Band Practice #2

Just finished a three hour session, after three scheduled practices were interrupted with duck hunting (not me), family, and work. It is amazing how much better I felt after just trying for the first time earlier this month. I needed two glasses of wine and a beta blocker (no, I don't take those often, just had a leftover prescription from when I was on TV for the swine flu earlier this year). I felt so self-conscious, that first night, internally self-berating that I had never learned a musical instrument, cause he was so good. Still falling short. I think I need to accept the fact that I will never feel like I measure up to anyone. And just quit worrying about it. Doesn't everyone feel this way?

At a party a couple of weeks later, my friend's wife laughed. "Chet said that all singers are like that in the beginning. You will do better next time." In the interim, I learned a few new songs and found myself singing better to car CD's - not comparing myself to all the singers and feeling like I was falling short (again), but finding where I could sing well within my range and (gasp) do better. My own voice.

Tonight, a couple of cups of coffee and a giant Powerade prepared me, and I got through the long practice with just two beers. GD, blues, etc. My friend and his wife were encouraging. He played great - so incredibly talented - he could just pick up a song on his guitar he didn't know when I sang it. We mastered about four or five songs and played around with a bunch more. He played some amazing original stuff I want to try to write to. We planned to try to meet again next week. It is so fun to have something non-work related to look forward to.

Excuse me, I've got to go write my Grammy acceptance speech (hee hee just kidding).

Newest Addiction

Fingerless gloves. I love them. I bought a cheap pair of gloves in Chicago earlier this month, and became frustrated when I was trying to take a picture of the snow for Facebook. I couldn't do it. Quickly realized the gloves were the impediment, and slid my nose across to open the phone, belatedly acknowledging the fact that using my nose to go in and actually take the pic to upload to FB would prove too much. So I begrudgingly set down my Christmas present shopping bags and took off my gloves to snap the photo.

The next day I went to Eileen Fisher in the mall to present shop for my mom. I remember my mom taking me to Eileen Fisher when I was a teenager, California or New York I can't remember, only being in the store and picking out a sundress that was apricot-colored, with soft, luxurious light fabric, draping almost to the floor - this didn't happen a lot with me and dresses once I hit puberty. I love that dress. I still have it - good quality lasts a long time.

As I was running around the store quickly taking in colors and images to get ideas, I happened across a stand with these amazing bronze and charcoal-colored fingerless gloves. They were thin, soft wool, and had tiny bronze and silver beads in different patterns - just a few so they were elegant, not gaudy. My search was over. Iphone gloves - bronze for me and charcoal for my mom. There was a little story behind the gloves on the back of the tag - someone had made them for Eileen Fisher for Christmas last year and she loved them so much, she was selling them in her stores this year.

Of course I couldn't wait until Christmas - I wanted my mom (and me) to be able to wear them to all of her holiday parties and get use out of them immediately. I get compliments on them wherever I go. So does she. People laugh when I call them my iphone gloves - someone in a tiny shop in the Heights supporting local artists said, "Hey! We should get our knitters to make those! What a great idea!"

My mom loved them so much when she came across a pair at the mall - soft, fluffy ones with pastel rainbow stripes, she bought me a pair. Now I can mix and match and accessorize.

Last week as I marched into work one day through transcription area, everyone looked up and I suddenly felt self-conscious. I was in a black overcoat - the Gandolf one, according to Mellificent in residency - my hair still slightly damp from my shower. I was slumped over from carrying the giant black leather bag I bought in residency to house diapers that is currently sheltering my Christmas card project, the book I am reading (The Year of Magical Thinking - Joan Didion - big winner), a cd project for the kids that may or may not happen, recipes for cooking projects with the kids when I am off this week, and various menus and receipts, in addition to my wallet, lip gloss, and press powder. My laptop rendered my slouch symmetrical. I was wearing the rainbow fingerless gloves. I did not have on the beautiful, cozy bright blue slippers with the flowers on them (a present from Dr. Styles), the ones I noticed were still on my feet on the way to work, quickly turning around on Evergreen cause they just screamed crazy lady (in my defense, that's a first for this year. I did it twice last year. If you had such cozy slippers, you would accidentally almost wear them to work, too), but I looked down because I suddenly worried I still did. That I looked like a bag lady. Then I just laughed. Who cares?

Fragile

This is another one of my favorite songs. I remember listening to this album over and over, when it first came out. Been listening to this all week in the car. Merry Christmas Eve. Please fall asleep, sweet Sicily, so I can play Santa!

Kind of fitting, considering we are trying to survive a flood, this Christmas Eve. Listening to all of the lab workers and transcriptionist's heart-breaking stories about trying to get to the hospital to work, even though

interstates were closed, was tough. Listening to their anxiety about getting home for Christmas Eve was even harder. I fought the urge to save everyone. I have my own family. I work with a truly incredible group of people.

I don't know why I can't control the font or the spacing, suddenly, on my blog. But I am tired of trying to fix it. So you'll have to accept my post, flaws and all. Hopefully my stupidity will make you smile.

Christmas Miracle II

Damnit, I couldn't help it. I am just so happy. Here it is.

A Christmas Miracle

Well, my daughter's art is pretty miraculous. She called this one "Potato Penguins." I asked her a couple of months ago, "Why potatoes?" "Potato stamps, mom. I used potato stamps to make them. It was easy." I had never heard of those, but loved her penguins so much I vowed to save them for the Christmas card. Then I used kid pics instead, so here are the penguins in a Christmas Eve Eve post.

But that's not the miracle I'm talking about. It deserves a long, wonderful post, one that I will write eventually, when I am not wrapping presents and setting the table for Christmas Eve dinner, and readying myself for a final day of work before Christmas vacation. For now, a few words will have to suffice.

Welcome, welcome to the newest addition to the Gasper family, Lorelei Ruth. She is a beautiful 4lb. 5oz. bundle of peacefulness and serenity that I had the privilege of meeting this morning in the NICU. I cannot imagine what it is like to find out at noon you will be a parent, meet your daughter, sign the papers, and learn you will probably take her home on Christmas Day. After a long wait, what a tremendous amount of body-rocking and mind-blowing emotion to experience during the holidays. I got to watch her dad and mom take turns holding her and telling her amazing story - the beginning of their journey. I could hardly work today because I kept thinking about them and getting choked up.

She is ravishing. She looks a lot like her adoptive mom, Courtney. Luckily, she doesn't favor her adoptive dad (hee hee just kidding Brent) but I hope like hell she adopts his enormous compassion, humor, and intelligence. What lucky parents. What a lucky little girl. I can't wait to see her again tomorrow.

By the way, guys, I am dropping off a very un-festive collection of Kroger sacks filled with essentials on your front porch on the way to work tomorrow. Congratulations, you three!

John Doe

That's the name of the candy bar I got my partners for Christmas this year - I had fun playing Santa today. It is the creation of Bloomsberry & Co., a chocolate company originating from New Zealand that now sells in the U.S. I received one from my creative sister-in-law and brother for Halloween, in my work mail. I was wondering how I could top the Giotto's rocket blaster I got last year for everyone to clean their scopes, and was glad that someone else did the legwork for me.

Every chocolate bar offered has amazing cover art and clever sayings, tailored for all holidays. Some are incredibly racy, like this one:

Others are sweet:

Anyway, you get the picture. It's fun just to look. There are tons of them. And at $5.00, it won't break the bank. Fortunately the quality of the chocolate lives up to the packaging. I was happy to find the quintessential pathologist's candy bar in the John Doe - death by chocolate. How delightfully morbid.

I also ran around to different departments passing out Killer Pecans and White Trash snack mix, two of my favorite food gifts. I was so happy to see Killer Pecans back on the shelves at the gourmet food stores this year - I couldn't even find them on a website last year and I have mourned their absence for two to three years. Pecans laced in sugar, butter, cayenne, and cumin - oh my god they are incredible. I kept checking to see if histology opened their tin so I could sneak some. I got a tin for my house for Christmas Eve dinner snacking.

Almost as fun as giving was receiving - someone from the blood bank made some incredibly gooey lemon cookies (I got the recipe), someone from the gross room made homemade smoky, chili powder pecans and peanut butter fudge. I could go on and on, like the ever expanding size of my stomach capacity. The biggest hit for the kids was our business manager's Oreo cookie truffles - I got the recipe for this, too, and instructions to vary with Nutter Butter's. Hopefully if I am brave enough to attempt cooking next week it will go over better than last Christmas. Well, re-reading that post made me realize I didn't properly describe the angst and severe five minute couch depression of the failed candy experiment. I never tried again -- needed a year to recover.

Playing Santa makes me so happy. Work is done. Now on to the kids later this week.

Love

I've been reading some psychological and spiritual mumbo jumbo lately. I'm pretty callous so I'm not proud to admit this, but sometimes it's what we need, in our lives.

My mom gave me this book called "How to be an Adult: A Handbook on Psychological and Spiritual Integration," by David Richo. They recommend that it is read slowly, in order to digest the teachings. So of course I sped-read it in one night. It's pretty short.

Two quotes struck a chord, so I'll share.

"We discover the gift dimension of the music and feel it in our bodies. We find out why it has survived the ages: it shows love and helps us receive it. 'We are put on this earth a little space, that we may learn to bear the beams of love,' says William Blake."

"Then we know that music is what love sounds like, and art, drama, and dance are what love looks like. When something still has the power to move us, it must have been love all along, since love moves the earth and other stars."

Reminds me a little of a quote I love by Gabriel Garcia Marquez. Of course I gave away Love in the Time of Cholera - it is no longer on my bookshelf - I usually give away books I love the most quickly. And of course when I tried to google the quote I couldn't find it. It has something to do with actualized love and unrequited love. How actualized love is quiet, and unassuming. But unrequited love is the love that moves the earth, and powers the world. Makes men (and women) great. Realizes potential. Furthers civilization.

Back to fiction now. The gut-wrenching, heart-stomping, wonderful kind that helps you escape and handle reality.

Somewhere Over the Rainbow

Don't Put Your Hands On Me

Fluidity

Sometimes I wonder if the more experienced a pathologist I become, the hedgy-er and weirder my sign-outs will get. I start to see mistakes that people make, and the culmination of past history makes me hesitate more and more with my diagnostic words. This is vague, I know. I'll try to make it a little more clear.

When you first come out of residency, you have a nice set of rules to work from. A follicular lymphoma is a follicular lymphoma because it looks like this, it marks like that, and the flow cytometry fits perfectly. So you type that into your diagnostic line (or dictate it for the transcriptionists). Follicular lymphoma, grade 1 or 2 or 3. Depending on the rules you read in your fancy book. The ones you memorized to take your boards.

But then life gets messy. People are messy. They don't always follow the rules. There are articles you can find on pubmed to deal with the messiness - ones that people publish about these five cases that don't quite fit the rules but we are going to call it this. You read the well-known academic author, and feel confident in following their lead. Sometimes you send it to them to get their name on it, pay lots of money for back-up. After all, you want to get the proper diagnosis for the patient, so they can get the proper treatment.

Then, a few years into practice, a new book comes out, and come to find out that thing you used to confidently call this is no longer considered this. New molecular information has come to light, and now they call it that. You squirm uncomfortably in your $1200 chair, the one you purchased with your continuing medical education money to prevent slipped discs and chronic pain issues you have seen your partners deal with. You think of all the cases you used to call this, and wonder how in God's name you could ever go back and call them all that. You look at partners that are good, solid, hard-working people, and understand all the quirks and strange habits they have developed over the years to help them sleep at night. You wonder, two years into practice, what you will be like ten years down the road.

This week, I was asked by a medical oncologist to review a case I signed out last December. It was a simple question, "Can you grade this lymphoma?" I had the case pulled, but didn't have time to review it for a couple of days. We were slammed with record high block counts all week long, everyone trying to get in their surgeries before the holidays and new year. Add in trying to rearrange schedules to make it to my kids amazing Christmas programs, and John's febrile illness that finally peaked in the middle of the night last night, and wow. I love having tough days, because work is stimulating, but it is nice to balance out hard days with light ones. Hopefully next week will oblige.

When I finally got around to looking at the biopsy, I was mortified. I won't bore you with the details, but I had confidently called a GI biopsy this, and I didn't feel so confident about my diagnosis in hindsight. I sounded like I knew the patient had already had this diagnosis, but failed to explain anything about past history or clinician communication in the comment I made. I told my partner I shared it with, "This isn't like me. I am not that much of a cowboy, on a first time diagnosis. Something is missing."

I was further alarmed to read in a GI note I had faxed from a clinic that the patient did not have a pathological diagnosis, prior to mine. He was being treated presumptively, based on radiology, according to the note. I searched his history in the archives on our computer. No previous. What have I done.

I resolved to call the oncologist and explain the situation. I talked to her before - she is based in another town, and she seemed reasonable. I would tell her we needed more tissue to make a diagnosis. Maybe I jumped the gun. I should have called it suspicious. Hopefully it would all be OK. Unfortunately, she takes Fridays off. I talked to her nurse.

"Can you fax me all of his records in the chart, please?"

Two hours later, a transcriptionist came into my office. "Here is your book." I laughed. "You are right, she faxed me an entire tree."

I pored through the history searching for old path. Luckily, it was there. Five years ago, two people in my group had good tissue with good flow. I must have had this information a year ago, and forgot. I was so hell bent on figuring out what I did wrong, and the GI note really threw me off. Because the path was in the small town, it wasn't easy to find in our computer records. I sighed with relief. Suddenly, my cowboy, slipshod sign out made sense. I did the right thing. The diagnosis had already been made, as was evident to me in my sign out, but I had to play detective to find it out. I resolved to make more all inclusive sign-outs in the future.

Last night, I was up until midnight addressing Christmas cards. I just ordered more online, because I ran out. I looked at the pictures I took frantically in front of the tree last week, when I started receiving cards and realized I hadn't done mine yet. I was very proud of the ones I chose - the kids look great, happy and real - not posed, just having fun. I thought of how my past experiences with them shape the way I deal with them currently. My set of parenting rules is constantly shifting and changing based on new information. Life has so many parallels. I hope they don't think I'm hedge-y and weird. Fluidity is probably a good trait, in work and life.

Word Cloud

I got this idea from the person who accused me of making a statement in a comment that can be interpreted as racist. We're OK now. We hammered it out. I learned something. She had her one year anniversary, on her blog, and got a word cloud from Wordle. This website takes the text from your blog and features prominent words that you use.

I am sure there is a way to make this bigger. I just don't know how. It looks bigger on the website. And it is still really cool. Except I wondered, where the heck is my son?? Have I not mentioned him lately? Do I not talk about him as much? And work words are way bigger that words like "shopping" and "party." Not good.

Pot of Gold

Check it out, if you want, at MiM.

It is really out there now. It was removed briefly to put up a few more "Day In the Life" posts.

Art Part III

I opened up Sicily's glittery heart folder from her pink backpack last week, and saw a memo from the teacher.

"Please bring 15 gifts on December 15th to share with the classmates. Examples in the past have been Golden Books, stickers, etc. Do not spend a lot of money."

I cringed. 15 gifts? To go in a stocking? My child was going to come home with 15 gifts before Christmas break? Whew.

I decided to embrace the spirit of the endeavor. I would not run to Target at 9:00 at night to buy 15 plastic objects made by children in China. This was going to be about Sicily. So the next day, we were running through ideas.

"Here are the examples, Sicily -- what do you think?"

"Well, mom, we could go to Michael's and get some of those wind-up toys we got for the Halloween party."

"What about a CD?"

"Yeah! I'll make a song list right now."

She made one, and I stuffed it in my purse so I wouldn't lose it. I was going to have to buy a couple of the Polar Express songs on itunes, but oh well. Still a pretty cost-saving idea - one that she could make hers. One night last week on the way home from work, I stopped at Office Depot and found some CDs with great art - they weren't there the last time I picked up a big batch. I was so excited. I couldn't wait to show them to her. I was a little stressed about finding the time to make and label the CD's, but I was off the next week, so I figured I would work it in somehow.

Last night in the car on the way home from my mom's, Sicily was vying for attention over the music and her brother.

"Mom, listen to me. I have an idea. Do you have pictures of my classmates? Like in the yearbook? We could cut them out and put them on the CD's."

"No, Sicily, that won't work, if we glue them or tape them on the CD's it might mess them up when they put them in the CD player. We could maybe put them on the cover - the one we label. You can decorate them."

She answered emphatically. "No, mom, that's not my idea. There's not going to be music anymore."

I thought the music idea was so good, I initially tried to dissuade her. She had other ideas.

"I want to make the CD's Christmas ornaments, for their tree. We can get some great ribbon to tie through the middle. I want to decorate them with my classmate's pictures."

What a fabulous idea. And less work, for me. "I'll stop by my office tomorrow and check for pictures in the directory."

Unfortunately, there weren't any pictures in the directory. When I broke the news to Sicily today in the afternoon carpool line, she wasn't dissuaded. "It's OK. I have those wonderful scraps, from your friend Ramona. I think I know where some pink ribbon is. We have lots of stuff around the house. I'll make it work."

I had a long lunch Thursday with a blogging friend, Ramona Bates. She is a plastic surgeon in Little Rock, and we met through a medical bloggers in Arkansas article. I've been following her blog for a few months, and we finally found the time to meet in person. I was incredibly touched that she brought quilting scraps for Sicily - I had mentioned in a comment a couple of months back that Sicily's old school liked to use quilting scraps for sewing buttons, when she wondered on her blog what to do with her quilting scraps. Her blog has the smart title Suture For A Living, and she often reviews articles and books and talks about her hobbies. She is the person that suggested I post over at Mothers in Medicine, so I am incredibly thankful to her for plugging me into this community. Her blog is worth checking out. If you like to read about reviews of nail bed injuries over your morning coffee, or 30 pound breast tumors (I thought only ovarian tumors got that big!), then you'll have fun.

Tonight Sicily grabbed her bag of quilting scraps, (my goodness she was like a kid in a candy store when she received them - so incredibly grateful and excited - "Who do you know that gave me such a great gift?? Can I meet her someday? Can we take some to Nana's house so I can sew with her on my Nana days?"), some pink ribbon, and went to town. The picture above shows some of the results. I am so incredibly proud of her creativity and work.

I loved meeting Ramona. We cut to the chase, face to face, and unloaded about business practices, dreams, regrets, and family. She's an amazing person.

Rosemary

This is one of my favorite songs, of all time. The visuals are a little weird. Close your eyes.

I am off this week, and got to meet my daughter's piano teacher tonight, sitting in on a lesson.

"I really think you need to get her into voice lessons. She is amazing. Most kids her age are all over the map, with their voices. She is pitch perfect."

We work on it a lot. Every night. I am so proud. It's nice to hear someone recognizing our efforts.

Relativity

I walk into the FNA (fine needle aspiration biopsy) room, to perform a procedure. A 53 year old woman is sitting in the clinic chair - my patient. Her husband sits to the left of me, and I introduce myself to both of them. I run through the procedure, and then listen to her talk.

"It's been here for a couple of years. I wasn't that worried about it, but my mom recently was diagnosed with breast cancer, and thyroid cancer, and I decided to get it checked out."

She had a mass below the ear, a parotid mass. Slow growing parotid masses are usually one of two things - pleomorphic adenoma, if you aren't a smoker. Warthin tumor, if you are. Both benign entities. She wasn't a smoker.

I steadied my needle and performed one pass. I was confident that I got good material, so let her apply pressure and take a break while I waited for the tech to stain the slides. We chatted about her life.

"My husband and I are going to D.C. tomorrow, for a vacation. So we won't know about the diagnosis until we return. I'm going to be anxious thinking about it, the whole time."

I learned about her children, what they were doing. The slides were ready, so I looked in the scope. It was a great pass. Photo worthy. One to stash away in the files, for the cytotech students. Beautiful magenta metachromatic stroma surrounding football-shaped myoepithelial cells. A pleomorphic adenoma. We were done.

As the tech lowered the clinic chair so she could step down onto the floor, I looked her in the eye. "Have a great trip in D.C. You've got nothing to worry about."

Back in my office, I called the ENT doctor, and told him the diagnosis. "Wonderful. Thanks."

A week and a half later, I received a phone call in my office. It was a transcriptionist. "I've got a lady on the phone, and she wants to talk to you. A patient. She is really upset, and thinks you may have gotten her slides mixed up with someone else. Do you want me to take a message?"

I quickly looked her up on CoPath, saw the name and diagnosis, and remembered her. "No, I'll be happy to talk to her. What line is she on?"

I don't often get phone calls, from patients. The transcriptionist was trying to protect me. We usually leave all the interaction to the clinicians. But having a patient worried and doubtful about my diagnosis alarmed me.

"Hello, Dr. Shyder? Do you remember me?" Her voice was laced with hysteria.

"Of course. How was your trip?"

"Great, but I just went to the doctor. He told me I would have to have surgery, to remove the mass. You told me I had nothing to worry about, you thought. Are you sure you didn't get my slides mixed up?"

Pleomorphic adenomas are, by rule, benign. One in a million can be cancerous, so they have to be removed surgically. I have seen pictures in books, but never run across a malignant one. I'm a young pathologist, but I'd be willing to wager that none of my 13 partners have ever seen a malignant one, either. I'm guessing at these stats, but malignancy, in a PA, is a true anomaly. As pathologists, we don't discuss diagnosis or treatment with our patients, when performing FNA's. But on the precipice of her vacation, and with her mother's history in my head, I felt moved to console her.

"Yes, they have to be removed. But the vast majority are benign. When I saw the slides, I was thinking of your anxiety about your mother's two cancer diagnoses, and was attempting to reassure you on that point. I apologize for any miscommunication. I realize that having surgery is a big deal, and I am sorry to have misled you. I will be happy to have the slides pulled, and will review them today, since you are worried. If there is any change in diagnosis, I will notify your clinician immediately."

Lesson learned. I won't be so quick to pacify a patient, in the future. My idea of "no big deal," isn't every one's. I'm not the one going under the knife - this week, anyway.

Book Club

Is this Thursday. I read the book while in Chicago. I picked it a while back, but we were having trouble finding it in stores (I think we kept getting the name confused and it just isn't out there) so we postponed it until now.

One of the first books we read, when we started book club a couple of years ago, was Eat, Pray, Love: One Woman's Search for Everything Across Italy, India, and Indonesia. I don't really remember the particulars of each adventure - I read it so long ago, but I do remember the feeling I got. I loved Eat - who wouldn't enjoy reading about a woman leaving her husband and gallivanting around Italy, enjoying wonderful food? But by the time I got halfway through the part about the Indian ashram, I became annoyed with her narcissism. So annoyed, that I don't really even remember Indonesia - it got weird and I was bored and speed-reading, to finish the book. I didn't really care about her finding love, because I didn't care about her. I can't speak for everyone in book club, but that's how I felt.

So when I came across a fictional parody response by the man she jilted, called Drink, Play, F@#k: A Man's Search for Anything Across Ireland, Las Vegas, and Thailand, I thought it would be fun to read. I floated the idea and everyone agreed. I don't know what I expected - maybe a big dose of revenge and debauchery. There was a little revenge talk, but it was respectful, especially given she was the one who did the cheating. He drank a hell of a lot in Ireland, I probably missed some of the golf and gambling metaphors in Las Vegas, and I fully expected that in Thailand Bob would be reveling in rampant sexual hedonism. But I was pleasantly surprised. He was really funny throughout the book, in a self-deprecating way. The story was highly improbable, but his "gurus" (a midget in Ireland, a personal trainer in Vegas) were fantastic and doled out wonderful philosophy in such light spoonfuls that it wasn't so painful to receive. He was such a decent guy, I found myself cheering for him and might have even forgiven him if he strayed off the moral track. But he didn't. By the time I watched him dive into the ocean away from what I would consider to be every man's greatest fantasy to find true love (I'm such a sucker for that sort of thing), I was so happy on the inside.

So if you ever get inclined to read one of them, I vote for the latter. I'm shocked that his book didn't stomp hers in critical acclaim. It was a much better read.

Week In Review

What a hell week.

I was crazy busy, on cytology. Tons of needles. And we are going live, with PCR from H1N1. I was trying to compose a fastfax, for all the doctors. One that is legal, satisfying to both the lab and the hospital. We, meaning the micro lab, are happy, because we got a badass molecular machine that will do all kinds of other things to make our lives easier.

I found out I made a diagnosis, on a patient, that resulted in the wrong treatment. I am still reeling from this one. In my defense, I made the proper call at the time, and was backed up by an experienced colleague. All the ancillary tests fit. It was the right diagnosis, with all the clinical information, but time told a different story. The clinician was cool about it. But still - I made a wrong call. I learned that this happens, in my job. It is not a perfect science. I have heard other stories, from pathologists, about mistakes. This is my first. I lost sleep.

I made a comment, on my new blog at Mothers In Medicine, that was unintentionally viewed as racist. A smart Indian-American girl called me out on it. The last thing I view myself as, on the planet, is racist. But in retrospect, I could see where she was coming from. I need to be more specific, in writing. Because you can't assume that others will always share your background experiences, and know how you stand.

I haven't run in a week.

But none of this matters. Because Wednesday night, I got together with an old friend, a particularly musical one, and sang, to his guitar playing. I've never sang with an instrument before. I was inhibited at first, even though it was my idea. I loosened up eventually, and had fun. I think he did, too. We were all over the map - Kravitz to Loretta Lynn. We made a song list to start working on. I can't wait to meet again next week.

Off to Chicago in the a.m. Looking forward to some time away.

Picking up Sushi

I just posted again, to Mothers in Medicine. I think I'm overexcited and hyper, the crazy new chick, but oh well.

You can read it here.

Looking forward to tomorrow, a post-call Monday.

Happy Holiday Weekend

All the Fame of Lofty Deeds

Next weekend, Mike and I are headed to Chicago for a three day trip. We haven't been on a plane trip without kids in over four years, and Mike's been itching to get away. I told him to plan it all, then quickly took over. I'm such a control freak.

I chose Chicago - he's never been but I have lots of family there and have been there frequently. I haven't been to Chicago around the holidays since I was nine, when my grandma Loretta and grandpa Chuck took my sister, my cousin Eleanor and I by train to see my Chicago cousins. I remember being awed by the fold out beds and fold out toilets. We stopped on the way to visit Lincoln's home, and arrived to find the city fully decked out in holiday splendor. I was amazed. I remember it was snowing, and I was thinking that I never knew so many holiday decorations existed on the planet.

Mike asked me, "What do you want to do there?" I replied, "Christmas shop. And see a play."

"What play?"

"Facebook your cousin Zack. The one that just put on Zombies Attack Chicago. That has ended, but I'm sure that he would have a cool recommendation."

I wanted it to be a surprise. But I got curious. I asked Mike, "What did Zack say?"

"I got tickets to something he said would be good. Something about lofty deeds, I can't remember the name."

I was busy at work when he texted me this information, but this past weekend, I googled it. I was impressed.

David Lynch (one of my all time favorite directors) meets Howdy Doody? Sounds fascinating. I was curious about Jon Langford, and decided to buy his album of the same name so I could be familiar with the music before next weekend. That picture up there is the album cover. Again, wow. Here is the only song on the album that has a YouTube clip.

I've been listening to the album all weekend.

My brother recommended a great restaurant, Moto, with an incredible reputation. I think the chef is a food scientist, like my brother - interested in texture and science as much as taste and presentation. We signed up for the twenty course meal one night. The courses have wonderful names like, "Ants on a Log," "Milk Chocolate Forms," "Rainbow Sprinkles,"Reuben Lasagna," and "Pineapple Jerk."

I hope I can get my Christmas shopping done. I'm well on my way, and happy to say for the first time in many years that it is being carried out leisurely in stores, instead of at midnight on the Internet.

Mothers In Medicine

I was asked this week to join a community of physician mothers, at mothers in medicine. I was so excited, it's hard to express. It happened Monday night.

Tuesday morning, I woke up to run. I accidentally got in the shower, I was so jazzed about my new community. I've never done this before. You might think that getting in the shower would be good for a run - a wet head might cool one down. But ironically, it became like a plaster glue cap, inhibiting freedom.

Anyway, my first charge was to write about A Day in the Life of a mother physician. I chose to go back in time, to residency. If you are interested, you can read it at my new second home.

Enjoy!

The Sleepover

Last Thursday afternoon Mike called me at work.

"Sicily's been invited to a sleepover."

I was mortified. "What? Who?"

"Her friend Emmarie. The one that came to the Halloween party." I had thrown a little Halloween party for Sicily - well, not me really. Sicily made the invitations and cajoled me into throwing the party for three of her friends. She picked the fabulous lantern art activity. She made the goody bags. I just chaperoned - cannot take a single bit of credit. One of the girls was a new friend from her school. I met the dad for the first time when he picked her up, and I hadn't yet met the mother.

I frantically asked Mike, "When is the sleepover? Does Sicily know about it?" I was thinking maybe we could just make an excuse to the parents and never tell her about the party.

He replied, "Yes, and she's really excited. It's Emmarie's seventh birthday party. There are four other girls going. It's tomorrow night."

My head went into a tailspin. I wasn't ready for Sicily to spend the night at someone's house, other than a family member. Sure, she had been begging for a long time, but I actively avoided the subject. And I thought her first one would be a friend that we had known for a long time, and we knew the parents, like Helen or Phoebe. Or Annika. People I was comfortable with, and trusted that they weren't murderers or child molesters. But at the same time, she is over six and a half. I had to let this happen at some point. But six and a half is still so young, I thought. I didn't remember doing this sleepover thing until I was at least eight or nine.

While I was taking her to her stroke technique class Thursday night, she was complaining about her day. I love telling people that I need to leave early so I can get Sicily to her stroke class. They look so puzzled, and I wonder what they are thinking. Is it a class where one learns how to gracefully survive a brain infarct? Or a lesson in the proper etiquette of soothing one's cat? Sometimes I jump in and just tell them she is learning swim strokes, and sometimes I make them suffer and ask.

I was tired of listening to Sicily complain. So I started whining. "Listen to my day. I had one of the biggest caseloads I've ever had. And I'm tired from traveling. I was working crazy hard and busy this afternoon, and Daddy called and told me you were invited to a sleepover. I was so upset and worried, and wanted to try to hide it from you. I don't know the parents, and I am not sure I want you to sleep in a house with people I don't know. I'm scared, Sicily."

She was clearly shocked. She doesn't hear me complain, often. "Mommy, why are you acting like a child? I'll be fine, I really want to go. I've been wanting to do this for a long time." I said, "OK, but I'm taking you over there. And I'm warning you. I'm going inside to meet the mom. If something seems off to me, or I don't like the look of the place, I'm leaving, and you're coming with me."

"Mom, what would have to happen for you to not let me stay?"

"Well, if there are children hanging from the kitchen ceiling bleeding, or screaming in the back room - not excited, party screams, but I'm being tortured screams, then you definitely cannot spend the night."

I looked in the rear view mirror to gauge her reaction. She was smiling and rolling her eyes. "Mom, you're crazy."

Friday night I raced home to get her - I had to drive her 45 minutes away to a gated community in Roland, AR. Mike and I had looked at a house there many years ago, so at least I knew the area. It was nice - large lots, giant houses. Not that this fact calmed me down - evil people transcend socioeconomic status. We had a long drive, so we discussed manners. I quickly glossed over the basics - "If you don't like something they are offering to eat, say no thank you. Use the word please if you need help." We did some role playing, and she gleefully mimicked her most horrible screams at foods she did not like as an example of what not to do. She was having fun. "What else, mom?"

"Well, the goal of spending the night out is to behave well so you will be asked back again, if you like it and are having fun."

"So what would I have to do that they wouldn't ask me back?"

"Well, I wouldn't blow your nose on their cat. They might not like a snotty cat."

"Mom! How do you know they even have a cat!"

"I don't, that's just an example. I also wouldn't poop on any one's head."

She cackled. "What if I pooped on their head, and then had diarrhea on it?"

"Then you definitely wouldn't be asked back. In fact, I might be required to take you to the doctor."

"Oh, mom. Would they give me a shot?"

"No, but he might make you talk to him or her. About why you pooped on some one's head. It's really not done, in polite society."

I checked the mirror. It was dark and rainy, and her eyes were glowing. She caught me watching her, and looked away and shrugged. She gave me my favorite response, to the information I dole out to her. She looked away, scrunched up her face, and said nonchalantly, "Hmm."

When we arrived there were lots of girls jumping around animatedly, and the mom was busy with make-your-own-pizza fixings and cupcakes, so I didn't keep her long. I just introduced myself and wrote down phone numbers. I could hardly get Sicily to say goodbye to me - she was having so much fun.

After a family dinner, Mike retired early in preparation for a big hunting weekend and I stayed up. I was watching Escape From Alcatraz, and it was so much fun to see a movie set in the place I had visited Monday night. I think Clint Eastwood was thrown into the same solitary cell that I had spent time in, on D Block. At about 11:15 p.m., my cell phone rang. It was Emmarie's mother. "Sorry to wake you - Sicily just wanted to talk to you." She passed the phone before I could reply.

"Mommy, I miss you! I love you! Can I talk to Daddy and John?"

"No Sicily, they are long in bed sleeping. You should try to go to sleep, it's really late. Do you need me to come get you?"

"No, I just wanted to tell you I missed you."

"I'll be there first thing in the morning, I promise."

"No, mom! Not first thing! I'm always the first to leave. Come a little late so I can play, OK?"

I smiled. "OK sweetie. Try to sleep. I love you. Goodnight."

Whew. We survived. I hung out with the mom then next morning, for a half hour or so, and she seemed nice. She was pleased with Sicily, telling me amusing stories from her observations, and I reciprocated by sharing some stories about her daughter when she was at the Halloween party. She assured me that she was the second to last, not the last kid to go to sleep. Oh the trials of motherhood. I don't know what I'm gonna do when Sicily goes off to college.

Truth is Stranger Than Fiction

I have been trying to resist posting this for over 24 hours, in the interest of, well, propriety, I guess. My partner Michelle walked in on me, bringing a consult, while I was reading it. A prostate consult, of all things. She was as shocked as me.

Sometimes you think you have heard it all. Then you are proved wrong.

Milk Massage.

Necrotizing fasciitis is a nasty thing. We see it occasionally, under the scope. I've never heard of anyone losing their testicles to it.

Alcatraz

Not a long postponement. But I can't sleep. So here's to San Fran. But first, Vegas. I went to Vegas for the first time on the way to San Francisco, and learned that you don't have to go far, even leave the airport, to experience the mood. These were everywhere. I didn't engage, but had fun watching others pour their money down the drain.

Here's Madeleine. Her mom and dad, the infamous pathology duo who are taking the academic scene by storm at Stanford, picked me up from the airport, with their three kids. We went to dinner at a fabulous Mexican organic (every thing's organic in California) kitchen. I tasted Amy's tamale and quesadilla, and Jesse's carnitas. Somehow, I couldn't get anyone to taste my squid and rock cod ceviche. Don't know why - it was fabulous. Maddie, their eldest, turned her nose up at my meal, but here she is enjoying her chocolate and cinnamon Popsicle.

They dropped me off downtown at The Palace Hotel, an elegant Grand Dame of a hotel. No coffee machine in the room, though. My view, each morning, on the way to the workout room, was of a grand hallway with regal carpets and endless closed wooden doors. Kinda spooky. Redrum. The rooms were nice.

I mostly hung out with this one guy - he was amazing. I couldn't tell you the name of a single pathologist at the conference - there were around a hundred, but I didn't meet a one. Me and this guy, though, we hung out at breakfast, lunch, and dinner. He is a great storyteller, and well traveled. A bit of a drama queen, with a flair for a punchy ending. He likes the word interminable, and used it so much, I began to look for it in every story. Luckily for my husband, he is dead. W. Somerset Maugham. I bought his short story collection a while ago, on a recommendation from a novelist I admired but now can't remember. I powered through 800 plus pages in the course of the trip. It is fun going to fancy restaurants solo, armed with a burgundy hardcover book. It's like a flag, "I am dining alone." We enjoyed sashimi tuna, foie gras, panna cotta, etc.

At breakfast each morning before the conference, there was a veritable feast. Pastries and bagels with so many accouterments, I took to putting a little of each on my plate, to taste. My favorite was a cream cheese laced with blobs of pink jelly, that I first thought was grapefruit. A quick sample proved me wrong. Smoked salmon. Wow. Good thing I was running each morning.

The lecturers were really good - if you are into pathology. One guy, a Northerner with silver hair, liked to tell jokes. I was impressed with his fancy suit and his seemingly winning battle with middle-aged paunch. He was pretty smart about hemepath, too. He prefaced each joke with the statement, "My wife OK'd this one. I think you'll like it. It should go over better than the last." I had sympathy for him - he was entertaining a roomful of solemn scientists, many of whom were from another country. I wondered if they could appreciate the humor. Here's an example:

A woman walked into a drugstore and went up to the pharmacist's counter. She said, "I want some cyanide, please." The pharmacist was taken aback. He replied incredulously, "Miss, that is an illegal substance! I can't give you cyanide." She rummaged around in her purse for a minute, and pulled out a photograph. She presented it to him. It was a picture of her husband in bed with his wife. He looked at it for a long time, and stared her straight in the eye. "Miss, you didn't tell me you had a prescription."

On Monday night I went to the night tour of Alcatraz. It was everything I hoped it would be, and more. I was a little anxious about traveling in a big city by myself, but the concierge and the cabbie assured me that I would easily find a cab when the tour ended. I found myself irrationally sizing up people to hang with, in case something happened. Unfortunately, most of them spoke a foreign, Western European language, quickly ending my imagined intimacy. The only couple that spoke English included a Jewish Princess from the Bronx who sang the entire theme song to Gilligan's Island, loudly, in Uggs and a pink and white striped scarf, while we were boarding the ferry. No disrespect meant, but not someone I wanted to become acquainted with, despite the fact that I was impressed with her memory of all the refrains.

Here's a picture of the dilapidated industry buildings, before night fell.

Here's a picture of a cell, waiting for an inmate.

I was a little embarrassed that everyone but me had seen Clint Eastwood's Escape From Alcatraz, and The Birdman of Alcatraz, and The Rock, but they are all in my Netflix queue now, I promise. I saw the library, which was sad and dreary. And I spent some time in solitary confinement on D Block. Here is the door.

I only spent about a minute in there, but that was enough. I can't imagine the thirty days that all prisoners spent there, when they first arrived to the prison. Reform had a different definition, back then. There was one solitary block, unlike the others, with no sink or toilet. Just a hole in the floor. That was the place where you went when you were really bad. Completely naked. For days on end. Without light. Unthinkable.

On the way out, I got waylaid by a placard announcement of the prison morgue. It was sealed off in plexiglass, so I had trouble taking a picture with my flash camera. But the iphone did a pretty good job. It was built into the side of the hill, back before Alcatraz was a prison for bad prisoners - when it was just a federal prison. Here it is:

I thought my training hospital had rough morgue conditions! I hope you can see that, with the dark blog background. I love this photo. Especially since I got yelled at by the guards on the island while I was trying to take it. "Keep moving! Down to the boat!"

The concierge and the cabbie I had consulted were wrong about the taxi back to the hotel - it was rough getting one and I got scared. But I hijacked a hotel shuttle full of Dutchmen and talked the Chinese driver into taking me back to my hotel.

Wicked is an incredible musical. I can't wait to find a venue to take Sicily. It has everything you would hope to find in a fun package - political subterfuge, love, female friendship bonds, trusting your own instincts, and being alienated for your appearance. All important messages.

The last lecture I almost skipped, but I'm glad I attended. The speaker talked of brown stains, immunos, quite hilariously. Antibodies weren't just non-specific, they were promiscuous. Infidels. This unassuming elderly gentleman was randy. He was totally jazzed about the role of p16 in basal cell carcinomas of the head and neck. A large slide read: Genital-Oral and Genital-Anal transmission. Better Prognosis. He promised us all we would be reflexing our cases to molecular analysis in the next five years. "This is where we are headed."

I surfed around today, on the internet, looking for a conference for next year. I am excited already. It's a little early, but I found a possible candidate in Hawaii.

Postponement

I'm dying to blog about Alcatraz and San Francisco, but I'm so exhausted from traveling all day yesterday, and being up all night with a puking son, and having a whopping record number of blocks today that I still haven't finished, that it's not going to happen tonight. Instead, I just want to quickly refer a blog by a primary care pathologist (like me!) who is new to the blogging scene, and quite excellent. Gregory Henderson wrote a great blog about the landmark federal task force decision, one I read about in the restaurant at the Palace Hotel. While I was reading my eyes got as big as saucers and I almost fell out of my chair. You know the one - the new controversial mammogram guidelines. His blog, posted today, is titled "Hell Hath No Fury like 287 Breast Cancer Patients Scorned." I wonder what the numbers are in my own practice. It's as entertaining as Gail Collins' NY Times editorial, The Breast Brouhaha.

Important breast reading, for now. Alcatraz later.

My Estrogen Lifeboat

This is a picture of my partner Michelle at her wedding last summer. She is amazingly beautiful, isn't she? Her husband's quite a looker too, and he has a wonderful singing voice that brings down a house every Sunday. I've been invited, and am plotting a time to take Sicily.

She's my estrogen lifeboat - that's how I think of her when we bump into each other in the doctor's lounge once in a blue moon. She's usually picking out the best looking apple while I'm over in the corner drudging oil from the coffee machine, contemplating whether or not I could just hook up an IV bag to get my much needed caffeine in quicker. That's why she looks like that, and I look like me.

She is probably one of the people I laugh with the most on this planet. I grabbed this photo from the publication Weddings In Arkansas a while ago - I think of blogs all the time about her, but they pile up so much in my head that I get overwhelmed and blocked. When I read her piece in the magazine, I thought it was funny and mentioned it to her.

"Michelle, this looks great, but it's kind of odd, don't you think?"

"What do you mean?"

"Well, y'all are the only black couple featured. You're sandwiched in by all of these boring, traditional white yuppie couples."

She laughed. I love her laugh. "I am so glad you are comfortable enough to say that to me, and not worry that I would take it wrong."

One day she brought me a case, for consultation.

"I need to send this to Dr. Styles, but I'm embarrassed to. Could you just look at it? It's a rectal polyp. I know it is benign, and I should be able to put a name to it, but I just can't." She walked out of my office.

I put the slide under my scope and looked. My mind was blown away. Rectal polyp? What the heck was this? Yes, it did look benign, but those glands are so fluffy! And the stroma is so jazzy! I got more bogged down and started to pull out a book, but Michelle reappeared at my door.

"Um, never mind about the consult. Can I have that slide back?"

I looked up, confused. "Are you sure? I still haven't figured it out."

"It's OK, please, just give it back to me. Don't worry about it."

As she started walking down the hall, my mind snapped into place and it all made sense. The requisitions must have been mixed up. It happens all the time. Paperwork gets shuffled into the wrong order in histology, and we get confused. I yelled down the hall, "Michelle!"

"Yeah?"

"Was that endometrium?"

We laughed so hard we cried.

On another day, I brought her a case. It was a breast. I told her, "I know this is benign, but I can't put a name to it. It doesn't quite look like a fibroadenoma (common benign female breast tumor), but it's not one of those other weird ones either. I'm going to lunch. Help."

When I came back, the case was on my desk, and she had circled the gender. Male. DUH! Of course. It was just gynecomastia. We so rarely get male breasts, compared to female, that I had forgotten to look and assumed the wrong gender, wreaking havoc with the diagnostic reference atlas in my brain. I sheepishly went to her office to thank her, and she waved me off and laughed. "Not something I haven't done before!"

Anyway, I was thinking about her, because she came back from D.C. today, and came into my office. She complimented me, on my outfit, and I became horribly flustered. Physiologically unglued. The compliment was sweet and friendly and heartfelt. I called myself out, because I didn't want her to leave, I wanted to catch up. "I'm flustered. I'm not sure why. Stay here. It will go away in a minute." She said, "I hope you don't think I'm a lesbian. Not that there's anything wrong with that, but I'm as straight as 6:00." I laughed, "No no, of course not, it's just me. I have a problem with compliments. Especially when they catch me unawares."

"Oh yeah, I remember that time I whistled about your legs in front of the office staff and you got so embarrassed."

"Yeah, and the time Brian complimented me on my article in front of everyone and I had to run into my office and close the door for a while. I don't know why I do that. But trust me. It's me. I'm weird. Not you. Promise me you will only ever say bad things about me. If you have something good to say, do it over the phone. I promise I won't think you're a lesbian. I'm not either. Not that there's anything wrong with that." So funny, the how we always couch our words to be politically correct. One of us would probably have to be a lesbian, in order for us to feel comfortable enough not to say that.

Now that I've introduced her, I can start slowly leaking out stories. Some of them are really funny.

Park The Van

This is an amazing record label. I am so impressed with everything I am hearing from them. The Peekers, Dr. Dog, Floating Action, etc. I got a mix recently, and have been enjoying it with the kids on the way to school.

http://www.parkthevan.com/home.php

My favorite song this week is by the Generationals. I tried to find the lyrics or the youtube video to embed, but no dice. So I will try to recite the chorus from memory. Don't quote me.

Everybody's making faces in the dark

Don't stop struggling that's what sets you apart

It's the ghost of inhibition that keeps breaking your heart

Everybody's making faces in the dark.

It's pop, it's fun. They have other great songs on their debut album, Con Law, like Angry Charlie, When They Fight, They Fight, and Nobody Can Change Your Mind. But this is the one me and the kids are addicted to, this week anyway.

Girl's Weekend

I hadn't been on one in a couple of years. My best friend from med school, Alyssa the ophthalmologist, and I hit the town of Hot Springs on Friday and didn't leave until Sunday morning. We were pretty exhausted from being up with sick kids all week, so we ate dinner and retired to the room early Friday night, using up all the juice on my computer showing off kid pics, songs, and favorite YouTube videos.

After a full day of shopping and massages on Saturday, we went back to the hotel room to rest and get some coffee before hitting the lobby for drinks, after being rendered somnolent by a mud and steam massage. Unexpectedly, we received a cup of mud tea to drink afterwards, touted as an "internal cleansing, like the Native Americans used to do." Being pretty relaxed, I agreed and as I tossed the cup back there was a startling amount of silt at the bottom. I worried about receiving a diagnosis of pica.

Unfortunately, the mud was not agreeing with Alyssa. I figured out the single cup coffee machine, and brewed the two cups successfully. Alyssa was pacing uncomfortably and trying to decide whether or not to lay down for a few minutes. In the meantime, I added sweetener to my cup and was in the process of adding half and half. As I stirred, large white curds rose to the top of the liquid. This did not agree with Alyssa's already upset stomach.

"Oh my god. That is disgusting. I am going to go lay down now."

I stirred, still perplexed. I had not seen chunks come out of the half and half. Maybe if I stirred a little more it would go away. I smelled the coffee, then the residual half and half. No sour milk smell. I asked Alyssa, "Are you sure it was the half and half?" I was reluctant to pour my one cup of coffee down the sink. I was also finding it rather amusing that Alyssa, who operates on eyeballs, was about to hurl over a little sour milk. I guess the mud tea was to blame.

I studied the half and half, and looked at the other three containers. "Alyssa, is there even an expiration date on these things? Can they go bad? I can't find one."

Alyssa moaned from the bedroom. "Trust me. It's bad. Just take my coffee. I don't think I can drink it anymore. Pour yours out."

I was feeling bad for her, but excited to get her coffee. I poured mine down the sink, and was determined not to make the same error with this last cup. I poured in the sweetener first and stirred. No chunks. Then I decided to test the last three containers of half and half individually, in the sink. I wasn't convinced of my ability to discover a half and half that wouldn't curd up in my coffee, since I was unable to detect anything wrong with the first one. So I poured each out slowly into the sink, sniffing and testing. Finally, I got brave on the last one, and dumped it in. "Hooray!" I announced to the green Alyssa. "No chunks!"

Alyssa rallied, and we had a fabulous dinner Saturday night at a new fusion restaurant in town.

After we ordered, she said, "I am so laughing about what a dork you are. Not that I am any better."

"What do you mean? Me dorky?"

"I am referring to your store purchases."

Earlier in the day while shopping, we were wandering around an upscale rock shop, with eclectic jewelry and rocks. Alyssa was trying on necklaces, and I was picking out gifts for the kids - soapstone dinosaur for John, and a beautiful piece of lab grown bismuth for Sicily. The bismuth looked like a miniature M.C. Escher bizarre stair step, metallic and shimmering with pastel rainbow colors. I looked at all the jewelry in the store and decided there was nothing there for me. Then I noticed a back room. It was amazing - full of fossils, teeth, all kinds of unusual museum relics. I immediately fell in love with the Crinoid fossils. I jumped back and forth, trying to decide which one to get. I grabbed Alyssa.

"See, this one looks like Aspergillus Niger! With the medusa head! It's amazing! But the colors on this other one look much better, even though I don't like the morphology of this animal quite so much." Crinoids have been around since the Paleozoic Era, and these fossils were from Morocco. They are also known as sea lilies or feather stars. Upon googling Crinoids, I learned that their mouth was located directly adjacent to their anus. Ha! A new secret name for those I consider to be talking shit. But that might be an insult to the Crinoid - it is such a beautiful marine creature.

I agreed with Alyssa. I was not very cool. But it is so much cooler to be a nerd in your thirties than in your teens. Suddenly, you just quit caring what anyone else thinks, anymore.

Alyssa texted her husband in the middle of dinner, who was busy working a night shift in the ICU. "We are going to bars to pick up twenty-five year old guys." Alyssa could do it. She looks about eighteen, and upon reluctantly admitting that she is a doctor to anyone who inquires she often gets incredulous looks and exclamations. By the end of dinner, we were glowing from our shared bottle of wine, and I was beginning to distrust our already challenged iphone navigational skills to get us bar-hopping in Hot Springs. Plus, I didn't want to drive on much more than I had in my system. I said, "Why don't we just go back to the hotel bar and pick up some forty-five year olds?" She agreed, and we headed back to have another glass of wine. In the meantime, we did manage to bump into a group of youngsters who were trying to entice us to go out with them. They were stylish and infectious, but we had to go home in the morning.

I looked at Alyssa, "Wanna go out? It's up to you. My computer is dead, and I forgot the charger. No more YouTubing Les Mis show tunes in French."

She looked at me and smiled. "We can always use our iphones for that."

Now who's the dork? Well, me again, for not thinking of that. We headed back to the room, full of mud and wine and yummy food. A great girl's weekend. By the way, that's my fossil in the picture. My Crinoid. It's in my office. I own it. Aren't you jealous?

Class Act

Today, I was the member of a five-person team in a sailboat race on Lake Maumelle. I showed up early, having missed the "meet the crew" dinner the night before because Mike was on call and I was with the kids. It was chilly, and I was glad they were handing out gloves to the participants, but the last day in October promised to be one of the few wonderful ones. The sun was shining, finally.

Myself, my Uncle Chuck, and my Conway partner Amy were the three completely inexperienced participants benefiting from a donation made by my group to join two seasoned boaters in a morning and afternoon race. Our skipper, John Class, was originally from Holland, and had begun his boating experience in the 40's as a member of the Sea Scouts, an aquatic equivalent of our Boy Scouts in America. He participated in the Olympics in the 80's; missed out when we boycotted Moscow, but was sailing in California and Canada. He was clearly an esteemed member of the club, and assured Amy at the Friday dinner that he usually won the races. I found it difficult, upon meeting him, to imagine this boast: he was a man of few words, unless he was instructing us. He had a heavy Dutch accent, and his widely spaced teeth and sun-weathered, distinguished face gave the assurance of safety. We were in good hands.

When I agreed, three weeks earlier, to participate in the races, I imagined myself sitting on a sailboat in glorious weather like today, gazing at the water and trees, in a relaxed state of semi-participation, occasionally lending a hand and learning a little terminology. So I was just as surprised as my uncle and Amy, that it was constant work. And we were expected to be fully engaged. Not a bad thing - wonderful and rewarding, but shocking nonetheless.

There are numerous ropes, pulleys, and wenches on a sailboat, each with about six synonymous names, requiring repetitive releasing, pulling, and clenching, in order to race the boat. There are three sails: The main, the jib, and the spinnaker; the last needs hoisting and taking down. I used all my strength, pressed against the side of the boat, to pull ropes. But the funniest aspect of the whole experience, was the fact that Chuck, Amy and I knew nothing of boat anatomy. Whenever the skipper's language failed to generate action our part, he was frustratingly reduced to simple terms. "That black round thing! Over there! Now! Grab that rope! The one with the tiny green dots! No! Not the blue one! Hurry! Pull as hard as you can!"

The two races were each over an hour, briefly interrupted by a catered lunch. We thought, after the first race, we had the important parts down - the tucking and jibing (sp?), raising and lowering the spinnaker. But we were wrong. Problems arose on the second race - our spinnaker was stuck because we failed to release it from the front of the boat - we tried to release it from below the deck, and it got hung up on another sail. When we tried to pull the spinnaker in, it fell into the water, and we had to drag it out. Our speed suffered. We learned that the term for this was "shrimping." Not a complimentary term.

While all of this was happening, I imagined pulling our captain and his mate into the autopsy suite. With no knowledge of human anatomy, they would flounder. I would try to instruct them: "Now! Follow the stomach along the greater curvature down to the pyloric valve. The muscle is thicker there, you will need strong scissors!" As they cluelessly picked up the gallbladder, I might yell, "No! not the green bag, the beige one! The bigger sack! The one that looks like a leather water bottle! No! Don't cut that! Not yet! We haven't run the bowel yet! That will make a tremendous mess!" Or better yet - get them behind a microscope. "Now! Count the mitoses! That will determine how aggressive the cancer is. Count! We have to grade this cancer! NO! That is not a mitosis, that's an apoptotic cell! Here, it looks like this!"

That is what it was like - being thrust into a new situation with no prior knowledge on which to operate, and having to act quickly. But it was fun. And it was a glorious day. I learned how to watch the horizon, and steer the ship. I learned how to watch the water, to look at the color, in order to see an approaching wind. The water is darker, under a wind, and you can see it moving toward you and predict the precise moment it will fill your sails and affect your course. I learned to avoid the swing of the main sail when tucking, and how to wrap the ropes around a wench, clockwise. I am sure I am screwing up all this terminology, but having the experience inspired me to research it. Someday. After I get over the soreness and bumps and bruises, from the boat. Anyone who thinks sailing is a lazy sport, needs to go out and try it.

The Dancing Gorilla

I walked into Jack's classroom this morning, to help out at his Halloween party. Playing pass the Hot Pumpkin, freeze dance, helping with juice boxes and cupcakes - it was pure Dr. mom bliss. A nice ending to a week of volunteering at fall carnivals at the school and playing stay-at-home mom.

I showed up a half hour early - one of the teachers told me the time was nine-thirty instead of ten. I got to listen to another dad, a former UCA football player, regale the room with stories of his physical injuries retained during college. He listed them proudly: torn ligaments, broken ankles, broken ribs. At the end of his story, he was asked to read a book to the kids, and I was impressed at how he captured their attention and involved them in the book. I wouldn't have guessed that this overweight, bearded father, reliving his glory days with a classroom of four-year-olds, would be able to shift focus from his own accomplishments, but he did. Most of the children sat silently, enraptured, while I chatted with the teachers. Except for mine.

The teachers laughed while we were observing them. My son and the other Jack were silent, but their constantly shifting bodies, crawling around the legs of the chairs and the table-tops, were a sight to behold. The silently migrated towards the story-teller, occasionally interrupted by the teacher. "Jack. Back in your chair. Try to sit still."

"Is he like this at home?" They asked me. I replied, "Yes, it is tough to keep him in his seat at the dinner table. He seems to have an innate drive to climb on the counter tops, often resulting in mishaps. I thought all four-year-olds were like this, but now that you mention it, Sicily wasn't. His body is in constant motion. I chalked it up to a boy thing."

"Well, there are only two, in this class of twelve. Ironically, they are both named Jack. We are usually happy with their constant motion, as long as they are working, but we try to reign them in every once in a while. We tried to call them Jack S. and Jack H., but after saying Jack S. over and over, trying to keep him still, it started to sound, well, inappropriate."

I said Jack S. to myself, over and over in my head, and understood. I laughed out loud.

"So now we say Schneider and Halloway. It works better."

I marveled that I had been in the room for twenty minutes and was able to observe Jack, without being noticed. He had looked in my direction many times, but did not really see me. It reminded me of an unknown session at a pathology conference in Vancouver, a few years ago. The academic was showing unknown slides to a large audience, and occasionally flashed a dancing gorilla on the screen. The audience was so caught up in trying to figure out the answer, that when he asked, thirty minutes into the session, how many people had observed the dancing gorilla, only a small fraction of the audience raised their hands.

How could you miss a dancing gorilla?

It just goes to show, that even as an adult, you observe what you expect to see. When a room full of pathologists are concentrating on a projected view of an unknown slide, they are working so hard to find the answer, that important observations go unnoticed. And when your mother, who is not a normal presence in your school classroom, shows up to help, you can miss her, entirely, in the context of the situation.

He finally noticed. After I finished my duties, we danced. Then he asked me to take him with me on errands. I obliged, and we mailed the Halloween cards Sicily had made the night before to Uncle Mike and Aunt Effie. The we dropped of my favorite new children's book on the planet, Neil Gaiman's Blueberry Girl (warning: it will make you cry in the middle of Barnes & Noble), on a friend who just had a baby girl's front porch. She didn't even know I was dropping it off; we haven't really kept up. But we were friends in medical school, and I still have the pillow she embroidered for my daughter when I was pregnant. I hope she doesn't miss it - the book on the front porch. I hope I don't ever miss it. The dancing gorilla.

Thursday, 7:45 a.m., Conway Doctor's Lounge

I walked in with my coffee cup, behind an elderly gentleman in a white coat. The Conway doctor's lounge is less industrial than the one at the big hospital in Little Rock: cushioned chairs, flat-screen television, and did I mention the food? Cabinets, fully stocked refrigerator, counter tops overflowing. There is a cozy computer nook. A mustached, middle-aged man was sitting at a round table, eating a sausage biscuit. He remarked, "This guy is selling books. He's gonna sell a lot of books."

I assumed that his comments were directed towards the older man, since I knew neither of them. But the older gentleman marched resolutely into the men's room, seemingly oblivious to his remark. I walked over to the coffeepot, finding it difficult to resist societal decorum. I stared at the television. There was a post-college aged man, with blandly conventional good looks, discussing economics on the television. A broad band at the bottom of the screen advertised the title of his book, and a phone number. Curiously, at one corner, cursive script spelled the names "Denise" and "Sara." I decided reluctantly to engage. "Why do you think that guy is going to sell books?"

"Just wait. Wait a second and watch. You're gonna see in just a second."

As I poured my coffee, hoping I remembered correctly that the brown pot held caffeine, the camera shifted to two young blonds in skimpy outfits, large breasts spilling out of fluorescent yellow and blue spaghetti strap tops, solving the mystery of the cursive script on the screen. They stared open-mouthed at the aged frat-boy - seeming to yearn for knowledge. The doctor continued, "And these women are so stupid! He just explained to them that the government was giving away money for cars. And they didn't know! That was over a couple of months ago."

I silently questioned the women's stupidity. This was television. Probably scripted. Just because they were blond and big-breasted didn't mean they were stupid, and didn't know about Cash for Clunkers. They didn't seem any less intelligent than the guy peddling his wares. But who knows.

The doctor introduced himself. "I'm Kent Riley. Are you one of the new radiologists?" I told him I recognized his name from some of the surgical reports, and remembered talking to him on the phone. I explained that I was a pathologist rotating in Conway three or four days a month. I smiled and shook his hand, stating my name.

He said, "Can you believe this marketing? What they are doing these days? I just got out of a six thirty meeting. Do you know that these guys are grading us? The insurance companies, I mean. They are grading us. Unbelievable."

I was confused. "Do you mean grading as in our performance?"

"No! They look at Web M.D., and look at what people are searching. What the patients are curious about. And they grade us, according to how much money they can make from us. By looking at our specialty. Outrageous!"

I looked at the buxom blonds on the screen, and thought that plastic surgeons are probably graded pretty high. But I didn't bring this up. This was a professional atmosphere. I had just met this man. And we had already alluded to breasts, once. That was enough.

Instead I said, "Well, did you read that expose in the New York Times a couple of years ago? The one that talked about how drug companies were whisking off family doctors to large conferences, all expenses paid, and marketing anti-psychotics to women with depression? They showed videos of typically depressed women making typically depressed statements, and then resolution upon taking the drug. So millions of women were taking anti-psychotics, because they were complaining to their family doctors about feeling sad, lonely, and frustrated with life."

I remember reading that article, and thinking about my clients I worked with in college, at the home for schizophrenia. Many of whom suffered from extra-pyramidal symptoms, from first-generation antipsychotics. Restlessness. Resting hand tremors. Involuntary muscle spasms of the tongue, eyes, and mouth. I imagined a large body of small-town women, drooling and twitching uncontrollably while trying to make their kid's breakfast. A league of soccer-mom zombies. I realize that the second-generation antipsychotics have less side effects, and a couple of years ago, this is probably what was being pushed. But does this make the deception any less devious? Troubling? Downright wrong? I imagined the fat cats making the money, spending it gleefully and remorselessly. Drug companies, insurance companies, it's all the same.

So I told Dr. Riley, "I am no longer surprised, by what anyone will do for money." He stared at me, without comment.

I started for the door. He said, "Hey, it was nice to meet you."

I smiled. "You, too. See you around." It's always nice to put a face to a name.

Wedding Reception Recollections

Discussing the creepiness of a large baby doll, with a full head of golden curls, in an ancient pram, with John and his friend Annika. "Mommy, who is she? She's kinda scary." We were waiting for the cake to be cut.

Discussing molecular genetics with a plant geneticist, a researcher with a large crop of peaches and grapes. He failed to remember the tour he gave me seven years ago, when I flew with Mike, his dad, and a family friend to visit the experimental research station in small-town Arkansas.

Discussing philosophy and China with a student of my stepmother-in-law's (anthropology and education) and her boyfriend, who is pursuing his Ph.D. in philosophy. I had some intelligent things to say on the subject, thanks to my good friend Christie, whose husband is a philosopher. They recently spent a few months in China.

Learning of yet another witticism of my daughter, from an observation of a good friend, while unintentionally blocking the chocolate-covered strawberries, looming under a beautiful indoor gas-lamp, in the historic Arkansas home in downtown Little Rock. Why wasn't there any soot on the ceiling, I wondered? And when do you, as a parent, cease to take any responsibility of the keen observations of your offspring? From day one, I think. Sicily is in a league of her own.

Cutting a rug. Literally. I have not enjoyed myself on the dance floor so much since a family cruise to Jamaica at the end of medical school. One of the groomsmen, whose dance moves I couldn't help but admire, pulled me aside. "Your daughter is the best dancer here. Where did she learn it from?" I replied, "Well, we sing show tunes at breakfast, and play scenes from our favorite movies over and over, dancing and singing in the evenings, but I can't take credit for that." Eventually, she pulled me into it. After about an hour and a half, I overheard her saying, "Daddy! Where's my daddy? I really need a drink!" She was fortified with Sprite, and continued until the end of the night. Slept until after nine the next day. John went home early to bed with our nanny, but I hadn't the heart to pull Sicily out of her element. She was a sight to behold; I lamented later that she had me so caught up in her ecstasy that I failed to pull out the video camera. I'm hoping the photographer got some good pics.

The wedding was fabulous. I hope Annie and Dave are having a wonderful time in Napa. The kids were just squirrely enough, in their duties as ring bearer and flower girl, to be cute without ruining the wedding. John kept trying to engage me, and I deflected it to my nanny in the audience; after all, I was in charge of the bride's bouquet and the bridal train. I was trying to pay attention to the ceremony. John was disturbed that the fake ring tied to the pillow Annie had made had come free from its string tether. Josephina helped him put it back on, which he proudly announced to me in a loud whisper, during the ceremony. Later, my mother observed that his smile, during the ceremony, was diabolical. He was trying to orchestrate chaos, sweetly. This does not portend well for the future.