Tuesday, October 25, 2016


Dr. Music: Yes, S.E.?

He calls me S.E. Cupp, ever since I got my blended bifocals in February for presbyopia. I don't have cable, had to google her.

Me: Help. Endobronchial lesion. Bland as hell. Ordered some stains, no hits. I'm stumped.

Three hours later. Most consults like to tell you what they think. This guy likes to play attending. I'm used to it. His expertise is almost worth it.

Dr. Music (barging in my office): So what do you think this is?

Me: Well not sure. Bland endobronchial lesion. Obviously ruled out carcinoid and low grade adeno, my best thoughts. What do you think?

Dr. Music: It's obviously prostate cancer, and he has a history.

Me: Um, well, I guess that fits histologically, but I've never seen it metastasize there. History? Oops I missed that. Had like 8 diagnostics this morning. I'll throw on a PSA and PAP. Surely you saw the history before you figured that out?

Dr. Music: No. I thought of prostate cancer right away. (Barges out the door).

5 minutes later phone rings.

Me: Hello?

Dr. Music: Didn't you have Dr. Ancient at the VA? If you paid attention you would have known what this is.

Me: Yes I had Dr. Ancient.

Dr. Music: Dr. Ancient taught us that there are three cancers that metastasize as endobronchial lesions. Melanoma. Renal cell carcinoma. Prostate adenocarcinoma.

Me: Well, but . . .

Dr. Music: You would have known what this was right away if you were paying any attention at all in residency.

With all due respect to the great Dr. Ancient, by the time I was his resident he was Dr. Over Ancient. For example, once he gave an unknown conference where every single unknown for the entire hour was small cell carcinoma. We residents vacillated between alarm, amusement, and pity. But Dr. Music didn't let me get a word in edgewise to tell him about that.

Me: I've never seen any of those cancers manifest as endobronchial lesions. And I doubt I'll see it again in the next 15 years. But don't worry, you are burning it into my brain today. I won't forget.

Dr. Music: Good! You'd better think of that next time. I've done my duty here.

Next morning PSA (prostate specific antigen) and PAP lit up like a Christmas tree. I didn't text Dr. Music to let him know he was right. He's already a megalomaniac, as evidenced by the nickname given to him by the secretaries.

Friday, October 21, 2016


Secretary: Dr. Shyder a woman called and wants you to look at her mom's case. She needs an expert.

Me: No, what? Are you sure? She probably wants her mom's case to be sent out to be reviewed by an expert. Did you get her mom's name? A case number? How do I look her up?

Secretary: No. She was talking so fast. I only got a number.

Secretary #2: I'll call the number and try to get more information for you.

Me: Thanks. Weird. No rush on that.

Later in the afternoon.

Secretary #2: Dr. Shyder you're not going to believe this. She's from another state. Her mom's death was ruled a suicide. She googled and found you as the expert. She wants you to review the case because she believes it was a homicide.

Me: ?? Give me a little bit of time to figure this out.

Post in PMG pathology. Get lots of advice. Most pertinent:

I'm Priya Banerjee. Please refer her to me. Autopsymd@gmail.com. www.anchorforensicpathology.com. I'll evaluate the case, and even if she doesn't like my assessment I'll be objective.

Me: Secretary #2 will you please call her back and tell her I'm not an expert in forensic pathology but this doc is and she can call her for a second opinion?

Glad to know there is someone out there I can use if I ever have trouble with a death and need an independent evaluation.

Sunday, October 16, 2016

Infection Control

Head nurse #1: It's the food! It's a big problem. Not the patients, but the families. I walked into the SICU the other day and Subway everywhere! Hello people, would you eat out of a toilet? No! So don't eat in an intensive care setting.

Head nurse #2: I fielded a complaint the other day from a guy who said his wife got C.Diff. from our hospital. She wasn't even a patient here.

Head nurse #3: Was she visiting someone?

Head nurse#2: Yes, some in-law.

Head nurse #1: I'll bet she brought in Subway!! Not our fault.

Head nurse #4: It's a shift issue. One person will acquiesce, and the family will think they can bring in food all the time. We are very strict about it in the NICU.

Head nurse #1: It should't be just a nursing issue. They need to get the guest service representatives to help us reinforce the rules.

Head nurse #2: I also got a complaint from a guy who said his wife had to sleep on the bathroom floor. That's a choice, in my opinion.

Wednesday, October 12, 2016

Enterobius Vermicularis

Secretary: You have a call from OB.

OB: Can I talk to you about this case? What I saw?

Me: Oh yeah, there's some foreign material in your cervical biopsy. I was wondering if it was plant? I mean weird, never seen that, but I've heard of people sticking veggies up there?

OB: No this was a white spot on the cervix. It was wriggling around. Freaked me out. I've been consulting and googling all week. Could it be pinworm?

Me: Oh. Not sure. Only seen that once in appendix in residency. I'll pull the case and google image. Can I text you?

OB: Please. If it is pinworm, I need to treat her.

Me: Help consult. Weird story. (I relayed as he looked at slide - told him I was thinking carrot maybe?).

Dr. Music: I agree. I would have thought plant too. But yes, this is pinworm. I'm guessing why you are thinking of carrot. Personal experience, maybe?

Me: Hell no. I've heard of it but . . . not that I will ever convince you.

Dr. Music: I hesitate to say this but. With the carrot. Are you ever thinking, What's up doc?

Me: Post to PMG pathology. Get smart path girls take.

Much ewww and vomiting emojis.

NB: Love this! We see pinworm in vaginas all the time in peds path.

Me: Yes I can see that from poor wiping hygiene, but adults? Never.

Path girl#1: Anal to vaginal intercourse maybe?

Me: I guess, double dipping?

Path girl#2: They come out at night and party in the perineum. The drunk ones accidentally return through the wrong hole.

Path girl #3: I was a med student in Miami. Labor and delivery. Tons of pinworms coming out during delivery.

Me: NO! My moving parasites memories consist of only maggots on BKA! If I knew that knowledge would have resulted from this post I would have refrained.

Enterobius Vermicularis. If you google image Pinworm, it fits. I wonder if the cervix is as itchy as the anus purportedly is. Scotch tape test might be a little harder to do way up there.

Friday, October 7, 2016

Just Because

Public Service Announcement: Do not drop a Yeti cup on your big toe, unless you enjoy it being blue, purple, and yellow.

I weigh daily religiously. Lifelong habit. Somehow I stopped in May and didn't again until September. I GAINED 21 POUNDS!! Where did you put it? Asked my partner. I don't know! But my pants sure don't fit. Or the shorts I bought last Spring. How does anyone gain that much weight in one summer? I guess, as the old saying goes, fat and happy. But I'm not buying all new clothes so I'm determined to lose it. I'm down 7 lb. from my high point, but still not even halfway there. Dieting is hard! I researched macros and read Thinner Leaner Stronger but I just cannot pay that much attention to my food - weighing and all. So I got the Weight Watchers app and researched the points of all the foods so I could know how much carbs to skip in order to get in my nightly wine. I got into some shorts today - real ones not just the only pair of workout shorts I fit into. I'm so happy. And I think this Plexus thing I've been doing for two months will help eventually once I get past the detox and the constant feeling that I have fuzzy mold growing all around my mouth (Is that a side effect? I asked Kalina. Um, not one I heard of). On the plus side, that is an appetite suppressant.

Shirley Jackson's autobiographies are like reading a 1950's housewife version of David Sedaris. Yesterday I laughed so hard one one chapter of Life Among the Savages I almost cried.

I had four days off this week, planning to get a book chapter done I haven't started on even though I've known about it since March, and it's still not happened. Well, a little in my head. But I've got until Nov. 4 deadline. I'll be out of town then, so hoping to write it next weekend when I'm on call. I never really get creative unless I've got lots of pressure.

We adopted a new kitten. One of my Facebook friends had four black kittens show up under her house and posted them for adoption. She put ribbons around their neck - pink, purple, blue and green to id them. Thursday night we adopted Pink, and the name stuck. Cecelia wanted to call her Harambe or Baby Frances after Dirty Dancing but she was outnumbered. We did agree to put Babypink on the name tag to placate her, but she's really just Pink. Love that on Breast Cancer Awareness month, which I am especially aware of this month.  She's adorable!! I rescued Katybell as an adolescent so haven't had much experience with kittens. Jack and I spent all afternoon playing with her.

Here's to lazy weekends and kittens and homemade chocolate chip pumpkin muffins (I know it sounds terrible but they are addictive, at least the two bites of one I am allotted daily) and Jack's new friend playing air hockey and the piano downstairs tonight and my awesome Halloween decorations and my currents author addiction Shirley Jackson, who is about to gain my full attention.