I stepped onto the hospital elevator today between two people. The woman on my left wore a white short coat and a nutritionist name tag. The man on my right carried a tray of fancy desserts. They stared at the front wall in silence. The door closed.
The woman said, "--- went to get her shots today. She was by herself."
I wasn't sure who she was talking to at first. Me? She talked so low I almost didn't hear her. Then the man on my right grunted in acknowledgment. They knew each other, I surmised.
We rode the rest of the way down two floors in silence. The elevator stopped. A bell dinged. The doors started to open.
Woman on left: "--- attempted suicide last night. She is in the hospital."
Man on my right: "For real?"
It was as much of a statement as a question. We walked our separate ways.
I went down to the basement with my partners to a reception today. It was reminiscent of the one two weeks ago where we grouped together and traveled down in a pack to attend a farewell reception for the CEO of our hospital - he had been working there for over 30 years. I went to high school with his daughter. Today it was time to usher in the new CEO and COO.
The mood again was festive. We are so busy we rarely have time to get together. We joked and laughed as we took the stairs to the ground floor and walked through the cafeteria to the reception hall. We had planned a time earlier in the day - I was the ringleader calling and reminding everyone of the 4:30 event.
As we walked in it was immediately apparent that the crowd was smaller, but the event was still young. Our goal was to mingle and dole out our congratulations then get back to work. I was trying to find the new COO - I used to live down the street from him - he is a boyishly handsome man with a nice smile that shows in his eyes more than his mouth. I located him and noticed with a partner that he wasn't as surrounded as the new CEO. "Let's go surround him" I said, and marched in his direction. My partner agreed and followed me.
As I walked up to shake his hand and congratulate him he introduced the guy standing next to him, who frankly dwarfed him and myself and most of the room. "Of course you know Keith Jackson." I was within less than a foot of him, and cranked my head up to peer into his face. I tried to place him but couldn't, and I felt embarrassed. Where should I know him from? I hadn't seen him around work. I smiled and shook his hand and introduced myself. My megalomaniac sports loving partner and jazz musician laughed behind me. "You really don't know who this guy is, do you?" He apologized to the man. "She doesn't know sports at all. Please forgive her."
Then my close girlfriend partner walked up and unknowingly added salt to the wounds. She reached out to him to introduce herself and shake his hand. "I don't follow sports and I'm not from Arkansas but I of course know who you are and it is my great pleasure to meet you." I was dumbfounded and chagrined. I started laughing, what else could I do?
He was so calm and gracious in his reaction to my ignorance. "Around here I am known best for being my Mother's son. She worked here for 30 years. It is a pleasure to be here and to meet you." He turned to my partner. "I'm happy to meet you too. Where are you from?" She smiled and told him, "Virginia Beach."
On the way out the door, after we greeted and congratulated and ushered in the CEO, my jazz/sports partner was laughing so hard he was annoying me. "I hate these things but that was so worth it. I can't believe you had no idea who he was." I replied, "Well, I don't know sports at all. I feel bad that I didn't represent." He said, "Oh, don't worry, he is pretty laid back, I'm sure you didn't ruffle his feathers. But did you notice the Superbowl ring on his hand?" Ribbing me, laughing again.
"So I guess that means he is/was a football player?"
Last night in Boston: In this contest, everyone is a winner.
First we made up ice cream company names. Effie was the judge, so she was exempt.
Then we started the creating process.
Caption: The Template
Effie brought home some new Baskin Robbins flavors from her food scientist job at their headquarters. I would tell you the names but then I'd have to kill you because they have yet to be released. No matter though, we had lots of toppings from the local ice cream store and Whole Foods to make them our own.
Caption: Jack scooping
Caption: Jack stirring. Notice the repeated arm blur. All action.
Caption: Cecelia creating Schlag. That's the fancy name for homemade whipped cream (Uncle Mike taught us that)
Caption: It's a collaboration, not a competition (Um, Cecelia? Uncle Mike?)
Then we showcased our creations.
Caption: Giz's Creation from the company Dancing Daisies Ice Dream. It is a mixture of birthday cake (loosely) ice cream with cookie dough, Japanese rocket candy Effie brought from a trip (think best rock candy you ever had) and maraschino cherries. The inspiration was Uni Kitty from The Lego Movie. Winning Category: Texture
Caption: Jack won for appearance. Bits of waffle cone butter cookies graced vanilla ice cream dotted with mini chocolate chips. His company name was Freezer Overpowered.
Caption: Uncle Mike won for darn I forgot. Because I hate to lose anything to him. His company was Fabulous Frozen Foam aka My Three Schlags. I'm going to screw this up royally, but he flavored schlag in three different amazing ways and did some caramelized sauce that smelled and tasted incredible over vanilla ice cream. He is a freaking trained chef and food scientist so he had a big handicap. We made him work only with his feet. Kidding.
Caption: Cecelia's OMG!!!!Brainfreeze trademarked creation. The oreo cookie schlag on top was good, but the ice cream mixed with natural peanut butter and oreo cookie bits and mini Reese's pieces stole the taste category. I gained five pounds on this trip darn you all and swam a mile yesterday to try to begin to burn it off.
It was the best last night of a trip I've ever had. And the fullest. What's a competition without a subsequent gorge?
Last year, my boyfriend and I were completing a 20 mile bike ride on a Saturday and I got a phone call. My kids were the last ones left at their week long summer camp. I thought the pick up date was Sunday. We sped like banshees to retrieve them almost two hours after the last campers left - they were mad we had returned so soon they were soaking up the one on one attention from the staff and the Lord of the Flies atmosphere of having the solo run of their camp.
This year was a big time crunch. I arrived 5 hours late from Boston Thursday night, and had to prepare them for camp before drop off on Saturday at 3. We needed lots of errands and packing. I group texted a Peds mom and an OB mom Saturday morning - their kids, friends of ours, are also going to camp this week.
Me: Happy Camp Day! What time is your drop off? Ours is 3:00. Just wondering if I'm going to see you there.
Peds mom: We are dropping at the same time. We usually meet at this parking lot at 1:30 to caravan. You guys game?
Me: Sound great! See you there.
Peds mom: Peds spouse and I are both working clinic today. We have a lot of packing to do.
Me, alarmed: Oh my good luck. We are doing Target run do you need anything last minute?
Peds mom: Two loofahs. That is a huge help! You rock!
Me (laughing at the term she used that we call bath scrubs with C): That is on my list too no prob. I'll drop on your porch.
OB mom: Sounds good! We will see you tomorrow.
Me: OMG I thought it was today ha ha whew I can breathe.
Peds mom: At least you are ready for tomorrow!
Stepmom on phone after hearing my mess up: Ha better day early than day late like last year:)
Peds mom today: Hey Giz - it's today!
Me: Oh no I dropped them off in the night. Where the heck were y'all at 1:30 am in that parking lot.
Caption: Captain Jack in his bunk with his Minecraft Trunk
My trip to Boston to visit bro Mike and his amazing wife Effie was so full and wonderful I'm going to have to dole it out slowly.
Caption: Photo of George Washington Statue I thought was Paul Revere
We took the train into Boston last Sunday to eat at Sportello (my daughter still remembers the amazing pasta from two years ago) and wander around the parks and shops downtown. Advantage of Little Rock over Boston: there are bathrooms they let you use in the stores. You don't have to go to that one Starbucks two blocks away and stand in line for 30 minutes to use a bathroom that disgustingly rivals the worst back town gas station bathroom you have ever been to. Good for Starbucks though - after that long wait you are willing to wait another 30 minutes for a coffee to wake you back up so you can shop some more.
Wandering around a park - I dunno which there were people riding swan boats and statues of George Washington (that I mistakenly thought was Paul Revere until I read the plaque), we encountered lots of birds. The kids were fascinated but not so much Aunt Effie. "I don't like the birds they freak me out. They are so unpredictable." So my son took it upon himself to chase all birds out of Effie's way for the entire trip. The Bird Protector, we called him, even though the Aunt Effie Protector might have been more accurate.
Caption: Jack waiting on pasta at Sportello
He really got into his role for the rest of the trip. On our last night we went to The Shake Shack - my foodie bro gave me all of the back history. After our burgers and dogs and fries we headed back to the car. Jack spotted two small birds and ran screaming and waving his arms to clear the way for Effie. We all smiled at the spectacle.
Me: "Jack, you are The Bird Protector. Thank you for doing your job."
Mike: "Yes, it's nice to have a break. When Jack is not around that's my job."
Me and Cecelia laughed at the thought of Uncle Mike screaming and chasing the birds away from Effie.
Effie, laughing: "It's true, he does that for me. It's a little weird, but he and I don't worry about anyone else's opinion but our own."
I'm taking a few days off with my kids to head Northeast to visit Uncle Effie and Aunt Mike. Sometimes I accidentally say this, to my kids amusement.
I'll leave you with this.
I encounter this on my walk from the doctor's parking deck to the super high security wave a magic card to open the heavy back entrance lab door into work each day. What is this even called? I have no idea. An electronic arm. A gateway. Once, when I was really angry, I imagined I might rip it from its anchor and whack something (a bowling ball? a giant boulder? the person I am pissed at?) all the way to another planet.
Sometimes, when I am leaving work, I am texting and forget it is there and almost bump into it. Often it is up, and I don't have to worry about that. Occasionally, I will be walking along oblivious, see it coming down in my peripheral vision and scatter frantically out of the way. Would it really hit me or does that anchor have the sensitivity to avoid objects? And if it does how big does the object have to be? Am I big enough?
Once I had a pretty near miss that left my heart pounding. I imagined myself sprawled out on the asphalt. Now that would be dumb way to die. And an embarrassing way to be discovered dead.
I love my job, so I like walking into work. But they way out to the parking deck, especially on a Friday before a week of vacation, is always a little bit brighter.
Conversation between me and the kids in the car. I was driving (duh), Jack was in the front seat playing his ipad game, Cecelia was in the back seat.
Jack: Mom, why can't we spend the night at your house?
Me: It's Daddy and Miss Rachel's week. I just got you for quick dinner, walk through new house before closing, and ordering camp trunks. I've got to go home and prepare for Breast Conference. It's early in the morning - 7:00 - I would have to get you up super early anyway so I could get there on time. You like to sleep in in the summer. I'll see you Friday to pack for our vacation.
Jack: Mommy, you know how flying pigs are good look.
Me(?): No, I'm not sure what that means. Is that a part of your game you are playing? Do they have good looking flying pigs?
Cecelia: No mom, good LUCK.
Me: Oh! I didn't know flying pigs were good luck either. You'll have to explain that to me, but good luck makes more sense than good look.
Jack: Why do you have to present at a conference on rest? What is a Rest Conference?
Me: No, not rest, breast.
Jack: Oh. What is that conference about?
Me: Well, it runs about like any other doctor conference, sort of. It's me and lots of docs and nurses. The surgeons present the history of the patient, and the problem. Usually it's a breast tumor like cancer. Then the radiologist shows the pictures on a light box - kind of like X-rays. Not a picture of the patient, but of the problem in the breast. We all gather around and take a close look. Then the surgeon talks about what they did during surgery, and then it's my turn. I show pictures we take of the slides, talking about the cancer. Pictures of the things I see in my microscope. Then the oncologists - that's the doctor that is in charge of treating the cancer, talks about how they are or plan to treat the patient. It's a learning thing for all of us. It's good to know what everyone is doing in these hard cases. It helps the patients.
Jack: So Mom, are you a Big Time Doctor?
Me, laughing: Well, yes Jack, I'm pretty big time. I solve puzzles all day long. The puzzles I solve are the key to getting the patient good treatment. It's pretty fun. But sometimes the doctors call all day long wanting to know the answers for their patients. I feel popular, which is kind of cool, and I don't tell them this, but it's frustrating when I have so much work to do. But I really enjoy talking to them because I usually learn things that help me be a better doctor. They are only calling because they care big time about their patients.
Jack: These flying pigs are really good luck.
I love this album. It came out in 1987 - but I didn't discover it until 1990. Made it to Lollapalooza twice in Dallas to see them live during college. The first was probably it's inaugural year. The second time I went the Beastie Boys were there and it was raining hard but no one cared the mosh pits were muddy and intense and even though I was only brave enough to grace the outskirts of those pits I felt like I was at the Center of the Universe and time had no meaning outside the pulse of the music.
I was looking at a fluid of a 93 year old man. Checking out his H&P in medical records to see if there was anything important I might need to know. I came across this sentence at the end of the Plan.
"He indicated that he wants to be a Do Not Hesitate status. We will respect his wishes."
It was obvious from the rest of the note that the doctor meant Do Not Resuscitate. What an ultimate autocorrect - I thought.
If I ever end up on a gurney in the ED with no capability to communicate I am saying it here and now so everyone knows:
My status is Do Not Hesitate.
At least until I get my kids a little farther along in life. Unless it's a hopeless case, of course. I don't want to be a in a gorked out state for an extended period of time no thank you.
Me: Will you look at this and agree with me? I think it's a REAH (Respiratory Epitheliod Adenomatoid Hamartoma).
Partner a few hours later: I agree with you. I had to look it up. I've never seen or heard of a REAH.
Me: I haven't either in real life. As you saw they are really rare. I learned about it in residency from great attending now at Cleveland Clinic that we send cases to all the time. It took me 15 minutes to find it I knew what it was right when I saw it but I couldn't remember what it was called. I got hung up looking up Pulmonary things in the ENT WHO index.
Partner: Well that's what it is.
Me: Me and Dr. Woods used to drive Cleveland Clinic doc crazy with our abbrevations. It was so fun. For example when we were surgical pathology fellows we would write on the working draft of a case DHUT, or tell him it was D-HUT. He said what the heck is D-HUT what are you talking about. Duh, we would say, ductal hyperplasia of the usual type in the breast (A common B9 entity).
Partner: That's funny.
Me: We loved aggravating him. He is so smart and unflappable it was a big challenge to get a rise out of him. But Dr. Woods and I, we love a challenge, so we rose to the occasion.
I swam a mile on Saturday - first time to exercise by swimming in years. It felt amazing. I am still sore.
Last week at work I was talking to a criminal defense lawyer turned path assistant - his time with my group predates my own. He tells cool stories. We were waiting for a frozen. We started on music, and that somehow turned into a David Lynch love fest. While emerging from that mutually beneficial intellectual undertaking, he recommended "Even Cowgirls Get the Blues" directed by Gus Van Sant. I told him I remembered wanting to see it based on the previews but it got such poor ratings I never got around to it. His reply, "Well, the critics often get it wrong. Because most people are stupid. You need to watch it." I did tonight. It was bizarre and amazing. And (surprise) dedicated to my childhood heart throb - River Phoenix.
I'm excited to turn over the call pager tomorrow morning.
I'm closing on a new house Friday. I haven't managed to sell mine yet. Anyone want to buy a house?
I love wearing band t-shirts and frayed, torn jean shorts and edgy snake sandals and bumping into school moms at fancy grocery stores. Will she still allow her kid to play with mine? I think so based on our conversation. Who cares, really.
Is how long my Internet went out for yesterday at work. I have been there seven years - that was a first. It was crippling. Couldn't dictate, look up medical records, do any web-based reporting. I was flummoxed.
I called computer services. Twice. The phone rang 20 times - that never happens. No answer. I decided it was Armageddon. I called our lab IT person who I try not to bug about these issues unless I am in crisis or I think it is a reporting program problem (her specialty). She came down within 5 minutes and burst into my office.
"I would have been here quicker but the electronic door wasn't working and I had to walk all the way around. I think it's somehow related." She too tried to call IT, she plugged and unplugged my network connection, but no dice. She called a co-worker.
"Dr. Shyder is completely cut off from the network. No signal. She might as well be dead to our system." She listened then exited my office to problem solve. I was a little excited that my phone call generated such a flurry of activity. When I have problems with the Internet at home I can't get anyone on the phone for hours. I depend on my 9 year old to help. Since it makes a difference between him playing his web based games or not, he's got it all figured out.
I worked on cases and pulled out my pen to make notes on the working drafts. I took a phone call from a physician. As I was chatting about a case the IT person popped her head in my door. During my wait I had repeatedly been trying to get on the internet and about two seconds before the door opened I got online. I felt like I had just busted through a brick wall into an oasis. Sigh of relief.
I told the clinician to hold for a second and put the phone down. I told her, "I'm on!" She replied with an explanation of the problem - network connection, closet in a room, that's about all I got out of it. If I don't really understand something I don't let it occupy too much space in my head. I smiled, gave her a thumbs up, and resumed my phone conversation.
I remember there was a brief problem with the EMR a few weeks ago that caused patients to be left on tables in radiology too long, meds not given, surgeries postponed - general hospital chaos. It is fearfully distasteful food for thought.
Was an incredibly painful place to be. But ultimately productive. I guess you could call me a match veteran. Two years out, I can finally turn the battle scars into comedy.
If I told you about every miserable coffee date I could fill up a book. But I thought I might turn it into a series. Weave the stories into my blog.
You could weed a lot of the guys out by their pictures. Shirtless guys next to their boat. Guys in camo toting guns bigger than their torso. Creepy guys who didn't post a pic at all (faceless shadow men) but wrote you tomes as if they knew you.
This guy I had already nixed. He took a selfie (before that term became mainstream) in front of his mirror in a wife beater shirt with a backwards ball cap. Sure he had a nice face and some impressive guns but still. You get a lot of messages to which there is no response. This was one of them.
"Hey good lookin wanna do somethin here's my digits text me don't call I'm usually busy at work at my gym but I'll get back 2 U when I can and we can set somethin up."
I walked into the doctor's lounge for my afternoon coffee, well, second afternoon coffee before the third on the way out the door to a school meeting at 5:30 - there were storms last night and Jack was up scared and the power went out and I didn't sleep much at all and had to take a cold shower and it's a busy call and a stressful week but who's complaining? Not me. The kids ate with their dad and stepmom tonight so I had a lovely nap after dinner on the couch.
I smiled to see one of my favorite hospitalists on her cell phone. I don't see her very often - she's all over the place, but she was the chief resident of internal medicine when I was a med student so I've known her for a long time. She's incredibly fashionable and always wears the season well - it is summer so she had on a bright pink coral dress and cute kitten heels. I recognized her by her platinum blonde straight hair even though her back was turned.
All of a sudden she said in her loud vivacious high-pitched eternally optimistic voice that fills up any room or corridor she graces, "Do you happen to carry Schlitz Beer in a bottle?"
Normally when a doctor is on the cell phone in a lounge there are hushed tones and serious doctor words being uttered or important commands barked. The three other male doctors in the room, in addition to myself, burst into laughter. She finished her conversation, her voice dwindling in disappointment. Doctor at Table said, as she hung up the phone, "Do they even make that anymore?"
She laughed. "Well, it's really hard to find." I had come around to the mini fridge for a touch of milk to cut the bitterness of my coffee, but not enough for a color change. It's a constant struggle to get this right balance. She turned to me, smiled, and winked. "It's Luke's favorite beer, you know Luke? I'm always trying to find it for him."
I have no idea who Luke is, even though she said his last name. I just nodded and smiled as she dialed another number. She was the center of attention standing there in the middle of the lounge. She said it again, "Do you happen to carry Shlitz Beer in a bottle?" Her audience smiled and Doctor on Couch asked, "Do you have all of the liquor stores in Little Rock on speed dial or what?"
She giggled and pulled the phone away from her ear, whispering conspiratorially in his direction, but loud enough so we could all hear, "No no, this is New Orleans. I've already tried all of Little Rock."
Doctor on Couch got up and walked over to her as she hung up. She was again disappointed, but cheerily so. I thought this girl isn't going to stop even if she has to dial New York City. She and the doc started chatting about a mutual patient and walking out the door. She smiled as she passed me, "Anything for Luke, right?" I wished her good luck. I thought that Luke sure is a lucky guy, whoever he is.
I picked up one of oh about 40 cases today. This was an easy one - one slide. The specimen name is always written in all caps, so it screams at you. PANCREAS. ANTRUM. ESOPHAGOGASTRECTOMY. This was a new one for me. I laughed and called the path assistant on the report.
Me: Do you remember that case you grossed in over the weekend? Thromb rrhoids?
Path Assistant: I guess that's an abbreviation for thrombosed hemorrhoids. It sounded like the name of a giant exotic drum.
Me: It certainly looks like hemorrhoids. Focally clotted. I guess you are right.
I was talking to a partner later about a consult on the phone. He's less than 40 feet away but on a busy call day with lots of frozens it's easier to pick up the phone. I decided to pick his brain about my new specimen.
Me: Have you heard this one before?
Partner: I think there is a band with that name.
Me: Really? I'll have to look that up.
Partner: Their first album was "Rectal Heartbeat"
Me: Ok now I know you are pulling my leg.
Partner: Are you still planning on going to that molecular urology dinner at fancy restaurant's wine cellar tonight?
Maleficent was incredible. Yes the effects were sometimes a bit child-like and seemed to be repeated/pirated from other movies. Aren't they all. But the story was amazing and the slow-pacing was refreshing in this age of manic kid movies. It's nice for villains to be recognized for the heroes they truly are. And even if Angelina Jolie plays a similar hard character over and over, she is such a real life badass that I can buy into it - the few movies of hers I actually see. I filled my kids in with her recent headlines - championing against using abuse of women as a war tactic. Also my daughter with remote headlines - her arguable but personally defensive decision for a double mastectomy based on her family history and genetic predisposition to breast cancer. The movie story, while predictable, still brought tears to my eyes in one scene (and laughter when I caught my daughter watching me fill with emotion and roll her eyes). Go see it or rent it.
Sometimes the critics get it right.
How to Train Your Dragon 2. We re-watched How to Train Your Dragon this morning in preparation, despite having seen it twice five years ago. It might have been better than the first. At least equal.
Jack turned 9 last month. His dream was to be the scientist at his birthday party.
Embarrassingly, I tried to set up a home visit from a scientist - any scientist - who would take care of it. The experiments, the ingredients, anything to make my life easier. Luckily, my efforts went to no avail.
A week before the birthday party we scrambled. A science teacher at his school told me about Steve Spangler science. I highly recommend the website. We searched for a few experiments that required little more than household items to perform. Jack and Cecelia planned the performance. My boyfriend and I spent an entire day accruing the materials. When they day came, there was a little anxiety as we had not really had time to practice. We made homemade slime to give out as party favors. We did a mini home version of elephant's toothpaste. There was a dry ice segment. It was a small crowd - maybe 15 or 20 at the most. It was comical and impressive and extemporaneous and perfect.
Jack doing colored tornado experiment. Notice the LED balloons in the background on the shelves. His Taekwondo jacket doubled as a science lab coat.
Cecelia was the dry ice queen
Jack and Cecelia performing the soap bubble dry ice segment
I've been covering at the smaller hospital outside of Little Rock this week. Nice drive and change of pace, but new challenges.
Different EMR. Wider range of responsibilities. I always appreciate my secretary/transcriptionists in LR when I come here, because I field a lot more phone calls that they shield me from at the big hospital. I got really frustrated yesterday when I got a third phone call before 1 pm from Dr. Hothead's nurse. I do not know how to look up the status of molecular studies ordered here. We are short staffed. You said at 8 to get it by the end of the day is 1 really your end of the day because I'm just getting started (I didn't say that, but she was pushy and I pushed back). Can I please just finish this radical prostatectomy I started an hour ago before I problem solve for you (I didn't say this either. No matter. Apparently no I cannot finish my case I have to respond to you immediately. That's ok. I'm adaptable).
So I answered the phone at 9 am today with my guard up.
Recorded male phone voice: "Congratulations! You have just won $3,000 in grocery coupons. And this is your lucky day; it comes with a free medical alert system. (Repeat, repeat). If you want to find out more about this incredible offer, press 1. If you want to be removed from our exclusive phone list, press 2."
I usually hang up on these things, but this was a new one for me, and my lack of responsibility to do something for someone was liberating. I pressed 2. I laughed and stared out the window then went back to triaging my GI biopsies.
