Tuesday, January 31, 2017

Tumor Board

Oncologist: I have this guy. He had Diffuse Large B Cell Lymphoma in his spine. I treated it with CHOP. Now he has back pain. I called the insurance company, to get a PET. They said no. I told them emphatically that it was the standard of care. There was no beating around the bushes. They said, "We will not pay for that."

Thoracic surgeon: At least they were honest. They told you right away, instead of giving you a fifteen minute song and dance saying the same thing but all the while wasting the hell out of your time.

Oncologist: But still, where does that leave us? Luckily this is a man of means. We are working hard to find the least expensive pay out of pocket PET scan. We shouldn't be reduced to doing this. Any advice?

The silence was palpable. No wonder physician suicide rate is higher now than any other profession. I feel guilty - I get to hide behind my scope. I'm only accountable to the clinicians who hang on my diagnoses. They have to face the patients. And the patients, if not already screwed, are about to be royally fucked.

Monday, January 30, 2017

Sunday School

I led yesterday, tasked a few weeks before to speak about the Woman's March on Washington.

I started by reading a private essay I wrote last fall, a piece I am particularly proud of. I hadn't practiced, only hatched the idea, so I was unprepared for how much my voice shook in the beginning. But by the middle, I had gained my voice and finished strong. This was my tribe, this group of women - ones I only met last summer but would now walk through a raging fire to save each of their lives. Some I know better than others, but I'm confident that will change over time.

I spoke about the March - the hope and solidarity that for the first time filled a void that was created by the presidential election. I concluded by opening the floor to sharing. Some women spoke about being surrounded by white males in their jobs. By becoming slowly aware that the "locker room talk" that is taken for granted in our society is not normal, or respectful. When it is something you grow up in, something that is accepted by society, you tend to fall victim to it being the norm.

One woman spoke of her volunteer work for PATH. I asked, "What is PATH?"

"It stands for Partners Against Trafficking of Humans. There is an office in Little Rock, but there is no sign on the door, no identifier. I help women who have been trafficked by giving them financial counseling. Girls here in Arkansas."

Made sense. She started the bank account for our group, and takes up collections each week. She is one of the organizers. And she is a single mom to a handsome kindergartner. The pictures of his new beagle puppy she got him for Christmas lit up my Facebook like a Christmas tree. Single mom. Career woman. Volunteer. All of these women are rock stars.

"The frustrating thing is that the pimps get little to no punishment when they are caught by the law. They prey on high school students. They are trained to identify the girls that have low self esteem,  the one's without good family support. They shower them with attention, then plow them with drugs to introduce them into a life of prostitution. They also bring them in from Mexico. They are leaving the drug business in droves to do this. A drug is a commodity that can be sold only once. A girl can be sold over and over. It's basic economics. One girl I talked to spoke of being sold 60 times a day."

How is that possible, we wondered aloud. I calculated a twelve hour day would require being sold every 12 minutes. But if drugged, a girl could easily work 24 hours. And what's this business about building a wall? Let's just incarcerate these scumbags for life and that might solve some of our "supposed" inflow issues. Such a double standard. In many ways more than just this.

"The girl's lives are ruined. Their perps get a slap on the wrist. It's not fair. Only a small percentage get back into life and climb out. The vast majority confront financial problems, PTSD, and social ostracization. They go back to the only life they know - the only thing that obliterates the pain - drugs and prostitution." At least we have come far enough that the girls are being prosecuted less and less for the crime of prostitution, and finally seen as victims in the eyes of the law.

"I think we need to end the hour. I want to hear more about PATH, though. I think you" - I looked to my left - "said you would say the ending prayer for me?"

She led the prayer and we adjourned slowly. Many girls offered me much appreciated hugs and words of encouragement. One of the girls who came in late asked where she could read the essay she missed - I handed her my copy. Another wanted to know if she could have a copy to read to her son.

Today over lunch I found the website for PATH and listened to the video - my eyes welled up. I donated a couple hundred dollars immediately, and was thankful I knew someone on the inside who might present an opportunity to help in other ways.

Sunday, January 29, 2017

Narrow Misses, Part 6?

I listened to Sinead O'Conner's first album over and over senior year of high school. I had a friend ask me who that bald chic was I was listening too - it was before she went mainstream. I loved Mandinka, and Nothing Compares 2 U. But my favorite song was Last Day of Our Acquaintance - loved the arc of the song, how it started slow and ended in crescendo. Those lyrics. Little did I know it would serve me well 20 years later when I was getting divorced.

That same friend years later marveled when a singer I recommended to her, Alanis Morissette, blew up a few months after I introduced the music to her. "You always seem to know who is going to get big, before they get big. How do you do that?" There's plenty of stuff I liked that never got big, was my response.

Me and Kallie (different friend) used to spend summers after high school riding around in my Jeep, often clad in little more than bikini tops and cutoff jean shorts. By this time Sinead O'Conner was big, and Nothing Compares 2 U was played ad nauseum on the radio station. We penned an alternate version, which we sang at the top of our lungs whenever it came on. I'm thinking of it because when I was at the grocery store today (alt title box of food with cheezy 90's hits pumped into the background) I heard Nothing Compares 2 U for the first time in a while. I guess it's not on Spotify b/c it was written by Prince - I checked on the way home. But I'll never forget our version.

It's been 7 hours and 15 days
Since you took your dick away
I go out every night and sleep all day
Since you took your dick away
Since you've been gone I can fuck whoever I want
I can sleep with whomever I choose
I can eat my dick in a fancy restaurant
But nothing, no nothing can take away these blues
Cause no dick compares
No dick compares
To yours

It's been so lonely without your dick
Like a bird without a song
Nothing can stop these lonely tears from falling
Tell me baby, where did I go wrong
I can put my lips around every dick I see
But they only remind me of yours
I went to the doctor and guess what he told me guess what he told me
He said girl you better stop having fun no matter what you do
But he's a dick
Cause no dick compares, no dick compares to yours

All the flowers that you planted mama
In the backyard
All died and went away (we faltered here, I must admit)
I know that living with you baby was always hard
So I'm willing to give it another try
Cause no dick compares, no dick compares, to yours.

Crass and salty, I know. We were pretty young. Once we were in said Jeep and bikini tops - white wine zinfandel (cringe) in the cup holders, singing and laughing. The hard top and soft top were back in a garage. All of a sudden Kallie screamed.

"What happened?"

"This guy in the car next to us, he's jacking off."

"No. Gross. He wishes."

"I'm serious. Look."

I really didn't want to see. I saw his face only, he was about thirty something and staring straight at us, I took her on faith. I slammed on the brakes, and he slowed down too. I gunned the engine - it was a four lane highway, and he sped up to catch us.

I looked at Kallie. "Hold on, I'm going to lose him."

I've gotten one speeding ticket in my life - I was very pregnant with C going 55 in a 35 down Evergreen, according to the cop. On my way to work at UAMS. But I've been lucky. I remember going on off campus lunch senior year down Napa Valley to Andy's in my Oldsmobile Toronado convertible multiple times topping 80. I watched my Dad in his Jaguar heading to Florida for vacation topping 110 when I held the lucky front seat in the rotation. Like father like daughter. Despite being stopped a couple of times, I always managed to talk my way out of a ticket. I can play vapid blonde to my advantage - used that many times in different situations. I can't deny there are perks to being blonde.

I pushed the limits of my Jeep and managed to escape that pervert. Kallie and I laughed and sang when we lost the creep.

Thursday, January 26, 2017

Gross Room

I was called at about 11:30 a.m. "It's a peritoneal biopsy. Dr. Surgeon. She's got a history of cancer - had most of her bowel removed. I guess they are looking for more."

"Ok I'll come over." I walked to the gross room from my office.

"Here, the slide is already done."

"What type of cancer?"

"Not sure I'll look it up for you."

I look at the slide. Macrophages, no cancer. Unless - signet ring cell can masquerade as macrophages.

"Did you find a cancer type?"

"Mucinous adenocarcinoma."

Good. This isn't that. I called the surgeon on the bat phone. "No cancer. Looks like treatment related changes. Macrophages gather in infection, but based on the history, I favor the former. You can culture it of you like."

J: "We've got another frozen. Gyn/onc."

I walked over to look at the uterus.

"He already opened it."

"It looks benign. Easy case. I'll just hang out while you freeze it. Looks like you had fun in Nashville last weekend, J!"

I'd seen a pic of her and her four girlfriends standing on the bar at Coyote Ugly on Facebook.

"Ugh, too much fun. I'm having my New Year's resolution late. Calming down for a bit. It was really fun. We were in this one bar, and there was a girl perched up on a stool - she was overlooking the whole bar and just strumming her guitar and singing. It was so cool."

"That reminds me of the time I went to New Orleans for New Year's Eve. With a bunch of high school friends, but we were already in college. They were all 21, but I was still 19. Luckily the drinking age in NOLA at the time was 18. The streets were so crowded we had to hold hands moving from bar to bar, to avoid getting lost in the sea of people. We girls, about half of our crowd, decided to go to a strip bar. We had never been, and it took us some time to find a male strip bar. When we walked in, there were girls perched on platforms hung by chains over the bar. They were very scantily clad - tassels and thongs. We were shocked, but marched on through to the back of the bar where stripping men were promised. It was just one guy - he was in a snakeskin bikini - is that what you call it on men? I've no idea. Haven't been to a strip bar before or since. Except this one, but I'll tell you about that later. Anyway, he was skinny as shit. No muscles at all. Just dancing to this lame music, it was pathetic. We sat down and ordered a pitcher of beer just to see if anything better happened. It didn't."

"Was there anyone else in there?"

"No, well, maybe four or five people. Most of the tables were empty. Finally we decided to get out of there but took a group trip to the bathroom first. Oh. My slide is ready. I'll tell you the rest later."

Bat phone to gyn/onc OR. "Benign endometrial polyp."

J: "There is another frozen. Another peritoneal biopsy from that cancer case."

"I guess they want to hold me hostage until noon. Ok. So anyway, we went to the bathroom. There was this woman in there, super pudgy, she was bawling. Like the happy well adjusted empathic college kids we were, we surrounded her and hugged her. Asked her what was wrong. She told us that her husband was stripping out there, to make money. She hated that other women were ogling him. She was miserable that he had to do that for her and the baby. We were taken aback, but assured her that we were leaving the bar - we assured her emphatically and truthfully that we would not be ogling her husband - and told her that everything would be ok."

"That's crazy."

"I know right? It was like Jack Sprat the stripper on stage and his wife dejected in the bathroom. Put a damper on the college kids seeking the stripper experience. One good thing, though - my friend brought one of her college friends. She was blond, and resembled me a little. She had two driver's licenses for some reason, one was lost then found. So she gave me her ID to use as a fake - I had fake's all through college since I didn't turn 21 until after I graduated and this one lasted the longest. It was from Oklahoma. Her name was Cindy Cox - sounded like a stripper name to me. I was her for over a year in Arkansas, until I got lulled into complacency and one night a smart bouncer at Juanita's caught me tipsy and daydreaming and tripped me up on the address I had memorized by heart. He also looked into my eyes. Realized that mine were blue, and hers were green. No other bouncer ever bothered to check that. He confiscated that ID, and left me scrambling. Is that other slide ready?"

"Here it is."

I put it under the scope. Called the OR. "Recurrent metastatic mucinous adenocarcinoma."

Dr. Surgeon: "Really? Ok, thanks."

I walked back into the gross room from the scope room.

"Thanks for all your help guys. I'm going to get some soup."

This album was a fave of mine in high school. I wore it out. Was fascinated how it could run from synth pop to arresting ballads to creepy chants that when learned could transform into a droning lullaby; a backdrop to the drudgery of life. I never knew anyone else who listened to Yaz, until I read Rob Sheffield's Love is a Mix Tape about 7 years ago. It's a memoir about his first wife who died prematurely. I think they enjoyed this album as much as I did. And they were way more creative with Zima, I was super jealous.

Wednesday, January 25, 2017


I binge-watched the Mary Tyler Moore Show in college. So I'm a little sad today. Oh well.

Is this Armageddon? It seems like it is, every time you open the news.

David Brooks, who has garnered my suspicion and disregard in the past, is now dead to me. I will not longer click on a single opinion piece of his. White elitist academic male cliche. How dare he write the opinion he did this week. I enjoyed watching a Slate writer take him out. Life is more simple, when you toss out the undesirables. And the longer you live, the more of those there are.

Happy almost Thursday.

Tuesday, January 24, 2017

Planes, Trains, and Automobiles

At 4:00 p.m. on Sunday we were crushed into a corner of Reagan airport, trying to board. It took over an hour later than planned. We stood in a throng of people, pussyhats and Make America Great hats side by side. I recognized a YouTube sensation - young guys were approaching her begging for selfies.

Me: Look at her. I recognize her from Trevor Noah. She's a conservative idiot. I can't remember her name.

S: Who is she?

Me: I'm not sure, but she's big. Look at her, she's gorgeous. Every middle American teenager's wet dream.

Leave it to me to find my least favorite celebrity in an airport. Tomi Lahren, I later found out on google. Luckily she boarded the plane to Salt Lake City; we were headed to Atlanta. Slower than we thought.

After we boarded, we were grounded due to bad weather in Atlanta. The pilot was nice and transparent: He walked down the aisle and took selfies with the passengers. He explained we had to de-plane due to the Passenger's Bill of Rights - they couldn't keep us on the plane more than two hours. I had developed an excruciating stomachache, the likes of which I hadn't had in over six months. I knew I just had to lay down for 30 minutes, but that wouldn't happen until 4am. I didn't know that at the time - it was only about 6:30 p.m. and we watched airport passengers hungrily devour the victory of the Atlanta Falcons over the Green Bay Packers before we boarded again.

Pilot: After we made it to the tarmac. "We are grounded again. We have to wait."

So we did. I read, all the while a knife twisting in my belly. Angry at the white privileged girl behind me who chronicled her saga as if it were hers alone loudly to her parents and friends over and over while we waited. We finally took off around 10 p.m.

When we landed in Atlanta the gate we were supposed to approach was occupied. Garnering many choice words from the captain. Grounding us for another hour before we found another gate in F. This is as far away as you can get from B, where our connection to Little Rock was.

But we walked, and we made the connection. Seems that plane was having mechanical problems, and they found another plane that promised to take off, so we waited. Took the tram, me lying down miserably on the back bench hoping for relief that never came. More waiting at the gate. Finally we boarded at 1 am. I looked at the line to the Delta help phones, 500 people deep, and at all of the overnight strays sleeping at will wherever they could. Thought I was going to be more lucky than them. I was wrong, but I didn't figure that out until 3 a.m.

They boarded us, manically, at 2 a.m. Asked and received praise and thanks, prematurely I thought at the time with an eye roll to my husband. I was right. The plane had no fuel. There was no longer staff to administer the fuel. The pilot was running up against his 14 hour flight limit. Time ran out, and he canceled the flight.

After 5 phone calls we found the last room at an airport Marriott hotel. Walked a mile to get out of the airport - the trams were dead - and took a cab to the hotel. I couldn't help noticing all the strays making camp for the night - in between the "fast" walkways. It looked like the End of Days.

Despite the angry people in the hotel - seems they were promised a room by Delta but there were none to be had - security was on hand to contain them - we made it to the last room in the large high rise. Finally I was able to relax and get over my stomachache. Fell asleep at five. Woke at nine to be put on standby for CT. Had to call in for the first time for work in over 10 years. I was chagrined. "I'm in Atlanta. Won't be there today. Couldn't catch a flight until way too late. I've rented a car and am going to drive back, so I can take my call and be there tomorrow."

"Don't worry - it's a light day. We will take care of it. Safe travels."

Women's March on Washington

Read it, over at MiM.

Wednesday, January 18, 2017


Worth every penny. Y'all. That bass.

Tuesday, January 17, 2017

Gunshot Wound to the Abdomen

I called Dr. Woods on the intercom.

Me: So I have this specimen full of hemorrhage: kidney and most of the colon and small bowel. Requisition says gunshot. I open the EMR for the clinical, thinking I would be seeing some street war story. Instead, this 40 something year old guy was taking sleeping pills, and shot himself in the abdomen. He doesn't remember, but it was self-inflicted. Apparently the wife was taking sleeping pills too, and doesn't remember anything either.

Dr. Woods: I think they were taking more than sleeping pills.

Me: Doesn't the story seem fishy to you?

Dr. Woods: It certainly could have been the wife.

Me: So was it a cover up? Would she have shot him and convinced him in his compromised state that he did it to himself? Was he defending her? Or was she pulling the wool over his eyes?

Dr. Woods: It was most certainly the wife. The wives are always fiendish.

Me: Fiendish wives almost always have a reason for their behavior.

Monday, January 16, 2017

Andalusian Horses

I was at a birthday party in the back room of Ciao Baci tonight, from 5:30-7. The party girl is an OB I know through my kids.

She repeatedly introduced us to each other, when a new girl entered the room. "She's my divorce guru." I'm a divorce guru, I guess. She's turning 37 - the same age I was when I got divorced. I remember, because I put my birthdate on Match.com and that's what turned up. I was honest, which is more that I can say for this one guy I met, who was about ten years beyond his stated age.

We had lunch at Pizza Cafe. He was obviously hung up on his ex. She raised Andalusian horses. He was a bronze Olympian medalist, swimming I think, in a former life. Now he was IT, working on his Master's degree. He had Allport's syndrome, so was very hard of hearing and had kidney issues. Was also sterile, so when his wife got pregnant, the marriage was over.

We had a few phone calls after the lunch, but things fizzled quickly. Once there was a tornado alarm and I was sheltering under the stairs. We talked. He was also hung up on another ex-girlfriend - a single mom with two girls. He had once rescued them from a tree falling on their house - he liked to tell the story. He seemed to want me to be afraid, and to want to be rescued.

"Aren't you scared? There's a tornado alarm. Do you need me to come over?"

"No, I'm not scared. I'm fine. If you need someone to rescue, you are knocking on the wrong door. Go back to your ex-girlfriend. It was nice talking to you."

I sat in between a beautiful ENT to my left and my friend's OB partner to my right. The OB announced, midway through cocktails and appetizers, "Just look at all the talent in this room. There is unlimited potential here. OB, psychologists, ENT, yoga instructors, cRNA's, we can get anything done with the people collected in this room. This is power!"

"I can do autopsies, when you all die."

Love pulling that party trick.

Sunday, January 15, 2017

Centering Prayer

The guest speaker at Sunday school was - let's just call it like it is - a freaking badass.

She has three kids under five. She went to Harvard and works at Stephen's. She has worked with refugees in Africa. She has studied in Indian ashrams. She knows my new orthopod friend from book club - we bonded over that before class started.

She told a little of her story. She studied hard, and got to her goal, only to realize that her goal sucked. So she learned about centering prayer. The Catholics dug it up, it's like Buddhist meditation, but the Episcopal's have been responsible for knocking it out of the ballpark lately. There's a place of silence on Chenal Valley Road, called the House of Prayer, inviting anyone from any faith to worship. She knows the people that started it. She shared a little of her own hardships in life - we all have them, and it gave her street cred. So when she asked us to meditate in silence for five minutes, we were all, albeit somewhat reluctantly, game.

"Here's what I do. I just meditate in silence. Once we start, sounds that are happening that we all aren't aware of will come into focus. The clock ticking. Someone walking by outside the door. Our job is to let all that go. I use a word - my word is Jesus. But it isn't like a chant. It's more like a word to ground me when my mind is wandering - thinking about the grocery list or what I'm going to do about dinner. It centers me."

We started. One of the founders of the group pulled out her mediation app and set if for five minutes. A gong went off, and there we went.

Last week, our guest speaker was a gritty divorce lawyer who was also a healer and a practitioner of Qigong. She was amazing. After everyone left, she told me I held all my stress in my lower back. So I told her about my premature pregnancy and having to find a chiropractor to move again. Then she looked me straight in the eye.

"You have had some major emotional trauma lately. Your lungs are fine, but you have pleuritis. What happened?"

I told her about New Year's Day. "It was one week ago to this hour. I'm walking a lot on the treadmill, doing as much yoga as I can, trying to open things up because I feel closed and shut down and sick. Monday and Tuesday were hell, but I feel like I'm back in the game."

"Can I tell you about a mediation that can help you? When you breathe in, breathe white light. Make it hot. Not so hot that it causes pain, but hot enough to burn that shit out. You've got to burn it, or it will never go away."

So when a gong sounded this week, and our five minutes were over, we shared about our experiences. Some said - "That five minutes seemed like thirty." Others said, "that was the hardest thing I've ever done in my life."

I said, "When I was a teenager, I had bad stomachaches. A counselor once told me when I got them I should lay down and breathe. Pretend I was breathing in white healing light, and target it to my stomach. Then breathe out the pain - make it a color. I chose red. It helped - the breathing, the color imagery. My five minutes seemed like one second. I used color imagery - used white light to target not physical but spiritual pain. It felt like it was working."

Guest speaker: I love that. It doesn't have to be a word - imagery can work too. I've heard of some people that use imagery in their centering prayer. It's been great to be here. I've never been asked to share, and speak about this before. This is a first for me, I hope not a last.

Saturday, January 14, 2017

Doc Mom Book Club

Oncologist's house, 2:30-5:00pm. I got the book pic, since I hosted the last one. A Man Called Ove. We were discussing how he stuck to his principles. Knew how to fix things. Breast radiologist raved about her grandparents, who grew up poor. They couldn't call an electrician or a plumber when something went wrong - so they figured out how to fix it. We were all getting worked up telling our stories.

Breast radiologist: And my son is going to learn how to drive a manual transmission! I've been looking for a car for two years, and finally bought one this week. Took peds to my right for a spin this week.

Peds: It was incredible.

Me: Ok, you've set the bar too high. No manual for me, I never even learned that.

Breast radiologist: I had very specific specifications. I wanted a manual, but also with heated seats and a back up mirror. I wanted a car made in America - that didn't exist two years ago. I test drove everything. The Subaru (something something) was nice but Car Talk says their (something) craps out at 40,000 miles. I didn't want that. I got a Ford Focus ST. Only 4,000 made.

Orthopedic Surgeon: OHH! What color? What horsepower?

The rest of us were watching in awe and amazement.

Breast rad: 350 horsepower. White.

Me: You are talking a language I don't speak.

My path partner: I'm pretty sure the Range Rover I bought my husband doesn't have that much horsepower.

Breast rad: My brothers turbo engines and build drones on the weekends. This is my lineage. Here, want to see a pic?

Orhopod: Look at those rims!!

Me: What are rims?

Breast rad: I got new tires since that pic. Ordered them on the internet, and my husband put them on last night. I don't have a pic with the new tires, but here is a pic of the tires I ordered.

Everyone: Oooh. Aaaah. Nice. Understated. Elegant.

Breast rad: So I was driving it yesterday, and a Subaru (something something - hell give me credit for memorizing the name of her car) pulled up next to me. He was looking over, I thought he was challenging me to a race. I'm like DUDE! No fair. I'm boxed in. No contest. Then I really looked, and he was giving me the sign.

She held up her hands with thumb and first finger in a circle, the last three fingers extending upwards. Universal sign, even underwater when scuba diving, for I'm ok. Or you are ok.

Breast rad: He knew how awesome my car was, and he approved! Y'ALL! I'm in the club!!!!

Orthopod (she has a two and a one year old. Irish twins. A tiny circle of hell. She's about ten years younger that the rest of us - from Chicago. Husband from the South Side - he's anesthesia. She regaled us with a hilarious story of a rented minivan and road trip to Chicago for Thanksgiving that ended with her flying back with the kids and her husband driving the minivan home alone. We all remembered those days): Can I tell you my recipe for lemon curd in a blender? It's divine. It's my grandmother's.

My path partner: You mean you don't use gelatin?

Orthopod: No, the butter does the trick. You don't need gelatin.

Friday, January 13, 2017

Narrow Misses, Part 5

Me: Here's the cases. The pleural fluid is full of signet ring cell gastric carcinoma. Mucicarmine lit up like a Christmas tree. After you look I'd like them back, to show the cytotechs.

I pull the earplugs from my ears to be able to hear her.

Me: Sorry, I forgot these were in. Drilling started around noon. Surprised me, it's been a few weeks. Driving me crazy. Luckily I got most of my work done before it started.

Dr. Earnest (I say this in the kindest light - I was Dr. Earnest my first five years here. I recognize myself in her, and she makes me happy): I know right? I hear this knocking, from this vent in the ceiling, every day. It's unpredictable, but it's daily. It's like there is someone living up there, constantly reminding me of their presence. Every once and a while a shower of dirt and dust will descend upon my desk from the vent. There's something going on in there. I'm convinced someone lives up there.

Me: I'm glad you alerted me of the gastric cancer. Signet ring cells look exactly like normal mesothelial cells, on cytology. A week ago he didn't have the diagnosis, and I just thought they looked a little atypical. I called the oncologist, and amended my report. Metastatic cancer will make a huge difference in staging, prognosis, and treatment.

Signet ring cell carcinoma is the sneakiest cancer of the lot. Everyone has a story to tell, of how they missed it. Dr. Earnest alerted me not only of my miss, but another seasoned pathologist missed it in an earlier gastric biopsy (1mm lit up on immunos. We all would have missed it on morphology). Luckily all of these specimens were taken within two weeks of each other. No harm to the patient.

Reminded me of myself, two years in, discovering a mesothelioma that three other senior pathologists had called negative. Again, normal time frame - no harm to the patient, but still. Gives you the shakes, knowing there are cancers out there that elude our routine evaluation. Still, we argue, it's not reasonable to stain every normal appearing tissue to look for something we will only come across once every five years. The money spent in stains would be a ridiculous waste to the system. It's a hard balance between being thorough and correct, and being judicious with the tools we have on hand. In my experience, as long as we are in good communication with our fellow clinicians, we will get the right diagnosis in time to start treatment, despite occasionally falling victim to the morphology that betrays us.

Thursday, January 12, 2017

Cold Moon

Bronch #1 - hilar nodes.

Me: Blood. Still blood. More blood.

Cyd Vicious: Fuck. I thought I could get it.

Me: This slide is still blood.

Cyd: I'm done.

Me: She seemed like a tough patient. Coughing, talking.

Cyd: That shouldn't have affected anything.

Bronch #2 - hilar nodes.

Me: Metastatic poorly diff adenocarcinoma. Doesn't look like colon, unless it is poorly diff. When colon goes to the lung, it usually retains it's architecture. Picket fence nuclei. Dirty necrosis. This is ugly and clean as a whistle.

Cyd: He doesn't just have colon cancer. There's lung too.

Me: Oh! I didn't know that. Could be ugly lung. Get a good cell block so I can stain it up.

Cyd to nurses: I need to get to the contralateral node and see what's going on.

My tech (not hearing about the contralateral node): Are you done with us?

Cyd: Sure, I'll just put the rest in cell block.

Me: Are you sure? I can stick around. It's 15 minutes until my lunch (garner guffaws from the nurses and respiratory therapists).

Cyd looks up from the procedure into my eyes.

Me: I'll stay. No problem. That's what I'm here for.

Cyd: Ok, sure. Sure.

Me: Lots of lymphs, heterogeneous, and no cancer. This is a great sample. I think the contralateral side is clean.

Cyd: Ok. That's what I thought. Makes a big difference. Thank you.

I walked out of the bronch lab, mind on Boulevard Soup. Vietnamese Hot Pot today, I discovered when I got there. It felt good, having my time valued by an esteemed colleague. Many lesser clinicians take three times as much of our time for granted. It made me feel light and ever willing to stay in the fight.

The Cold Moon is also called the Wolf Moon. It is one of the longest Full Moons, as nights in January are long and dark. It is both painful and transformative.

Wednesday, January 11, 2017


Someone knocked on my office door at 2:15 this afternoon, and popped in.

Me: Oh, hi! Ramona! Come in. Hang on, let me get off the phone, and down from this chair.

I was talking on speaker phone to my financial advisor. "I have to go - can I call you back? It's someone I don't see very often."

Ramona: What were you doing on that chair?

Me: Dusting. It's terrible. I have to do this once a month. It covers my office like radiation fallout.

Ramona: Doesn't someone do that for you?

Me: Hell, no. But I don't mind. I don't do it at home. I've got lots of dusters, see? Look at my mitts. I even scrub my floor with clorox wipes by hand occasionally. There were some guys in my office this morning on a ladder for an hour working on the thermostat problem. My office is fine, but histology head next door is freezing. So there is lots of extra dust. Look at those giant dust bunnies under the chair. I need to get those. You should see what it is like when I come back from a week of vacation. Entire dust tumbleweeds, crowding my small space. Please sit down.

Ramona: No, I don't want to intrude. I just want to give you something.

Me: It's no intrusion. This morning was batshit crazy, but this afternoon is dead. Seems to be a theme this week. I wonder if there is anyone in the hospital, it's so quiet. Very unusual. What is that?

Ramona: It's a pussyhat, for your Washington march.

Me: Oh! I've read about those. They were saying in the Arkansas Times that all the stores have yarn shortages. Thank you so much!

Ramona: I actually hate the cut, and I hate the name for the hat. I won't be wearing one in the Arkansas march, but I made three for you and your friends.

Me: I agree with you - bad name and cheesy look. But it will fit with my plan. Are you familiar with Luke Cage?

Ramona: No.

Me: He's a superhero, Marvel character. I'm currently addicted to the series - it's on Netflix if you want to check it out. He wears a black hoodie. I went on the Women's March on Washington official merchandise site and bought a black hoodie. It shipped today. I plan to be the Luke Cage of the Women's March. It will be pretty cold up there I imagine, this will work well under the black hoodie. Let's chat awhile. I've got no cases. You can watch me dust.

I guess when you put it on, the corners stay raised like a cat. I haven't tried it on in front of a mirror yet. Ramona knits like a woman on fire, and my house is loaded with her talent, less than 1% of her entire inventory.

Tuesday, January 10, 2017

I'm Bored

I walked into Dr. Music's office about 2:15 p.m.

Me: I'm bored. Entertain me. I had a shit morning, but now I'm bored. I've read everything I wanted to on NYTimes, the Atlantic, Slate, and Huffington Post. I'm caught up on Facebook and Insta. I saw all the clever clips about Trump on Colbert and Trevor Noah. Help.

Dr. Music: Ok. What do you want to know.

I wave my hand over the ghost that is transcription. They have all moved down two flights of stairs and down two long hallways into a hellhole. I visited it on Monday. I had to send a case out to my contact at Cleveland Clinic. Gave him a heads up on e-mail, but getting the block and the slides and the history together for transcription to FedEx was much harder than usual. Where they were before the flood was now empty large wooden desks and a single industrial white noise blow dryer, down from three yesterday. It still stank like hell. The dishwater blue 50 year old carpet is now dry, but still needs to be removed and no one is giving us a timeline. When the head of transcription came into my office to give me a genetic report to release, she started rummaging through my candy dish. I told her stop, reached into my food drawer, and gave her an entire bag of her fave - Butterfingers. They need the fuel.

Me: So what are the plans for this?

Dr. Music: We are planning to let the flora and the fauna take over.

Me: Well, that will be an improvement over this. One day you are going to walk out of your office and fall into a black hole. Did you hear what happened to me today? About my scope?

Dr. Music: No.

Me: What? Do you mean to tell me that my problems aren't national news?

Dr. Music: Well, I haven't checked CNN yet.

Me: Well you should. I came in this morning and my scope didn't work. Remember when I had all those problems a few years ago with my bulbs crapping out on me every two months? I called you an Dr. Woods to help me all the time.

Dr. Music: Yes.

Me: So this morning, it happened again. Called Dr. Woods. We changed bulbs and worked on it for over a half hour. Finally called in the first responder for help. He showed up an hour later, meantime in my first of three bronchs I decided to hijack the scope from the cart. Tony helped me move it to my office. It took first responder two hours to fix it. I was working all the while handicapped. No 2X, no bird's eye view. I had to count the number of tissue on the junk surgicals to ensure I was looking at every piece. No problem for cytology, though. Turns out my lamp socket was shot.

Dr. Music: I've had this scope since I got here. Never had a bulb go out on me - they change it when they clean. I've always got an extra, but never needed it.

Me: They don't make things like they used too. But I need the moveable eyepiece. I move around too much, while I'm reading. Don't know how you guys can handle the stationary eyepiece. OK, I'll go find somebody else to bug. Thanks for your attention.

Dr. Music: It's been lovely.

Me: Thanks for lying.

Sunday, January 8, 2017


He's what I named my blog for. He's the most thorough pathologist I've ever met in my life. His reports are a work of art. He lives in our department - he just passes through his house occasionally to make appearances. His three adult children are amazing - his wife sends out Christmas cards every year documenting their year's journey in creative ways. Last year it was the picture perfect family on the front. On the back was a picture of a game of Life, with their personal milestones written on the board.

I was so afraid of him when I first started. I'd show him cases asking one question, he would find things I hadn't seen leaving me embarrassed and asking new questions. I also worried for him - I would only show him my hardest cases because he seemed to be working so hard I didn't want to bother him with my trivialities. We have sparred, on occasion. His passion can drown me. I like to think now, in our new more convivial working climate than it was ten years ago, that I am his equal.

When one of our transcriptionists had a routine hysterectomy for fibroids, she wanted it to go to him. Because the rest of us would have treated it as a routine hysterectomy for fibroids, but not him. He looks at every fibroid as if it might be a leiomyosarcoma. He hunts for atypia and mitoses. He lets no routine case lie - he overanalyzes everything. If anyone asks for a consult, he marks every slide he looks at with a slash over the patient identifier at the top. Just in case, if any case goes to court, and there is a question that he has looked at it, the slash will tell the truth.

On occasion, his wife has tried to help him clean his office, but a few days later papers and articles multiply like rabbits around the floor. I once read an article that a messy office is the sign of intelligence. I berated myself for keeping mine clean. Currently, there are many undone projects in my office - gold star for me - clutter is good, right? If his office is the example, then I'm on my way to genius.

When the lab flooded last week, he was off on Friday. Must have been traveling, because he didn't come in. I asked Dr. Music - did you call Dr. OCD to tell him of the tragedy? He said yes, and then I heard a gunshot, and the phone went dead.

Around noon the head transcriptionist started moving his wet piles of papers from his floor to the path library, so they could dry and environmental services could do their job vacuuming his floor - everyone who got flooded (except often lonely me across the hell yea for once) was clearing their offices too. Our new doc, Melody (love her name), let's just call her Dr. Earnest, came out of her office alarmed.

"What are you doing?"

"I have to clear the area. He's not here. I'm moving his piles to this table in the path library."

"No, wait! Where did that pile of papers come from?"

"It was the one nearest the door."

"Stop, please. Until I can draw a map. I think it will help him, when he comes back. I'll map all of his piles, soaked as they are."
Here are some of his files. I hope they can be recovered. There were more, they are on a large hospital cart. We are taking care of him the best we can, because he takes care of the entire population of the state of Arkansas. And he does it very well.

She looked like Christoper Robin. We were all wearing boots that day - it was a Snow Day. Hers were bright red and full of confidence and maternal love. I thought, in that moment, seeing her take care of him in his absence, that I wanted her to be my mother in my next life.

Saturday, January 7, 2017

Bulletin Board

I can't believe I forgot to add this one to the office post. I've been making these these all my life. One from college, in the basement, has concert tix and my first lift tickets. I'm the queen of the bulletin board.

Friday, January 6, 2017


I received a group text at 7 am, from the new Chief. This is unprecedented.

"I hear there is a flood. One of the main ducts in the men's bathroom busted. Dr. Music is already there, he told me about it. I'm on my way in now."

Flood is an understatement. When I got there, the carpet was saturated with water. Dr. Music had texted me earlier on my way in. "Your office is the only one that is spared."

Thank goodness, for once, I was at the opposite end of the hallway.

God it stank. Walking around in our snowshoes we were squishing water. Everything on the floor of the pathologist's offices and transcription was ruined. "What's the plan?" I asked the transcriptionists, one of whom was sitting on her desk. "There is no plan yet."

I learned from a maintenance man in the doctor's lounge that some offices below us were even in deeper trouble. Max, the admin who helped me with my office temperature earlier in the week, was hit the worst - apparently his office is right below us. He had to be moved immediately - his desk, files, everything was ruined. His office was right next to the data center, so the EMR (electronic medial record - Epic) was at risk. Sure enough, it went out for almost two hours, crippling the entire hospital for the morning.

Someone told me, when I was wandering, that it was the result of a sink being ripped off of a wall in the men's restroom. "It was vandalism. Obviously premeditated. Who could have done this?"

I had three needles in bronch before noon, so I was too busy to figure out exactly what happened. What could rip a sink off of the wall, and leave it to spew for hours before our early morning path crew discovered it?

At one point a little after noon I wandered into the transcription area. Asked our head transcriptionist if there was an investigation. "Well, I don't know about that, but when I went in there this morning, I saw a small foil open square package on the floor of the bathroom, as they were cleaning up the mess."

I'm going to be clear here, because I laughed so hard and told this story all afternoon. The women got it, but for most of the men I had to spell it out. It was an empty condom package. Maybe unrelated, but some two people were probably doing something on the sink in the wee hours of the morn for it to break off of the wall. This bathroom is pretty remote. Maybe lab staff, maybe janitorial staff. Whatever they were doing, it crippled us and the entire hospital.

I imagined them in their passion and distress. They probably got really wet. Hopefully not hurt. But it would have been nice for us if they had blown an anonymous whistle. It wasn't cold temperatures, but passion, that took down path, and briefly, the entire hospital.

Thursday, January 5, 2017

Station 7

Ok this one requires a little education. Endobronchial ultrasound guided biopsy (EBUS) is a procedure where the pulmonologist places a scope down the esophagus or the trachea to sample one of many lymph nodes - see above. They all have names: Station 10, Station 7, 4L, 2R. A needle is inserted through the trachea or the esophagus to sample the lymph node. Blood and tissue are aspirated through the needle, which is at the end of a long thin clear catheter, and retracted from the endoscope in the trachea or esophagus. A nurse pumps the sample onto a slide. The cytotech smears the blood, dries it, and stains it for the pathologist to read on a slide.

I got a text from the cytotech at 12:30 today. Interrupting my soup. Come on down to bronch lab.

It's in the basement of the hospital. If you are thinking white walls and shiny equipment, you are thinking wrong. The linoleum is yellowed, and there are large ancient metal shelves and cabinets floor to ceiling against the wall, holding old and new medical supplies. There are holes in the walls, some of which have gaped for years yearning for outdated equipment. The main area holds maybe one patient being prepped for the next procedure, lying on a gurney. My scope is set up in the main area, on a cart next the metal shelving. I often have to scrounge for a chair so I don't have to hunch over the microscope.

Right next door is the procedure room with the pulmonologist, the patient, the endoscope, a male nurse, a male respiratory therapist, all assisting. Imaging equipment hangs from the ceiling for constant reference. It's dark in there, it's light out here.

I'm glad to have one of my best techs working this week. He's already got a slide on the scope. I scan it, seeing only blood and lymphocytes. I walk into the procedure room. Thank God. It's Cyd Vicious. I relay my diagnosis, while he's getting more tissue.

"So what's the story?"

"I'm going to hit 4R, 11R, and Station 7."

That might take him 20 minutes or so. Any other pulmonologist would take over an hour. Thank goodness for the iphone. I picked the right field. He's working hard to get tissue, I can Facebook and Insta while I wait for the slides. It's a busy day, but I knocked out most of my work before lunch. "Ok, no rush."

In the meantime, I talk to the nurse standing in the main room. I've seen her, but didn't realize she worked with him. She's adorable, in a bookish way. Startlingly young for her wit. I finish 4R, still more of the same, and while he moves to 11R we start to talk. She regales me with stories of him - her sarcastic low voice so lulling that she can pop out a zinger and it takes my brain a few seconds to grasp it. She had me laughing so hard I wasn't paying attention. Cyd calls from the procedure room. "Haven't you read 11R?"

I turn around and realize there are two slides on the scope. Scan them quickly. More blood and lymphs. I tell him this, and he moves onto his final node, Station 7. More of the same. He walks out and I apologize for being late with 11R. "She is so entertaining. She's telling me stories of you." He looks at me and rolls his eyes. "I wouldn't call her that."

I ask him, "So what are we doing?"

He becomes animated. "This is why EBUS is so important. This 74 year old guy has a large lung mass with contralateral lymph node enlargement. A few years ago, he would have been treated with chemo and radiation. Not a surgical candidate. Presumptive metastasis. Now, we can prove it's not there - it's just reactive. Now he can have surgery."

That is a huge difference in prognosis and survival. Presumptive chemo can kill. Surgery can cure for much longer term.

He goes to talk to the family. I tell the nurse, "I didn't believe in this procedure, before he came here. We would sit here for an hour reading blood after blood after blood. They were hunting in the dark. Blind pigs looking for an acorn. But I know when I'm working with him, he's in the tissue. It's not just a fruitless patient waterboarding, it's making a difference."

She walked over to me. "We could use you. We are having a big party. A fun one - we are renting out a bar, maybe during the Kentucky Derby. We want docs and health care workers who know what he can do, to explain it to the one's who don't. We are inviting a lot of primary health care docs. You can talk to them about what he does."

"I'm Gizabeth. What's your name?"

"I'm Molly."

"Here's my phone number. If I'm in town, I'll be there."

The next day I get a phone call from the patient's primary doc. "Cyd told me it was negative, and that makes a big different in treatment. I need to hear it from you."

"Yes, it is. Great sample. He's the best. Call anytime."

My Office

During November, one of my friends from Sunday School volunteered to take over. Her subject was thankfulness, and each week we were tasked by e-mail. One week she told us to think about our favorite space, and we would discuss in a roundtable discussion.

For some, it was their bed at the end of the night. For one, it was the farm she grew up on. Two people talked about their shower. Mine was my office.

I was met with an incredulous gasp by the leader. "My office is my crazy space. How could it be your office?"

"Well, of course I love the ocean, but I'm not there much. My office is a safe, quiet space. It's where I do the work I trained to do to the best of my abilities, and I think I do a pretty good job. It's got lots of memories - I've been there ten years. Kid art. Bulletin boards with play tickets and pictures and prostate cancer guidelines. It's small, but I love being there."

This week has taxed me a little. On Tuesday, it was 80 degrees and stuffy. Three calls to maintenance only yielded a brief thirty minutes of air. It was so bad that I locked my door and took my shirt off to eat my soup at lunch. I drank so many bottles of cold water that day I was in the bathroom every 45 minutes. A maintenance guy who takes care of me came by at the end of the day. "They said it was fixed! This is miserable. I'll make sure you are ok by tomorrow." I usually open the door in order to let hallway air in, but the high traffic won't end until January 6th so it's too loud and uncomfortable. I had on boots and jeans and flannel and even a ponytail gave me little relief. It wasn't just me, the blood bank director and I next door joked about wearing bathing suits to work the next day.

When I came in this morning it was 64 degrees. I had dressed for warm weather so I was miserably cold. My next door neighbor, the head of histology, shares my airstream. "Can we please call maintenance? I'm tough, but not this tough."

So we asked the transcriptionist to put in yet another work order. In the meantime, I decided to go to the gift shop to buy some heavy socks or slippers. The blood bank director, who was still sweating under 80 degrees next door, brought me a flannel blanket.

On the way back from the gift shop - I had picked out some sparkly red slippers that reminded me of Dorothy in the Wizard of Oz, I saw an admin who used to be an OB. He delivered Jack. He was talking to another admin I recognized but had never met. I approached them. "Let me tell you a funny story!" And showed them the slippers.

I introduced myself to Max, and he walked with me to my office. "This is ridiculous. I'm going to call the head of HVAC immediately. They said yeah, why are they complaining, they were hot yesterday. "Well, I'm in her office right now, and you could hang meat in here. Let's find a happy medium."

And they did. It pays to know brass. It took two hours, but the temp eventually went from 64 to 70. In the meantime, I tried on my slippers, and quickly went from Dorothy to an ugly stepsister. I hadn't checked the shoe size, assumed one fit all, but I'm a nine and this was a six or seven. I gave them away to the secretary with the smallest foot. "If they don't fit you, just give them away."

Kid art wall. This is the back of my door.

Shelf. More kid art and pics and journals.

Ever filled candy dish.

This is what Jon Slaven called your "me wall"

Blankets from techs today - much appreciated.

More shelves.

I'd show you my scope and computer but I think the pic I took has patient identifiers. 

This is my fave accessory. A rotating light illuminates the space art I got in Eureka Springs. The tiny purple pencil from stepmom makes it look like a space station. Jack won the star behind from one of those grab the stuffed animal with the hanging tongs things at the movie theater.

Tuesday, January 3, 2017

An Ode to the Beta Blocker

I first discovered Metoprolol in residency. A friend who has essential tremor when doing large public speaking, it even affected her voice (sorry if effected is called for here - I mix the two), was recommended it by an attending, and the drug got rid of her symptoms (sx).

About that time, even though I was giving speeches and lectures in pathology to residents and cytotech students, I was paralyzed by fear at the prospect of giving med student lectures (150 in the audience!). So I tried it. It was amazing. Tamped down all the physiologic responses to fear, and left you with a clear head. I was hooked, but have used it sparingly over the years.

I appeared on TV many years back as an expert on Flu Swine. Couldn't have done it without a low dose beta blocker.

When I got divorced, I had to go on Match.com and date. Pulled out the 5 year old bottle of beta blockers. Dating is hard, when you aren't used to it. Or if you have fears of it. Some people set up dinners with wine, but I liked to set up lunch dates. Maybe a hike later, if I trusted them. If I can't get along with someone without wine, there is no point in a next date.

Last Summer I gained too much weight, and developed hypertension - discovered by a routine trip to the OB. The FP she recommended prescribed beta blockers. Hell, yeah, I thought, love them. It didn't seem to help my HTN, but a couple of months later I was ten pounds down and didn't need them anymore. Health is really all about nutrition and healthy body weight, not drugs.

But some docs have told me that beta blockers should be in drinking water - they are that harmless. So I had no qualms about getting a second of five refills today. They help with HTN, but they also help calm unmitigated rage. So after a busy day at work, I was able to hit the treadmill, go to yoga, and chill with Ray Donovan and a glass of wine.

In PMG pathology one of the best and funniest pathologists recently sang the praised of beta blockers - she takes one every day to deal with work. I'm not there, but I certainly don't judge. It's an amazing, harmless drug. It's gotten me through a lot of tough times.

Monday, January 2, 2017

Van Morrison - Tupelo Honey

Ack lots of music tonight. Music soothes the soul.

On the way back from a road trip to Florida last night we stopped in Tupelo, MS. Home of the largest automobile expo this side of the Mississippi (North? South? Not sure. Not so good with direction). Also some big Elvis museum. And of course Tupelo honey. No time for that, although in our house we are addicted to honey - we put it on everything from eggs to sausage to veggies and fruit. My fault, my long time vice. We drove in pouring rain all day. Time to chill in the hotel, not sightsee and shop for honey.

Big time milestone is to be able to put the kids in an adjoining room. I taught them how to order room service last night. They were so delighted. Chicken parmesan, chicken Ceasar salad, and special dessert brownie sundae.

The next morning at breakfast we had omelettes and english muffin sausage and egg sandwiches. On a rare note, the kids were quizzing me about my life.

I have published many articles on DNA ovarian cancer research. In lofty magazines. My mentor was up for the Nobel Prize at that time. Jack googled, and found one on serine proteases. I was working for a Ph.D candidate Jack White lookalike named Joey - he was the first author. He taught me a lot, in between my pre-md classes at UALR and my psych counselor gig at nights and on weekends.

I hated writing science articles - tech writing. After doing lots of creative writing, it was like writing inside of a box. The intro, the stats, the tables, the conclusion. I did it in pre-med, in med school, and in residency. And I got proficient, but it wasn't fun. I found it very confining.

What was fun was the DNA research. Working at the bench, extracting DNA, designing primers to hunt for novel proteins and genes that might become potential targets for cancer therapy. It took hours, but I felt like I was a Queen of molecular warfare. Jack was delighted with the stories. C seemed impressed. The technology has changed now, it is much more advanced, but I still get to partake in being a lab manager of scientific machines that seek out genes for lung cancer, colon cancer, head and neck cancer - genes that predict prognosis and chemotherapy response. It's a little remote from the mic, but it's mainstream in today's therapy.

I think honey is therapy too - therapy for the immune system. If we build up our immune system from local antigens through honey, we can fight precancerous cells in our own body. I'm glad my kids have garnered a taste for daily honey. Our progeny are our future.

Shakey Graves - Roll the Bones - Audiotree Live

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