Friday Eve

     Whew only a few more days of call then a week of work then I'm off. I have never been so ready. In addition to work, I had some jaw-dropping news in my personal and work family this week that have made me manic. Finally feeling more grounded. Nothing terrible (well the work was a little frustrating), nothing that doesn't make sense in retrospect, but still. There are things that make you change your worldview. Like having a kid. Lys brought me homemade pumpkin bread in the hospital when I had Cecelia, I will never forget how wonderful it tasted. And on the ride home, with little C in her carseat, I marveled at how I will never look at banal things like Toys R Us the same. It's like being cracked open, raw and bloody. Then you get grounded, and realize you have to fit into a new mold now.

    I had Paula yesterday for the first time in a month, it was much needed. The clearing over the last few months has helped my GI issues in so many ways. I only have exorcist moments every month, instead of three times a week. I finally went to the dentist for the first time in two years. Last time, she told me my gag reflex was so bad (she couldn't take films) that I'd have to take a benzo and have a driver to come back. That daunted me. After I broke my jaw, I had two root canals in the middle of a work day. Can't take benzos and go to work. So I learned the other day I needed a root canal then a crown and then she can fill four cavities. FOUR! I have never had more than one at a time. Got the root set up for Monday the 5th. After a mom and daughter massage in the morning.

    C leaves for Denmark and London on the 8th of June. So I'm glad I have that week off to spend some time with her. Pedi's and walks together is on her wish list. I miss you mom, she said. She and Woody spent a few days in Florida with my mom and dad this week and that made me happy, the pics are amazing. Her ETA is 7:00 tonight. I bought lots of yummy goodies to plow her with. Dark chocolate covered cashews, caramelized pecans. Fresh pimento and pesto from Boulevard, chicken and garlic tortellini, and Amanda Ferrell, who came for book club last weekend, introduced me to yet another incredible candy bar. Mayan chocolate.

    Where the hell did you get this? I texted her the next day. You are my chocolate angel. Whole Foods check out, she texted back. Jack and S went to town I had to hide the last two. I enjoyed the chocolate pretzel peanut butter one last night there are lots of varieties. Jauss said her son loved them so much she will also be headed to buy more soon. I'm more of a savory than sweet person but I appreciate a well thought out sweet, if only a bite or two.

    Jess told me there were three autopsies (!) while I was gone - she said the transfer to UAMS has gotten much smoother. Gross room is busy, but running well. Lots of John Sims frozens this week. And neuro. I told Blake Phillips in the Dr. Lounge the other morning at 7:30 you and Burson are taxing me this week with weird cases. Tell me, he said. There was an NF1 (think Elephant man). 7 cm mediastinal mass eroding into the C-spine. This is a first for me. I feel like Shaver and I are on the path to figure it out. Detective work. Not easy, but fun, and hopefully we can help the patient.

    Been emotionally labile, uncharacteristically crying. Surprising myself. Luckily I have lots of support. Singing helps. Writing helps. Connection helps. Looking forward to a full house this weekend, Jack is coming over tomorrow too. S's dad (who I love) will be here and his ex Monica is hosting her oldest son Chris and his adult son Zach. Probably will be some pool fun on Sunday, even though we discovered the pool heater is broken and although we are on a list we cannot get a pool fixer to show up for the second year in a row to save our lives. Maybe waist level? If not at least some sun and books and food and company. Happy Thursday, much love, Elizabeth.

    

    

Felix and Bidets

     Oh my god Europe was amazing. I got the bug - can't wait to plan a new trip for next year. New Zealand, Australia, Ireland, Scotland, Norway, I want to travel. I was too fear based, unlike Cecelia, in my twenties, but hell if we've got 80 year old presidents I've got a long way to go. Europeans are way more laid back - local parts of the towns closed on Sunday through Tuesday while the Sephoras and the Foot Lockers were open seven days a week. 

    S was super excited that there was a bidet in Bordeaux in our hotel. My expression was like Jessica's when I relayed this story in the gross room yesterday, a mix of shock and horror. Not being judgmental, I have learned in Bad Mom Docs that a lot of people like a good home bidet, but it wasn't something that I wanted to try. When we got to San Sebastian there was another one in the hotel. S urged me to try it - this one isn't as aggressive as the one in France (an aggressive bidet?)  so I vowed to try it, if only once.

    I woke up early one morning while S was still sleeping, and checked out the remote on the wall. Was surprised to learn there is a front bidet and a back bidet (I thought only back?). After using the restroom, I pushed the remote on the back, which I thought was mounted to the wall. It fell down behind the toilet. There was a steady stream of water, at first lukewarm and not entirely unpleasant, but it shifted to hot and I was uncomfortable.

    Surely this will abate after thirty seconds, I thought, but no. I was fidgeting at a crazy angle with my foot to try to retrieve the remote unsuccessfully. Finally I realized this was a bad strategy and shifted back from the toilet to try to grab it with my hands to stop the unmerciful stream of water. Water started shooting all over the bathroom door and floor. Thank god, I thought, I didn't pick the front bidet, it would be hitting me in the face. I grabbed the remote and pushed many buttons before it finally stopped. No more bidets for me. Not in this lifetime.

    I still get really dizzy and spinny with heights, so I tailored the tours to accommodate my weakness. Me, who has ziplined in Costa Rica and hiked mountains. Currently, not so much. We had some non-English speaking transfers, which is fine, but everyone on the tours had a good command of the language. Saying this, I realize my privilege, to not know more than one language (but to be surrounded by French in Bordeaux, after having five years and losing it was a balm). Most of the tour guides were sensitive and accommodated me. But not Felix.

    He picked us up at the last day in the hotel in San Sebastian. The place I wanted to read on the beach (I read four books, only one of which was terrible). It was rainy and 60 the whole time. Felix proclaimed in a heavy Basque accent that he was an amazing driver and had been doing this for 30 years. Red flag. But the trip to the cave and the Witch Museum went without incident, so I wasn't fearful. I heard him talking to S about a place at the top of the highest mountain where you can get good views and buy cheap tobacco and liquor. Thank god I didn't book that tour, I thought.

    We ate lunch at a small town in France with no internet. The food was passable, but when the guide clearly did not understand either French Fries or Pomme du Terres (sorry if I murdered the spelling) I knew he was lying about knowing 5 languages. I saw them everywhere and although we were served them despite our guide's lack of understanding they were soggy and bland. When S went to the bathroom Felix asked me if his driving scared me. No, I said, and this felt like permission, later on, for what happened next.

    S thinks he inadvertently agreed to a trip up the highest mountain. It was at breakneck speed - think of the Pig Trail going almost a hundred miles an hour. I was thrown against the minivan door so much my back felt like it was going to break. He has been cited for his driving, I told S. I accidentally gave him license for this. I'm sick, I cannot get out. I'm a little angry, I agreed to a fisherman's village which should be by the ocean and here we are at the top of the Pyrenees. 

    To his credit, he took it a lot slowly down the mountain after he saw me slumping on the floor of the car and was so solicitous we tipped him as well as any other tour guide. I often tell my kids, when they are going through rough times, turn it into comedy. Own it. Don't be a victim. Like Obama's first book taught me, we learn more from our failures than our wins. 

    Back at work with two weeks of call in front of me. Jet lag has made it tough. Hurtling across the ocean at break neck speed has got to hurt you on a cellular as well as emotional level. Finally recovering today especially since the cases are tough as nails. Cecelia told me she was so jet lagged getting into Spain last summer she was bawling profusely. Made me feel a little better about my struggles the past few days.

    Scottish Brian at Boulevard and I talked about my travels today, he follows me on Insta. I get a pimento only sandwich there - half, and save the other half in the fridge for the next day. I won the free cookie yesterday! Was so freaking excited. A first! He posts a song quote daily and usually by lunch someone has gotten it. Saving nickels, saving dimes. Looking forward to happier times. Linda, I told him. Usually he tells me it's already been deciphered. Monday he said name the song. Blue Bayou, I told him. You win. I want the ginger molasses. You got it. I usually get the quote too late. Ate a third of it for dessert. 

    Today I had a helluva hard case right before lunch. I was trying to pull the undigestible crust off and unprecedentally (not a word, but mine) threw pimento all over my scope and on my light source after the shitty breast case I have to finish off tomorrow, with a lot of others. It took over ten minutes to clean.

    I texted Melody. If I don't laugh about this, I'll cry. I'm in hell too, she said. Is this a Monday? Every day is a Monday lately, I texted back. Eye roll. Can't wait for the new path to start in August. We are running on empty fuel, and we need help. Thank god for vacay. I've got another one coming up in a few weeks starting June 3. Jack's bday! No plans for the summer. Happy Tuesday, much love, Elizabeth.

The Juicy Stuff Grows in the Shade

     Lab week was so much fun! I say was, bc I took tomorrow off to pack for Spain and France, we leave on Saturday. I had a near panic attack on Monday - histology is so unpredictable and even though our plane doesn't leave until 12:43 I did not want a full day of work with possibly leaving a shit ton of cases for my partners to finish off if I couldn't on Sat am. Too much to cram in. You have a lot of three man days left, said Shaver, so I peeled off a day from my vacay in August. Only one case to finish tomorrow, then I'm off for two weeks.

    Lab week started last Friday, when Hope asked if one of the pathologists wanted to go get the proclamation at the Capitol and get our picture taken with the Gov. I had no clue this ever happened. Why do we need a proclamation? I asked as she drove Angel and I downtown. It's just a thing we do every year, in order to make it official. It was terribly unorganized. A hipster with a messy dirty blonde bun didn't know anything about it, and the guy she promised would showed up 20 minutes later with his tight jeans and We The People tattoo was equally flummoxed. It's ok, Hope said, we can get it later.

    There were five groups of people - we were about 10-15, some from Baptist, some from UAMS, and it was nice to meet the medical director of OBI. Oklahoma Blood Institute, it used to be, but bc we work so closely with them it changed recently to Our Blood Institute. More inclusive. She was a charismatic young woman who asked me if I would help her get affiliation with Baptist - she was having trouble with BHPP. I went to Carla (head of blood bank) and Mackenzie (our admin) on Tuesday to advocate for her and hopefully that will get the ball rolling.

    They arranged us in front of a fireplace and arranged another group in front of a fireplace across the room. It was like an assembly line. Sarah came in at the last minute, the photographer shot our pic, and she moved on to the next group. One of the gals from UAMS told me at least Asa sat with us for 20-30 minutes and asked about lab issues. Talked to us. When I was telling a pulmonologist the story in the Dr. Lounge Friday afternoon, he said we are just a stepping stone for her political ambitions. I agreed, she doesn't really care. A true politician would have thanked us for our work during Covid (this was the first time we revived this tradition since Covid). Without the lab, you are only guessing, said one of the coffee mugs I bought for lab week. Carla showed me a statistic this week - 70% of clinician decision making about patient care is based on lab results. We are not the sideline, we are the frontline.

    Had med exec committee Monday night and it was full of acronyms, like alphabet soup. I had to lean over to Julia Goodwin, chair of OB, during the discussion on FPPE. What is that (I'm terrible about reading the topics emailed to us in advance)? Forced physician performance evaluation. We are just starting it, a way to monitor physicians who are deemed faulty, not the immediate revoking of privileges if you are putting patients in danger or are inebriated on the job but to do a six month monitoring of those in the grey area.

    There was a long discussion. Do we in med exec need to get involved? Or can PRC (peer review committee) and credentialing handle it? Ultimately we decided it needs to start in PRC and be handled by a chief or a designee of the chief and the chief can present the findings to credentialing. Revoking or denying privileges is a big deal, so it needs to be handled correctly. The head of credentialing was there, and he appreciated our input as we talked about issues that hadn't been raised yet in their committee. Later, when they were talking about bringing experts to improve ST (I mangled that I think there is another letter I forget) Julia saved me once again. Sterile Procedure in the OR.

    Sarah, who runs the morgue, was in charge of a lot of the doling out of my lab merch. She loved it. This was the best lab week since I've been here in five years! Finally, I told her, we are included again. It used to be so fun, but we've been iced out with changes in personnel. Our AP vendors delivered today. Corky's for lunch and take home dinners - there was food for days (too bad I hate BBQ but Jack and S are reaping the benefits). It's like the Freshman 15, Laurie said this morning, only Lab Week 15. Yes, I laughed, there has been a lot of food. Cupcakes, Potbelly, cookies, Papa John's. Our vendors aren't like drug reps - they don't give us exotic vacations to cause an opioid crisis, they are just molecular and lab machine people. It's all above board.

    I planned lots of things on Sunday - errands and treadmill but my body said Fuck No low energy you are going to be a couch potato. So I binge watched Beef and recommended it to Jack. The last two episodes are some of the finest TV on the planet. Monday Hal had almost finished it (no spoilers! Of course not, I said) and Kimberly's son's in-laws were watching it and Shaver had started it.

    I was walking back to my office on Tuesday after dropping off a consult to Shaver and Hal surprised me by jumping into the hallway with his hands clasped in a gun shape aimed at me. The juicy stuff grows in the shade! He said. (I may have mangled even that one, but you get the GIST - Gastrointestinal stromal tumor LOL). I laughed. You are going to have to help me, I said. I don't remember movie or TV quotes. Hal and Staggs are like encyclopedias, I can barely remember the Succession from the night before and often google it the next day for a recap. I finished Beef! Oh yeah, I said, I remember that now. We recounted the last two episodes for 20 minutes and laughed until we got exhausted. Happy Thursday, much love, Elizabeth.

    

    

Call Week Number 2

     I remember sitting in the car seat, maybe in the back, curled up around my med school books, studying. It could have been the red Wagoneer, it could have been the Acura Integra. Or the Taurus. Mike went through a lot of cars. Florence, his grandmother, had died in a house fire. Kitchen, in Greensborough South Carolina. We were headed to the funeral.

    A lot of my med school friends skipped their grandparent's funeral, with much regret. We all skipped a lot of things. Baby showers, weddings. The curriculum was brutal. So I was a little bit proud to skip a few days to attend my husband's grandmother's Orthodox Jewish funeral. I don't remember the burial, but I remember everyone going back to the house to stand shoulder to shoulder and wail. Bill and Esta, Florence's kids, were both very secular, which spoke volumes about their upbringing without speaking. Is this called Shiva? I wondered. 

    I had only met Florence once, when Mike and I were dating. We spent the night on the way to meet his Duke educated English major mom who now worked at the Waffle House. Mental health issues can be devastating. Mike warned me. Florence is a bit cantankerous, tough to go to a restaurant with. Everything is wrong. And she thinks Daniel saved me, but I saved Daniel, we really saved each other, so I have a little resentment.

    Sure enough, after a forgotten dinner, she raved about Daniel and Mike was irked. We were tasked to sleep in separate rooms - we weren't married yet - so we took a walk after she and Milton went to bed to vent. It helped. We were on our way to Gaffney in the morning. The next day he took me to his fave restaurant there - Hubcap maybe? Legendary peach iced tea, which I loved, even though I don't love iced tea. Super sweet and refreshing. Giant burgers - I think you got your name on the wall if you ate it all kind of like the plates at The Flying Saucer for your beer consumption.

    Mary was lovely, his Mom. She had made matching pajamas, a soft floral flannel for me and her - Mike took a picture that I continue to adore to this day. Schneider means tailor in German, Suzanne Klimberg told me on an elevator when I was training. Mary lived up to her name. When she passed, Cecelia, then just a tweener, read a poem and held a beautiful doll that Mary had made her. Mary took the kids to the library weekly, and stoked a love for books that I had no time to do. One that my own mother stoked in me. I still have a beautiful stitched potpourri pillow she made me in my office.

    I was up in the night from three to five am on Monday trying to stave off the images of a pathologist in NW AR. One that Melody and Annie had trained with, one that helped with Bill's cancer diagnosis last summer before he passed. Say what you will about Bill, but he moved Milton to Fayetteville and cared so much for his dad it melted my heart. Melody and Annie's friend was killed by her husband, stabbed to death, found in the street in her robe, presumably trying to escape. Melody and Annie had met the husband, a kind but forgettable presence in her background at events. When I was unable to sleep, I fondly remembered Milton and Florence.

    The pathologist's hubs tried to kill himself but failed. So the story will come out in his prosecution. Her story is over, but it will come to life with her friends and family. She didn't seem like an abuse victim, I hear. So what happened. Time will tell. Spinning and spinning on this this call week. How does a relationship get to this? What would this do to our work family, I wondered aloud. The dynamics would be holy hell. 

    Only three days left of call! I've got a 7am meeting - Baptist Health Extended Care quarterly where we discuss infections and falls and metrics and try to meet a fucked up national standard to get the maximum reimbursement. Lab week is next week, and I'm so excited I bought tons of merch on Amazon that I can't wait to disperse. Hope is including us this year. We are having lots of games and a photo booth! Nerdy, I know. Even though admin is still holy hell bottom line I am hoping that we are moving in a better direction. Love the lab. Happy Thursday stay safe in the storm, much love, Elizabeth

    

Call Week Number One

     Is almost under the wraps. Knock on wood tomorrow is a light day. The week, however, has been a doozy. 150 blocks on Monday, plus three big cases to photograph and present at ENT tumor board in the am. Blake Phillips sent me a late brain frozen. Cerebellar mass. WTF. 99.9% of our brain frozens are in the cortex (and easy peasy met vs GBM). The radiologic differential made my heart race and I had to take my white coat of bc I was getting sweaty. Medulloblastoma. Ependymoma. Choroid plexus papilloma. Low grade astrocytoma. Why oh why do you get this crap when there is no one around to consult? These are once in a lifetime if that diagnoses. I nailed it tho - in that hedgy way. Glial proliferation. Reactive gliosis vs. low grade neoplasm. 

    When Jon Wilson called today to follow up, of course I sent it out to Arkana to an expert, he shocked the hell outta me. Ganglioglioma, I think (very rare). I googled it and the history totally fits. Can you get a BRAF and a synaptophysin on C1? He is a nice guy - I used to do yoga with him at the Racquet Club so we caught up. I hadn't sent him a case in a year. Come to sip and stretch tonight! He said. He and his wife are DINKS like Mike and Effie and travel the world. It's been a brutal call, I said, but believe me it is on the radar. My gut health seems to be improving. Guess what? I sent you another case today so we will talk again soon.

    So it's been a brain zebra theme week. Blake Phillips sent me a frozen one morning and I was like I think it's a pituitary adenoma? Sellar mass. But I've never seen bone in one of those? He yelled back over the OR speaker phone, you and me both! Sure enough they can rarely have osseous metaplasia. Melody and I handled that one on our own. Then yesterday Tim Burson sent a submillimeter frozen from the spinal meninges. I called Melody from the gross room. I'm so sick of these weird neuro cases. Can I bring it to you for consult?

    Of course, she said, and we puzzled together over the tiny tissue. It's a multifocal spinal meningeal lesion. Lots of spots, I told her, in an immunosuppressed patient. They think it might be infectious. What are those clear cells, I asked. I can't tell, she said. I'd just say degenerative tissue no definitive lesional cells seen. Sounds good. Today, something that frozen lost (like I said wax is way better than ice) you could see little capsules in the cleared cells. I jumped up to show Melody. Holy shit cryptococcus. I ordered a crypto mucin and a GMS. Lindley called in the am, ID doc, so I called to give prelim and told him I'd text in the morning when I got the stains. Wow. He said. There is a history. His serum Ag is pos but his CSF Ag is neg so this is a true shocker.

    Tuesday morning I presented the three cases at ENT. Me, David Hays excellent IV Rad I've known forever, Stern, Sims, new ENT Travis, and newish Rad Onc Howard. A few support staff who didn't speak. I presented a nasty sialadenitis (It was like trying to FNA a street, Hays said, and we all laughed). I'm a little lazier that I used to be - when Hays brought up the pics of this from my jump drive Stern said I need my 3D glasses! I laughed. I forgot to put it in portrait mode for these. I didn't go back and retake them. The rest are in portrait mode, I assure you.

    Renal cell carcinoma to the thyroid - that is a board question, I said, what is the most common met but this is the first I've seen it 7 cm oh my. Look at the clear cells and the blood lakes - Hays can tell you why these are dangerous to FNA in the kidney they bleed like stink. It's the second one I've had this month, Sims said, and they do bleed like hell. The other was a once in a lifetime plasmablastic lymphome vs. low grade B cell lymphoma. They sent it to the NIH to see if they can be more decisive, I said. 

    Stern said a lot of time when y'all send it off they are just as hedgy. My heart swelled with pride. I notice that too, I said, but it's good to get an expert's name on it. You know that rare parotid tumor, I had one with Sims a couple of years ago, pleomorphic adenoma ex carcinoma? Bruce Wenig's comments read like a book and seem like they leave a lot of wiggle room. Stern said, oh my god his comments are so long. I imagine him drinking two bourbons when he's writing them. We all laughed, and Sims said I have blacked out trying to read his comments.

    Speaking of Sims, he kept me late on Wednesday doing frozens, about five or six. when I looked up the history I cringed. Adenoid cystic carcinoma? Recurrent? Talking to Savanna, who was covering for Laurie bc she had to go to a funeral. He was using a CO2 laser, and all of the tissue was burnt to high heaven and hard as hell to cut, according to Savanna. John came in to see what I thought of his margins. I sweated and took my white coat off for the second time in a week.

    Adenoid cystic is a really basaloid neoplasm that when crushed and burnt can look like lymphocytes or tumor, honestly. I said John, you are going to hate what I have to say. Atypical, cannot exclude neoplasm, on one and two. Savanna is still cutting the others. So, he said, tell me about atypical. Well you know cytology, I said, there is negative, atypical, suspicious, and positive. I want to break it down further, he said. OK. This one is atypical, favor negative. The other one is atypical, I'm really suspicious. Sometimes I feel like he misses the forest for the trees. But I"m not in the OR digging around in the complex head and neck, so it's hard to judge. I'd certainly pick him as my surgeon if I needed to.

    I made the gross room order permanents today, in order to try to find more viable tissue like I said ice leaves holes and wax is better. Was able to be more definitive on some of the margins. But adenoid cystic? It's like chasing the devil. It is extremely painful bc it wraps around nerves - that's it's predilection - and once you get a hold of a nerve, like a firepole, you can go anywhere.

    In good news I'm planning a 50th bday party with my cuz Eleanor (we had a big 40 too) and she and Anna came for lunch. Sooo excited we discussed possible cool venues and music and interactive guest art (for Eleanor she's the amazing artist) and signature cocktails. Eleanor and I are gonna split it. They loved seeing my office and I told them in a month or so we should do it again and I'd show them the gross room. Anna was thrilled. I want to see breast frozens! She kind of mangled what I promised her (we don't freeze breast) but I can't wait to deliver. Happy Friday, much love, Elizabeth

The Aftermath

     When my Mom warned me about tornadoes last night I looked online and was like Meh? Not us. It's never us. Usually not. I was the teenager that drove around during tornado warnings thinking I was completely immune. Jeep top down. Ignorant as bliss. Dumb as shit. Not so much in my almost 50.

    I looked last night at the weather and it seemed to not be going to Pulaski County. I woke up at 4:00, anxious about finishing my stupid American Board of Pathology questions before the deadline. 18 of them. I always push it to the last minute. Melody, not so much, she does them right away. Different personalities. Me, peaking at the deadline, her, the ever loving amazing schoolgirl getting it all done up front.

    I was at work so early I finished my cases at 1:00. Started looking at the storm news and freaked out. It was like Hurricane Michael, which destroyed my parent's house. It went from 0-100 in a few hours. I don't like driving in storms these days. Jack called and said he was headed to NLR for an appointment and I said hell no go straight home postpone that. I called S and asked him to come to the hospital - I was covering frozens until Shaver finished a meeting and an errand.

    He thought I was being an alarmist, but I never usually am. Still, blood pressure was mounting and I took a Hydroxyzine (fancy Benadryl) to calm my chest pain. When at 2:30 Shaver finally returned to let me go he told S don't leave right now. I had already heard the secretaries talking about touch down in Chenal and the Rodney Parham Kroger. Let's just wait this out for a bit, I said.

    We decided to go to the gift shop to waste time but that was a bad idea. I had already heard they were evacuating patients at ACH (Jan's kid works there) and the front of the hospital, usually teeming with visitors, was empty. Med Towers 2 was completely in the dark (Tornado protocol? Generator failure ? No clue). I was scared walking in front of the windows, and the creepy vibe of the visitors and patients in the Med Towers huddling in the dark scrunched down in the hallway from the windows made my anxiety shoot through the roof.

    After the danger passed I just wanted to go home. But the traffic, holy hell! 430 was completely at a standstill. I know a way through Shackleford, I said. but it was completely impassable. Tried to get through Bowman to Mara Lynn to Green Mountain but it seemed like every time we got to a place to get free a shitload of cops blocked the intersection. WTF? They are making this worse, I thought, seeing cars blown into buildings at ridiculous angles. Cartoonish people making poor decisions at the defunct stoplights. Clogging up the intersections. 

    There were miracles, too, just like in the movies and TV shows. After the cops blocked up all the intersections, clownishly, forcing us into a never ending circle. Chenal was the only route home. Still agonizingly slow, but there were two adorable youngish girls directing traffic, think long neon braided hair and fancy dresses, helping us poor tired motorists at the last bottleneck in middle Chenal. I wanted to hug them.

    Lots of pics shared, in group texts. Foxcroft looks destroyed, Pavilion in the Park looks like the victim of a monsoon. Middle Chenal had trees downed everywhere. One of my micro techs, who lives near Rodney Parham has significant damage to her house. So funny how it skips things, I wondered in the traffic. Like Crohn's disease. One block intact, one part of the intestine intact, the other part annihilated. 

    So far everyone I know and love is accounted for. But the pics on FB! I hope there weren't too many casualties. What a storm. Rivercrest looks untouched. Planning long needed lazy weekend and my only work day next week is Monday. ZERO plans for Tuesday through Friday. Maybe a massage. Book reading. Speaking of, I read Demon Copperhead last week and I've read most of Kingsolver's body of work but this was definitely one of my faves. Happy Friday, much love, Elizabeth

    

Low Hanging Fish

     Rage, is what I'm feeling. Past 48 hours. Full of it. Finally knocking the wind out of my sails. Can't really discuss why, sometimes you have to reign it in instead of airing your dirty laundry for the whole world (at least my 22 or so hits a post) to see. Writing is like activating the steam valve. Like S's riding of bikes. We joke, he's riding, I'm writing. Or like singing, for me anyway. It helps stem the urge to curse the shit out of anyone and everyone.

    I ran out of my blood pressure meds on Sunday and yesterday, well it went by way of the water and yogurt and berries in my stomach that cut my day way short. Luckily I hit the trash can. But embarrassing. It's like the Exorcist girl, for all the office with the thin walls to hear. Today when I came in to see my work was taken care of I cried to the secretary in relief and gratitude. Shaver came in this morning and gave me a loving lecture, much needed. We are family. We need to depend on each other. You aren't the only one who gets sick. I didn't even know you went home.

    I should have told you, I said. I was just feeling helpless and weak. To ask for help? Unthinkable. More sign of already weakness. We were happy to plug in. You know that breast cancer case (I had done half of my work but couldn't stay around bc I was running hot and cold and felt like I was going to blow off to histology, them bringing cases too slow to get me out of there). I did ask Staggs to cover my afternoon frozens, I said. But thank you for recognizing and absorbing. There was a micromet in the lymph node that you half worked up. You didn't see it, I didn't either, on the H&E. I told him that's why I always tell the gross room cytokeratins are important, on these breast sentinel nodes. Order in advance. I've seen two of those, since January. You cannot be too careful.

    I went to get my metoprolol about 6 hours after I turned in the slip to the pharmacy. Usually you text me a lot sooner than this? She spent an excruciating ten minutes looking through the drawers. It's not here. An agonizingly slow consult with the pharmacist revealed that I cannot pick them up until April 1. You picked it up last January 23. But that's not until Saturday, I said, my blood pressure rising ironically. Do you want me to wait until Saturday to control my blood pressure? Thinking, they are acting like I'm begging for Vicodin or something. 

    Well, she finally said, under pressure and the state of my duress, we can get you some but you have to pay for it. Fine! I said. How much can it cost? Um 10 dollars and 49 cents. That's well worth my while to get it, I told her. And you will have extra! She said. What the fresh hell is this? New insurance rules? I've never been denied the one med I have needed over the past few years.

    My financial advisor came for a regular update today. Things are looking good. He's smart, I learn a lot by listening to him but this is not my area of expertise, like physics, so I sometimes get lost in my head. We were discussing ways to save money. How about running one of those audits on our checking account? To get rid of those miscellaneous charges. I've seen it advertised on TV, I asked. Or is that just a low hanging fish. Drumbeat. Fruit I meant, and we LOLOL'd. He said I was thinking catfish maybe? Or flounder! I quipped. Absolutely not a low hanging fruit. Give me a year's statement, I'll get James on that ASAP.

    So then we got onto the subject of our upcoming vacation in May for two weeks. I've never done two weeks in a row - years ago Maria told me it was the best, you really get to unwind. My first European trip was a few years ago with S and his Mom to the small town she grew up in, Bad Herzfeld. It was nice, scenery beautiful, but no one spoke English. No menus in English. S's mom can speak fluent German, but doesn't have a lot of reading capacity. I'd order something on a menu and it would come out like a fish head floating in jelly, something completely unedible. S said this was not the case before the Wall fell. Everyone spoke English. Like the rest of the world, people are getting more territorial.

    So I was super claustrophobic planning this trip. Katherine Lu was recommended by Scott Marotti and Laura Sanders. Needed a change from at least in my recent experience overpriced and incompetent Poe. You will be fine, my brother told me. There is Google translate now. Katherine created a super personal 16 page itinerary. I know that this sounds like a lot, but it is very detailed. 

    I want a terrace or balcony every place we stay. Check. S needs access to a bike. Check. We don't want that experience of running around like chickens with our heads cut off, we need built in free time. Check. We want English speaking tour guides, and when we go to a wine tasting in Bordeaux, we want someone to transport us there that speaks English. Gotcha, in a Mercedes SUV. Ah bliss.

    When I was in Chicago last week Mike and Effie took us to a restaurant. In Chinatown, we went to a hot-pot - new to me. Three amazing bubbling broths in the middle of the table to dip a million things in that was staged. Watermelon slush so yummy I ordered an extra pitcher. Kimuki? Maybe? Which I splurged on the 22 bc it was Michael's bday. 35 dollar cocktails, more than the small plates. I had the smoothest Japanese whiskey on the planet. Effie and Mike told me they were world-known for their cocktails (and I can't spell renouned so we will leave it at that).

    So I'm excited for food in Spain and France and not feeling like I'm hemmed in by not knowing the language. Thank goddess I'm not on call this week. Too much else is going on. Happy Tuesday, much love, Elizabeth