Tumor Board

The Nightingale (female oncologist): So something happened today, that has never happened before. I had a patient in my office, she was on IV Dilaudid. She was very sick, throwing up, and I tried to call in some Fentanyl to her pharmacy. The pharmacist denied it. Told me I had to have her on three days of morphine, before they approved the Fentanyl. She has metastatic cancer. She was tolerant. She needed it. She's throwing up in my office, and I'm on the phone. I'm always on the phone - insurance companies, pharmacists now? Two hours I spent trying to get her what she needed. Help?

Swagger and Sagacity (male oncologist): WHAT? Those aren't RULES SET IN STONE. They are guidelines. They are there to prevent the family practitioner from prescribing Fentanyl patches to people with backaches that have no tolerance of pain medication. To prevent them from being killed by OD'ing on Fentanyl patches. Don't let this go. You need to call the National Association, and report it.

The Nightingale: I had to admit her to the hospital, to get her what she needed.

Swagger and Sagacity: You need to tell them that because of that person's ignorance they caused unnecessary hospitalization. They need to PAY FOR IT. This is not KUMBAYA, where everyone is holding hands. We are the CAPTAIN of this SHIP, and they need to realize that.

The Nightingale: Thank you, that helps. Next case?

The Tigress (female oncologist): This is such a great space. Can we bring Mimosas? Is that allowed?

The Nightingale: I want to have a party. At my house. No really, I'm not kidding. Let's celebrate practicing the art of medicine. This space, this community, without all the financial interest noise, is combating burnout.

Swagger and Sagacity: Do you know how much this means to my patients? When I tell them I'm meeting with 15-20 great minds about their case on Thursday morning I can feel a palpable sense of relief. Hell I'm relieved, to have help with the tough cases.

I think we all are. We run through 10-15 cases in the space of an hour. They started this tumor board last October. My group learned about it three months ago, and we are permanent fixtures. About seven years ago, this space was envisioned by Jim (male oncologist), and he and I had three meetings hatching its existence. A month later he was killed in a motorcycle accident. I like to think he is watching over us, viewing the radiology, quizzing the pathologists, giving his take on treatment plans, spinning his tales (he was a writer with some local and national acclaim), and orchestrating our existence.

Cid Vicious (in between 10 pages): I'll be there.

Everyone else nods and agrees to a celebration with guarded optimism. It is 7am. We all have a long day ahead of us. And we are only on our first or second cup of coffee.

A Tribute to a Pathologist

Read it, Over at MiM.

Cid Vicious

That's my nickname for him.

He's an excellent pulmonologist, and technician. A rare and deadly combo; unprecedented for me. So good for the patient.

"Why can't I get tissue? These mediastinal nodes are huge."

"I have a theory. It's the necrosis. It's gumming up your needle. Just get a good cell block, we will get the diagnosis. Wait. Your stat case? I am worried about the patient. Is the airway compromise an issue?"

"No. No. Don't worry. Different patient. This one is fine. Totally different patient. Probably benign. He's fine too. His airway compromise is chronic. Old big bad goiter. It's ok."

So why the hell is it stat. Sigh.

"I think it's malignant, but I need the cell block. May need stains. Can you be patient?"

"He's ok. Don't worry. Thanks for your help here."

"Don't forget to get cultures. Mostly blood, but I think I see a granuloma. Are you done with me? I need to get to my cases."

"Go. I'm just going to get fluid from the pleura. I don't need you anymore."

Passing Angel

When I was sixteen years old I was enamored with a friend I met volunteering at Camp Aldersgate. Her name, Kallie Byrd, was befitting; she sang like one. She was incredibly beautiful and bold in ways I could only imagine myself to be. We would drive around in my Jeep on nights and weekends off like we ruled the world.

I don't remember how she met Brent - must have been in a bar singing, maybe one night with Tim Sullivan, one night with Steve Christie, another night there he was. I like to imagine I was with her. He was short and stocky with a cherubic face and a constant twinkle in his blue eyes. When he sang I got goose bumps, and it wasn't long before they tumbled into love despite an 8-10 year age discrepancy.

I cannot count the number of times I heard him sing - probably in the hundreds. I remember one particular haunt - My Friend's Place in Levy, Arkansas near his small white house where we would drink wine after the show until the middle of the night, talking about our dreams and our pasts. The sun was shining through the trees overhanging the deck that was built like a treehouse on this early Friday afternoon and he took the stage with the swagger of a professional. Stormy Monday was one of his best songs. I wish I had cell phone footage to share here the but technology at the time renders me incapable of sharing anything but my memories.

Kallie and I would drive back and forth from her house in Allen,TX to my house in Little Rock, AR that summer. We haunted bars in Plano, playing pool and flirting with boys after she got off work waiting tables at The Mustang. I'm not sure if that was the name of the high end bar, but I remember the large bronze Mustang statues out front that I would stare at while I waited for her to be free so we could claim the night.

She invited me to their wedding in Phoenix, AZ. I flew there and was startled by the desert air; how fast water dried from my skin. I'd never been to that part of the country. Either before or after the wedding at her parent's home we drove to the Grand Canyon. I was amazed with how rapid the landscape changed - from forest to desert. Sedona was stunning. We arrived at the Grand Canyon just as the sun went down and toasted their union.

When I got married she already had her daughter Annie Laura. Life circumstances tore our friendship asunder but we periodically kept in touch. Last year we reunited on Facebook after a long hiatus. I remember her sharing her daughter's youtube channel. I watched one night. It was haunting and thrilling; her daughter being the same age as as Kallie was when I met her. Looking and sounding incredibly similar. I still some nights will pull it up and watch it. It's like I'm sixteen years old again staring at my sun.

When I talked to Kallie last fall she told me that Brent had died. I think he was in his early 50's. I felt profoundly sad, but also incredibly lucky to have been a witness to all the good and light that was peaking in him at the time of their love for each other. Their marriage did not last long, but what they created will forever tell the tale of their hearts. I can't wait to meet the adult Annie Laura. Looks like Kallie has done an amazing job. I'd expect no less of one of my best friends on the planet.

Like a River

Favorite Movie of All Time

Everyone has one. I watched this tonight for the first time in over 20 years. Tears.

The Prophet

I was researching something, a couple of weeks ago. About something. Some things are something.

I came across a guy, Khalil Gibran, who wrote a tome called The Prophet.

He influenced John Lennon on The White Album. Also Johnny Cash, and David Bowie.

I ordered the book.

And read it on my vacation.

Your worldview is mostly fixed, at 42. But great literature can shift that. Glacially, but importantly.

This is the kind of poetry that does that. I might read it again in a year, and shift again. Incrementally, but importantly.

Here is my favorite quote.

Life, and all that lives, is conceived in the mist, and not in the crystal.
And who knows but a crystal is mist in decay?

Summer Solstice

Waves break

Under the Full Moon

Kinetic pools of silver

Gateways to ancient depths

Buried secrets 

Omnipresent

HEATHEN

I'm a self described one. So it surprised me when this song helped me through a dark time. My brother was having health problems, back before I even had kids.  This song, coupled with the Arkansas River, got me through.

My sister is a devout Christian. She practices the faith we grew up in - Catholicism. She blows me away with her wisdom and strength.

There are many paths to the divine, and who am I to judge which one is correct. They all have truth. I tell my daughter that faith is a journey, and we all have our own path. I love watching her discover her own; it's truly magical.

Awful-topsy

Autopsies aren't so awful when you only do them once every couple of years. A lot better than getting slammed with five in one day on autopsy rotation in residency.

I was surprised on Monday - I was up, my turn, and even though it blew a hole in my already busy double workload on call I wished I had dressed even more carefully for the occasion. The morgue, the smells, the ritual, the discovery - it reminded me of returning to a Catholic mass.

When you are in residency, autopsy is largely an academic endeavor. We don't need it - radiology and ever advancing labs render the ritual archaic. But every once in a while, as in this case, the clinician needs an answer. This makes the exercise more meaningful. To be surprised by the interior of the body, to discover things no one else could find, to aid in closure for the family and the clinician, lends light and art back to a profession being squashed by insurance companies, administrators, and pharmaceutical corporations.

I've had three twelve hour days in a row and tomorrow, after morning tumor board, I will have the highest case load in my ten years of practice. To be stretched is exhausting and rewarding. Tonight I got to take my kids out to dinner - Cecelia and I shopped afterwards while Jack and S played video games at the movie theater. Stepmom dropped the kids off at work around 4:30 while I was in the middle of a complicated brain frozen - they hung out in my office and waited for me.

I sent them to Boulevard with my debit card to charm my friend Mercy who works there so I could finish the work that was leftover. When they got back I asked if anyone wanted to go with me to the gross room and radiology - my end of the day sweep on call to make sure it was ok to go home.

C: "No mom. Gross. It's the gross room."

J: "I want to go! I want to see a brain."

He held my hand and as we walked down the hallway. I tried to protect the PA on call from Jack's desires - she has a one-year-old waiting at home, but she was all caught up and happy to retrieve a brain from a bucket. She laid it out on the gross station. I put gloves on and took over.

"This is the cortex. This is where a lot of our conscious thought arises from, as well as our feelings. Here is the brainstem. It is responsible for making sure we take breaths, so if it is damaged it might end a life. Here is the cerebellum. Balance. Gait."

I'm not sure if he was paying much attention. He was finding his own set of gloves. He had a mission.

"I want to touch it Mom. But I'm scared."

I massaged it with my hands. "Don't be scared, Jack. It's here for us to learn. There's no person here. Just a brain. Our bodies are vessels for our souls, and there is no soul left here, it's moved on."

He held out his finger and placed it on a gyrus on the left cerebral surface. There was a prominent vessel running through the adjacent sulcus. I watched him experience the moment, and retract with pride.

Empire Of The Sun Soundtrack - Suo Gan

Ok, here we go. That new version was blowing me away last night. But here is the first time I heard it - in one of my all time favorite movies. I'm pretty sure that wasn't Christian Bale's voice, but it still brought tears to my eyes. I need to show that movie to my kids, before they fly the coop.

Charlotte Church - Suo Gan, Live (2001)

Charlotte Church - Suo Gan, Live (2001)


I can't figure out how to embed this. Just youtube. You won't regret it.

Siouxsie & the Banshees - Burn-up

This was my favorite album in 1988. I think I was 15. Egyptian blues rock; amazing. The one song that made the radio is my least favorite song. I love this song - it is a preparation for war song.

The French Version is So Much Better

It Doesn't Have to be a Freaking Haiku

Tonight I sleep bathed in the ocean
Tossed upon my skin
By an ancient dolphin tail.

Les Miserables - Samantha Barks - On My Own (lyrics) (Full Verison)