Merry Christmas

I'm pretty proud of my grandma Loretta a.k.a Rett for this one. There's Uncle Tom, Aunt Sheeran, Dad, and Uncle Chuck. Aunt Peggy must not have been born yet. Pretty amazing Christmas card, don't you think?

Mom, Dad, and brother Mike recently collaborated to get thousands of pictures and documents scanned onto a disc. Some of the letters from my Dad to his family when he was away at Boy Scout camp got me all teary.

Christmas brunch casserole in fridge. Kids almost asleep. Time to wait for Santa. Jack asked me to wear a necklace he made for me out of magnetic buckeyballs (sp?) and wait on the couch for Santa Claus to come down the chimney. I asked him why, and he said, "So Santa Claus will want to marry you. You look so pretty." Ha! Can you imagine scoring Santa for a stepdad? Keep dreaming, Jack.

Merry Christmas.

Christmas Eve Eve

I just finished wrapping all my adult gifts - insert gift card into sack, fluff tissue paper - and am waiting for my night owl Cecelia to fall asleep. She is singing her favorite doll Pippi to sleep, and I hope she finishes soon so the "elves" can start wrapping kid gifts. I've got a huge buzz off of one glass of Cabernet - it's been a while so I'd better slow down if I'm going to outlast the nocturnal one.

Got my Christmas cards in the mail yesterday and addressed for 2 1/2 hours last night - oops! I only got 100 this year and for the first time in about five years I ran out. Oh well. Here are some pics that made the cut. Cecelia dubbed Jack the candy cane alien in the last one.

Despite a busy work week, and rolling into a big week of call starting Monday night, it's been a great holiday so far. One of the keys to surviving a week without kids over the holidays (next week for me), I think, is a batch of books from B&N, half of which I've already read. I plan to post a list with one word book reviews when I'm done, hopefully by next weekend. And lots of exercise, to balance out the already plentiful over indulgences (red velvet brownies with homemade cream cheese icing, gingerbread cookies, annual giant sack of homemade treats from the billing office, boxes of chocolates from friends, Dad's homemade toffee, peppermint bark, etc. etc.).

I had a blast today gifting my partners with soap. It's not just any soap, it looks like bacteria growing on a petri dish. My brother and his wife Effie sent some to me for my birthday, and if it wasn't for those two dishes of bacteria soap I would not have been very clean for the first week or so after my move in September - it took me about a week to locate the master bathroom box. I attached a typed greeting assuring my partners that if they received Klebsiella pneumonia, it meant that I thought they drank too much at the Christmas party last Friday (Klebsiella is the bug that alcoholics tend to get when they aspirate). Dr. Woods got E.Coli (or was it Salmonella?) with a special treatment - after all, I am the Director of the Micro lab so I have special micro treatment powers. He won't be needing his rocket blaster enema for a while (hee hee). My partner Michelle was ecstatic to receive Pseudomonas aeruginosa, which carries its real life characteristic "grape-like" smell. "I was hoping to get Pseudomonas, and I was so happy when I did!" God, we are such nerds. The transcriptionists were not nearly as excited about the soap as we all were ("Um, so what?). Here is an example - the E. Coli smells like honey - one of my favorites! You can find it on Etsy - just google cleaner science. They even have glow in the dark bacterial soap. No, I was not paid for this, I just think they are really cool. They are so life-like - as one partner pointed out, there are even divots in the agar simulating inoculation by the loop (he would use golf terminology).

Those that I worried would not appreciate the petri dish soap got food - sesame almond and rosemary snack mixes. I made sure to stick around until flow cytometry opened theirs so I could have a big handful. The buzz I got off running around gifting today topped the one I am currently experiencing from my glass of Cabernet. I love Christmas!

Hope you are having a fabulous holiday.

New Office

About a year and a half ago, I was told that I needed to move out of my office. The hospital is doing a staged, multi-gazillion dollar Emergency Department remodel - and my tiny corner office is slated to become a small portion of the new lab storage closet. The ED has been slowly taking over the pathology lab for the past couple of years - toxicology has moved away, the lab break room is shrinking. I've seen the pictures - the new ED is going to be incredible. A sharp contrast to our 1950's hospital lab decor, but after all, the ED is the gateway to the public, so that is where we as a hospital need to shine. The lab is never seen, so updating our environment is not a priority. Last December, I was visited by various men in suits and construction outfits, informing me in serious tones that the move was imminent.

Back in September, nine months after this hushed meeting, the men returned.

"A major contract decision was finally reached. You will probably move sometime this month. Things are going to start moving quickly now."

Luckily, they planned to build me an office before kicking me out of mine. I had several meetings with a bigwig hospital architect - picking colors of walls, floors, and desktop formica. We decided how we were going to reconvene my current desk furniture into a new longer but narrower space. They were taking up a portion of the lab test draw waiting area, an area that currently becomes fast-track ED waiting in the late afternoon/early evening. I hoped that the walls would be thick enough to block out sound. It gets kind of loud and crazy in there.

As construction began about six weeks ago, my new office became the buzz of our small pathology world. Asbestos removal necessitated an outer wall to be built around the construction, and eventually the next door office, housing part-time pathologists like jazz pianist extraordinaire Rex Bell, was evacuated. Then the procedure room, where we perform all of our fine needle aspiration biopsies (FNAs). Procedures were turfed to the fast-track ED, which is not too far away. The pathologist performing the procedures, and cytotechs assisting, were not too miffed - after all the new rooms were much more modern clinical spaces and God forbid someone actually having a medical emergency while we were sticking a 25 gauge needle into their lump or bump - well, we would have back-up help. Not that any patient has ever done anything beyond fainting, but still. As one of my senior partners says, the last doctor you want to run into if you have an actual bona fide medical emergency is a pathologist. Shortness of breath? Get a thoracic surgeon to do a VATS and we'll take a gander at the lung wedge under our scope. GI bleed? Grab the gastroenterologist and well look at whatever he finds in his endoscope. But after a few years of living inside our microscopes we are helpless at clinical-decision making beyond common sense.

About a week and a half ago, construction abruptly halted. I was summoned one morning by one of the lab administrators. Apparently, word came down from high that my new office plan was unacceptable, for reasons which I can only guess at. It was aesthetically awkward, but that doesn't seem to stop hospital construction historically. I think maybe they needed that space for ED waiting - that cutting the waiting area even 1/3 was not ideal, since the new ED might not be ready for a couple of years. My half constructed office is now planned to be torn down, the waiting area will be remodeled, and I will move to the procedure room - since we have been doing our FNA's fine for a few weeks in the ED, we will permanently shift there.

I hope they plan to remodel the procedure room, but I'll likely not hear until at least after the holidays. It is a very small space lined on one wall by ancient metal drawers and cabinets with glass doors. The walls are cinder blocks painted aged ivory. There is an old leather clinical chair bolted into the floor in the middle of the room - reminiscent of a piece in a torture or death chamber. It can be manipulated electronically but only the most seasoned cytotechs understand the cryptic levers and buttons involved in making the patient "more comfortable." I'm always afraid if I touch them I'll send the patient through the apparently asbestos-laden panels in the ceiling.

That was the hot topic of conversation at our lab Christmas party tonight - with the Rex Bell Jazz trio playing in the background and the beautiful cardiologist nurse crooning in the marble foyer of my beautiful Hispanic partner - part-tiger, part-ballerina's home. I planned to wait until my new office was completed until I blogged about it but hell, its already been over a year and who knows when it will be done. I told someone tonight that in January, they could probably open the old procedure room door and find me sitting in the torture chair with my scope on my lap, signing out cases.

Walking in Place

Big little brother Matt is back in town, and this is good because:

1) I finally have a date. Hung out with him and six of his friends tonight -- a night filled with spirits and merriment.

2) I get to indulge in my jam band side. He sent me a video he was addicted to during his law school finals last week.

The holidays have officially started. They'll hit their full groove when culinary brother Mike arrives this weekend with his fabulous sensory scientist wife Effie. I'm almost done with my Christmas shopping, and my toes are a beautiful gunmetal silver with sparkles. All set for three Christmas parties this weekend. Life doesn't get much better than this.

I hope you still smile when you're singing.

Walking the Line

Posted at MiM.

Sing Me To Sleep

Employee Phone Call - Don't Mess With This Guy's Dog

As heard by me, while I was looking at a prostate around 11:00 a.m.

"I can't really talk about this right now, I'm at work. I don't want to start yelling." This was the only normal, somewhat discreet statement in the entire hallway phone conversation.

"Don't you dare go mess with my dog, woman! You have no business going over to my house, and you cannot mess with my dog. That's my dog!"

"He has bad hair, that's all. He's got food and water, he's fine. Don't you go near him."

"What? You'd better not! Like hell! I'll call the FBI - you just think you have methamphetamine problems now, you wait, you, I'll call the law on you!"

"Don't. Mess! With! My! Dog!"

"You will not. I'll take care of your son, if you mess with my dog. That 35 year old lazy good for nothing - I'll take care of him, you wait and see. I'll take care of him for good, if you mess with my dog."

His voice faded as he exited the building. I was glad I didn't recognize it.

Meeting Baby Beckett

It has been a long time since I've been around a baby.

My best friend from medical school, Lys, delivered her second child, a son, 2 1/2 weeks ago. Her daughter Ainsley is 3 1/2 years old. I was ecstatic to plan a trip to Jonesboro this past weekend to meet him. Since I didn't have the kids, I was able to focus on her family, which was a luxury.

I spent the week picking out gifts for them all - a soft camel jacket with satin lining and a reindeer hood for Beckett, a stuffed Santa with a rainbow cap and candy glitter buttons for Ainsley, a long hammered gold necklace with variably sized chained hoops for Lys, and barley wine for Chris. I didn't even know it was called barley wine, but spent some time researching to try to find a good one - I remembered that he was well stocked. He gave me a lesson in hops on Saturday night - most of which went right over my head, but as I tasted some of his favorites, I began to glean a small understanding.

Lys looked amazing for having just delivered two weeks ago - her pre-baby jeans were hanging off of her. I laughed and warned her how skinny I got while nursing Jack. She smiled and said, "I couldn't have picked a better time to be nursing and on maternity leave - I am really going to enjoy the holidays this year." It made me remember the massive quantities I could eat while nursing - so many more calories being burned while the body is producing milk. Her husband took charge of the kids for a couple of hours Saturday night so we could enjoy Indian dinner solo, then drinks and dessert at a local restaurant/bar. I laughed watching her pack back enormous amounts of chicken vindaloo and enough naan to feed an army. Today after breakfast we ate lunch at a buffet and she had two giant plates of food - broiled shrimp, deviled eggs, veggies, fried chicken, then a large three egg omelet filled with tomatoes, mushrooms and cheese. Her hunger was rivaled only by her thirst - reminding me of sitting on the couch nursing my own kids and having that constant "I need water NOW!" feeling as if I was in the middle of the Sahara desert.

The kids were adorable. The spring in Ainsley's golden curls competed with her gymnastic legs - she is growing out of her toddler clumsiness and tumbled deftly around the house all weekend. And oh, that baby smell that Beckett exuded filled the house, but was best savored as he snuggled on my shoulder, his head resting right where I could breathe it in like a drug. I read an article in the NYTimes recently about combating bully behavior in early elementary school by having a mother and new baby visit weekly throughout the year so the children could witness and participate in the miracle of the first year of development. There is something about being around babies that brings out the good in all of us, no matter what our age. Chemicals, hormones, emotions, whatever you want to call it - it works.

While Lys and I were at dinner we discussed professional challenges. I had one of the worst days at work on Thursday that I have had in my career, so my planned trip out of town was not only a fun visit, but a much needed refuge. Working in medicine carries enormous weight and responsibility - and although we constantly thrive to do our best, mistakes happen. Even when the mistakes bear no harm to our patients we bang our heads and wonder, in our 20/20 hindsight, how in the hell they could have happened. It shakes your confidence and wrenches your guts and keeps you awake at night when it happens to you. I look around at how different people cope with 15, 20 years of experience - see all the emotional quirks that develop- and wonder how much longer I can keep all of this up and still be sane. Lys is an ophthalmologist, not a pathologist, but she could certainly empathize. When there is a complication surrounding something bearing your name and responsibility, whether or not it was your fault, your head spins into such an amazingly awful place that it threatens your sense of self. Even when you can count hundreds, even thousands of successes, it is the near misses that stand out in your head like a giant flare. I guess, in a way, it is what keeps us all in check, and makes us better at what we do.

As I drove the 2 hour drive home today, anxiously anticipating seeing my own kids and tucking them safely into bed, I listened to some new country and blues that Chris burned for me last night. I felt amazingly refreshed after the weekend in their new baby home. Looked forward to knocking out another couple of hours of SAMs, which I have done, before the new work week starts. There is very little in life that can compete with being nurtured by close friends. I am so lucky.

MOC, SAMs, and CME, Oh My!

Read it, if you want, over at MiM.