up. Much love, Elizabeth.

Tuesday, July 20, 2021

Interventional Radiology

      I walked into radiology for the sixth time this afternoon. Which was an unexpected nuisance - the new guys don't call us much anymore so we are used to maybe one a day from them. But I'd had a bunch of thyroids and Ken was on, he always still uses us and it's to his credit - he gets good material and we get good radiographic correlation for working up the case the next morning. I signed out over 50 cases today - a record I hadn't reached in years. That's what made it such a distraction. It was a Monday on a Tuesday. 

    There were only three rad assistants - none of whom I recognized other than earlier today. Tony, my cytotech, was staining the slides. I looked at the specimen name. Left groind node. I knew it was a typo, but I was having a day - already bitched about some changes I didn't agree with that were made in cytology when I was off last week. Back when I started, when the rad room wasn't a rotating bumbling cast of characters, I would have had my secretaries fix it the next day. But I was in the mood to ruffle feathers.

    Um, what is this specimen source? I asked the blond with braids. I'm pretty sure the groind is something I never learned about in medical school. Is that a new anatomy term? She giggled. The male assistant apologized, appeared embarrassed, and said he would fix it right away in the computer and get me a new rec and sticker for the patient. I sat down to read the dif quik. It was cellular, and looked like metastatic malignancy.

    So what's the history, I asked. The male assistant said, oh, I'm not sure, let me look in Epic (they used to always have the history pulled up back in the day - I sound ancient and crotchety lol) and said the thyroid was removed at one point? Maybe he had thyroid carcinoma? Tony and I, who are in a separate sort of antechamber looked at each other and rolled our eyes. I'm pretty sure no thyroid cancer ever has leaped to a groin node, I muttered under my breath, and he laughed. The brunette, who had also pulled up Epic, said there are liver masses! Over twenty they say. Too many to count, but then they say over twenty. Oh, and something about a lung mass? I muttered, "How many rad assistants does it take to get a patient history right?" Tony laughed again and I said louder, so they could hear me, "Who did this needle anyway?" Apparently Ken was out of the room working on another case.

    I don't fault the staff here - it's frustrating as hell but it's like this everywhere. No more consistency - and the blame should start at the top not the bottom. This constant staff shuffle has got to be one of those cost saving measures that makes the system infinitely less efficient and more prone to error. To her credit, the brunette asked me as I was leaving what was the purpose of Cytorich Red and did it have something to do with cell counts in the lab. Bless her heart she was trying to learn and wrap her head around the media and what our role was - she has a long way to go - but today was not the day for me to find the patience to explain it to her so I pointed to Tony to answer her questions and walked back to my office. 

    Watching Lisey's story and jeez it's a little much at times but good so far. I started a book by an Arkansas author - Michael Ray Taylor - called Southern Caves on the way back from Vail. Unfortunately managed to lose it somehow halfway through so ordered a new one on Amazon today it is fascinating. The chapter on the evolution of a new way of thinking about cave development with the assistance of heretofore undiscovered bacteria, some of the likes of which mimic the ones they are seeing on other planets, just about blew me away. It's not just chemicals, which was heresy to say 20 years ago, but now that myth is being debunked. Caves would not exist without the assistance of biolife. 

    Michael wore teflon suits to go into caves with scientists to study the bacteria that hides in invisible spiderweb form on the ground but if it touches skin the acid it (emits? Can't remember) will burn badly. And this guy, I researched him last night, is a freaking communications/theater professor at Henderson. Go figure. Genius springs forth from unlikely places. 

    Hoping that my surprise call week post vacay slows down (but with Rex retired and us being short staffed in summer months not keeping my fingers crossed on that one). I actually have triple surgical load on Friday. Yikes a first if I remember correctly. Oh well I'm taking it in stride I scheduled a chiropracter appointment tomorrow to address the mound of concrete that my upper back and neck have reverted to in the past 24 hours and luckily going to orthopod to address the right arm issues on Thursday afternoon. In good news on that front, my ambidextrous origins have come in handy over the past two weeks, especially with my ADL's. Aging is such a joy. Happy Tuesday. Much love, Elizabeth

Thursday, July 15, 2021

Angel Wings

    It's weird being in another state vacationing while your home state is making national headlines because of a new delta variant wave. Sunday I texted Annie because her hospital system, Missouri Cox, was on the cover of the New York Times and today I read quotes by Jennifer Dilaha, of Arkansas Department of Health and recent physician Covid inservice fame, in The Guardian. NBC even did a piece on us, according to the Arkansas Times. And we have been banned from Chicago, along with Missouri, unless we produce a negative Covid test 72 hours before arrival or something like that. Eye roll. I've been second guessing my decision not to bring my vaccination card to prove I'm vaccinated even though they aren't yet required for travel. But I take solace knowing I could tell Melody where it is in my office - she could take a picture and text it to me if necessary. I asked her to send out the Baptist numbers again - it's been awhile - since we are a new hotspot. Systemwide there are 163 inpatients with 47 in the ICU. That's a lot.
    Other than hiking and shopping and reading and eating fabulous food not much going on here. We had a spa day yesterday and my masseuse was fascinating - I watched her walk in with her cowboy boots and cutoffs and half shaved head covered with tattoos and thought I hope that badass is the Sara that is supposed to give me a 105 minute treatment after my hour scrub/hydration with Krista. I got lucky. She had changed into appropriate professional scrubs but I complimented her on her previous outfit to get us off on the right foot. Sometimes I'm chatty, sometimes I'm silent. We did not stop talking the entire time.
    Turns out Sara, despite being in her early 30's, has traveled the world. She entertained me with stories of Cambodia, Australia, Germany, Egypt, and the Philippines, the latter of which is one of her favorite places to go - friendly people, amazing cheap food. She often works in hostels or volunteers for non-profits in order to pay for her room and board. She told me the best place to stay in Egypt that is right across from the pyramids - it is a family owned hotel for generations and she got to meet the patriarch before he passed. You can sit on the roof and watch the sunset, she told me. It is incredible. Of course I forgot the name, sphinx was a part of it, but we became Instagram friends after the session (I entertained her with some Dr. stories too) so when I plan a trip to Egypt I can message her. She told me most of her IMs are travel questions but she doesn't mind. I told her I get a lot of medical questions but I don't mind either - it's fun to share your area of expertise. 
    She plans to move to Costa Rica soon but has never been there - I told her I've been three times and we bonded politically over how much better women led countries are run -Jacinda Ardern! Etc, etc, - New Zealand is one place she's never been to but has heard a lot about Kiwis. I told her about Judy Melenik and how I'm waiting for Dawn to migrate us over to wordpress to write that article. We preached to our own choirs about the shifting climate from patriarchy to matriarchy, and how it's a frustrating but amazing time to be alive. 
    I also met a guy named Jack in the fossil shop in Lionshead - it is one of the most amazing fossil shops I've ever been to I've already been twice. I had a few half off smaller items shipped - I found these stunning blue quartz candle holders that were listed for almost $300 apiece in Vail Village on Sunday (ack too much) and they were half off in Lionshead Village at $70. I prided myself in getting out of there without a huge purchase - my last big one was in Aspen buying matching trilobite fossils about six years ago. Then I saw the quartz angel wings. Jack appropriately ascertained my emotional pull and described the artist and looked at the ticket and offered me 2K off of the list price. He said they had already sold out in Utah. I talked it over with S and his advice was to sleep on it - good advice for big purchases.
    I told Jack I'd be there until Saturday but he said he was leaving Thursday for the Ukraine to meet a friend - they are planning to hike the Carpathian Mountains. I told him quartz was big where I was from in Arkansas and he said come look at this piece from Arkansas. It was surrounded by Columbian quartz but it was twice as beautiful because it was spotted with gold. He also showed me an amazing museum quality dinosaur skeleton embedded in stone worth over a million dollars. When I went back today to seal the deal (turns out I dreamt about the angel wings - Sara agreed there are things that pull you and it is meant to be) I made sure Jack would get the commission since I spent yesterday at the hotel. The worker, surprised that I knew Jack was going to the Ukraine, assured me he would, and verified the price he gave me with her boss on the phone. 
    Dinner tonight is at Montauk in Lionshead the menu looks amazing - hoping it's as good as the Veal Chophouse the other night. Lionshead is a little more charming than Vail Village; I'm sure there are a lot of good restaurants there but it's closer and has plenty. We arranged a float trip for tomorrow - nothing too scary since I have been ignoring (like a doctor, I joked with Sara) a pulled muscle in my right deltoid for two weeks (paddle boarding incident) and it has not gotten better. It's either a badly pulled muscle or a hairline fracture of the humerus, mid-shaft. The orthopedic clinic in Vail, world renowned, was booked this week so I'll got to OrthoArkansas to get it x-rayed next week. I almost started crying in yoga last week and it wakes me up at night. Advil and Ace wrapping aren't helping. I'll take this though over the vastly improving GI issues that plagued me over the last year any day. I'm finally feeling normal again. Practically cough drop free, unless I want one. No longer dependent. Wine is good again. Happy Friday Eve, much love, Elizabeth



Friday, July 9, 2021

Gross Room

     I still don't know what the hell that arm thing was. I told Jessica to give it to me for today, but Bob reassigned it yesterday evening. Not his fault, their job is to make the block count even however they so choose, but by the time I realized that I wasn't getting it and figured out who was they were already gone for the day. Oh well, I'm off for a week so I'll figure it out when I get back. 

    I was on afternoon frozens this week and the first two days were quiet but then it ramped up. Yesterday I got called to a brain frozen mid afternoon. This neurosurgeon has worked there for years, but he's pretty stoic - I can pick him out in the hallway but I've never met him. Bob said the radiology looked like a 4 cm GBM but I was hard pressed to call anything besides normal brain on the sliver of tissue he sent to freeze. I called Staggs for a consult, he agreed. 

    I called back the surgeon on the bat phone and told him he did not have diagnostic tissue. He loudly asked in front of all the OR staff how long it would take to do the next frozen. Confusedly, I asked what? He said I'm sitting here waiting for your result with the patient on the table not being able to make a next move can you tell me how long next time? I channelled my inner Michelle Obama. When they go low, we go high. I told him the average frozen takes 15-20 minutes (this is not an arbitrary number these are the CAP standards) and that if it is difficult we sometimes, like I did on his, get a consult and it takes a little longer. I apologized for his wait. 

    After I hung up the phone I walked back into the gross room and told Jessica what a dickhead! I haven't been treated like that since training - what an ego. She told me way before 15 minutes his staff was calling the gross room wondering when they would get a result. She was seething. If you call, she wanted to say but held her tongue, I have to stop doing the frozen and answer your call so you are chopping off your own leg here. 

    I went back to Stagg's office to vent. He told me yeah, that's the guy who idolizes John Wilson. John is a neuropath expert over at nephropath at Arkana - we send him rare difficult brain cases. I met John and his wife at Martha's Friday night sip and sit yoga a few years ago - he is an amazing individual who trained all over the country and he's humble as hell. He also goes to great lenghths not to step on our toes, which is different from a lot of consultants (Jesse McKenney is good about this too). A lot of consultant's mission is to steal our business with a lot of fear mongering over, basically, bullshit. 95% of what we see in our practice on brains is cookie cutter - either metastatic lung or GBM. Not rocket science, but if it's hard, we send it to John.

    Staggs told me about five years ago he had a frozen from this guy about like mine, non-diagnostic and the surgeon got so angry he didn't get an answer he asked Staggs to take it to John. At the time Arkana was behind the Heart Hospital. I called him on his bluff, Staggs said, and told him it would be an hour turnaround. Luckily John said the same thing - non-diagnostic. This surgeon is a young soul, I decided. The next two frozens he sent were similar. Luckily he got the tumor on permanents today. I bumped into him in the hallway today and introduced myself. Told him he got the diagnosis on the perms. He looked like a deer in headlights, and I wondered where his headspace was. So it will be out Monday? He asked. But I just told the patient I didn't get a diagnosis. I gave up on frozens. No, I said, it will be out today. I got a second, it's a done deal. Necrosis, prominent vasculature, nuclear pleomorphism, atypical mitoses, it's a shoe in for GBM. He startled, thanked me, and walked away.

    Bob had the best retort. Next time, he said, you should tell him you are waiting and twiddling your thumbs for the next frozen bc he isn't getting good tissue he needs to speed up his turnaround too. LOLOL. I would never. I get it - they are working in the brain looking through loops it's gotta be tough. But no excuse to shit all over your help. This afternoon Sims sent nine frozens. It was all good, mostly negative margins on a glossectomy, and the positive one that he had to send a supplemental margin on was negative. Promise to follow up on the arm mass sometime this week. So excited to leave for Vail in the early afternoon - time to wake and pack and clean the fridge. Happy Friday - much love, Elizabeth

Wednesday, July 7, 2021

Denial

     I got a call at 6:45am Tuesday from Jessica. She said you are on the schedule to go to Conway tomorrow for frozens, but the surgeon moved the surgery to today. So you need to go to Conway. Oh, I said, thanks for the heads up. She told me he was starting at 8:00. He's usually a slow starter, so I figured I had time to eat breakfast and head to Baptist to get my early biopsies and diagnostics before I hit the road. I asked her to call the histology lab and tell them and to please notify the business office I needed  to have the courier, John, bring me a run at 10. Emily in histology assured me I would have most, if not all of my 120 blocks by then. 

    I texted Misty on the way up I would be there if she needed me to sign anything. I didn't hear back but bumped in to her when I was looking for a water at 9:45 - the surgeon was having a time finding the offending parathyroid (adenomas and hyperplasia can cause hypercalcemia, it's an easy frozen) and we weren't released to go back to Little Rock until early afternoon. Bob lives in Conway, one of our PA's, so he showed up to do the frozens. Thank goodness because the frozen machine broke and he had to perform miracles to get a section. Misty asked if I would like to have lunch, and I was excited. She's gluten free too. After the lab inspection we shared a philly cheese chicken sandwich, sans bread, over french fries. We talk process. Yesterday we did the same. She was upset. 

    We bumped into the CEO, Tim, he's so nice, getting food. He asked if she was on vacation last week because he didn't see her. No, I was in Little Rock, she said. He asked about our holiday weekend, and she replied that she was in Conway Baptist every day catching up. Oh god I offended him, she worried over lunch. I'm usually not that blunt. But I would never just take a week off? Without telling him? WTH? Turns out Covid is ramping back up with the re-opening, I'm sure you've read all about it in the news. Delta, Delta plus, Delta schmus. Luckily it's not so dangerous for vaccinated people, but so many are unvaccinated. 

    Misty started dishing on the real reason she is frustrated. She told me she was instructed by a doc to bring up the antigen test again, Sofia, for employee testing. But that's a bad test, I said. If there is a false positive, we have to quarantine them for two weeks and it is a waste of resources. Inefficient. If it's a false negative, we are exposing the other employees for 7 days, the amount of time recommended in the doctor generated algorithm before we do a PCR test. She crafted an intelligent, non-emotional e-mail to the doc and showed me it and his response over lunch. Did he even read your e-mail? I asked. It doesn't look like it from his response. She wanted them to do the PCR test day one and day 7, and do the antigen test in between.

    I was texting her today worried - Amy and Olivia in micro (two seniors) are off this week so I couldn't run it by them. She told me that it would probably be ok. We take care of our employees, she said. If there is an exposure or a symptomatic employee, we usually bypass protocol and do the PCR test. Whew. What a relief. Hopefully they do that in LR too, I know Mandee Novack does not trust the antigen test either. The gift shop worker at Conway - we have chatted about divorce and kids in the past - said her unvaccinated nurse kiddo was calling her worried. There was another exposed nurse that worked half a day exposing everyone before he tested positive for Covid. Gift shop manager said I'm vaccinated, but my adult kids are opposed.

    I get it, I told her, I'm not judgmental. It's not FDA approved, it's still under EUA. We cannot really mandate it yet. But from everything I read the side effects are less than .1%. That is dwarfed by the side effects of getting Covid. It's a gamble I am willing to take. Despite the relaxations in public, we are all still masking at the hospital. 

    While I was waiting on another frozen around 1 yesterday a surgical tech walked a specimen into the gross room. Y'all gotta see this, she said. Just hold your nose. It's an arm mass. I held my nose and looked in the white bucket. It was a 15 x 5 cm cylindrical shaped mass that was flaky and grey-green and gangrenous with an ulcer on the top. Gosh, I said. I've never seen anything like that let me see the name so I can look it up in Epic. The doc had taken a pic in situ and I asked Bob, where is that? On the shoulder? He said no it is protruding from her arm right above the elbow, according to the surgical tech.  In the H&P she said it had been there two months and was the result of a minor scrape.

    I went into the gross room in LR today and was telling them about it - Michelle said we just got it and accessioned it I told her and the rest of the crew the story and showed them the pics and told them to give it to me for tomorrow. Jessica asked do you think it's a squame? I said like none I've ever seen but I'll lyk tomorrow. If it's weird I'll send it out. I had heard there were a lot of frozens over the holiday weekend - more than usual. Jessica said one was a young woman diagnosed with a 3cm cervical tumor at UAMS last year and she went to a natural healing place in another state for a year to get treated. She presented with total ureteral obstruction - the mass had grown to 10 cm and there were implants all over the pelvis. Ugh, I said, poor thing. I get denial too, I've been there. But modern medicine has a lot to offer, despite its downfalls. Do the natural thing, I'm all about that, but in conjunction with us. Surgery, immunotherapy, radiation, there is a lot out there to combat cancer these days. We don't have all the answers, but we have a lot of good science driven tools in our toolbox. 

    On the home front, things are looking up. I haven't expelled any demons in two weeks. I started drinking and enjoying hot coffee for the first time in a year on vacation last week. TMI, but lower GI tract is normalizing as well, giving me the energy to walk and exercise. I went to my first gym yoga class in over a year tonight. It was Monique, who is amazing, nice and slow. Cecelia and Joelle went with me, which was ecstasy. I saw Shelly, an old supper club friend from Foxcroft, and we crazily hugged. My body temp is normalizing back to the colder side of things. I'm cautiously optimistic. 

    Misty told me that Covid numbers in our hospital system are rising. We were down in the 40's in June. She said last week we jumped to 60's and this week we are in the 80's. Makes sense, as C would say. Probably over half of our state is unvaccinated. Hopefully we can get control, but I'm not holding my breath. Or planning any European vacations in the next year. Got CARTI tumor board in am looking forward to seeing that crew it's been a bit. Happy Wednesday. Much love, Elizabeth