Spotty Dangerous

We would like to welcome the newest member of our family.

It all started in the middle of last week, when Sicily and John caught a lizard in the backyard. They convinced Ike to get a cage and some food.

Sicily informed me, "It's a boy, mom. We named him Zap."

"How do you know it's a boy?"

"He is black with blue and red stripes on his back. You know, like racing stripes. That's why I decided to call him Zap."

So Sicily made a sign for his cage, with ball-point pen on white construction paper, in all capital letters: ZAPE."

The next morning, while I was cooking breakfast, the kids sounded an alarm.

"Mom! Zap's missing! We can't find him anywhere! Come quickly!"

"Well, I guess that means he is running around the house somewhere. Let me finish the eggs before they burn, then I'll come look."

I peered into the cage. It was located on the hall counter, in between the kid's bedrooms, which was the result of a late night compromise stemming from an argument over whose room Zap would sleep in.

"Sicily, did you put this conch shell in his cage?"

"Yeah, last night. For decoration."

"I'll bet he's curled up in there somewhere, terrified. We'll find him tonight. Let's get ready for school."

Sure enough, he emerged that evening, and all was well. Until his tail fell off.

"Mom! John must have been playing with Zap without asking! He pulled the tail off!"

John emphatically denied any involvement in the tail incident, and I told Sicily it was probably a sign of stress. Twenty-four hours later Zap had still not touched either of the crickets jumping around his cage, and he appeared listless. A family decision was made to release Zap back into the wild, much to the kid's chagrin. But the reptile seed had been planted, and the kids were relentless in their requests for a pet store replacement. On Saturday morning before HarvestFest, Ike took them to the pet store after getting his iphone replaced, which had been submerged in a river somewhere on Friday.

They came home with a baby fancy corn snake, a new cage, and frozen mouse embryos. Both John and Sicily were over the moon.

I asked them, "What is his name?"

John answered first, in a serious and hushed tone, "I call him Dangerous."

Sicily replied loudly, "No fair! I get to name him! I want to call him Spotty, because he has all those spots!"

"Well, why don't we use both names? We'll call him Dangerous Spotty. Or better yet, Spotty Dangerous."

Sunday we had a successful feeding, and Spotty D was happy winding his way around Sicily's fingers after dinner tonight. Both kids are enamored. Or deprived, depending on how you look at it. But we're not quite ready for a dog, yet. Maybe in a few months.

Son Volt - Roll On

Post-Call Thursday

Yes, I was done with call on Monday. But every once in a while, Saturday is so bad, the aftereffects last well into the week.

Last Friday, I began to worry when the transcriptionists, flow techs, and histotechs; all the lab personnel that were receiving the specimens and preparing them for me to look at on Saturday, started saying things like:

"You had better eat your Wheaties tomorrow morning!"

"I hope you have some Valium to take tonight at bedtime!"

I didn't do either, but I did get up and run Saturday morning, in mental preparation for the onslaught. And I haven't run since, an unprecedented length of non-exercise for me in the past three years, cause I have been plain wore out. Putting together bone marrow and lymph node cases is the pinnacle of specimen puzzles - it takes clinical history, radiology, immunophenotyping, flow cytometry phenotyping, and often molecular genetics (FISH, PCR, conventional cytogenetics) in order to pull it all together. And I wasn't really trained in this area, unless you count the 30 myeloma bone marrows I counted plasma cell percentages for one disease, multiple myeloma, during my three months of hematology. One of those months I was extremely pregnant, and I remember the then dictator-like ruler, who suffered from bouts of mania, threatened to install a port-a potty in the heme sign out room so he could keep tabs on the residents at all times. He was serious. I think he actually looked into renting one.

Luckily, I have only had three Saturdays with this degree of work since I have been here. And I get nine a year. So that's only about 16%, according to the calculator I use to figure cell count percentages in the blood and bone marrow.

I did come up to work after the kids went to bed Sunday night, and again on Tuesday, to finish up some cases without daily distractions from the phone, new cases, frozen sections, etc. It is usually dead quiet in the lab at night, so much so that it reminds me of being in med school, studying in the basement of ED II all alone in a classroom in the middle of the night, when I would drive myself to paranoia thinking about stories of lost hoodlums finding their way from the ER to education buildings to commit crimes out of boredom. I think I was just distracting myself from the task at hand, studying, with the entertainment of fear.

Strangely, it was not so quiet on Sunday night. Babies crying, people talking - I finally got up to take a break and pay a bill in the main lobby of the hospital and passed through the lab-draw waiting area, right down from my office, which usually holds five to six adults at the most, during the day, and is never occupied at night. I was shocked to see all of the chairs full, 20 or 30 people at least, at 10 o'clock at night, slumped on the brown pleather couches staring at CNN, two thirds of whom were wearing surgical masks. I reflexively held my breath, like when I pass by a graveyard (to prevent evil souls from trying to inhabit my body - some leftover childhood ghost story) or through an underground tunnel. I wondered if I had been so occupied with my call that I had missed the newest pandemic, and vowed to check the news when I got back to my office. As I was returning, I still held my breath but slowed down a little to take in the listless faces, all of whom stared quietly, mouthless.

The next day in micro q/a after we had covered molecular and the latest on the H1N1, I asked, "What is going on in the lab waiting area at night?"

The emergency room is being renovated, and it is now a fast-track ER waiting room, holding patients triaged for less emergent needs. Makes sense. I guess the face precautions for fever/cough are either still in place from the spring, or were never removed.

So when I was up again late on Tuesday night, I paid better attention and watched a nurse stick out her neck from a door I was certain, previously, served no purpose in the last two years, and yell, "NEXT!" Better yet, I can now hear all of this from my office. No more nighttime quiet. There were a lot more screaming babies on Tuesday, and those seeking more privacy to work out their personal problems tend to gravitate down the hall, right outside my office. For example,

"Did you see who threw that brick through the window last night? Almost hit the television! I thought --- was back in prison! Now who in the hell are we going to get to take --- to school tomorrow? I'm going to have to deal with all of this for the next few days."

OK, so I am omitting many expletives. I also heard a melodramatic, Jerry Springer show-like relationship fight. I no longer need my own imagination to entertain myself here at night. Hopefully I won't have to be up here again late for another few months.

I finally got the last problem case shipped off to Boston yesterday - the only one I couldn't finish without outside consultation. I was happy to climb into bed at 8:30 last night and read a novel until after 11:00 - brain candy, I can't remember the author, but of the British loser girl turns successful Cinderella variety. I'm glad that call is over, and I can't wait for the weekend. But a little part of me is missing the high from all the work. It felt good to tackle all those challenging cases - for both the learning curve and confidence level. God knows I need all the help I can get in the latter arena.

Urethral Spelunking

While I try not to obsess about my readership (or lack thereof), I enjoy going to Google Analytics every once in a while. My favorite info is the section where it tells you what people googled to get to your blog. Remember? How to clean semen out of your hot tub?

The other day, I found out someone googled *Urethral Spelunking* and ended up on an entry where I apparently discussed the urethra and spelunking all in one post. But urethral spelunking?

I immediately thought of an Amazonian fish I learned about a couple of months ago when I read The Lost City of Z. It is called the candiru, and it is a urinophilic fish. Very few human attacks are documented, but there are many "urban" legends (ha ha we are obviously in the Amazonian jungle) about how this fish will swim out of the water toward a human stream of urine and lodge itself into the urethra, causing incredible pain, and sometimes necessitating amputation of certain body parts for relief. Luckily, (or not, really) it is easy for a male to find relief upon amputation - stories of female attacks are rarer and more problematic, I learned, from my limited research.

But aside from the candiru, I can't think of another reason to google Urethral Spelunking. I guess there are certain bacteria and viruses that might imagine the urethra to be a cave-like haven, but are they really googling? I don't think so.

Foley catheters are inserted into the urethra during surgery, paralysis, etc. to relieve the bladder, but it is a bit of a stretch to imagine that the catheter is spelunking. Maybe performing a cystoscopy exam to look at the bladder is a little like spelunking - I imagine, although I have never seen one, that the urologist must have a light at the end of the tube to look at the bladder mucosa and take pictures to put in the medical record and share with the pathologist who will be looking at the biopsy. When we get the bladder as a surgical specimen we insert formalin and blow up the bladder like a water balloon to fix the tissue, overnight, for easier sectioning and evaluation. A darkened, in situ bladder with its thick muscular wall and undulating, edematous mucosa may not evoke stalactites and stalagmites, but I can see drawing parallels to a cavern.

I have exhausted my thoughts on urethral spelunking. Anyone have any other ideas?

Art Part II

This art is not so random, but amazing. We were invited to dinner at a friend's house, and after two months of planning, we finally nailed down a date last weekend. Mom painted the kid's faces for fun. I think I'm going to hire her for our next birthday party!

John is still infatuated with snakes, and wanted to look like his friend Phoebe. He insisted on three fang revisions; after playing, dinner and dessert. The final set was wildly menacing. This was the first set.

Sicily wanted to be a butterfly princess:

Encountering Random Art . . .

It continues. Via the internet. Sicily's art teacher sent a flier allowing me to sign up to a website that shares kid's art internationally. I have sole rights (with the school) to invite family to view the art and can preview and allow comments, like on my blog. Granted, it smacks of a marketing scheme, cause you can buy all sorts of calendars, coffee mugs, and t-shirts plastered with your kid's art, but it's still genius, I think.

I got my first e-mail today with some of her art scanned in. Here it is. I love it! She's gonna be famous, someday. The website is called artsonia.com.

Another place I have been encountering kids art lately is on my iphone. I downloaded a free app called Canvas Artist, and the kids are way more enthralled with it than with Paper Toss or CatchaMouse or Chase the Dot. They can play around with the colors and shake up their picture if they don't like it, like an etch-a-sketch, and it disappears. If they want to save it, it goes into the camera photos. Here are some examples, Sicily:

And John:

I'm having a little trouble with the layout, and apologize. I want to add a little more, but can't seem to get it right, so I'm just going to continue in a new post.

Hooray

Figured out how to post a youtube video to my blog. I know. You're bored. You've known how to do this for ages.

I'm excited.

Now I need to figure out how to embed it into text.

White Rabbits "Percussion Gun" Official Video

Killing a Fly With a Bomb

While dictating today, I was reminded of an enigma from my fellowship.  It was my first fellowship year - Surgical Pathology with an emphasis in Gastrointestinal(GI) Pathology.  Every other month Dr. Woods and I would switch off sitting at the scope with the GI Princess, Dr. Styles, while she was doing her afternoon outside challenging GI consultations.  

One day, we started getting calls and complaints from her consultants -  cases we had already completed with e-mailed reports were not getting back to the consulting doctors.  Strangely, the majority of the reports were making it to the outside institution (the one that I now work at), but sporadically they would disappear.  Despite enjoying wading around in the muck of the GI tract, Dr. Styles is a highly obsessive compulsive perfectionist, and disappearing reports not only did not fit her image, they also started to frustrate her to no end.  I had to bring a lot of extra chocolate to keep her in a good mood that week.  And she's picky about her chocolate.  As she should be.

Neither Dr. Styles or myself are the most tech savvy individuals on the planet; at the time, she deferred to me to take her pictures for her conferences and insert them into her power point presentations.  You can imagine how hard up she was - depending on me of all people.  A week's worth of detective work was centered first around Dr. Styles' computer and her sending techniques, but nothing seemed out of sorts.  Turning the investigation to the receiving secretary's computers, and then the entire hospital network systems, finally revealed the culprit.  The hospital she was sending her reports to had just installed a new porn filter system, one that was kicking out all reports with the words "rectum" and "anus" in them.  This is a big problem for a gastrointestinal pathologist.

So if you want to get your kicks at this hospital, you will be just fine if you are into the duodenum, jejunum, or ileum.  It is easy to search the colon or the esophagus.  You are only in trouble if you stick to the conventionally erotic body parts.  

I wonder if Dr. K had trouble sending breast reports that week.

Blonde Moment

Once, when my blonde friend Trishie was still training, she sat down in to sign out at the microscope with the infamous, excellently trained young ruffian attending pathologist Dr. J.  He asked her, 

"Are you still cycling?"

An innocent enough question, especially given Trish's highly athletic nature - running, bicycling, water skiing, etc.  At the time, however, she was trying to get pregnant.  No one knew this - we female residents tend to keep this a secret for as long as we can.  While everyone in the department acts happy on the surface, getting pregnant during training can be the kiss of death; akin to slashing the tires of your attendings.  Nine months of pregnancy - then the baby comes, and a once studious, focused resident might become scattered and sometimes distracted by all night nursing, episodes of mastitis, ear infections, and childcare issues.  Unless you become somewhat of a superhero.  Take myself, for instance.  Not one but TWO babies during residency - all the while staying at the top of my game, earning the respect of my attendings, becoming chief resident, flying through multiple boards seemingly effortlessly, and finally receiving the coup de grace - what I consider the best job in the state of Arkansas.  But that kind of sacrifice can take its toll - causing irreparable damage to one's psyche - as evidenced by my blog content, which is only a superficial measurement of the massive mental destruction.  Not that I was unique as a resident Wonder Woman - Dr. Mellificent preceded me, was an example and mentor, and there were others that preceded her.  

Anyway, I can imagine the inner surprise, my friend Trish thinking that Dr. J had somehow guessed her maternal desires, her ensuing paranoia and quick defensiveness.  She replied,

"My cycles are fine.  Completely regular.  Why do you ask?"

He looked up at her, confused.  "I was just wondering if you were still riding your bicycle?"

Trish answered with a mixture of relief and embarrassment, "Oh, I thought you were asking about my menstrual cycles!"

I'll bet they are still telling that one in the sign out room.

Guilty Conscience

"Mom, why did you put a picture of John on your blog, and not me? You like him better than me!"

Here she is, in all her Labor Day Weekend ski boat glory.

Number 11

I forgot about one of my alter egos.  I was reminded yesterday at work when there was a mix-up on the phone, between myself and a nurse, while I was trying to get some crucial patient information faxed from a clinic on a case - CT scan reports, colonoscopy procedure notes, and clinic notes.  Six hours later as I was digging around at the bottom of my pending cases stack I cursed silently, realizing that the fax had never come and it was now early afternoon.  I was headed to Conway the next day and didn't want to have too much hanging over my head.  I called and asked for the nurse again.

"Oh Dr. Shyder!  I am so happy you called me back!  I had no idea how to get in touch with you.  I will need to get a faxed permission slip from the patient before I can fax you that information, and we have been trying to get in touch with him all day."

I was confused.  I have been calling clinics - heme/onc, ENT, GI, you name it, sometimes three or four cases a day, and getting patient information faxed without a permission slip for two years  This was the first time I had heard it mentioned.  When a patient is in house, it is easy to look up labs and doctor notes on the computer chart, but outpatient cases occasionally require a little extra effort, if necessary.   This particular case had an entirely different pre- and post-op diagnosis listed on the requisition slip that came with it, two diagnoses that had nothing in common with each other, and the image on the slide didn't really fit.  So I needed some more information.  I explained my confusion to the nurse, and she said, "You're who?  You mean we sent a specimen to you?  Hold on, let me get the doctor."  

I spoke with the doctor and it quickly became apparent that he was mistaking me for a family doctor in town, one with a similar last name.  His first name is Steve.  I introduced myself as one of the members of the pathology group he hired recently, and he gave me the information I needed over the phone.  He apologized for the delay.  

"That's all right, I often get mistaken for Steve.  I guess it's my low voice."  I hadn't been aware that other clinicians require a faxed patient permission slip to get patient records, and suddenly felt heady with the power of being able to request confidential information and have it faxed directly to me, whenever I wanted it.  Just by dropping MY name.  Abracadabra.  Not that I would abuse it, but man.  The power.

When I first started working in private practice, this happened often.  I would get shuffled from secretary to nurse, finally landing in the doctor's hand as he picked up the phone and said, "Hey man, what's up?  What's going on?," obviously mistaking me for this Steve doctor, who I have never met.  I would have to awkwardly explain that I was Gizabeth, not Steve, one of the new pathologists, and whatever doctor I was talking to would re-adjust his familiarity to detached professionalism so I could continue with my questions.  Now, the savvier offices ask for my first name before passing me on to the doctor.

Once I was in the doctor's lounge getting coffee.  One of the heme/onc doctors walked over and said, "Guess what?  You aren't going to believe this.  Do you remember when you called me the other day?  To talk about that patient?  I thought you were this other clinician, Steve, for the first three minutes on the phone.  Three whole minutes!"  I smiled and nodded incredulously, covering up the fact that I really wasn't surprised, by now, at all.  This was old hat.  My 11th personality.  Didn't Sybil get to change genders a few times?  It's only fair that I get to try it out.

This phone talk reminds me of one time in college when I was the etiology of a big relationship fight.  I was calling my friend Merry on the phone, and her boyfriend Stash answered.  He said she was busy, but would be there in a minute, and I was a little frustrated that he stayed on the phone to chit chat so I couldn't just wait in peace.  I don't really remember what we talked about - college blather probably -- did you go to that party last weekend, are you going to go to this party this weekend, or something like that.  All of a sudden I heard Merry  screaming at Stash and he quickly hung up the phone.  I didn't have long to wonder in alarm what had happened, because Stash called me back within five minutes, beseeching me to help him crawl out of the doghouse.  While I was on the phone with Stash, Merry had picked up the phone, listened for a second, and jumped to conclusions.

"Can you please tell Merry I was talking to you?  Not some phone sex girl?  She thinks you were a phone sex girl."

I straightened out that fight, but I recently became friends with her on Facebook, and was not surprised that her married name was not his.  I wondered, at the time, what sort of previous incident had caused her to jump so quickly to me as phone sex girl.  I wasn't certain whether to be flattered or not.  And I guess there really isn't much difference between the low, breathy voice of a guy and a phone sex girl.

I am really not sure what the picture of me and John on the horse has to do with this blog, other than I really liked riding on horseback with John last weekend, even though I had to mask abject fear for the first ten minutes, left over from an early childhood incident at my aunt's stable outside Chicago.  I thought maybe Steve should be riding a horse.  It would fit him - this guy that inspires such easy male camaraderie.  Yup.  Getting on a horse is right up Steve's alley, I think.  I could be him.

I am going to get back to the third of six birthday gift books I have been reading - this one is by far the best.  The Brief Wondrous Life of Oscar Wao, by Junot Diaz (thanks Annie!).  His writing is knocking my socks off.  Not that the others were too shabby - Amy and Isabelle cemented my adoration of Elizabeth Strout, and Zeitoun by Dave Eggers fueled my anger at politicians and the military.  Looking forward to a long, lazy overcast weekend with few plans.

Alter Ego

My latest is Lucille.  AT&T promised it would remedy the situation within 48-72 hours of me getting my iphone, but now it's been a few weeks and I'm still Lucille.

Compared to all of the other nicknames I have been called in my life:  Betty, Big Belly Betty, Liz, Lizzard, Lizzie, Elizabeth, Z-Beth, Elizabeth Ann (my mom when I was in trouble), and Gizabeth; I kind of like this one.  Lucille.  It's a little different - not related to the native Elizabeth.

That's 10 personalities, so far.  Call me Sybil.

Warning

Incubus

My First Idol

Last year today, my cousin Tommy died.  

I've been thinking about him a lot this week.  He was super cool, stunningly handsome, achingly generous, musically talented, wildly artistic, sweet and loving, and his personality was larger than life.  

I love you and miss you.  A lot.

Vagabond

Wolfmother

Butterflies and Vanity

At the beginning of the summer when I started swimming, I was horribly distressed by my goggle imprints.  So, for vanity's sake, I decided to go out and buy my first pair of sunglasses.  I think I may have bought a pair or two before, at a convenient store, trying to model after friends in high school or college, but they looked so horrible on my face that I never wore them.  So I decided I needed to do research.

I went to one of those how to sites that I had read about in the New York Times that day, a site where the serious developer was not too happy that the most common things people looked up on his site were "How to have sex in a car" and "How to get rid of man-boobs."  That was the funniest part of the story.  I looked up how to buy sunglasses, and learned there was indeed a trick.  My long oval face would not look good with the cute, small, catty frames I had tried in the past - I needed to go for size and volume.  My favorite laser chick, Ruby, assured me that large glasses would protect the skin around my eyes and keep me from squinting - both preventing wrinkles.  More vanity reasons to buy sunglasses.

So one Sunday afternoon I went to the Sunglass Hut at the mall and tried on a bunch of glasses.  Of course I liked some of the most expensive ones the best, but I decided hell, I was making up for all of those sunglasses I never bought in the past.  And I am pretty good at keeping up with things. 

I became addicted to my sunglasses.  They were amazing!  No squinting, hiding goggle eyes, being sneaky about where you were looking, and a fabulous headband all in one product!  I wondered how in the world I had managed 36 years without them.  Then, Sunday night, I developed an itchy, flaky rash on either side of my nose.  I decided it must be overuse of the sunglasses, and wore them around on my head all day Monday when I was off work.  But rather than relieve the process, this morning it had progressed; the rash was now spreading across my face, under my eyes, and the itchiness was getting red.  I decided it must be contact eczema, and I couldn't even cover it up with the sunglasses because they were the culprit!  I look like I have that butterfly rash from lupus - the one that we study and see pictures of and memorize for our boards, yet I have never encountered it in a lupus patient.  I worried all day at work that one of my partners would pull me aside and quietly recommend a rheumatologist.  

I searched frantically in my cabinet this morning for the tube of steroid cream I have been dragging around since I was diagnosed with nummular eczema in medical school.  I couldn't find it because I haven't had a problem with eczema since before I was pregnant with Sicily, so I suffered all day.  I was diagnosed with nummular eczema, a coin-shaped rash that was on my shins, in December of my first year of medical school.  Ike diagnosed me with ringworm (in his defense, it is often misdiagnosed as ringworm), and I stubbornly treated it with anti-fungals for nine months before deciding, when there was honey-colored pus oozing out of my tights at the med school Christmas formal Cadaver Ball, so I had to keep running to the bathroom and wiping with tissues so no one would see, that maybe I needed a second opinion.  The dermatologist in whose house I now reside took one look, said I had nummular eczema with a secondary staph bacterial infection (the honey-colored pus - I would learn about that later), and prescribed me some steroids that cleared it up in a week.  Whew.  What a frustrating nine months.  A good reminder of what ignorance can do to a person, so when someone tells me that they had a car wreck a year ago and that was about the time this giant tumor started growing on their chin, and they ignored it until now, because they figured they were somehow related and it would just clear up eventually, I really shouldn't laugh or scoff.  They are probably really smart about something I have not a clue about.  We all can't know everything.  Sometimes I entertain myself by getting the patients to chat about what they know, and I learn something.

Today I had my sunglasses perched on my nose to avoid the sore area while Sicily was having her first stroke camp class.  John was gleefully trying on ten pairs of goggles behind me.  I listened to Sicily beg the teacher over and over to teach her the butterfly.  Sicily knows that her grandpa held state records in the butterfly, and she really likes butterflies, so she is particularly interested in learning that stroke.  I thought of my butterfly rash and kept wrinkling my nose to itch it.  Even though I realize this is not true, I decided that's what I get for being vain in the first place.  Time to go find that steroid cream.