9 a.m. I sit down at the scope, flanked by the radiologist, and my wingman cytotech.
Me: So what am I looking at.
Rad: Indiscrete mass in the lung. Maybe pneumonia. Why are you so dressed up.
Me: I've got a meeting at the school today, C's advisor. And tonight I'm going to a breast molecular update. Breast surgeon hosts these one or two times a year, usually at good restaurants. We get free food, and learn about the latest prognostic information. It's path, rad/onc, and onc.
Cytotech: I've never been invited.
Rad: Me neither. But I'm not a breast man.
Me: Really? You aren't a breast man?
Cytotech: He must be an Ass Man.
Rad: That's actually what is on my license plate. Ass Man.
Me: I was asking cause I was wondering. What man isn't a breast man.
Rad: It's not that I don't like breasts. It's just that it's a hobby, it's not my day job.
Me: I see macrophages. No big inflammation, no malignancy. Good news for the patient. It always feels good to hand out good news. No news is good news, right?
Rad: Sounds good to me. I'll get cultures. We've got a couple more cases for you after lunch.
Me: Good - bronch lab has two cases, but they should be done before lunch. See you later.
Tuesday, February 28, 2017
Friday, February 24, 2017
INFJ
I was lurking in a PMG Pathology thread the other day - they were talking about how they scored on the Myers Briggs personality scale. Many pathologists are INTJ's. I was a psych major, I took that test over 20 years ago, I'll never forget my type. INFJ. But I forgot what it meant, so I googled it today over lunch.
I found out I am a rare and complex personality type, shared by Eleanor Roosevelt. Gandhi. Umm, Nicole Kidman. Piers Morgan? Them's fighting words. Reading about who you are, based on a personality test, is indulgent. The ego is a necessary evil of human existence. Watering it seems trite, but is nevertheless satisfying. There are entire books, I learned, on Myers Briggs personality types, but a quick scour of the internet was enough for me. My ego is fine. Overly indulged last summer - like someone took my ego's mouth to a fire hose.
There are days when you are tasked to challenge your nature. Today was one of those. I had to show humility to a clinician I had unintentionally misled on a frozen. Separately, I had to (gulp, cough, spit) ask for help, something that is akin to torture for me. The volumes of challenging cases I had on call this week, some of which I hope to resolve tomorrow, set records in my ten years of practice.
I reminded my daughter today while I was carpooling her to her church retreat weekend that when we are faced with obstacles that seem insurmountable, ones that we hope to but cannot control, it's happening for a reason. Kind of like destiny. The challenges we face are tests to our ego, lessons that need to be learned. If you are impatient, there will be a test to challenge your patience. If you are overly confident, a missed call will humble you. If you think your diagnoses can help a clinician, there will be a difficult case that will stymie you and the patient will go downhill no matter what the morphology shows you. A blow to the ego necessitates a surrender to the divine. You duck and shield, you stand up, and you move forward. Experience, including mistakes, begets fresh revelation.
"It is better to light a candle than to curse the darkness." - Eleanor Roosevelt
I found out I am a rare and complex personality type, shared by Eleanor Roosevelt. Gandhi. Umm, Nicole Kidman. Piers Morgan? Them's fighting words. Reading about who you are, based on a personality test, is indulgent. The ego is a necessary evil of human existence. Watering it seems trite, but is nevertheless satisfying. There are entire books, I learned, on Myers Briggs personality types, but a quick scour of the internet was enough for me. My ego is fine. Overly indulged last summer - like someone took my ego's mouth to a fire hose.
There are days when you are tasked to challenge your nature. Today was one of those. I had to show humility to a clinician I had unintentionally misled on a frozen. Separately, I had to (gulp, cough, spit) ask for help, something that is akin to torture for me. The volumes of challenging cases I had on call this week, some of which I hope to resolve tomorrow, set records in my ten years of practice.
I reminded my daughter today while I was carpooling her to her church retreat weekend that when we are faced with obstacles that seem insurmountable, ones that we hope to but cannot control, it's happening for a reason. Kind of like destiny. The challenges we face are tests to our ego, lessons that need to be learned. If you are impatient, there will be a test to challenge your patience. If you are overly confident, a missed call will humble you. If you think your diagnoses can help a clinician, there will be a difficult case that will stymie you and the patient will go downhill no matter what the morphology shows you. A blow to the ego necessitates a surrender to the divine. You duck and shield, you stand up, and you move forward. Experience, including mistakes, begets fresh revelation.
"It is better to light a candle than to curse the darkness." - Eleanor Roosevelt
Thursday, February 23, 2017
SMD
No, it doesn't stand for sadomasochist disorder, or even suck my dick, as Urban Dictionary purports.
At least not in this context.
Style MD. It has over 6,000 doc mom members on Facebook, although only a few hundred regularly participate. I'm mostly a voyeur, but try to post a selfie every other month, just to stay relevant. Selfies are hard, and my daughter has seen mine in the cloud somehow, and is highly critical. "Mom, you need to smile. Don't do that weird smirk thing." Well, that's what all my friends do, at my age, so she needs to accept that.
See, the arms are awkward. But it's a work in progress.
SMD has a Queen, her name is Sasha. She posts motivational messages on a daily basis. She's uber positive, crazy smart, and an amazing mom. She speaks all over the country about doctoring and empowering women. She's hosting the first ever SMD conference in her home state of Nebraska this fall, and I've already booked a hotel room. Convinced a good friend from residency to do the same. The final line up isn't announced yet, but there will be continuing medical education (CME) and yoga sessions and cocktail hours and pajama parties and pedicures. I can't think of a better way to spend my CME money. Sasha seems poised on the brink of stardom, at least in the doc mom world. Despite her white blond roots, she's very inclusive. Our cover photo is dark haired women from all nationalities. She's not on it. Beautiful and humble.
She's a curvy cornhusker beauty. She leaks these professional pics tantalizingly, teasing us of announcements to come. Her followers ask, A blog? A book? What are you planning? We wait in suspense.
She often posts from her gym early in the morning, after she has done her weights and cardio and is dressed for the day to come. Today she posted a pic of herself in a black tank top and leggings. She lamented forgetting her blazer and top, she was spending all day in a conference with admin. "I cannot wear this in front of the dean. What am I going to do?"
Many suggestions poured in:
Do you have a friend the same size you can call on?
White coat, it's so forgiving! No one will know you have a tank on underneath.
Blarf at the hospital gift shop?
Can your husband bail you out? Mine's a SAHD (Stay at Home Dad) - he always saves me.
Me: You look like Linda Hamilton in The Terminator - screw the white coat admin requires shades and a gun.
At least not in this context.
Style MD. It has over 6,000 doc mom members on Facebook, although only a few hundred regularly participate. I'm mostly a voyeur, but try to post a selfie every other month, just to stay relevant. Selfies are hard, and my daughter has seen mine in the cloud somehow, and is highly critical. "Mom, you need to smile. Don't do that weird smirk thing." Well, that's what all my friends do, at my age, so she needs to accept that.
See, the arms are awkward. But it's a work in progress.
SMD has a Queen, her name is Sasha. She posts motivational messages on a daily basis. She's uber positive, crazy smart, and an amazing mom. She speaks all over the country about doctoring and empowering women. She's hosting the first ever SMD conference in her home state of Nebraska this fall, and I've already booked a hotel room. Convinced a good friend from residency to do the same. The final line up isn't announced yet, but there will be continuing medical education (CME) and yoga sessions and cocktail hours and pajama parties and pedicures. I can't think of a better way to spend my CME money. Sasha seems poised on the brink of stardom, at least in the doc mom world. Despite her white blond roots, she's very inclusive. Our cover photo is dark haired women from all nationalities. She's not on it. Beautiful and humble.
She's a curvy cornhusker beauty. She leaks these professional pics tantalizingly, teasing us of announcements to come. Her followers ask, A blog? A book? What are you planning? We wait in suspense.
She often posts from her gym early in the morning, after she has done her weights and cardio and is dressed for the day to come. Today she posted a pic of herself in a black tank top and leggings. She lamented forgetting her blazer and top, she was spending all day in a conference with admin. "I cannot wear this in front of the dean. What am I going to do?"
Many suggestions poured in:
Do you have a friend the same size you can call on?
White coat, it's so forgiving! No one will know you have a tank on underneath.
Blarf at the hospital gift shop?
Can your husband bail you out? Mine's a SAHD (Stay at Home Dad) - he always saves me.
Me: You look like Linda Hamilton in The Terminator - screw the white coat admin requires shades and a gun.
My pulmonologist friend from Philly: This will probably go down just fine where you live.
Me: That's how we regulate admin in AR baby
Philly: UAMS was so mild mannered compared to your place.
Me: You should see the Glock our business manager packs for insurance reimbursement negotiations. We know how to keep these guys in line. We aren't Pathology Labs of Arkansas we are Pathology Renegades of Arkansas (PRA). They are gonna pray when they see us coming.
Sasha: This is my fav EVER!
I think she liked being compared to the Terminator chick. We are all one pair of sunglasses and a gun away from being the Terminator chick these days. Medicine, like politics, is a battleground. It wears you down, but it's definitely worth fighting for.
Wednesday, February 22, 2017
Ectopic Pregnancy
Life threatening, due to probable rupture and hemorrhage. A pregnancy in which the fertilized egg implants outside the uterus. Usually in the fallopian tube. We get these specimens not infrequently. It is unusual to see the placental villi intact inside the fallopian tube wall, it is usually ruptured and full of hemorrhage. So this is a rare pic. "Wow," says PMG pathology. "WTF" is what I know you are thinking. No fetal tissue here, though - just immature placental villi inside a fallopian tube.
I'm going to Shaky Knees in Atlanta. Just bought 2 VIP tix (Love you Matt). So I'm boning up on the lineup. Cage the Elephant headlines Friday night.
I'm going to Shaky Knees in Atlanta. Just bought 2 VIP tix (Love you Matt). So I'm boning up on the lineup. Cage the Elephant headlines Friday night.
Tuesday, February 14, 2017
Monday, February 13, 2017
Accepting Limits
I remember the moment I decided to give up on skiing. Vividly - it was last year during Spring Break. One minute I was on the verge of a tiny snow hill, one long conquered by my kids and then boyfriend, heart beating rapidly. The next moment I was lying on the ground in the snow, my body in an awkward X shape like a dead body police mark, buried skis making it seem impossible to move without breaking a kneecap. I stared up at the sky. "This is actually relaxing," I thought. "I could stay here forever, and never have to try to run a blue to impress my kids." I didn't stay there forever, but it was a good 20 minutes before I even tried to move.
Nevertheless, I tried. The year before I ponied up for group lessons, to no avail. Last year I ponied up even ridiculously more for individual lessons. Still I couldn't stay the anxiety that kept me moving in slow horizontal terror down a vertical slope, kids smiling and racing in front of me, beating me to the mid-blue hill restaurant by almost a half hour. "But I can scuba dive," I wanted to scream. "I can name cancer on 5 cells. I'm a badass in other arenas." But not this. Maybe not ever.
It's calming, to relinquish the desire to achieve in areas your kids pressure you to. There are other activities to do in snowy weather. Today, I signed up for a two hour guided snowshoe tour - one that my Facebook path friend lauded. She was at this conference a few years ago, and was giving me tips on messenger. "I only do greens and easy blues. I take beta blockers."
"I've taken beta blockers for many situations, but never skiing. Good idea. But maybe next year - I'm taking a break this year. And I've gotta convince my kids that I'm never going to be as good as them, and they will have to accept that fact and let me be happy with my greens."
This conference starts at 6:30 am and is over by 11:00 am everyday, so everyone can hit the slopes. Not me. I'm hitting the salon for a pedi and massages, and snowshoe tours. Planning to go to Aspen one evening - ACES (Aspen Center for Environmental Studies) does free lectures on Naturalist Nights. There's one on Wednesday by a Professor at Colorado State University about energy development impacts on wildlife. They sponsor the 2 hour snowshoe tours in Snowmass, and I can hire a naturalist guide to do an even longer one later this week. That's about my speed.
Nevertheless, I tried. The year before I ponied up for group lessons, to no avail. Last year I ponied up even ridiculously more for individual lessons. Still I couldn't stay the anxiety that kept me moving in slow horizontal terror down a vertical slope, kids smiling and racing in front of me, beating me to the mid-blue hill restaurant by almost a half hour. "But I can scuba dive," I wanted to scream. "I can name cancer on 5 cells. I'm a badass in other arenas." But not this. Maybe not ever.
It's calming, to relinquish the desire to achieve in areas your kids pressure you to. There are other activities to do in snowy weather. Today, I signed up for a two hour guided snowshoe tour - one that my Facebook path friend lauded. She was at this conference a few years ago, and was giving me tips on messenger. "I only do greens and easy blues. I take beta blockers."
"I've taken beta blockers for many situations, but never skiing. Good idea. But maybe next year - I'm taking a break this year. And I've gotta convince my kids that I'm never going to be as good as them, and they will have to accept that fact and let me be happy with my greens."
This conference starts at 6:30 am and is over by 11:00 am everyday, so everyone can hit the slopes. Not me. I'm hitting the salon for a pedi and massages, and snowshoe tours. Planning to go to Aspen one evening - ACES (Aspen Center for Environmental Studies) does free lectures on Naturalist Nights. There's one on Wednesday by a Professor at Colorado State University about energy development impacts on wildlife. They sponsor the 2 hour snowshoe tours in Snowmass, and I can hire a naturalist guide to do an even longer one later this week. That's about my speed.
Friday, February 10, 2017
Gross Room
Me: So what's up with this new hat everyone in the OR is wearing? It's so crazy. Tall skinny floral chef hat. Combined with the scrubs and the clogs, it's not good.
Female PA: I think they put their hair under it.
Me: They would need a helluva lot of hair to fill that hat. Who do they think they are? British soldiers gone Mad Hatter? What happened to the chill square version of the do-rag?
Female PA: And they are all so skinny, those nurse anesthetists. Don't they get cold back there in the OR?
Me: Yes. I was walking behind one, on my way here, and I was trying to find the contours of her butt through her skinny scrubs while she was walking. A personal challenge. No dice.
Female PA: We need to help them. Sweaters and cheeseburgers!!
Me: LOL! I agree. And a freaking stylist. So what are we doing?
Female PA: Ovarian cancer. Pretty obvious. I'm cutting now, will have it ready in a minute or so.
Male PA, working at another grossing station: Who would name their daughter Nympha?
Me: Really? That's her name?
Male PA: Well, it's spelled different, but still.
Me: How old is she?
Male PA: 40 ish.
Me: Well at least she made it that far.
Male PA #2: I'll bet she was invited to all the dances.
Me: I'm guessing she wasn't the wallflower.
Female PA: Frozen is ready.
Me: You were right. Ugly. I called, gyn/onc is sending the other ovary, he says it's the same but he's cool with no frozen. Thanks a bunch.
Female PA: I think they put their hair under it.
Me: They would need a helluva lot of hair to fill that hat. Who do they think they are? British soldiers gone Mad Hatter? What happened to the chill square version of the do-rag?
Female PA: And they are all so skinny, those nurse anesthetists. Don't they get cold back there in the OR?
Me: Yes. I was walking behind one, on my way here, and I was trying to find the contours of her butt through her skinny scrubs while she was walking. A personal challenge. No dice.
Female PA: We need to help them. Sweaters and cheeseburgers!!
Me: LOL! I agree. And a freaking stylist. So what are we doing?
Female PA: Ovarian cancer. Pretty obvious. I'm cutting now, will have it ready in a minute or so.
Male PA, working at another grossing station: Who would name their daughter Nympha?
Me: Really? That's her name?
Male PA: Well, it's spelled different, but still.
Me: How old is she?
Male PA: 40 ish.
Me: Well at least she made it that far.
Male PA #2: I'll bet she was invited to all the dances.
Me: I'm guessing she wasn't the wallflower.
Female PA: Frozen is ready.
Me: You were right. Ugly. I called, gyn/onc is sending the other ovary, he says it's the same but he's cool with no frozen. Thanks a bunch.
Thursday, February 9, 2017
BHEC QRC
Pronounced B-heck QRC. Affectionately. Stands for Baptist Health Extended Care Quality Review Committee. I've been on it for over a year. And I missed the last two, for kid stuff, so I needed to be there last night. We mostly talk about the long term patients, their CAUTI's and CLABSI's first: the infection nurse leads the meeting.
If you are feeling left behind with the acronyms you are not alone. When I first got on board I needed to get up to speed. Catheter associated urinary tract infections. Central line associated blood stream infections. The entire meeting is a check on the system; comparing it to national norms. They are earnestly trying, against all natural odds, to serve the patients as best as they can. They put more effort into it than I could imagine, and despite all the crazy standards they are held too, more often than not they succeed.
After infection control left last night - she leads then heads to her church group - we moved on to pharmacy. There were a lot of new procedures to approve. We got to one called "Unresolved Discrepancies."
ID doc: That sounds scandalous.
Pharm: It's just that when a controlled med goes missing, we can always track it. Figure out why. But not this time. We couldn't find the source of the problem. So we had to create a new policy to report missing meds that aren't accounted for.
Me: Sounds like an inside job.
Laughter.
Pharm: Yeah, you are probably right. I can think of a few people that might target the narcotic bin, especially late at night. Next policy.
Television monitor at the front of the room: Sedation Monitoring.
Admin: If I was a joking man I might make one about keeping you all awake during this review.
Pharm: Beats her fingers against the table in the universal culmination of a joke sound. Bah bum bum. No, this is about making sure the patients who are getting procedures get the right support.
ID doc: Not sure I understand. Explain.
GI doc: Like if you want to do a scope - GI, pulmonary, you need the right support. You can't just do it in any room. You can't have a nurse anesthetist monitor five rooms on the floor. There are only certain areas, with the right support staff, that are allowed to do those procedures.
Me: It's the Joan Rivers Rule.
ID doc gives delayed incredulous belly laugh. "Exactly!" I love inducing that.
Me: Motion to approve.
FP doc: I second.
Admin: Everyone in favor?
Collective: Aye.
If you are feeling left behind with the acronyms you are not alone. When I first got on board I needed to get up to speed. Catheter associated urinary tract infections. Central line associated blood stream infections. The entire meeting is a check on the system; comparing it to national norms. They are earnestly trying, against all natural odds, to serve the patients as best as they can. They put more effort into it than I could imagine, and despite all the crazy standards they are held too, more often than not they succeed.
After infection control left last night - she leads then heads to her church group - we moved on to pharmacy. There were a lot of new procedures to approve. We got to one called "Unresolved Discrepancies."
ID doc: That sounds scandalous.
Pharm: It's just that when a controlled med goes missing, we can always track it. Figure out why. But not this time. We couldn't find the source of the problem. So we had to create a new policy to report missing meds that aren't accounted for.
Me: Sounds like an inside job.
Laughter.
Pharm: Yeah, you are probably right. I can think of a few people that might target the narcotic bin, especially late at night. Next policy.
Television monitor at the front of the room: Sedation Monitoring.
Admin: If I was a joking man I might make one about keeping you all awake during this review.
Pharm: Beats her fingers against the table in the universal culmination of a joke sound. Bah bum bum. No, this is about making sure the patients who are getting procedures get the right support.
ID doc: Not sure I understand. Explain.
GI doc: Like if you want to do a scope - GI, pulmonary, you need the right support. You can't just do it in any room. You can't have a nurse anesthetist monitor five rooms on the floor. There are only certain areas, with the right support staff, that are allowed to do those procedures.
Me: It's the Joan Rivers Rule.
ID doc gives delayed incredulous belly laugh. "Exactly!" I love inducing that.
Me: Motion to approve.
FP doc: I second.
Admin: Everyone in favor?
Collective: Aye.
Wednesday, February 8, 2017
The Quest
Mid-morning, while I'm reading my GI's I become determined to find someone else who hasn't heard of vodka tampons. I decide to call Dr. Music on the intercom.
Dr. Music (he can see who is calling): No one's home.
Me: Well that sucks, because I'm on the hunt.
Dr. Music: And I'm being hunted? Not sure if I like that or not.
Me: I'm looking for someone, besides me last week, who has never heard of vodka tampons.
Dr. Music: Vodka what?
Me: So you haven't? I finally get to explain it. (So I did).
Dr. Music: That sounds crazy. What if you don't have the right orifice?
Me: I hear from my friend that it works in the other one down there too.
Dr. Music: That doesn't make sense about the breathalyzer. Once it goes into your bloodstream, it would register on the breathalyzer.
Me: I don't know, I've never been breathalyzed so I don't know the technology. But I would think it would register less, not having been sitting in your stomach.
Dr. Music: Maybe they will make an assalyzer.
Me: I was thinking a vaginalyzer. Not too farfetched in our current political climate.
Dr. Music: Yeah I saw that pic on Facebook of you and your husband at the Woman's March. I can't believe you dragged him up there. Did you make him wear a pussyhat?
Me: Hell no. I hate them too, but you can't always choose the symbols of your movement, you've just got to run with it. There were 30-40% guys there, by the way. Way more than anticipated. And three of S's male colleagues called him to thank him for participating in the March.
Dr. Music: Well that's something.
Me: You aren't on Instagram, are you?
Dr. Music: No.
Me: I posted tons of pics. I didn't carry a sign, I just took pics of signs. I'll text spam you when I'm done with my GI's. I made a series on Instagram. I'll even send you some that I didn't post - because they were pretty salty and I know I've got a big following from C's friends. Your wife will love the pics.
Dr. Music: She will. I can't even have Trump or Trump news on the TV - she will run and attack the television.
Me: I'm trying to take it all in as entertainment. A necessary step to a better future. Helps me cope.
Dr. Music: Yes, I'm spinning it that way too.
Me: Except it's hard when people are held and detained at airports by misguided officials because of their religion. Then it's not so funny.
Dr. Music: Can't argue with that.
Dr. Music (he can see who is calling): No one's home.
Me: Well that sucks, because I'm on the hunt.
Dr. Music: And I'm being hunted? Not sure if I like that or not.
Me: I'm looking for someone, besides me last week, who has never heard of vodka tampons.
Dr. Music: Vodka what?
Me: So you haven't? I finally get to explain it. (So I did).
Dr. Music: That sounds crazy. What if you don't have the right orifice?
Me: I hear from my friend that it works in the other one down there too.
Dr. Music: That doesn't make sense about the breathalyzer. Once it goes into your bloodstream, it would register on the breathalyzer.
Me: I don't know, I've never been breathalyzed so I don't know the technology. But I would think it would register less, not having been sitting in your stomach.
Dr. Music: Maybe they will make an assalyzer.
Me: I was thinking a vaginalyzer. Not too farfetched in our current political climate.
Dr. Music: Yeah I saw that pic on Facebook of you and your husband at the Woman's March. I can't believe you dragged him up there. Did you make him wear a pussyhat?
Me: Hell no. I hate them too, but you can't always choose the symbols of your movement, you've just got to run with it. There were 30-40% guys there, by the way. Way more than anticipated. And three of S's male colleagues called him to thank him for participating in the March.
Dr. Music: Well that's something.
Me: You aren't on Instagram, are you?
Dr. Music: No.
Me: I posted tons of pics. I didn't carry a sign, I just took pics of signs. I'll text spam you when I'm done with my GI's. I made a series on Instagram. I'll even send you some that I didn't post - because they were pretty salty and I know I've got a big following from C's friends. Your wife will love the pics.
Dr. Music: She will. I can't even have Trump or Trump news on the TV - she will run and attack the television.
Me: I'm trying to take it all in as entertainment. A necessary step to a better future. Helps me cope.
Dr. Music: Yes, I'm spinning it that way too.
Me: Except it's hard when people are held and detained at airports by misguided officials because of their religion. Then it's not so funny.
Dr. Music: Can't argue with that.
I took the first four, but I can't take credit for this last pic I cribbed it off of a Democratic facebook group I think? Not sure if it was in Washington or not. Ballsy chick, though.
Tuesday, February 7, 2017
Gross Room
PA: I'm cutting the frozen, it's almost ready.
Me: What is it?
PA: Pancreatic mass. Nothing in the computer.
Me: Ugh I hate pancreas. So my friend told me last week I'm the only one who hasn't heard of vodka tampons. I'm trying to prove her wrong.
PA: No luck here. Vodka tampons are all over the place. How could you have not heard of them?
Me: Living under a rock, I guess. You haven't tried that, have you?
PA: Hell no. Young girls are doing it, I hear. Helps to avoid the breathalyzer.
Me: But how do you regulate it? If you aren't sipping slowly. Wouldn't it be easier to OD? Where are the Vodka tampon rules and regulations?
PA: Yeah, it's supposed to absorb quickly; it's really vascular down there. I don't know. A new way to overdo it.
We both agreed that we certainly weren't the queens of abstinence in our younger years, method of delivery be damned.
Me: But still - tampons? Ewww.
PA: Can't disagree with you there. Here's the slide, it's ready.
Me to surgeon on bat phone: Long comment about frozen.
Surgeon: I can't hear a word you are saying on this intercom thing. Let me scrub out and get the phone.
Me: I know right? It's like Charlie Brown's teacher.
Surgeon: What do you think?
Me: Mostly chronically inflamed fibrosis. There isn't an epithelial wall per se, but some of the area that looks like lining is teeming with neutrophils. Could this be an old walled off abscess? I see atrophic acini, but no tumor.
Surgeon: So it might just be a pseudocyst? That's great news.
Me: Yeah that fits. We will look at the whole thing tomorrow to make sure.
Me: What is it?
PA: Pancreatic mass. Nothing in the computer.
Me: Ugh I hate pancreas. So my friend told me last week I'm the only one who hasn't heard of vodka tampons. I'm trying to prove her wrong.
PA: No luck here. Vodka tampons are all over the place. How could you have not heard of them?
Me: Living under a rock, I guess. You haven't tried that, have you?
PA: Hell no. Young girls are doing it, I hear. Helps to avoid the breathalyzer.
Me: But how do you regulate it? If you aren't sipping slowly. Wouldn't it be easier to OD? Where are the Vodka tampon rules and regulations?
PA: Yeah, it's supposed to absorb quickly; it's really vascular down there. I don't know. A new way to overdo it.
We both agreed that we certainly weren't the queens of abstinence in our younger years, method of delivery be damned.
Me: But still - tampons? Ewww.
PA: Can't disagree with you there. Here's the slide, it's ready.
Me to surgeon on bat phone: Long comment about frozen.
Surgeon: I can't hear a word you are saying on this intercom thing. Let me scrub out and get the phone.
Me: I know right? It's like Charlie Brown's teacher.
Surgeon: What do you think?
Me: Mostly chronically inflamed fibrosis. There isn't an epithelial wall per se, but some of the area that looks like lining is teeming with neutrophils. Could this be an old walled off abscess? I see atrophic acini, but no tumor.
Surgeon: So it might just be a pseudocyst? That's great news.
Me: Yeah that fits. We will look at the whole thing tomorrow to make sure.
Monday, February 6, 2017
Densus Church
This is the oldest church in Romania. I spent a chunk of the day riveted by it's limited online history (I favor the pagan theory) and that of the pagan Gods of Europe - Swedish, Norse, German, and Romanian. Much more fascinating than my morning frozens. A slow day, finally, thank God (Gods?). Last week was insane.
Sunday, February 5, 2017
AURORA
Aurora carries the Mother feeling of peace and love to all mankind. Hers is the assurance that always flows from a mother’s love—all is well, “the dawn is coming.”
Aurora is an archangel. Which makes me love this song even more. There's more to archangels than the Teenage Mutant Ninja Turtles. Raphael and Michael are my favorites. If you doubt me, google them. They are pretty impressive.
When I was in college, I had a silver foil tree. I decided to make a theme: it was angels. I still have many of the angel ornaments I gathered back then on my yearly live tree. I trolled arts and craft fairs looking for angels, with good results.
I still look for angels. Humans are vessels for angels; they can make miracles.
I can't fix this font, no matter how hard I try. LOL.
Aurora is an archangel. Which makes me love this song even more. There's more to archangels than the Teenage Mutant Ninja Turtles. Raphael and Michael are my favorites. If you doubt me, google them. They are pretty impressive.
When I was in college, I had a silver foil tree. I decided to make a theme: it was angels. I still have many of the angel ornaments I gathered back then on my yearly live tree. I trolled arts and craft fairs looking for angels, with good results.
I still look for angels. Humans are vessels for angels; they can make miracles.
I can't fix this font, no matter how hard I try. LOL.
Friday, February 3, 2017
Bronch Lab
11:00 a.m. My fifth procedure before noon. This was one of those days when your intelligence crackles from your fingers like lightning, because there is no way in hell you are going to get any rest.
Tech: It looks malignant.
Me: Well it looks like I showed up at the right time. You guys already have it all figured out. I agree.
The librarian (nurse who works with Cyd Vicious): Do you want to see a picture of the mass? It's in the mainstem bronchus.
Me: Yes, please.
Cyd Vicious to librarian: Give me my phone I need to show the patient's family.
Librarian raises her eyes in apology.
Me: No worries. I can wait.
Librarian: Want me to show you a funny video in the meantime?
I watch a video of an 11 month old boy in a sink reveling in water being sprayed on him from the kitchen sink sprayer (is there a more consolidated word for this?). He is lapping up the water like a dog.
Me: Who is that?
Librarian: That's my foster kid. I foster kids. He's getting his TPR on Monday.
Me: What's a TPR?
Librarian: A termination of parental rights.
Me: Let's back up here. Why do you foster kids?
Librarian: I had a hysterectomy at 27. I love kids. I applied to be a foster parent.
Me: So, you look 25. How did you have a hysterectomy 2 years into the future.
Librarian: I'm 29. Started fostering right after the surgery. That's why I love working with Cyd. He forgives the times I can't show up because I am being there for the kids. But this one, I'm really attached. I'm trying to adopt him.
Me: Why now? I mean, fostering kids must be hard. You have to build a wall, because you know they are going to leave. Do you have a partner? A spouse?
Librarian: No it's just me. That's precisely why I'm adopting. I've built that wall. And it's not fair for the kids. They need unconditional love, and if you aren't prepared to give them that at such a crucial time in their lives, you are shorting them. The foster system sucks. It's rough. I get picked on all the time. I've been written up as a delinquent. Once, when I had bathroom cleaner on the floor next to my toilet. The child I was fostering was six weeks old. - there's no way he could have gotten into that bathroom cleaner. Made no freaking sense. And there's this other rule, that all knives have to be in the kitchen. I had a butter knife in the living room once, and voila. Another deficiency.
Me: So you are a single mom. Of foster kids. One of which you are trying to adopt. (Reeling) And they are picking on you? What about all the other foster parents leeching on the system, the ones I read about who take the money and ignore the kids?
Librarian: I'm still trying to figure out how foster parents make bank. I'm in the hole. I spend way more on the kids I foster than the $400 bucks a month I receive for what I do. Sorry I've got to take this call.
Cyd walks over, done with the procedure: So it's malignant.
Me: Yes. I hear you encountered a giant mass in the mainstem bronchus, and have a pic. Can I see?
Cyd: Sure. Here it is. We could debulk it, they would have ten years ago, but it's got more of a chance shrinking with chemo/rad. You see this, right (giant fungating mass), and want to take it out. But it's not the standard of care these days. I'll do it if it doesn't respond to treatment. But that's rare. She's got a good chance of responding.
Me: I'm going to go upstairs and try to get some work done. Call me when you need me.
Tech: It looks malignant.
Me: Well it looks like I showed up at the right time. You guys already have it all figured out. I agree.
The librarian (nurse who works with Cyd Vicious): Do you want to see a picture of the mass? It's in the mainstem bronchus.
Me: Yes, please.
Cyd Vicious to librarian: Give me my phone I need to show the patient's family.
Librarian raises her eyes in apology.
Me: No worries. I can wait.
Librarian: Want me to show you a funny video in the meantime?
I watch a video of an 11 month old boy in a sink reveling in water being sprayed on him from the kitchen sink sprayer (is there a more consolidated word for this?). He is lapping up the water like a dog.
Me: Who is that?
Librarian: That's my foster kid. I foster kids. He's getting his TPR on Monday.
Me: What's a TPR?
Librarian: A termination of parental rights.
Me: Let's back up here. Why do you foster kids?
Librarian: I had a hysterectomy at 27. I love kids. I applied to be a foster parent.
Me: So, you look 25. How did you have a hysterectomy 2 years into the future.
Librarian: I'm 29. Started fostering right after the surgery. That's why I love working with Cyd. He forgives the times I can't show up because I am being there for the kids. But this one, I'm really attached. I'm trying to adopt him.
Me: Why now? I mean, fostering kids must be hard. You have to build a wall, because you know they are going to leave. Do you have a partner? A spouse?
Librarian: No it's just me. That's precisely why I'm adopting. I've built that wall. And it's not fair for the kids. They need unconditional love, and if you aren't prepared to give them that at such a crucial time in their lives, you are shorting them. The foster system sucks. It's rough. I get picked on all the time. I've been written up as a delinquent. Once, when I had bathroom cleaner on the floor next to my toilet. The child I was fostering was six weeks old. - there's no way he could have gotten into that bathroom cleaner. Made no freaking sense. And there's this other rule, that all knives have to be in the kitchen. I had a butter knife in the living room once, and voila. Another deficiency.
Me: So you are a single mom. Of foster kids. One of which you are trying to adopt. (Reeling) And they are picking on you? What about all the other foster parents leeching on the system, the ones I read about who take the money and ignore the kids?
Librarian: I'm still trying to figure out how foster parents make bank. I'm in the hole. I spend way more on the kids I foster than the $400 bucks a month I receive for what I do. Sorry I've got to take this call.
Cyd walks over, done with the procedure: So it's malignant.
Me: Yes. I hear you encountered a giant mass in the mainstem bronchus, and have a pic. Can I see?
Cyd: Sure. Here it is. We could debulk it, they would have ten years ago, but it's got more of a chance shrinking with chemo/rad. You see this, right (giant fungating mass), and want to take it out. But it's not the standard of care these days. I'll do it if it doesn't respond to treatment. But that's rare. She's got a good chance of responding.
Me: I'm going to go upstairs and try to get some work done. Call me when you need me.
Thursday, February 2, 2017
Rummi Bears and Tampons
Dinner with big time Girlfriend. After catching up on all the personal stuff, we moved on to more important things.
GF: We were going on a three day road trip. We weren't driving. I prepared with gummy bears - Rum and Vodka infused Vanilla.
Me: Wait. What? I have no idea what you are talking about.
GF: Well, you soak the gummy bears in alcohol. At room temperature. No longer than three days, or it will congeal into a large gummy mess - that works, but it isn't pretty. You have to get the good kind, the Hasbro.
Me: Yes, I know, we are gummy bear snobs. So you soak them? Or infuse them? I'm confused.
GF: You just soak them. But I like the idea of infusing. Could that be C or (her son) J's next science fair project? Soaking vs. infusing gummy bears with alcohol. How do you propose we measure that, besides weight?
Me: Maybe you could measure the blood alcohol content after a certain number of gummy bears, see which method makes it higher. Not sure that is a middle school/early high school project though.
GF: Of course you have heard of the vodka-infused tampons.
Me: No. You are joking.
GF: I'm not! I thought everyone had heard of them, until you. It's great - you've got no alcohol breath, you just insert and voila. I understand it's very vascular down there. After your first buzz, you just pull it out and replace another one. Of course I've never tried it, but it's out there. Lots of people are doing it.
Me: Unbelievable. You are putting me on. Wouldn't I have heard about this in medical school?
GF: No, it's just come out in the last few years. You don't have to settle for just one. You can do three or four at a time, especially if you use slender regular.
Me: What if you don't have the right, um, orifice?
GF: I hear it works just as well if you put it in the back door.
Me: No freaking way. You are insane. Can I drive you to your car? We need to do this more often, I miss you.
GF: We were going on a three day road trip. We weren't driving. I prepared with gummy bears - Rum and Vodka infused Vanilla.
Me: Wait. What? I have no idea what you are talking about.
GF: Well, you soak the gummy bears in alcohol. At room temperature. No longer than three days, or it will congeal into a large gummy mess - that works, but it isn't pretty. You have to get the good kind, the Hasbro.
Me: Yes, I know, we are gummy bear snobs. So you soak them? Or infuse them? I'm confused.
GF: You just soak them. But I like the idea of infusing. Could that be C or (her son) J's next science fair project? Soaking vs. infusing gummy bears with alcohol. How do you propose we measure that, besides weight?
Me: Maybe you could measure the blood alcohol content after a certain number of gummy bears, see which method makes it higher. Not sure that is a middle school/early high school project though.
GF: Of course you have heard of the vodka-infused tampons.
Me: No. You are joking.
GF: I'm not! I thought everyone had heard of them, until you. It's great - you've got no alcohol breath, you just insert and voila. I understand it's very vascular down there. After your first buzz, you just pull it out and replace another one. Of course I've never tried it, but it's out there. Lots of people are doing it.
Me: Unbelievable. You are putting me on. Wouldn't I have heard about this in medical school?
GF: No, it's just come out in the last few years. You don't have to settle for just one. You can do three or four at a time, especially if you use slender regular.
Me: What if you don't have the right, um, orifice?
GF: I hear it works just as well if you put it in the back door.
Me: No freaking way. You are insane. Can I drive you to your car? We need to do this more often, I miss you.
Wednesday, February 1, 2017
Private Mortuary
My daughter, 13, independent of me, decided to read The Devil's Knot by Mara Leveritt and base her yearlong history Capstone project on it. She spoke to me excitedly a couple of months ago about the details of the case. I told her I was here, I lived it. "Do you want me to hook you up with an interview with a forensic pathologist at the Crime Lab? I know Frank Peretti."
"You do??!!? He was the bad pathologist, in the book."
I've bought the book, but I haven't read it. Of course I know about his persecution, reading blogs and articles. It's been 11 years since I rotated with him at the Crime Lab, but he's a nice intelligent guy.
"Careful C. Evidence always has a spin. Keep an open mind. I'll work on it."
After many e-mails with his assistant over the last few weeks, I finally secured an interview at 4:30 today. Her last e-mail instructed me to meet him not at the Crime Lab, but at his private mortuary off of an exit near the airport. I got covered, got off early, and picked up C at the school.
We arrived at the mortuary five minutes early, after trying to secure some bottled water at a closed up chained off gas station - the only one we could find off of the exit. We were greeted by two coroner vans in the parking lot - one of the coroners nicely directed us to his office. We played with an eager dog - not sure of the breed, but it was regal. The assistant entered the hallway from the mortuary.
"I can't believe I missed you coming here. I was supposed to put the dog up. I'll let him know you are here."
We waited on the couch. When he entered, he looked disheveled as always, and surprised. "I know you!" I guess his assistant didn't tell him.
"Yes, I rotated with you for a month at the Crime Lab. Great to see you." I got up and gave him a hug.
Cecelia gave and recorded a thoughtful and intelligent interview that lasted a half hour. I was impressed with her knowledge of the case; I stayed silent in awe and respect. He turned the popular media impression of the case of the West Memphis Three over on it's head. She was clearly enamored and partially mind blown. His facts flew at the celebrity opinion in the face. She had much project fodder and he concluded, in his Northern accent blunt way, one that was used to testifying cases in a courtroom, that his opinion was correct. As soon as I become unshackled, he assured her, when I retire, I'm going to write my own book.
I'll leave the details to her project.
When it was over I asked, "So what do you have over there? How many tables, one? Dr. Woods told me about your private mortuary, but I've never seen it."
"Do you want a tour? We've got three tables."
"I'd love one. What about you (Cecelia)? Do you want to see? There are dead bodies in there."
I watched my daughter steel herself and answer emphatically. "Yes."
I worried. I'm a mother, that's our job. Plus I've been there. I asked the assistant for some candy - sugar or carbs. She produced a fortune cookie out of her purse, and I encouraged C to eat it.
As we walked through the room entering the mortuary there were four dead bodies on gurneys. In the mortuary, two of three gurneys were occupied. One was a large male that hadn't yet been autopsied. The other was a female whose autopsy was complete. Two men were about to embalm her. I looked back at C to make sure she was ok.
"They don't look real, they look like wax figures."
"Good, keep that mentality. That will help you."
The woman had her face peeled backwards over her skull. Her organs had been removed, so her ribs and body cavity were prominent. There was a pool of blood in the body cavity. We were regaled with stories - of her death, of his, of other interesting deaths in the past week - one's that we promised not to tell. It was thrilling for me to finally have C interested in what I do.
Peretti and his crew were impressed with C's countenance. "Why don't you watch me do the autopsy of her organs and brain?"
She was game. She donned an apron and gloves and he walked through the anatomy of the healthy organs. I stood over them like a mother hen; her asking questions, he explaining. At one point, the embalming guy called us over to the woman whose organs we were dissecting. "Look. This is so exciting. I've injected the embalming fluid into her right carotid. Look at her face."
Half the face was pink red with life, the other half drained of color in death. I remarked, "I've never seen this. You could draw a line, right down the center of the face."
He said, "It's remarkable, what anatomy does. I've only injected into the right carotid. Look at the results."
C asked, "What's in embalming fluid?"
"Mostly alcohol, and a heavy dose of red dye to make the body appear as it was in life."
We wandered back and finished the autopsy - brain, cerebellum, brainstem, adrenals, lungs, spleen, liver, gallbladder, aorta, thyroid, esophagus, trachea, kidneys, and finally the heart. C was enraptured. I told her this would take me all day to do, but these guys are experts, they can do it much faster.
The humble Peretti told her that they are quick because they are experts, and these are healthy organs. The nature of her death made it go by fast. Homicides, he told her, can take hours. "Your mom does disease. We don't know disease. When we run into something we don't understand, we turf it to her."
As we were leaving I asked him if we could do a follow up interview, in a month or so, at his house. "I heard you are a turtle expert, that you have quite a live collection. Dr. Woods bragged about it. We would love to see it - her project isn't due until May. Can we come check it out?"
I hear he has a turtle exhibition dedicated to him at the Memphis Zoo. He has donated many rehabilitated turtles to zoos.
"Anytime. You have my number. I'm taking care of those turtles all weekend long, every weekend. Would love to see you."
"You do??!!? He was the bad pathologist, in the book."
I've bought the book, but I haven't read it. Of course I know about his persecution, reading blogs and articles. It's been 11 years since I rotated with him at the Crime Lab, but he's a nice intelligent guy.
"Careful C. Evidence always has a spin. Keep an open mind. I'll work on it."
After many e-mails with his assistant over the last few weeks, I finally secured an interview at 4:30 today. Her last e-mail instructed me to meet him not at the Crime Lab, but at his private mortuary off of an exit near the airport. I got covered, got off early, and picked up C at the school.
We arrived at the mortuary five minutes early, after trying to secure some bottled water at a closed up chained off gas station - the only one we could find off of the exit. We were greeted by two coroner vans in the parking lot - one of the coroners nicely directed us to his office. We played with an eager dog - not sure of the breed, but it was regal. The assistant entered the hallway from the mortuary.
"I can't believe I missed you coming here. I was supposed to put the dog up. I'll let him know you are here."
We waited on the couch. When he entered, he looked disheveled as always, and surprised. "I know you!" I guess his assistant didn't tell him.
"Yes, I rotated with you for a month at the Crime Lab. Great to see you." I got up and gave him a hug.
Cecelia gave and recorded a thoughtful and intelligent interview that lasted a half hour. I was impressed with her knowledge of the case; I stayed silent in awe and respect. He turned the popular media impression of the case of the West Memphis Three over on it's head. She was clearly enamored and partially mind blown. His facts flew at the celebrity opinion in the face. She had much project fodder and he concluded, in his Northern accent blunt way, one that was used to testifying cases in a courtroom, that his opinion was correct. As soon as I become unshackled, he assured her, when I retire, I'm going to write my own book.
I'll leave the details to her project.
When it was over I asked, "So what do you have over there? How many tables, one? Dr. Woods told me about your private mortuary, but I've never seen it."
"Do you want a tour? We've got three tables."
"I'd love one. What about you (Cecelia)? Do you want to see? There are dead bodies in there."
I watched my daughter steel herself and answer emphatically. "Yes."
I worried. I'm a mother, that's our job. Plus I've been there. I asked the assistant for some candy - sugar or carbs. She produced a fortune cookie out of her purse, and I encouraged C to eat it.
As we walked through the room entering the mortuary there were four dead bodies on gurneys. In the mortuary, two of three gurneys were occupied. One was a large male that hadn't yet been autopsied. The other was a female whose autopsy was complete. Two men were about to embalm her. I looked back at C to make sure she was ok.
"They don't look real, they look like wax figures."
"Good, keep that mentality. That will help you."
The woman had her face peeled backwards over her skull. Her organs had been removed, so her ribs and body cavity were prominent. There was a pool of blood in the body cavity. We were regaled with stories - of her death, of his, of other interesting deaths in the past week - one's that we promised not to tell. It was thrilling for me to finally have C interested in what I do.
Peretti and his crew were impressed with C's countenance. "Why don't you watch me do the autopsy of her organs and brain?"
She was game. She donned an apron and gloves and he walked through the anatomy of the healthy organs. I stood over them like a mother hen; her asking questions, he explaining. At one point, the embalming guy called us over to the woman whose organs we were dissecting. "Look. This is so exciting. I've injected the embalming fluid into her right carotid. Look at her face."
Half the face was pink red with life, the other half drained of color in death. I remarked, "I've never seen this. You could draw a line, right down the center of the face."
He said, "It's remarkable, what anatomy does. I've only injected into the right carotid. Look at the results."
C asked, "What's in embalming fluid?"
"Mostly alcohol, and a heavy dose of red dye to make the body appear as it was in life."
We wandered back and finished the autopsy - brain, cerebellum, brainstem, adrenals, lungs, spleen, liver, gallbladder, aorta, thyroid, esophagus, trachea, kidneys, and finally the heart. C was enraptured. I told her this would take me all day to do, but these guys are experts, they can do it much faster.
The humble Peretti told her that they are quick because they are experts, and these are healthy organs. The nature of her death made it go by fast. Homicides, he told her, can take hours. "Your mom does disease. We don't know disease. When we run into something we don't understand, we turf it to her."
As we were leaving I asked him if we could do a follow up interview, in a month or so, at his house. "I heard you are a turtle expert, that you have quite a live collection. Dr. Woods bragged about it. We would love to see it - her project isn't due until May. Can we come check it out?"
I hear he has a turtle exhibition dedicated to him at the Memphis Zoo. He has donated many rehabilitated turtles to zoos.
"Anytime. You have my number. I'm taking care of those turtles all weekend long, every weekend. Would love to see you."
Cecelia and Dr. Frank Peretti, status post her first autopsy.
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