Happy Halloween

Annual Visit to the Crime Lab

I won't apologize for my dearth of posts lately, but let's just say that the events of last month have completely undermined my immune system and I'm still fighting off two weeks of sinus/URI crud that the kids are bringing home. I paint a pretty picture, but life is not easy right now. But the not fun stuff isn't fun to dwell on.

I was off this past week and despite lofty goals to organize all the boxes and mess upstairs, there are still lots of boxes and a big mess upstairs (but our living area downstairs looks fabulous!). Soccer games, Halloween parades, Halloween parties at school, and helping Sicily with presentations for Nature Week, coupled with our snake Spotty Dangerous AKA Cosmic Creepers week long visit/tour at the kid's school kept me busy. Not to mention meetings with accountants and financial advisers. I did manage to squeeze in a little fun - I revisited my old (well at least for a month) residency stomping grounds - the State Crime Lab.

I spent April of 2006 at the Crime Lab - becoming acquainted with the blowflies surrounding the bodies that met their ends by nefarious means. There was a rash of crime that month - it was covered all over the evening news - so I had copious learning opportunities. Unfortunately, I was trying to cram in studying for my combined AP/CP boards in June, so I largely neglected everything but the bare essentials of performing the autopsies in the morning so I could sprawl out on the warm Spring lawn and study all afternoon. The building and grounds are beautiful, and while I would have rather been immersing myself in the fascinating study of Forensic pathology than Blood Bank and Chemistry, the proportion of Forensics on the general boards is so slight that it would not have been prudent at the time. I stopped nursing my son in early February of that year, and his demands at night coupled with daily residency demands made studying absolutely impossible, so I had a lot of catching up to do.

But it's never too late to pursue sideline passions, so I like to check in with those guys yearly. I was especially excited to go this year because one of my fellow trainees, he was a year behind me, finished his Forensic Fellowship in Alabama in June and joined the staff at our State Crime Lab this past July. I feel like I have an inside connection now. This guy isn't just one of my former attendings - he's someone I sat alongside in excruciating morning conferences being pimped, and he had a propensity for party throwing so I've spent time sharing crawfish and beer with him at his abode. When he greeted me at the locked entrance after I signed in and got a visitor's badge, I felt like I was really in.

We spent a half hour or so catching up on personal life - kids, residency, his wife who is also a doctor, and life after residency. What it was like on the government vs. private side. He just got a new scope (exactly like the one I've got - he even got the free rocket blaster!). I couldn't help admiring his spacious office with the wall of windows - it was much better than my closet in the lab basement. I finally steered the subject into my intended direction - books.

After I had exhausted his library we wandered next door to another pathologist's office and I hungrily scanned the titles while he graciously grabbed post-it's and jotted down titles and authors. Then he said, "So, do you want to see a cool case?" This is the pinnacle of pathology science nerdiness - our sharing cool cases. I grinned, "Yes! Is it the Case of the Week? The COW?" He looked at my friend from residency knowingly. "No, more like Case of the Month. Or maybe the year." I sat down at the scope, briefly encumbered by the stage clips, and apologized as I pushed back his training wheels. A lot of the best pathologists I know use the stage clips religiously, but it's too cumbersome for me - I'd rather fly by my fingers. Mechanical stage lovers argue that we miss stuff in our haste. It's an internal one-upmanship. As I threw the slide on the stage, I balked. It was the heart. I never look at the heart. But the heart isn't really tough to look at - usually you are just looking for the boxcar nuclei of hypertrophy in autopsy or rejection in surgical specimens. None of which would constitute the case of the year.

"I need a hint."

"Focus on the vessels."

"Yikes!"

I'm not sure what is really kosher to reveal, especially in an ongoing Forensics case, so I'll stop there - it's pretty obscure science nerd stuff anyway, but I enjoyed reading an accompanying article in the Journal of Forensic Pathology that illuminated the rare disorder that caused this man's demise - something that I had never heard of in all of my training. My friend, the younger pathologist, expressed his awe. "I'm not sure I would have caught that." It was an amazing find.

I left with hearty handshakes and they promised to think of me when they went to their next Forensics meeting - get me lots of free stuff to read. I can't wait to dip into my CME fund and order some new books. Maybe next time I visit I'll ask to join in on Monday Morning Rounds (they don't work over the weekend - so Monday mornings are pretty exciting). For old time's sake.

There's No Going Back

I guess this means that at 7, Sicily is officially over princesses. Wait, that happened at age 5.

While I wholeheartedly approve of her costume choice, I can't take any credit. I took her and Jack to the Halloween Express, and after a quick survey of the dizzying array of choices, I offered my guidance. Sicily looked up at me. "Mom, who are the workers? The ones in the orange shirts?"

"Yes, Sicily."

She cornered a perky college-aged orange shirt clad attendant, and proceeded to monopolize her time for thirty minutes while Jack and I looked over his choices. When she was done, I asked her if she wanted to try it on in the dressing room. "No, I'm sure I will look great."

And she does. I love the dainty foot sticking out at the bottom. She hated it - thought it ruined her image, and made me take another picture so it didn't show.

Jack and I had his costume narrowed down to a zombie and a pirate. Sicily said, "No, Jack, you want to be a ninja. See the cool weapons you can get? All the daggers and mom, what do you call those things?"

"Nunchucks, I think."

So Jack chose the ninja.

I have officially lost any semblance of control. It feels great.

Day in the Life of a Single Mother Pathologist On Call

5:10 a.m. Alarm goes off. Hit snooze.

5:20 a.m. Alarm goes off again. Get up and run.

6:45 a.m. Dressed and ready to wake kids.

7:00 a.m. Prepare breakfast - eggs, cheese toast, waffles - while kids get dressed.

7:30 a.m. Drop kids off at school and head to main hospital.

8:00 a.m. Sip morning coffee and pay bills.

8:45 a.m. Triage first few cases. I should have known it was going to be a day in the trenches when my first three cases were "scrotal mass," "hemorrhoid donut," and "sacral and ischial pressure ulcer." Hemorrhoid donut? I've heard of colon donuts - they are the margins created by the auto anastamosis thingy during surgery - but hemorrhoid donut? Not something I really want to contemplate over my morning coffee.

9:15 a.m. Get text from histo tech at GI site - "I'll have slides ready at 10:00." All 90 blocks. Big day.

9:45 a.m. Head over to GI clinic to sign out cases. Frustratedly troubleshoot computer issues I've been having all week with our drop down diagnosis, web-based sign out which is normally a dream - saves having to dictate - but is causing problems currently. Try not to take out frustrations on the extremely nice and eager new histo tech that I already love. Resolve to surrender to computer and wait until my partner comes back on Monday to help me on the relatively few problem cases.

12:00 p.m. Hit a lull in cases and decide to run to Sears to tackle the tire pressure issue that elicited a warning light I had to look up in my car manual before I walked into work - it's been on all week and I had no idea what it meant.

12:20 p.m. Deliver divorce decree to financial adviser who is splitting my residency retirement $$.

12:45 p.m. Head back to GI clinic and wolf down frozen burger with corn nuts, Planter's chipotle cashews (Yum! Their skinless olive oil and sea salt almonds are also amazing!), and a Coke Zero.

1:00 p.m. Continue GI cases.

3:00 p.m. Run to Barnes & Noble to get a few books in a series Sicily has been begging for.

3:20 p.m. Head back to main hospital to tackle rest of cases there. Learn from partner that he successfully deflected a possible apheresis procedure. I joke with him later in the evening that he jinxed me.

5:00 p.m. Finish cases and start to leave hospital. As I am walking out the door, receive a phone call from a frantic oncologist who warns me of a critically ill transfer that will probably need apheresis. Call hematology and tell them to page me when they get blood work so I can review peripheral smear. Luckily there is a Quinton in place so I don't have to call radiology.

5:15 p.m. Run to house, get Jack's prescription bottle, and call in asthma meds. Rush to pharmacy to pick up asthma meds.

6:00 p.m. Empty dishwasher. Stuff down dinner - microwave nachos with beans and Rotel. Pager goes off halfway through eating.

6:15 p.m. Head back to hospital. Call mom to see if she can meet my kids when their dad drops them off at 7:30 and get them to bed.

6:45 p.m. Shake my head in disbelief as I look at smear. Definitely a procedure tonight. Go to ICU to meet with oncologist, see patient, then back to office to perform calculations necessary for plasma exchange. Call blood bank and dialysis nurse on call. Go back to ICU to complete consult in chart and write orders.

7:45 p.m. Lull. Waiting for blood bank to thaw necessary products for procedure. What to do? Catch up on journals? Nah. Read news. No. Head back to Barnes & Noble to buy mom gift for helping out tonight, knowing I won't be home until late. I really need to buy stock. It's my fourth trip to book stores this week - other two were Wordsworth.

8:30 p.m. Back in blood bank with techs watching dejectedly as some of the FFP busts after thaw (this is common). Jokingly blame tech I have known for many years. Go over to histology to chat with night crew. Call apheresis nurse to ensure that she has completed her dialysis procedure and is getting the apheresis machine ready. Take a picture of blood bank Halloween decorations.

9:30 p.m. Walk first bag of plasma over to the ICU so the procedure can start. She greets me with a wide grin. "Now that's what I call service!"

10:00 p.m. Head home to relieve mom. Check on kids, who are thankfully sleeping, and give kisses. Thank mom for going over spelling bee words with Sicily. Quickly memorize the four words out of dozens she fumbled so we can go over them on the way to school in the morning. "Stopped." "Barefoot." "Steep." "Without."

10:15 p.m. Troubleshoot start-up procedure problems with apheresis nurse.

10:45 p.m Check back in with apheresis nurse to make sure everything is going OK.

10:50 p.m. Settle in to blog/read and stay awake until procedure is over (in a couple of hours).

TGI almost F. Except it's a call weekend. Ugghh.

Yes, it's fun to complain. But I really love my job. Nights like this are pretty exciting, considering they don't happen all that often in the pathology world. We get emergency apheresis procedures maybe every other call. Once I was unlucky enough to have three in one week - but that was pretty strange. We pathologists like our predominantly solitary microscope lives, laced with rare moments of excitement.

The Colorful Cupcakes

Check it out, if you want, over at MiM.

Only

I've never been a big fan of Nine Inch Nails.

But my amazingly musical friend, the one who makes incredible mixes - Laurie, is.

So she peppers my mixes with their songs, most of which I skip.

She went to see them in Dallas a couple of years ago, and was delighted to see Trent Reznor in her hotel corridor. I'm not sure I would even recognize him, if I saw him.

A few months ago, I was listening to one of her mixes, and I happened across a song. I forgot to skip. I listened to the words, and found myself empathizing.

I've been playing it a lot lately - in my car on the way to Conway, and on the way to the main hospital after I drop my kids off. Because there is nothing like music that can drive a wedge into a feeling that you wonder if you ever really had in the first place. After a certain period of time, it starts working.

Then there's Fiona. Sweet, savvy, smart, and scathing. Her words place a sharp boundary between the past and the present.

Not many have said it better.

Now I find myself exactly where I should be, albeit somewhere I never would have dreamed. A single mother, primary custodian for two beautiful children. Slowly coming to realize that this place, although not easy, is the perfect place for me.

Mommy Magic

I was settling Jack down for bedtime tonight, and he was distraught. Both kids got into my memorabilia boxes in the move. I gifted Sicily some old high school jewelry, and Jack got a bear claw ring that he has become attached to.

"I can't find the ring, mom. I had it last night, and I looked all over for it this morning, but it's lost."

He wandered over to his desk to sip on a glass of ice water, and I searched under the bed. Bingo. It was by the post.

"Come here, Jack. I have a surprise for you."

"What?"

"Close your eyes and hold out your hand."

He obliged, and I slipped the turquoise bear claw ring on his finger.

When he opened his eyes, he smiled so wide I thought his face would crack wide open.

"How did you find it?"

"Mommy magic."

"Really, you are really magical?"

"Yes, Jack."

"Can you make me fly?"

I cringed internally. "Well, mommy magic only works once a day."

He looked at me seriously, his smile fading to curiosity.

"You have to charge it? Overnight?"

I couldn't help laughing. "Yes. Mommy magic needs to be charged. I'll try to make you fly tomorrow."

I hope I can find the right adaptor.

Metablogging

We're bloggin' about blogging this week, over at MiM. I am learning people do it for all sorts of reasons, and am surprised how many doctor/mom's keep it anon from friends, family, and co-workers (some blog statements contributed to a job loss!). You can check out my post here, if you want.

I love that some of the mom's collected blogs and made a book out of them for their kids, to give to them later on. I would love to do that with stories about Jack and Sicily.

Fashion Show

A couple of weeks ago, my friend texted me. “Want to go to the Harvest fashion show with me?” Her babysitter was highlighting her designs at the fashion show and all of the models would be preparing at her house. Sounded like a blast. I texted yes.

So after my 3:30 massage on Saturday, I headed to her home. There were 12 girls getting make-up and hair done with music pumping in the background. Two of them were veteran models, one had booked covers, and the others were friends of the designer from church and college. They were all twenty-something – tall, slender, and beautiful. The clothes were hand-made vintage designs that took my breath away.

Most of the girls were students, and were enthralled by the house. “I work at I-hop.” “Really? I work at Friday’s.” Listening to them made me happy I was at least 17 years their senior and beyond working three jobs to supplement my lack of college income. In between gossiping and drinking a pale ale (they were drinking Franzia white zin – eww!) My friend and I took pictures and complimented them.

Make-up, pizza boxes, a fruit tray, and hair products littered the dining room table as the girls rotated from one station to another – make-up first, then hair, then to the makeshift dressing room in the sunroom. Each came out shining in outfits and ten-inch heels. I was impressed with their ability to walk steadily in them.

One girl, she had a blond pageboy and was impossibly thin, came out of the changing room with a white satin backless shirt laced with gold chains. “Can you see my pasties?”

In observation, one breast had one and the other did not. The pastie looked like a flower. It was kind of weird. Luckily, the other girls spoke up so I didn’t have to.

“It might be better if you didn’t wear them.”

“But it’s supposed to get cold tonight! I don’t want everyone to see my nipples.”

“Nipples are better than flower-shaped pasties.”

The hair stylist said, “I have some band-aids in my car. They are waterproof.”

Another model said, “I have some silicone pasties in my bag. They will look better. I’ll go get them.” They were by far the best choice for the intended concealment.

While the earlier rotators were waiting they practiced their poses they were asked to make behind the white entrance sheet draped before the runway entrance. My favorite was the Charlie’s Angel.

The twelve girls posed for our camera and we drove them down to the restaurant adjacent to the runway, buoying them with compliments as they piled out of the car. I told my friend I could seat four and was shocked when more piled into my car. I guess I had underestimated because they were unnaturally thin.

The show started 45 minutes late – plenty of time for us to wander down to the street to talk and socialize with friends we bumped into. The first strong autumn wind of the year arrived and we started shivering and used our sunglasses for eye protection from dirt and debris. All the girls looked amazing on the runway. The designer, obviously anxious during the preparation back at the house, looked calm and beautiful on the stage.

Later on my friend and I decided to skip the post-show take down at her house and headed to an Italian restaurant for wine and cannelloni. She ignored the phone calls with the area code from the college town most of the girls were residing in. “They can figure it out.” We talked about life and kids until almost midnight. I was grateful for the experience – it was unparalleled - if a little like observing aliens on a foreign planet.