Sunday, January 31, 2010

Star Student

It's Sicily's turn, this week. We worked on her poster all day. Well, she did most of the work. Above her favorite picture, she wrote, "Let's rock out." The tiny, unreadable captions she wrote have lots to do with "rocking out" and "Jammin' out." She was so funny today - "Mom, I didn't know I was so rockin' and jammin' when I was younger!" I told her, "Yes, Sicily, you have always been this way." I wish I knew how to rotate that first picture.

At a birthday party tonight, (it was a "make-up" one from the snow day Sat., and all the kids were exhausted) she rocked out with a bunch of her classmates, despite a day long battle with intermittent sinus headaches and tummy aches. She passed on the cake. I was worried. Sicily never passes on cake. But she still managed to pose for the camera with glamour and personality. That's my girl.

Saturday, January 30, 2010

Getting Home

Check it out over at MiM.

Friday, January 29, 2010

Snowed In

I sure am glad I kept my reservation for tonight. The hotels are filling up and the sounds of rescue trucks on the highway pierce the silence of the town.

When I woke up to run early I looked outside my window and saw cars whooshing down the highway at full speed, and was encouraged. Ran for forty-five minutes and took a long shower. Packed up my bags for the car in case I got stuck at the hospital. Settled down for coffee and eggs when my pager started going off. The business manager in Little Rock wanted to know the situation, so he could decide whether or not to cancel the Conway courier who makes runs to all the clinics and the hospital here twice a day. After spending 20 minutes hacking the ice off of my windshield and crawling to work, just in time for an early frozen section (is it cancer or not? We want to start chemo this weekend if it is. . .), I called the manager and told him to cancel the courier.

One thing I love about the Conway office is the full wall of windows. In Little Rock, I am in the basement. I got to watch the snow all day, safe and snug in the warm office behind the scope. It was a little tough navigating the computer system, since I haven't been here in a couple of months, but with the aid of my crazy notes from August and support from lab staff, at work and home (I had been kicked out of the system from lack of use and needed some professional support), as well as my partner in Conway who helped me troubleshoot over the phone on her day off (thanks, Amy!!) I made it.

The lab staff here is a much smaller, closer, tight-knit family, and they seem younger. I guess because this is a college town. I had a ball eating lunch with the techs and supervisors, talking politics, and making fun of the various tactics people in the parking lot were using in attempt to get the ice off of their car. One guy was trying to use his finger. Quite comical. During a break mid-afternoon, one of the lab techs grabbed an ice scraper and worked on all of the staff's windshields. It was so funny watching this kid (I am 36, after all, he couldn't have been over 20) being all scrooge-y about his good deed, in order to maintain his cool reputation.

And even though it was a hard day and I miss my kids, I am happy because I am safe, I did my job well, I will hopefully get home tomorrow, and I'm on vacation! No work tomorrow or the rest of the week. I feel much more relaxed tonight, and had a nice long conversation with my sister in Atlanta. I'm not setting an alarm. Maybe another run in the morning - I hand-washed my work-out clothes in preparation. Just in case. I like being prepared.

Thursday, January 28, 2010

This Guy is Pretty Funny

Thanks, Laurie.

Party at the Hamptons

Well, not really the Hamptons (what are those, anyway?). The Hampton Inn, in Conway, AR. Come join.

At work this morning, I became riddled with anxiety over the impending weather. Normally, when I go to Conway hospital to work (it has been a couple of months), I get the kids up, take them to school early to a teacher that accepts money for her service, and get on the interstate. But everyone was talking, "the weather, the weather." I got on the national weather sites, and instead of 30%, 40%, like it has said in the past, it was predicting 100% icy storms with accumulation.

After looking at a few cases, I went into my partner Dr. Woods office. "I need to vent. About the weather." He assured me that there would be no accumulation, I would be fine.

I went to show another partner, one that commutes to Conway frequently, a case.

"I knew I was smart back in August when I put you on the Conway rotation. Thank goodness it's not me, tomorrow. Make sure you have a full tank of gas. Last time there was ice, a truck jackknifed over the interstate and I had to back up and take the old highway. It took me seven hours to get there."

More stressing. I arranged for my caretaker, her two youngest kids, and her granddaughter to spend the night at our house. I booked reservations at a hotel in Conway. I canceled the morning session with their teacher. I decided it may be highly unlikely that I would have trouble with the morning commute, given the recent warm weather, but with 100% chance precipitation and accumulation likely, I needed to be prepared. A lot of the histotechs, nurses, gross room assistants, lab technicians, etc., had completely booked the hotel across the street from the main hospital by noon.

As the day progressed, I looked at cases and tried to generally tie things up since I am on vacation next week. I started thinking about the prospect of a one or two night stay at a hotel, by myself, and got excited. All this was dashed when a bigwig from the lab stopped me in the hallway.

"I need to talk to you about something."

He gave me the names of two patients that I had looked up. Some Big Brother somewhere was wondering why I had gotten into their medical records, since I was not listed as the attending on that case. I sighed heavily.

"This happened to me once before. I got a list of six or seven names, when I hadn't been here but six months. I was told I was being audited, because they couldn't find an anatomic report with my name attached to the patient. It took me all afternoon, but I finally discovered I had read peripheral smears and serum protein electrophoreses on each and every patient, a few weeks before. I was a little angry and defensive, when it was all over. I am a mother! And a doctor! Does anyone really think I have the time to be snooping around in patient files? Or the inclination? Do they think I am stupid, and live under a rock? I followed the stories about Ann Pressley. I realize the consequences of looking around in patient files. Not that I want to - I would never think to do that. It's wrong. I'm the kind of person who worries about her patients, even when I am covering another service and am no longer responsible for them. But I would never stoop to checking up on them electronically, because it doesn't feel right."

The bigwig smiled and laughed, apologetically, but still wanted proof. One of the names I recognized immediately - I was still working on a bone marrow case of his. The other name was familiar, but I couldn't pin it down. I unsuccessfully enlisted the transcriptionists for help. Finally decided to figure it out on my own, and did some detective work. The reason I got into that other patient file, was because it was a common name, and I accidentally clicked on someone else with the same name and age, looking for relevant clinical information. I printed out the anatomic report for proof, with my explanation in a post-it. There, dammit. Don't crucify me. I am not a bad person. And I have more important things to do, than to prove that over and over.

Having vented about all that, I realize the importance of checking up on staff and ensuring patient confidentiality isn't breached. I read a story today, about something in L.A., that was despicable. I am glad someone is looking out for the patient. It just didn't fit into my schedule, today, and I got pissed about it.

Thank god that was over, and I could focus on getting to the hotel, and worrying about childcare. I packed a ridiculous amount of books, clothes, and snacks. I ensured that the hotel had internet access. So funny how in mid-range hotels, like this one, breakfast and internet access are free - a given. Not so much with high range hotels. I think I'm happier here.

There's also a workout room. It's been a few days, since I ran. I'd better go to sleep, so I can get up with my alarm at 5:30.

Tuesday, January 26, 2010

Band Practice #3

Ain't happening.

I'm so sad about this, it took me a couple of weeks to write about it.

Bright side: I sang. To an instrument. It was fun. I feel more brave and powerful.

Down side: Initial excitement petered. Not on my part. But I understand. Sometimes life, and work, and family, get in the way.

In the meantime, I'll just keep on singing to my kids. The most important audience. Maybe someday, I'll find another outlet for my burn.

Life with Mommy

Tonight, I had just finished singing and general silliness with John, and headed into Sicily's room to sing.

"What song do you want?"

"Wait, mom, I have to go to the bathroom."

I sighed and flopped down on her queen-sized bed amongst all the pink pillows. Waited. She was taking a while.

I called to her a little testily, "Tell me what song you want while you are going to the bathroom."

"Maybe (the song, not the word. I've already made that misinterpretation once - 'Maybe you'll tell me the song, or maybe you won't?' 'No mom, the song from Annie. Maybe.' Duh.)."

"Duet or solo?"

"Duet. But wait until I get back. I'm pooping."

"I hear that. What, can't you poop and sing at the same time?"

I hear her giggle. "Maybe you can mom, but I don't do that!" She finishes and opens the bathroom door, heading for the bed.

I exclaim, "Miss C! You can't come and sing a duet with me until you wash your hands. With soap. Are you crazy?"

She rolls her eyes and heads back into the bathroom. The door stays open this time. I watch her in her long cotton nightgown, white with peach and yellow vertical stripes. Ruffled sleeves and collar. Her long brown hair flowing down her back. She tosses it back and pushes up her sleeves to get some soap. All of a sudden, she starts whining. "Oowww! I forgot I got a cut today at school on my hand. It hurts so bad!"

"Rinse it with water, quick, to get the soap out." She does it, then heads back toward the bed, still whimpering and clutching her hand.

I look at her and sigh. "Pooping, cuts, lip, what's it going to be next, Miss C?"

She woke up this morning and came in my bed at 4 a.m., complaining of a bump on her lip. I told her to just put some chapstick or lotion on it, and try to sleep. A frustrated hour later we were still awake, and John had joined us. After showering, I noticed while she was getting ready she had her entire lower lip tucked in her mouth. I asked her if I could look at it, but she was reluctant. When she finally obliged after much cajoling on my part, I was astonished to see her entire lip swollen to four times its normal size. I palpated it in alarm, looked for bite marks, and finally gave her a dose of Benadryl so she could get some relief. By the time we were in the carpool line, it was back down to twice its normal size. I worried, since she was starting to take the Iowa Basic Skills Test today, that she wouldn't be able to concentrate. We had violated every rule on the testing guidelines sheet (Get a full nights rest, Eat a good breakfast - she couldn't because of her lip, and I think Don't drug your child before school probably goes without saying), so I notified the school of her predicament with a phone call to the office, so her teacher wouldn't get mad if she was having trouble concentrating. It was still a little swollen this evening, and she confessed to having seen a giant mosquito in her room (in this weather?) at bedtime, so I chalked it up to a mosquito bite, hesitatingly.

Back in the bedroom, she quit her whimpering when I teased her and looked at me with daggers in her eyes. She smiled a wicked smile.

"I think I am going to write a book. You know Tom and Jerry? Jerry wrote a book called 'Life With Tom'. I'm going to write a book called 'Life With Mommy'."

I smiled. "That is great, Sicily. I can't wait to read that book."

"It will be a story, of what it is like to live with you. With you teasing me. I'll even write a song to go with it."

"Can you sing a little for me?"

She adopted a strange Southern Jamaican sing-song voice. "I'm just a little Spanish girl sitting in a tree. Hoping my mean ole Mommy will stop teasing me." She started giggling uncontrollably, and I couldn't help joining her.

We finished the duet and snuggled. As I kissed her goodnight and tucked her in, she reminded me sleepily, "Don't forget to make another copy of my CD for the car." She designed a CD over the weekend, full of show tunes and her favorite songs, to send to her pen pal Ella. She brought our car copy in to school, and told me how she danced with her teacher's aide to "It's a Hard Knock Life" over lunch. She told me, "Miss Brooke loved the Enchanted songs, mom. We danced and danced."

I hope she remembers some of the good stuff, in her book. The dancing, the singing. Lord knows she could drag me through the coals - I'm not perfect and sometimes I lose my temper. Especially after a long call weekend. But I try to make up for it in other ways. I love her to death.

Monday, January 25, 2010

Call Weekend


6:00 a.m. Wake up, shower, and get out of the house before the kids wake up. I can't bear feeling guilty for leaving all day on a Saturday.

7:15 a.m. Get to work. Thank goodness, only three new marrows. I still have three hanging over my head from Friday. Triage the marrows and three nodes, order special stains and flow cytometry. I want to have this behind me before I take a break for coffee and breakfast. Stop by and ask the Saturday transcriptionist if she wants anything from the doctor's lounge. Can't offer her a hot meal - there's only yogurt, bagels, and cold cereal on Saturday. She seems pleased to get a bagel and yogurt. I pile on the cream cheese and add honey.

8:30 a.m. Settle down for a day's work. Notice, on the way back from breakfast, that one of my partner's light is on. Quickly work up my new acute leukemia so I can show it to him and get him to concur with my diagnosis before he leaves. He agrees with my classification, and I release it so the oncologists can begin treatment. Become slightly frustrated that the only name on the requisition is a family doc who isn't taking calls until noon. Spend 30 minutes tracking down an on-call oncologist. This is a serious diagnosis. Her marrow is being replaced with leukemic cells, and I notice her platelets are dropping exponentially. Someone needs to know.

9:30 a.m. Start getting notification from the blood bank about a problem patient - tough antibody work-up. They are getting pressure to gather 16 units to prepare for a possible heart transplant later on today. Her blood type and antibody work-up demand resourcefulness. Donor hearts don't come around every day - we need to be ready.

10:30 a.m. Show the on call anatomic pathologist a giant granuloma in one of my bone marrows. I learned from the clinician notes that she is worried about metastatic cancer, or lymphoma. All I see is a granuloma. "Would you call this caseating necrosis?" I ask. He said, "Well, it is definitely necrotizing. I wouldn't get hung up on the type of necrosis. Just get the bug stains, and look carefully. I almost missed an atypical mycobacteria last week." I thanked him. Necrotizing granulomatous inflammation.

12:00 Heat up a spicy black bean burger and take a 15 minute break. Surf around in my google reader and facebook. Become pleasantly surprised that one of my good friends made a post, a few minutes ago, on a weekend. Read it and laugh. Return an e-mail from Friday night. Close my laptop.

12:30 Spend the next 2.5 hours finishing what I can, with the flow and stain results rolling in. Work fast. Sicily was invited to a birthday party from 4:00-5:30, and I am determined to make it at any cost. We have been at this new school since last June, and I still don't really know any of the parents.

3:15 Leave work to gather Sicily and head over to Pink Bliss. Fraternize with the moms and dads while Sicily is getting her nails painted aqua and hot pink. Meet Abby's mom. Savannah's mom. Morgan's mom. Srilakshmi's mom. Tell little endearing stories about their children that Sicily has related to me at bedtime, over the year. Discuss kidney stone problems, with a mom. Delightfully run into John's teacher, who I didn't realize had a kid in first grade - I knew Sicily was her friend but mistakenly thought she was in Kindergarten. Bask in her compliments of my son.

6:00 Pick up take-out sushi to bring home for dinner.

8:30 Head back up to work after book and song time with the kids. Clear out peripheral smears and put the finishing touches on tough cases. Thoughtfully dole them out to partner's boxes for consult on Monday.

10:00 Scare the bejeezus out of two nighttime histo techs trying to say hello on my way out the door. Laugh and talk. Drive home.

10:30 Trying to veg out to music on the internet, when I get paged by the transplant cardiologist. The tough antibody work-up, from this morning. They are going in to harvest the heart, and plan to transplant around 2:30 or 3:00 a.m. He is giving me a heads-up on a desired apheresis treatment as soon as the patient gets back to the CVICU after post-op. I nail down as many logistics as I can, realizing that all of the lab values I need to plug into my formulas for plasma exchange will probably be altered drastically post-surgery. The cardiologist can't decide if he wants to replace her with albumin or FFP - fresh frozen plasma. He tells me that he will call me when she is stable, as early as 6:00 or 7:00 a.m. I alert the dialysis nurse on call. I am relieved to find out who the Sunday nurse is - she is very competent and I love working with her.

12:00 I go to sleep.

5:30 My alarm goes off. I don't want to miss the call from the cardiologist, and quickly check my bedside pager to make sure that I didn't miss a page. I lay in bed until my son John joins me at about 6:15.

6:30 John and I watch YouTube videos for a ridiculous hour. First, blizzards. I didn't realize there was a massive blizzard in 1977. I was John's age. I delighted to the radio recordings and the images from that time. We also watched a lot of videos of snow forts. Then we degenerated to anacondas. Eating hippos. Fighting crocodiles.

7:30 I lied and told John the battery was dead, on the computer, so he would let me get up and do coffee and breakfast. He cooked eggs while I heated the cheese toast. He insisted on setting a place for his sister, even though she was still getting her beauty sleep long after our food was ready.

8:30 I wake up Sicily and pop in a video so I can go run. My pager goes off. Time to coordinate the procedure. In between running, I spend time on the phone with the dialysis nurse, the transplant cardiologist, the CVICU nurse, and the blood bank trying to make everything a go by noon. I also arrange for childcare so I can be present for the procedure. I am busy, but happy that the patient made it through the surgery. And happy that I squeezed in my run.

11:15 Drop the kids off at my parents and head to the hospital. Introduce myself to the transplant cardiologist and the CVICU nurse, who feel like family after all the questions and logistics we have worked out together over the past 16 hours or so. Give a thumbs-up to the dialysis nurse, who is gloved and gowned in the sealed room. Everything is going great. Double check all the labs and calculations on the computer in the CVICU. Write notes. Firm up future plans for additional procedures, to notify the blood bank. Turn in the billing slip.

1:00 Get to my parents in time for wonderful Mexican and a large round of the German version of Uno. It's called Solo. It's a lot crazier.

3:30 Take kids home, play fort, clean house, cook dinner, and settle them into bed. Crash. Look forward to tonight, a post-call Monday.

Saturday, January 23, 2010

The Heavy


I've got a gold mine of a new mix, and I'm stuck on the first three songs. Reminds me of when I discovered the Amy Winehouse album Back to Black a couple of years ago, and it took me a month to get to my favorite song on the CD, because I kept playing the first five over and over. Didn't think it could get any better. I was wrong. I hope I still am.

Wednesday, January 20, 2010

Getting Wired

You can read it over at MiM. (I love how that sounds like nimh. As in Mrs. Frisby and the Secret Rats of).

Tuesday, January 19, 2010

Happy Birthday

I'm making a mix for my friend at work. It's called Gross Room IV. Her birthday is Friday. Can't wait to get hers - they are always mind-blowing.

Sunday, January 17, 2010


There's just something about being with my dad, that embodies this word. Earlier in the week, he stopped by my office and problem-solved with me about car issues. His advice, as always, was very helpful.

Today after a brunch with a mentor, I took the kids to my parent's new house on the Arkansas River. We haven't hung out much since the holidays - my mom spent a week in Montana and a fall on the ice induced a back injury. They've been convalescing all week, and she just turned the corner today.

She and Sicily stayed inside to play Uno, and my dad and I walked out with John to their new dock on the river. We took a fishing pole, tackle, and bait. I wordlessly watched Dad help John bait the hook and cast it into the water. Dad was stooped over to help him, in jeans and a fishing hat, silver hair peeking out underneath. I imagined him as a boy, John's age.

I was surprised how deep it was, so close to the shore. Dad was naming the parts of the pole, and John was so engrossed in the tasks that he failed to notice the skeet-shooting going on at the house next door.

My father and I watched the neighbors shoot skeet as John held the pole with purpose and concentration. I stared across the river. It was a beautiful day, like spring, the sun and warmth a sharp contrast to the bare trees and dead grass.

John asked, "Will we catch a fish?"

I wondered aloud, "Is this a good place to catch fish?"

Dad laughed. "I'll bet there are 50 to 60 pound catfish, at the bottom."

I thought they had probably been alive a lot longer than me.

After 20 minutes or so, John knelt down with the pole, shivering on the dock. We were in the shade, and the breeze from the river was cold.

I said, "Why don't we pack up the gear, put it back in the garage, and take a walk over to the pond, in the sun?"

We walked silently up the gravel road to the large pond in the front of the house.

Dad said, "The pond is shallow, now. The pump broke. I forgot to do maintenance, before the first freeze. We'll have to get another. Maybe we'll see some fish."

We didn't see any fish, but the pond-water was low, and I wondered at the hash-marks in the mud surrounding the water. There was a moderate stench of manure.

I asked Dad, "Is that from horses in a neighboring farm?"

"No, probably geese. Sometimes there are hundreds on this pond. See all their track marks, in the mud?"

I pointed them out to John, and we began to identify their feces in the dead grass around our feet.

As we headed back to the house, Dad pointed out the ruts in the gravel road, caused by work men's trucks, and talked about what would be required to repair them. I listened quietly, holding John's hand. Suddenly, John took off in run, across the long yard to the front door. He glanced back once and graced us with his devilish grin. We watched him, admiring his speed and abandon.

Dad said, "He's getting so tall. I'll bet he'll be taller than Mike, one day." I agreed silently, and we walked back into the house so I could collect the kids.

Someone at the Mothers in Medicine blog said in a post comment that behind every successful woman is a supportive and encouraging father. I guess that the parts of me that can be considered successful are largely a result of him.

Friday, January 15, 2010

To Rex

I wrote this blog, in October, and felt it was too personal, at the time, to post. I gave it to Rex on paper. Somehow I worried, knowing my brother reads this blog, that he would be upset knowing that I worry about him. Now I think that maybe it's a good thing, for him to know that.

Rex's brother, a picture of health, died suddenly in October. Recently, on my other blog home, mothers in medicine, a guest poster talked about the death of her father. He was a mentor. Another doctor, whose father was also deceased, wrote in a comment. It inspired me to appreciate my own dad, who I hope is very far from death.

I tried to finish my last Conway hangover case – extra levels on a cervix LEEP, on Wednesday morning after John’s Halloween Parade. I was delighted that he was still in it, and not held back for indecent exposure. I noticed, that morning at breakfast, when he sat on the floor in a cross-legged position, that he had a large crotch-rip in his pirate’s costume. But I didn’t have time before the 8:30 parade to get another, and was pleased that it wasn’t noticeable when he was standing up and walking. So I sent him to school. He was delightful to watch at the parade, and so excited that I attended. He had found the gaping hole, and spread his legs on the playground blacktop to show me, “Mommy, look!” I quickly shushed him, and went out to buy a new one that afternoon, for Halloween.

The levels on the cone had been lost, thanks to an inexperienced courier. So I left instructions for the group manager to call me when they were found, and proceeded with my day. After lunch, about 1:30, I went in to look at them. I was standing in the transcription area, and my partner Dianne saw me. She was handing out copies of paper to another partner. She said, “I am so glad you are here. Dr. Bell’s brother died this morning. These are the times of the visitation and the funeral.” Shock and grief penetrated my body. My eyes welled up, but I was in the middle of all the support staff, as well as Dr. Shaver and Dianne, so I suppressed the tears. Dianne looked at me and indicated wordlessly that I should follow her to her office.

I had already been privy to the first part of the story from Dr. Bell, and Dianne filled in the details of Tuesday afternoon to Wednesday morning. I decided that I had to attend something, but regretted that I had already promised to sail, for the group, in the sailboat race for Baptist on Saturday. I noted the Friday visitation, and resolved to get Mike to watch the kids so I could try to make it. I told this to Dianne – she was planning to attend the funeral on Saturday. Somehow I got the towns of Arkadelphia and Jonesboro confused in my head – I was thinking I could take a kid and spend the night Friday with my ophthalmologist friend in Jonesboro so I could be present. Further conversation with Dianne straightened out my error, and I felt stupid. I was so sad, I got muddled.

In my office, while I was looking at the levels, I remembered that Mike was on call Friday, and I had no one else to watch the kids. I felt dejected, and decided to send flowers instead. Dianne assured me that the group was sending flowers, but I wanted to do something myself. My own set of flowers, I guess. Dianne assured me that he would understand that I couldn’t make it for the visitation, and painted a quick, wonderful picture of his brother, from stories related to her over the years. I didn’t even know Rex had a brother. So I suppose it wouldn’t be too bad if I didn’t go. I was glad for Rex, at that moment, that he had the support of Dianne – a wonderfully empathic, crazy smart woman, who had been working with him for years, and a good friend. I had observed that much, in my time with the group.

Later, in my car, I thought of the little I knew of Rex. A wonderful wife. Incredible musical talent – the kind that made me loose and relaxed, more than the one glass of wine I had when I was listening. I sometimes wonder if the music makes him crawl into his head, and find clarity in complex issues. A great consultant, now that I am gaining the confidence to consult more than two or three people in the group. I thought that flowers weren’t the right thing to do; suddenly seeming too trivial. So I called Dianne and asked, “Does he have a favorite charity? I would much rather put money there, in memory of his brother.” She answered quickly, “The Humane Society. That’s were he asked me to donate, when he wouldn’t let me pay him for playing at my daughter’s wedding.” I resolved to do what she recommended.

I told her, “Dianne, I almost cried in front of the transcriptionists. This is terrible. I’m angry. This wasn’t supposed to happen.” She confessed, “I got choked up too. When I went into his office this morning, and he told me, I didn’t know what to do. I grabbed his knee awkwardly, trying to hug him. Jane says he is sleeping now, which is good. He needs it.” I looked at her and marveled once again, at her enormous capabilities of being a good doctor, lab director, mother, and friend.

After my visit to the chiropractor, I had thirty minutes to kill before I needed to pick up my daughter from her piano lesson. I spent it in the car. Listening to music. Thinking about my partner and his sudden, unexpected loss. Thinking about my own brother and his constant physical challenges from his health issues. Looking at the possibility of losing him, and scaring the hell out of myself. Staring at the trees, highlighted by the rare glimpse of the sun, this October. And I cried, silently. And prayed to a God I still am not sure exists, for healing. They say that music helps. I hope Rex can use his talent in this capacity.

Friday Special

I hit a home run with my molecular genetics. Sending good telepathic vibes to the patient. He's younger than me, and he has a great prognosis with the diagnosis if he can just get through the woods.

We had our lunch catered today, from Boulevard, by a fantastic oncology group, in appreciation of us. This is unprecedented, in my pathology history. We are the dungeon doctors, of the lab and morgue. We don't treat patients, so we don't have drug rep companies fawning over us and buying us lunches. Our microscope reps know we need them, so they don't have to work too hard. Most of us eat power bars, or apples, or spicy black bean burgers, in our office. Those of us who lunch, leave the premises. Sure, we potluck occasionally, but not often. Today, we got together and shared a great meal. Told stories. I learned that my senior partner had an oil rig job, one summer in college. His boss was terrified of snakes, so my partner's job was to walk in front of him and shoot them with a .22. He said all summer, he closed his eyes at night and saw snakes swimming in the water.

Boulevard gets a lot of their produce locally, so I was extremely excited to find a snail shell in my feta and macadamia nut salad. It was tiny, black, and swirly - so beautiful. I played a guessing game with my kids at dinner, "Guess what I found in my salad today?" It lasted for ten minutes. "A carrot?" "A bug?" "A cricket?"

I can't wait to write the letter of appreciation, for the meal. I trained with the oncologist who organized it. We worked together at the VA - she would call me when she was worried that a lump on a patient (behind the ear! Supraclavicular node!) was recurrent lymphoma or cancer. I helped her guide treatment. Still do. She called me, a couple of months ago, from the ER. I was reviewing a young girl's peripheral smear. Her hemoglobin and hematocrit were so low, they seemed incompatible with life. She and I were trying to figure out why, in order to triage and treat the patient. I pulled out a million books, and showed the smear around. I came up with a differential, and called her.

"She had a heart attack and died. I was there. There was nothing we could do." She sounded rattled. I am in awe of her - dealing with dying patients in her everyday life. I think if I saw them and got to know them, I would mentally crack.

I guess the patient's heart was working so hard, to pump what little blood she had around in her system, that it gave out. She was in her early 20's. It sucks when your best effort is not enough. We were never really sure why it happened, even when poring over her clinical history. Only theories. Sometimes nature trumps medicine and intelligence.

The oncologist showed up today in a Brett Favre jersey, on a dare from another clinician. I marveled.

"It's great that you can talk sports, with the guys. I would have no idea what I'm talking about." I can talk snakes, though. I've got a pretty good wealth of knowledge there. I told stories of tracking Timber rattlesnakes in the Ozarks, years ago, when GPS was still the stuff of government and research. That was kind of hairy. Thank goodness I never stepped on one.

My plastic surgeon blogging friend shares a lot of articles and blogs with me, in my reader. Today, she shared a link to Partners In Health, a group that has been based in Haiti for years and is primarily responsible for the relief efforts there, since they already have many clinics and camps in place. I donated over lunch. And felt good that the money was probably going to the right place.

Got ZERO plans this weekend. Except a fabulous brunch at Vieux Carre on Sunday with a friend and mentor, Dr. Styles. It's been four months, since we have seen each other in person. I can't wait to exchange gossip, advice, and Christmas gifts, over a Cajun brunch and great jazz music.

Kudos to my mother-in-law. She picks up the kids on Wed. (John) and Fri. (Sicily) for one-on-one time. They get ice cream and chocolate sauce and library and activities. I bought a kid's sewing machine at Christmas, with a child-sized table and chairs, to place in her house. Today was Sicily's second Friday of rapid, machine-paced sewing. She made an incredible bear with button eyes and nose (probably from Ramona's scrap stash). I just peeked in on her, sleeping. She's hugging her bear.

I'm so incredibly proud of Sicily - she had a deadline this week, in her Accelerated Reading class, so she could enjoy donuts and hot chocolate at a party today. Sugar is such a great motivator for her. She usually reads a Junie B. Jones book a week, but she needed four, with quizzes, in order to make her goal. She stayed up late at night reading, and aced her quizzes. One night she said, "Mom, I'm loving The Secret Garden, but could you just help me finish this book tonight? I don't think I can do it all myself." I readily obliged. I laughed on Wednesday, when I received four e-mails about her quiz grades. "Ding! Ding!"

Sicily was a little upset this week, because she got enough behavioral directives on Monday for talking in class to prevent her from participating in "Friday Special," when she gets to pick a treasure out of a box. A first, this year. I told her not to worry about it. I'm glad she isn't a completely perfect student. Straying from the rules, occasionally, will serve her well in life.

Thursday, January 14, 2010

New Initiative

I'm starting one. Feel free to make donations. It's a drive to spay/neuter peripheral smears. When I'm on X (the clinical pathology rotation, not the drug), they seem to multiply in my box, like rabbits. I'll finish five, feel warm and fuzzy and satisfied, and find six more in my box.

Two of the heme techs didn't donate, so I blamed them tonight, when I had to go back to work and finish up about 15 that I couldn't get to at work today. One of them said,

"Doc, I was hurting for you. You're going to have to work harder, on your drive. They keep on coming."

"Don't tell me Lil. I don't want to know. I'll sleep better, tonight."

I did get to make a rare diagnosis today, one that I have only read about in residency. That was incredibly cool. I can't wait to get the genetics back tomorrow.

Here's to PML/RARA. Go FISH. Funny how molecular genetics can take you back to your pom squad days.

Wednesday, January 13, 2010


John and I were finishing song tonight, a variation of Mining for Gold he made up, involving bunnies. You just throw the word bunny in occasionally for comic relief. I guess John realized this song needs comic relief. I love mixing the awesome pathology word "Silicosis" and dying miners with bunnies.

"Mom, I had a really bad dream last night. You were a princess, and an evil witch was eating you."

"Did you save me?"

He looked sad. "I couldn't. I kept trying to make the dream go away, but it kept coming back. Where is that thing? For dreams? Sicily still has her pink one, I saw it!"

"Do you mean the dream catcher? I don't know where yours went, John."

He sighed disconsolately. "My bad dreams won't go away. The thing that catches dreams is lost. I'm gonna have bad dreams."

"No you won't, John. It will catch bad dreams, no matter where it is in the house. I know yours is around here somewhere. And Sicily's will catch your bad dreams too, even though it is in her room. Don't worry."

He perked up. "How does it work? Does it get the bad things that come into the house in the night? The really bad things? Does it jump off of the nail and go like this?" He mimed grabbing a dream catcher off the side of his bunk bed and pounding an invisible bad thing on his pillow. Such a testosterone-laden interpretation of the function of a dream catcher. I loved it.


"But mom, mine isn't here. I'm still worried the bad dreams will come in the night."

"John, I've got a solution. Give me your ear."

He leaned over, and I made a loud inhaling breath noise, right beside his ear. He pulled away and watched me, while I chewed vigorously and swallowed.

"There. I ate all your bad dreams. Later, I'll poop them out and flush them down the toilet."

He laughed, then looked alarmed. "No mom, those were my good dreams! My bad dreams are in the other ear."

I quickly blew the good dreams back into his right ear and sucked the bad dreams from the other ear. "Better?"

"Yes mom! Don't forget to flush them away."

I hope it works. This age, four, is so wonderful. He still believes wholeheartedly in all of my magical mommy powers, like when I do something silly with a band-aid before I apply it so it will make him heal faster. If I forget, he'll remind me through his tears. "Don't forget to do that magic thing, mom!"

I hope I never see the day when he no longer believes in magic.

Tuesday, January 12, 2010

Truth is Stranger Than Fiction II

I follow this blog, The Happy Hospitalist, sporadically. The other day, he found an anonymous confession on the internet, and posted it. This must have really happened. I read it, laughed so hard I almost cried, and said a silent prayer for laser technology.
My only problem is "hoo-ha." Does anyone really use that word? That may be a sign that this is a fictional story.

You can read it here.

While we're on his blog, the cat enema interview is pretty funny, too.

Sunday, January 10, 2010

Saturday - Girl's Day

Here's my post for the month, over at MiM.

Thursday, January 7, 2010

The Secret Garden

That's the book Sicily and I are reading right now. It's one of my favorites from when I was little, and reading it to her is almost like reading it all over again for the first time. I love reading her chapter books - it's like torture leaving her hanging night after night. "One more chapter please" she begs, and I just smile. "Not on a school night."

It's kind of tough picking up the Yorkshire accent of the maid Martha - it took me a few chapters to get it right. I just took over Sicily's reading time after spending a couple of months with John. It was so much fun discovering Skippyjon Jones - my mom told me about this children's series over a year ago and I just ordered them a few months ago from the school book order form that came home one night in Sicily's folder. I love jumping from the deep Southern twang of the mama Siamese (Mama Junebug Jones) to the Mexican gang accents in Skippyjon's make believe (or is it?) Chihuahua world in his closet. Such fun little songs and rhymes - and nothing makes John laugh more than my Spanish accent. I can just read him Spanish picture books and he collapses into a fit of giggles. His favorite is "the radish," from a food picture book - Mi Comida. He can't wait until I get to that page - he points to the picture excitedly and asks, "Mama, what is that?"

"What is it in English, John?"

"A radish. Now your turn. What is it in Spanish mom?"

I hesitate for maximum effect, then belt out with as much Spanish flair as I can manage, "El Rabano!!"

Laughing ensues. All I have to do to turn a churlish breakfast mood around in the morning is yell, "El Rabano!" and he can't help but laugh. Sicily rolls her eyes. "Why is that so funny?"

Well, it's me. Trying for a Spanish accent. Pretty comical.

One of my favorite holiday moments was watching The Lion, The Witch, and The Wardrobe with the kids - I got giant goose bumps when the youngest girl entered the snow-covered forest from the back of the wardrobe for the first time, because it reminded me of reading the book when I was little. Took me back to that moment of wondrous discovery. Sicily found the book in her closet the other night, and made me promise to read it after The Secret Garden. I can't wait. Now back to my book.

Wednesday, January 6, 2010

The Black Nativity

Ha, ha. I've got tickets to the sold out matinee and you don't. Me and Sicily have the inside track, since my partner's husband is the gospel director at the church sponsoring this performance.

I thought Langston Hughes was a poet - didn't know he wrote plays and musicals. This one opened on Broadway in 1961 with rave reviews. When I asked my partner if she had the music for Sicily and I to listen to in preparation, she told me there was no record of the original score. It is re-interpreted by individual performers, all over the country.

I was assured that Sicily (and I) would experience her first interpretation of the Black Nativity to an abundance of gospel music, blues, and rap. What better way to be initiated? Apparently, during its original incarnation, two of the lead performers quit because they were worried the title was too controversial in 1960's America.

So I've been researching Langston all week. Are all great American writers closet homosexuals? Langston Hughes, Somerset Maugham - I'm starting to wonder. His parents were both of mixed heritage, explaining his light skin. His dad rejected his African American roots - fleeing to Mexico and the Caribbean after he left Langston's mom. Maybe that's why Langston embraced his roots so wholeheartedly in his art. I can't wait to see the play.

Sicily's formula for snow:

1) Wear your pajamas backwards (this is highly comical - considering Sicily and John were both in footie pajamas tonight).

2) Put three ice cubes in your toilet bowl.

3) Put a spoon under your pillow.

Here's hope for a happy snow day - one where I don't have to get my kids ready for school, but my childcare arrives promptly to get me to work safely and on time. Wish I could stay home and make snowballs and hot chocolate. But I'll just look on the bright side, and take what I can get.

I think we need to alter the formula.

Monday, January 4, 2010


The concrete rooftop is shrouded in shadows and reflections from floodlights under the stars. Six adolescents engage in a half-hearted game of volleyball.

"Hey! Watch your position! You could have caught that one!"

An anorexic blond with short, mousy hair and a pointed angry face appears to be drowning in a large ski parka and baggy jeans. She yells at a tall, muscular 15 year old boy who towers over everyone, staff included. It's a warm summer night - he is in shorts and a t-shirt.

"Watch it skinny. You don't know what the hell you're talking about. Shut your mouth."

"Don't you talk to me like that! I'm a girl. You can't talk to me like that. Didn't your mama raise you any better?"

"Don't you talk about my mama. You don't know my mama." I think I remember that his mama is dead.

A staff member, who appears to be in his late twenties, wanders between them. His bronze skin and long, shiny dark hair suggests American Indian ancestry. His angular face has a permanent smile. He always looks stoned, and his easygoing manner and slow, rambling walk reinforce this impression. I was mildly surprised, once, when he asked if I had any leftover pain medication at home, from minor surgeries. I told him I didn't think I did. We were supposed to be the staff. When did people grow up? Maybe if I got into med school, I decided. I was wrong. Maybe when we're doctors. Nope. Maybe never.

"Hey, guys, take it easy. It's just a game. We only have ten more minutes, before we have to go down to our last group. Let's have fun."

The anorexic blond steps back and smiles in wicked satisfaction. The 15 year old pounces, screaming obscenities. I shrink back in horror. He has easily twice the bulk of any single person on the roof, and the staff's just me and perma-smile. I'm barely twenty, fresh out of college, skinny myself in an over sized Lollapalooza t-shirt and baggy shorts. I've only been working in adolescent lock down a week, but instinctively know that a basket hold is not going to work in this situation.

Skinny girl runs to the corner of the chain-link fence that borders the rooftop, and hides in the shadows. Smiley rushes to restrain the mountain of uncontrolled testosterone. It's like watching a train wreck. I quickly quell the urge to help, knowing we would lose handily, and instead grab my keys and rush to unlock the gate and run down the concrete steps to the floor for help.

When I return with two men, one bearing a shot of Haldol, I can see, but not hear, what is going on. It's like being in a vortex. The 15 year old is trying to gut-punch the staff member, who is in turn trying to pin at least one arm down behind the large youth's back. They are both down on the ground, in constant motion and battle for control. Five 11-15 year olds, skinny included, are standing in various positions on the volleyball court, open-mouthed. The two staff members rush in to help and suddenly, the youth's scream of fury and defeat pierces my silence with the insertion of the antipsychotic. The men hold the youth until he is calm, and when I realize the situation is under control I escort the other patients down to the ward.

Friday, January 1, 2010