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.

Tuesday, March 23, 2021

Altitude Sickness

     Snuck up on me and kicked my ass today. I'd never experienced it before so I didn't know it was a thing and kids and S were skiing so didn't know my plight. I was sweaty and lethargic and in and out of consciousness so much it reminded me of when my best friend from med school Alyssa shared the story of how she was so sick in Africa they put her in a death hut and rats were nibbling at her. Luckily I was in an ArBnB not a death hut but I was in anguish. Thankfully my body knew what I needed even though I was thinking food poisoning I yelled at C for water late afternoon and finally started to heal and gain strength. Not enough to even bathe but enough to go to the couch and watch the college admissions scandal doc on Netflix (I was so addicted) and start Behind Her Eyes which was a C recommendation that we are now glued to - watched the first two episodes. A friend told me that as you age altitude adaption is more of an issue, well I'm aging for sure. He takes disposable oxygen tanks good to know for the future but lots of water righted me again.

    So hopefully now vacation can start I've burned two days sleeping and feeling way too sick but the Borg's came over last night and I freaking love Laura she's a ton of fun. Cute, quirky, Bernie fan. We got along really well. Tomorrow planning to cook for family so they can hit the slopes then walk to the grocery for a few items and shop in town in the afternoon. Need to book a spa for me and the girls Thursday afternoon. Planned to do that today but holy hell. Hope you are having a good week. Much love, Elizabeth

Friday, March 19, 2021

I'm So Excited!!!

     


    All packed up - books and candles and all - just need to pack an overnight bag in the am. Daniel and Mary invited us to stay at their house in Amarillo on the way there and way back they built a mansion since I've seen them last cannot wait to see it. And my niece and nephews, been missing seeing them grow up. Lucy and David and Henry. They are so grown up on social media. 

    The ides of March happened this week it made me think of Tommy. More good memories and he passed in 2008 but I will never forget him. He was poised to be a superstar he looked like a movie star and flamed out way too soon. Addiction and mental health issues are just like cancer. Unfortunately our society deems them flawed and their parents flawed for their struggles it's not ok. Kudos to all the good mommas and dads that are trying to help and support them it's not easy. 

    I had a weird breast cancer case that looked lobular and stained that way but there was a 2mm focus of clearly ductal it looked like a different cancer. Melody helped me with it and the dictation was lost but Janet found it and I managed to get it released before 5:00. The pathologist tasked with reading out the hormone receptors and the Ki-67 and the Her2 ISH when I am off next week will be super confused but hopefully my long comment helps. 

    S and J are picking up Aiden at the airport and I'm waiting on Taj Mahal BiteSquad. C is working at All Aboard. We won't leave for CB until around 8 so I'm hoping everyone will be comfortably packed by then. Jack had his three new friends over today and they had a Brazilian cheese bread competition - he and one of the girls - and he was frustrated that she won. Mom, he said, she used tapioca flour not yucca and her base was more watery and she put it in muffin tins but I thought mine was better. I didn't taste hers (apparently C is hoarding it) but I told him his Brazilian cheese bread wins for me every time. S saw them watching Harry Potter on the couch and told me they seemed like really good friends to J. He needs those. Hell, we all do.

    Such a wonderful lunch with Valerie in the Dr. lounge she was awed and I was embarrassed (drs do not deserve free food I told her. Kind of like swag bags for celebrities. Fing ridiculous). Introduced her to the server Shay is her name and she had her 34th grandkid yesterday. I did a double take "Did you say your third or fourth?" Nope. 34th. That's kind of amazing. She showed off the Facebook pics of her newest grandkid. Valerie was incredulous and I was happy she was so sweet to Shay, she's my new favorite person. Besides Kimberly.

    RIP Tommy. He's out there watching over me I just know it. Stay safe, much love, Elizabeth