Honored

Staggs walked into my office a couple of months ago, looking quite dapper.

Staggs is my work husband/brother. We went to med school together, but I didn't know him because he was on the golf course. We did residency together. We were hired at PLA together. He's smart, and inspirational in his nonchalance. But don't tell him I said that. It will go to his head.

He was upset when I wrote a blog on MiM about LGS. "Where's my blog?"

"Don't worry Brent. You aren't just a blog. You are a whole book. War and Peace. Be patient." I smoothed his ruffled feathers. "Why are you so dressed up?"

"I'm going to see BDQ win an award today at lunch."

"Oh! I'll go too."

If anyone deserves to win an award around here, it's Brian. He has a palette on the floor of his office. He lives there, sacrificing time at home to serve the clinicians. I named this blog after a quote with him in mind.

I gathered HEP and we wandered over to the award ceremony around noon.

The hostess, an admin assistant, seemed flustered at our presence. Easy to see why, in retrospect.

We have a wonderful team of doctors at Baptist and the coordination of care is exemplary when all physicians contribute their areas of expertise to a patient's needs. 

Sometimes the most important physicians on a care team, are the quiet, dedicated, hard working doctors who work in relative obscurity - apart from the busy interchange on a hospital floor or in a physician's office. 

It is these individuals, however, who provide the critical information that will guide diagnosis and treatment - the foundation of a patient's plan of care. 

You can imagine the fear and anxiety when a patient is told there is a mass or a "lesion" that is new and that needs further work up. Immediately, a patient feels vulnerable or in shock and disbelief that then turns into a grasp for hope - a grasp for a plan so that what is shocking and ill defined can turn into something that is manageable and clear. 

At that point, a patient's diagnosis is the key to formulating a treatment plan. It is also important, however, that it provides the patient with a guidepost, a transition point to which to cling until the natural resiliency of the spirit catches

Sometimes the diagnosis is clear and the path forward is relatively easy. But many times, the intricacies and the behavior of tumors or infection can impair the process of a quick determination. It is at this point that those physicians who superbly practice the discipline of pathology transcend science to invoke its art. And the art of medicine involves rising above normal expectations to diligently study, read, ask questions, communicate and research. 

Physician colleagues recognize this unique gift in Dr. Brian Quinn and Dr. Brent Staggs. We have found that these physicians deeply care about our patients, even when they've never met them. They seem to understand that the faces we are privileged to encounter in our serious discussions merit pristine data that then leads to accurate diagnosis, treatment and prognosis. 

Though our pathologist friends handle cells and tissue and things like immunohistochemical stains and receptors, they never see our patients through the prism of tissue, but rather, by their tenacity for accuracy and by their diligence of effort to understand- even long into the night and into the weekends - they prove to us that we present to the patient an army of professionals who care about them. 

It is with great admiration and appreciation that we applaud the heart, minds and efforts of Dr. Quinn and Dr. Staggs.

It was a little uncomfortable for me and HEP, as you might imagine. We walked back to our offices reassuring each other. 

"They are the faces, the ones who like to be out front. Go to the golf tournaments, and the social events. That award was for all of us, not just them."

Dr. Bell was thoroughly displeased. "We need to have black t-shirts made, for the rest of us at PLA. They should say: SUB-PAR Pathologists."

This was an award given to the two guys who discovered Tumor Board at CARTI first. Quinn sleuthed that it was The Nightingale that wrote that speech. Beautiful. A big donation to Baptist accompanied it.

Staggs was embarrassed, and sent this e-mail.  "This was for all of us, not just me and BDQ. Thanks for being my partners."

It's nice to be appreciated. But I like the black t-shirt idea. And I don't need an award to recognize the fact that I am working my ass off. Working my ass of is reward enough. It keeps me afloat on this crazy sea of life, where it is so easy to go adrift.

Sunday Morning

Ants crawl across wooden planks
Industrious and oblivious
To the human form
Studying, smoking, observing
Half-torn between their plight
And the recesses of the sky

Blue

Is my favorite color. I know, I'm not alone.

I was signing out an oligodendroglioma today - I don't do that very often. So I had to consult the books. Peter Burger is by far my fave in this arena. He reminded me of why today.

Microscopic features: Like pornography, in the observation by Supreme Court Justice Stewart, the oligodendroglioma is easy to recognize but may be difficult to define. Although there are objective histologic features that aid in recognition, only one or two may be found in a given microsection.

We had all the features of WHO Grade III. Nuclear atypia, hypercellularity, and rare mitoses.

Isn't it beautiful? Fried egg nuclei. Arcuate capillaries. This isn't my case, I stole it off of the internet. Sent off for characteristic LOH (loss of heterozygosity) for 1p and 19q. Will be surprised if it isn't positive.

ICD-10 is going to be the death of me.

Tumor Board this morning was only remarkable for its obscure chemo meds and stellar radiology shots. But no worries, tomorrow The Nightingale is having a tumor board party at her home on Edgehill. I cannot wait. Book club follows. Did anyone else cry as hard as I did? Dunno (ha accidentally typed Cujo). Emotion is so individual.

I read an article about Halsey a year or so ago but just started listening to BADLANDS this summer. Wow. Love it all, but Colors is by far my favorite.

Disjointed

It's been a busy week full of brain frozens and surprise important micro meetings so I feel all over the map.

My new pulmonologist friend invited me to the group Style MD and it is my new addiction. Docs take selfies from Target outfits to Jimmy Choo's. "The criteria is stringent," she assured me, "you cannot get in unless you are an female M.D."

This post took me by surprise this morning.

NAME YOUR VAGINA by using the name of the last movie you watched!!

The fun lasted throughout the day and continued into this evening.

Miracle on 34th Street
Popstar!
Bad moms (that was a frequent one, and my last movie, but I chose to list my favorite one The Resurrection - that got a few likes)
Spooky Buddies
Finding Dory (lots of Millenials here I'm past this)
Zootopia (Despite being past this I LOVED this movie)
The Jungle Book
Pete's Dragon
Suicide Squad
Anthropoid
Equity
The Secret Life of Pets (LOL! Someone commented - the secret life of your kitty-kat?)
The Hangover
Home
Frozen . . . Damn. Rough month at my house. Poor hubby.
Vacation
Olympus has Fallen (commenter: ya your vag took him down!)
Daddy's Home
God's Not Dead 2
Ice Age
Air Force One
Unstoppable
Hell or High Water
Independence Day
Monsters University
Wolf on Wall Street . . . I need a wax
Hunger Games
My King
The Usual Suspects
Now You See Me
The Martian
The Big Short
Central Intelligence
Eddie the Eagle
Nine Lives
Free Willy
Deadpool
Bad News Bears
Bladerunner
Sausage Party
The Revenant
The Last of the Mohicans
Big Ass Spider
The Boat That Rocked
Mary Poppins
Star Trek Into Darkness
X-Men - perfect for the lesbian
Batman vs. Superman
Red Riding Hood
Everest
Kikis Delivery
Maya the Bee
Monty Python and the Holy Grail
The Boss
Matrix Revolutions
Diamonds are Forever
Mission Impossible
Kubo and the Two Strings???
Harry Potter and the Chamber of Secrets
Pretty in Pink
Where to Invade Next
War Dogs
The Enterprise
The Terminator
Outbreak

I think you get the idea. I'd type in funny comments but that would take all night.

Very few things make me cry really hard. I can count on one hand in adulthood. My sister tells me I bawled hysterically on the last day of our yearly family vacations to Navarre Beach, Florida, but I don't remember doing that. I remember losing it for the first time in college when I heard the Bruce Springsteen song "Johnny 99." Surprised the Hell out of my boyfriend Snake, who was driving my Jeep. It's still one of my favorite songs.

I also remember losing it in residency when my brother was really sick. Driving around and crying so hard I really should have pulled over on the side of the road. Crime Lab rotation did me in. I told the guys one day I was leaving early and headed to the River to cry all afternoon. No one wants to hear about that shit, you have to just suck it up and deal with it. I remember my ex stopping me the first week, telling me it was too much. It may be too much, but it's still there.

But since then, nothing more than a moist eye and occasional tear. So imagine my surprise when I read the last chapter of my book club book last week, The One in a Million Boy, and major waterworks. I had to rush over and lock the door of my office it was so ridiculous. Tears flying out of my eyes all over my skirt. When I collected myself, after 20 minutes or so, I texted the one who picked the book. "Have you read it yet?" "Yes." "Did it do that to you?" "No."

Picture Perfect Words

One of my Facebook friends, breast surgeon I think - maybe he is distantly related to her, posted this at the beginning of the summer. I listened, and I'm addicted. He's pretty prolific, and he's from Arkansas! All the songs are good, but I think this one is my favorite.

Ironically, my daughter loves bro country. It's what I'm subjected to whenever she is in the car. She loves good country too - but it's the current radio that she is most addicted to. So I listen. And am marveled that singers like Blake Shelton and all the others I don't know the names of are topping the charts and this guy has less than a thousand hits on Spotify; because his songs are amazing. I encourage you to listen to all of his albums. If he's not going places, this country is on crack.

Chinese God Factory

At the culmination of a weekend full of debauchery I headed to my friend's mother's house in Harrison, AR for shrimp and grits and cornbread waffles with butter and syrup and chocolate waffles with local blueberry compost and cream. I have great friends. Med school and having kids derailed this. It's nice to rekindle the friendships.

Her dad died suddenly of a heart attack in March. So devastating. He was a staunch Democrat - spent his life in public service. So nice to see the pics of them attending two Clinton inaugurations and an Obama one on the wall of his well preserved office.

Both Hillary and Bill Clinton called to express their condolences.

Yes this was going on in the office. While I'm indulging in hangover food. But the thing that really intrigued me was this.

Chinese war gods, from a Chinese war god factory. Here's a factory pic. They had them shipped from China, and had to hire movers to get them into the house.

The factory belittles it, doesn't it? A little. They had a wonderful life. Although I didn't know him well, this is  a blunted testament to his soul. For Christie.

Tumor Board

I walked in 5 minutes late. The Nightingale patted a seat beside her at the front of the room, beckoning me to join.

I sat down after getting breakfast (greek yogurt, almonds, blueberries, water, coffee) amidst the din of cases being presented. Feeling guilty for being late.

As I settled in I noticed Cid Vicious. Decided to text him.

"I woke up at 6:50." My alarm originally went off at 5:30, but I fell back asleep. When I woke up I startled and got ready in 10 minutes. Skirt. Blouse. Wash face. Drive to CARTI.

He texted back. "I woke up at 4 - I have seen 11 ICU patients, put in 3 central lines, intubated and bronched so far this AM. I am going to Chicago at noon and have to get outta here."

"Are you calling me a slacker? What's in Chicago?"

"Nothing in particular. Just going up there for baseball, eating, drinking, etc."

"At least I'll get EBUS relief." Amid more talk of patients.

"You call non diluted cases with the peacock relief?"

He had a poker face. I could not. Kept silently laughing from the front of the room. I was jealous.

"Aren't you taking her with you?"

"Yeah, we usually travel together, my wife thinks it's weird but we really enjoy each other's company."

I've met his wife, in the Kroger parking lot. Super sweet and adorable.

"Traveling with the peacock would make a really good SNL skit."

Then I presented. It went over pretty well. I even had the hard nosed thoracic surgeon engaged. Can't wait to present next week.

I was trying all day to think of texts that might have broken Cid's poker face.

"It's a good thing my leg hair is blond because I've got two days growth going on."

"My ponytailed look is not styled by product. It's grease from lack of showering."

I'll have to try harder next time. Good to have goals.

My partner at work who missed tumor board was incredulous that I didn't have time to shower. "It looks like you took an hour to get ready."

This is a granular cell tumor. It was in the arytenoid cartilage. 30 ish year old. Very subtle on frozen section, but I called it. Looks like macrophages. Never seen it in the larynx. Has a 3 (or .3?) percent malignant rate - most are B9. The clinicians were fascinated, gave lots of good advice. I've only seen it malignant once, in Conway, in the soft tissues of the buttocks. I think this one is B9, but local recurrence is a concern. The hard nosed surgeon wants a full laryngeal resection. None of the radiation oncologists had any idea of what it's response to radiation therapy might be, it's so rare. I'm not so sure I agree with resection, but it's not my granular cell tumor.

Absorbing

I fell today, on a walk. It wasn't raining when I left the house, but a steady rain accompanied me as soon as I got going so I decided to cut it short, thirty minutes instead of forty-five. The road back to my house is steep. In retrospect I should have taken a different route. I debated taking my walking shoes off, but decided to trust them. I lost my footing about thirty seconds later. Skinned the hell out of my knee.

It bled. All the way back to my house blood and rain mixed in rivulets down my leg. I laughed at my situation (who falls on a walk?) but as soon as I got to the house the adrenaline that propelled me there exited my system and I got woozy - saw stars. First sat in a chair, then laid on the carpet. Still, it bled.

When I was finally coherent enough to move, I was surprised it was still bleeding. I've never had a cut bleed for more that a half hour. It bled while I changed the laundry. It bled while I had a whiskey to beat back the pain. It bled while I read a book. It bled while I took an hour and a half nap on the couch; it stained the couch. It was still bleeding while I finished the book. I cringed while I showered to get ready for my Uncle's 70th birthday party.

I catalogue the wounds of the dead - they don't bleed. So I am unfamiliar with live blood. I applied gauze and band-aids because it was still bleeding five hours after the injury. Not profusely, just oozing. And dripping. Must have been pretty deep. Wonder I made it home.

I used baby wipes to absorb the blood. I also finished a body of work that has interrupted my planned summer reading. It was a lot to absorb. Enjoyable, but sometimes when you read you learn something about yourself that precipitates a psychic crisis. But no matter the shock, somehow your soul absorbs, and you continue.

So I continue with new knowledge. Hopefully there will be no more bloodletting. I tread carefully. Trepidatiously. Fool me once, shame on you. Fool me twice, shame on me.

Reading in Reverse

Something funny happened today.

Have you ever walked into a lecture mid-way through and have been a little confused? Like, damn I wish I had seen the beginning so I could understand what the hell he/she is talking about. But you are a trooper, a hard worker; you puzzle and struggle through it anyway and it is rewarding nonetheless.

The book I finished yesterday felt like that. So imagine my surprise when I opened a new book today and discovered the same characters! A prequel. Relieving and comical at the same time. "Now I get to learn what I should have known all along. All the inside jokes." By the way that was a helluva good book. Caught a few typos though. Maybe I was an editor in my previous life.

You have to take your shoes off. Feet grounded to the Earth. Trust yourself. Don't be in a hurry; you have plenty of time. Let me look at you, OH! You are a . . . "

I was going to the bathroom today, sitting on the toilet, and something sticking out of the tampon dispenser distracted me. An empty package of beef jerky. I suppose beef jerky can pass the time as well as anything else (books, Facebook, but really? Beef jerky?). I have always professed my hate of beef jerky but truth is, I've never tried it. They say you can't really judge something you've never tried.

9:30 a.m. 8/3/2016

"Can I come into your office?"

Who asks? No one. So much so that I've taken to locking my door at lunch, for a short reprieve. "No, please don't." Half joking, but only half. I had a tray of placentas I wanted to finish before I worked on my Q/A.

"So I heard you had a possible autopsy last week, when I (head gross room PA, former defense lawyer) was on vacation." Long silver hair. Pony tail. He was perusing my bulletin board. I felt a little invaded, probably because I just wanted to get some work done. This is the time to acquiesce, because it's not about me. I turned to him and smiled.

"Yeah, but I beat it back. No worries."

"What would you have done? I'm the only deaner. It was a staycation, I could have come in."

"Well, John (morgue assistant - last name Horn - such a smooth voice I made excuses to call him again and again - could hear Gunsmoke re-runs in the background) and I decided that we would muddle through it if we had to. I've never performed the deaner job before, but I've seen plenty. He's seen more. Fortunately we didn't have to test ourselves. If we did, we might have pissed off a funeral home, but that's secondary right?"

"How did you get out of it?"

"It took about ten phone calls, but eventually I did. Wasn't even ordered by a doc. Was a screwy EMR mix up. On some social worker form."

"Wow, that's crazy. Did they ever fix that other problem in the EMR? With mandatory autopsy request by nurses?"

"Yeah, we nipped that in the bud. Don't worry about it."