Gout!!!

Here's a good one. Great things happen in threes. Which means I have one more gout in my near future. 

Chief: So you've never heard of the Shidem's stain?

Me: 5 years ago. "No. We stained the alcohol fixed gout with H&E."

Chief: Be careful with the transcription. I've had to edit Shit 'em's.

Me: Ok. Stunning, right?

Uterus Unicornis

Dr. Music: Rebecca? I think this is a hard case. Soft tissue mass in the ascending aorta. Is it luminal or adventitial?

Mary Pickford

He's been calling me Rebecca of Sunnybrook Farms today, on account of my dress. One I found last week on Amazon for 28 bucks. I told him I thought of it as more poodle skirt with a modern print. I've fielded more compliments, catcalls from phlebotomy, and requests for where I bought it than any other dress I've worn in history. I think the petticoat I bought online leads to a more vintage appealing look. I took a terrible selfie for Style MD that doesn't do it justice. I stopped a handsome yard guy at the wine store in his tracks. "I can't help but admire your dress, it's amazing." I replied, "Thank you, I've been hearing that all day! It's so comfy too. I ordered four different patterns - solid too - in the same dress this morning."

Terrible selfies

Me: That's a good question, I'll call cardiothoracic surgeon. I didn't think to ask. I thought the site was wrong, I felt for sure it was an atrial myxoma, but op note says it's in the ascending aorta. You know this week has been a treasure trove of unusual cases. Did you know I have a freaking uterus unicornus? I had to google that I've never heard of it.

Dr. Music: Me neither. I've heard it's a myth.

Me: No! Google it it's a true rare thing! I can't wait to call gross room and tell them about it. They thought the surgeon missed the uterus and got the cornu. But it's a true horn. Apparently an extremely rare congenital uterus anomaly is to have a banana shaped uterus and a horn. There are different variations. Mine has endometrium and myometrium.

Dr. Music: That was supposed to be a joke. Based on the uni . . .

Me: Oh duh. Ok I get it. But seriously, you can't top that can you?

Dr. Music: No. But back to the aortic mass.

Me: I know. I only found one case report from 1974 about a myxoma in the ascending aorta. She died. Not too encouraging. But this patient is fine.

Dr. Music: You did better than me. I found nothing. I'd send that to Jesse.

Me: I was thinking the same thing. Rare things have different rules. Ones best left to the experts. I'll send it to Cleveland Clinic tomorrow. After I find out exactly where it was growing.

It was growing in the pericardial space on the adventitia of the ascending aorta. I can't wait to see what Jesse thinks.

Blues Traveler - 100 Years

The best Blues Traveler song ever. Chris Cornell died, and that sucks, but I can't help thinking about John Popper. 

Ovary Frozen

"Ugh. An ovary frozen? On top of breast cases and interstitial lung disease and a full caseload on a Saturday? When does it end? Can you please look up the history?"

"I've got it pulled up right here."

"It's so confusing. She was diagnosed with cancer almost 15 years ago. So did she already get a hysterectomy? Why do we have the ovary?"

"Capsule looks intact. But it's huge. Gotta be cancer."

"The sections you took are necrotic. Let's take it over to the grossing station and breadloaf it - there must be viable tumor somewhere."

"Well, he (gyn/onc surgeon) would know if there is still a uterus."

"I'll ask him." Dial batphone. "Is there a history of endometrial cancer?"

OR help answers. "I'll ask him. No, there is no history of endometriosis."

"???!!!"

"Evans, she just told me there was no history of endometriosis. That's not what I asked her to ask him. I'm frustrated."

"Hello? Is there someone who knows medicine in there?"

"Right, calling all medicine help. Hello? Screw it. Just take this section and freeze it, it looks viable."

"OR. I've got malignant tumor. Not sure what kind. Do you still have the uterus? We will need to do stains."

"He's taking the uterus next."

"That's a big help. Thanks."

Living the Spicy Life

So my kids are making all kinds of new friends so quickly it's making my head spin. Cecelia hangs with mostly public school kids now (she's dying to go all of a sudden, maybe 10th grade I tell her - convince your father - I've already put down a deposit for next year), and I've met a couple of new moms and girls in the last month. Jack has an online friend from his video games that he apparently knows from 2nd grade maybe? He's been begging to get together with him for weeks. They reunited at a friend's house Friday night for a sleepover. Today he desperately wanted an afternoon playdate and despite my exhaustion from work I knew I'd be missing the hell out of him all next weekend so I acquiesced.

Jack finally found Russ online at 1:30 p.m. to set it up, and interrupted my walk texting me the number to call his mom. She didn't answer. Back at the house, Jack said no she's in bed sick. Call his uncle. Uncle answered the phone, "You have 30 seconds I'm on a bike ride." I said, "I want to pick up your nephew and take him for a treat with my son, his online friend, but I don't know where he lives" all the while thinking how bizarre this was. He gave me more than 30 seconds and found Stepdad's number.

Stepdad answered, "Yes, his Uncle told me you would be calling. I'll bet he would love that. Is this the Jack on Woodlawn?"

"No, we are in Foxcroft, they are online friends. I haven't met y'all yet, but I spoke with your wife on the phone to get her e-mail for Jack's birthday party. I'm just going to take them to get some ice cream and back to my house to play. I'll be there at three and I'll drop him back by six or so. Jack told me your address, thank goodness you are only 5 minutes away. Does that work?"

"Sounds great. I'm the contact now. Not mom or uncle. So funny how these boys get these ideas and everything gets messed up. I was right upstairs."

"Yes I've contacted three of Russ' family members to set this up. I hope they have fun."

I drove to the house with Jack and Russ ran out of the garage. I got out of the car and shook his hand, introducing myself. "So do I need to meet an adult? Or are they ok for us to go?"

"Oh, we can just go. I haven't had lunch, can we do that before treat?"

"Do you like Subway? My stomach is growling I need something too before yoga. Then we can go to Baskin Robbins." I brought my book so I could give them privacy and found a great table outdoors between the two restaurants.

"I love Subway!"

Jack had eaten lunch, so I told Russ to order what he wanted. After he ordered a foot long sandwich, politely asking if it was ok, I ordered a cup of jalapenos to go with the Sun Chips I picked out. He turned to me, looked up, and said with a straight face, "So, you are living the spicy life?"

You could have knocked me over with a feather. My kids friends don't address me quite so candidly, especially new ones. I was excited, and decided to hide my surprise and engage. "Yes, I live the spicy life. Do you live the spicy life?"

"Well, I used to live the spicy life. Then I ate this pepper, it was so hot, it hurt me. I had to give up the spicy life."

"Entirely? You gave it up for good?"

"Yes. I haven't had anything spicy in a while."

"You know, when I was your age, I ate some really spicy hot sauce at a Mexican restaurant at the Epcot Center in Disney and I spent about 30 minutes at a water fountain before I felt like I wasn't going to die. It scared me away from the spicy life. But eventually I got back to it, and I have no regrets. So I would encourage you to keep it open - you might enjoy the spicy life again someday. Now I'm going to go outside it's freezing in here. Enjoy your sandwich and come find me at Baskin Robbins when you are ready for ice cream."

I tucked Jack into bed tonight. I told him I really liked his new friend. "He gave me a new identity. I've irrevocably changed. Up until now, I was just Gizabeth. Now I'm living the spicy life. I can't wait to have him over again. Now I'll sign all my Instagram posts hashtag living the spicy life."

"No mom, please don't."

"Just kidding - I've never hashtagged. I'm above that. Or below it. Or off to the side maybe. Not a hashtagger. So did y'all have fun?"

"Yes, he was really scared when that song he played for you on Spotify had a cuss word in it."

"I noticed him whispering to you frantically in the back seat. I didn't mind."

"Yeah, I told him it was ok. No worries."

"There are worse things in life than cuss words. Just don't cuss at your teachers and you will be ok."

"Yeah mom, I know."

"I know you know. Good night, love you."

"Love you more."

Gout

Dr. Music barged into my office at 2pm.

"What is all this stuff you have written down. Pseudogout? Tumoral calcinosis? This is just gout."

I'm staring down the scope at the slide I am working up, but turn to look at him.

"Those were just ideas. Because, how can this be gout? It's so damn ugly."

"It's just gout."

"Are you sure? When I polarize it, it looks like crap. Like no gout I've ever seen. Like gout's red-headed stepchild."

"What do you mean?"

"I love gout. It's gorgeous. This is not like any gout I've ever seen."

"But it does polarize. There are crystals."

"Yes, few and far between. I'm a big fan of gout. I always take pictures."

"Show me."

"I'm not sure if I could find it on my phone. I only see it once every year or so. This gout is not picture worthy, if it is indeed gout. I'm not taking a picture of this. Gout usually takes my breath away. Not this one."

"Gout takes your breath away? That's crazy. Gout has never taken my breath away. Marie Osmond, in those weight commercials, she takes my breath away."

"Marie Osmond? And you watch TV that has commercials? Where does that still exist?"

"What, you only watch Netflix? And Marie Osmond has never looked better."

"Well, that and other TV with no commercials. I'll google her. She came to Baptist a few years ago, for Bolo Bash. Did you know that? Radiologist was bragging that she was at his house for a dinner. I didn't realize she was a thing. Wow, yes she's pretty hot, I'll give you that. But she can't hold a candle to a good gout."

"Just sign it out descriptively. Crystalline soft tissue deposits with giant cell reaction, favor gout; clinical correlation recommended."

"Sounds perfect. Thanks a bunch."

This is good gout. I cribbed it from the web. 

Conquer Me

I love this song so much. Watched the video over and over. Bought a striped shirt at Banana Republic in solidarity. Only it didn't bare my midriff. I wasn't that brave.

Fireflies

Pinpoints of bright light
Draw children streaming through dew
Longing for magic

Nature's Image

Thoughts today while signing out a ridiculous number of complex cases on call.

Feathers = fern leaves = muscular striations

Heart = caverns

Lung = trees and root systems

Pulmonary parenchyma = honeycomb of bees

Cracked dry Earth = pulmonary and liver fibrosis

Arteries = Rivers and tributaries

Thyroid micro = creeks with cobblestones

Brain and electrical synapses = stars, Universe, higher conciousness, a spider's web

Our bodies parallel nature. There is no ego. There is no one. There is only collective.

And when it goes haywire, I'm there to diagnose disease. As a placeholder. I'm not unique - others have done it before me, and others will do it after me. I'm just here for the duration, doing the best I can in my brief moment on Earth.

IT: 8:30 am

IT: You are having problems with your keyboard?

Me: This always happens, when I'm gone for a week. Something crazy with my computer. Not to mention the dust bunnies in my office. It's not working. The blue tooth light is on, which makes me think it isn't the batteries, but I can't log in to try to reconnect it. Because it won't work to put in my password.

IT (Incredulous): Do you know about Trojan? Did you know what happened over the weekend? Did you even read the news? Do you realize we have more important problems?

Me: Um, no I didn't. I was at a music festival with my brother in Atlanta.

IT: So you were partying?

Me: Yes, I was. But apparently I missed the IT Armageddon. What happened?

IT: We were getting messages all weekend. Texts. They are all in meetings all day. I'm on my way to one now. This ransomware, Trojan, infiltrated hospital systems through e-mail. Two of our units are shut down. It incapacitated the NLR hospital. Apparently entire hospitals were affected in Europe. And there are more dangerous ones on the horizon.

Me: Dangerous what? Is that a virus?

I was thinking, isn't that a condom? Or a wooden horse?

IT: It's a type of virus yes. Don't open your e-mail unless you trust it.

Me: So what should I not trust?

IT: Anyone who normally contacts you by another medium, suddenly does thorough e-mail. Don't open it. They are using your contacts.

Me: So chief normally texts me. If I get an e-mail from him, suspicious?

IT: Yes. Very. Delete. And go and get me some batteries from transcription.

Twenty minutes later.

IT: We got it working! We had to do something, something, something.

Me: Well I'm glad my keyboard is working. Thanks so much. Good luck with um, Trojan. So what happens, if you are affected? Just so I know.

IT: You get a blank slate. Try to get in the EMR, and nothing.

Me: That sounds pretty bad. Hope it doesn't happen to path.

Airport: 1:30 pm

Me: I'm running really late because I accidentally called Uberpool? Who knew there was such a thing. I paid the Uber girl $20 to kick two girls out of the car and get me to the airport as quick as possible. So anyway, my plane is boarding and I'm too late to check my bag and I want to see my kids for Mother's Day and I've got a bunch of liquids - where can I get rid of them?

Security: Over there. Get rid of whatever you need to.

Me: In the interest of time, I'll toss it all. ($350 dollars worth of beauty and bath products. Ugh.)

Security: No worries, happens all the time.

Made it.

So do you think they troll those trash cans looking for stuff? Because if they did today - Big time score.

Wheelchairs

Airport 10am

Hematology head tech: I'm so excited about the new wheelchairs!!

Lab director: I know me too. We get our first shipment soon. It will be so good for the hospital to get those wheelchairs.

Me: What new wheelchairs? 

Lab director: They are going to be so great. They are stackable, kind of like grocery store carts. And they will be color coded. For example, OB has pink, so if you see a pink wheelchair that isn't on OB, it will stick out like a sore thumb. 

Me: How is this good for the hospital?

Lab director: They have no way to drive, only push. So the person in them can't maneuver it. They can't steal the wheelchair.

Me: I didn't know that stealing wheelchairs was a problem.

Lab director (with other techs chiming in): Yes. Huge problem. Patients check out, and they steal anything that isn't nailed to the floor. You name it: wheelchairs, oxygen tanks, bed sheets, etc. Look! It's kind of like that airport one. That's stackable, and the person in it cannot drive.

Me: So the airports beat the hospital.

Lab director: Yes, they did. Wish I'd have thought of it. That's a billion dollar idea.

Hate?

Stirs slowly, in an effervescent stew.

The opposite of feeling is indifference.

Of which I'm an expert.

Words

Your words are a scorn
Ones I attempt to eschew
From the depths of my soul

Cryptococcus neoformans

Me: Cancer,  active esophagitis, all can be turfed until Monday. I'm passing the cases out like candy. I'm flying out early Monday morning for a lab inspection. I won't be available for the fallout. But this, this is a medical emergency. I've got to do some carpooling around noon - get my daughter and her friends from volunteering to lunch to Heights, so please do the special stain and I will be back in an hour and a half.

Mycology tech (after inconclusive India Inks and mucicarmines): I'd go suspicious. I found a single colony on the plate. Too young for stains. I will follow up on Monday. It's a fast grower. 24-48 hours.

Me: This is a rare bug. I need to call ID, and make sure it is covered.

ID: Thanks so much for calling me. We aren't currently covered for that fungus. I'll add an extra anti-fungal, and make sure she is covered until Monday.

Me: I'm flying out early Monday morning. But the tech will call you with the results. Thanks for adding coverage; this is highly suspicious  - I think you are being prudent.

Isn't that halo breathtaking? India ink and mucicarmine positive, in a perfect world. But we have to wait.

Bishop Briggs - Dark Side (Audio)

One week from tomorrow.

Musings

So I've decided not to lose the last few pounds. I'm enjoying the cleavage. It turns me on in yoga, during down dog. My own cleavage. And I can eat more. Finally indulge in what I've been denying my whole life.

I was at LuLu Lemon with my daughter last month. She was trying on a cute bralette, and I asked the clerk if I could try one on too.

"Um, no. Those are only for A and B cups. You are at least a C cup. You need to be looking in the C and D section. Over here."

I've never been guided to the C and D section. Seems like a milestone. One that I'll gladly take.

Gross Room

2:30 p.m.

Me: What? Who the heck is freezing testicle? I've never heard of such a thing.

Lin: I know. It's hard to freeze and gross, it's super fresh, I found a small lesion. Come look.

We normally fix testicles in formalin for a long time before we gross them. They are very squishy.

Me: That's so small. At least it seems clear of the margins. But a frozen? These tumors are so hard - we need stains to figure them out. Frozens ruins the tissue. At least we have the other half for permanents.

I looked through the microscope. Testicular tumors are so rare - we always need to pull out a book. I called Dr. Music for backup, and did just that - found the 1963 issue of male GU fascicle on the shelf and started to peruse. My best guess on first look was Leydig Cell tumor with extensive hyalinized stroma. But to call that on frozen? Pretty ballsy.

Dr. Music: I agree, this one is hard. But I think you love throwing the word testicle around.

Me: Isn't it fun? We get all the parts. Can you imagine a urologist throwing around the word breast, or vagina? They would be ostracized. But we can chant cervix, breast, penis, all day long.

Dr. Music: We can build a whole person. We can talk about every part. We look at it all. I agree. Suspicious for neoplasm, but we need stains.

Me: Thanks for your help. That's exactly where I was. I'll call the doc.

Of course the gross tech brings me his cell, because he has already left the OR. I'm a little incensed about the waste of the tissue for frozen. I explain to him nicely over the phone that we don't like to freeze these, because we need the tissue for immunostains. I think the message was lost.

Urologist: So it wasn't normal testes?

Me: Um, no. Not normal. I'm really worried about it. We need to do studies on the permanent sections to determine what it is.

I walked out of the reading room into the gross room. Told the techs if anyone ever decides to freeze a testicular mass they need to call me first, so I can try to talk them out of it.

Beetles and Wine

I stomp furiously to redirect the encroaching beetles. They persist.

The wine glass in my hand is jarred. Sweet wine drips down my calf.

People gather. Energy is garnered. Roots. Nets. Webs. Light. Earth. Divine.

It is time.

Diarrhea of the Mouth - Law and Order Version

It's close to midnight, and I'm up too late as usual, even though I've been up since 4am, and I'm talking too much (I do that sometimes, don't I?).

I had a unique experience today. I was a witness, not an expert witness, but a friend witness in a post divorce trial. Not sure of the outcome yet, but it was intense. What was supposed to be a half hour turned into 4 hours of an already busy call Monday. It was so toxic I was ready to pitch a tent for my friend. I've never been to the Pulaski County Courthouse, except to obtain marriage degrees.

Despite a dose of beta blockers I was nervous as hell. Sitting outside waiting, talking to other witnesses. At one point I learned my testimony might be blocked by the opposing counsel. They tried for over an hour, to no avail. I think they thought they could stall long enough that I would exasperatedly return to work. They thought wrong. I was strengthened by their determination to silence me.

The lunch in the basement of the courtroom was primitive. Ham or turkey sandwich, or choose from a variety of junk food. I found a Nature Valley oats and honey granola bar, and a large bottle of cold water. The plainclothes detective with handcuffs emerging from his back pocket moved aside so I could pay. I approached the counter. "Do you take a card? Check?"

"No, only cash. But I'll take your purse."

"Ha, I get lots of compliments. I'm keeping the purse. But I've got to go get some cash from my friends."

"I'll buy your lunch." This, from the detective. I thanked him profusely. Small courtesies in a long hard day seem overly gratuitous, and my appreciation swelled to astronomical heights.

When I was finally called I was so exhausted from lack of decent lunch and afternoon coffee I was ready for anything. I swore in, settled on the stand, and fielded questions through the microphone from both counsel. It was like a TV show - but I've never much preferred lawyer/court TV shows so I felt at a disadvantage. Maybe that played well for my friend. I hope so. She deserves it.

Despite objections and overrulings I think I got my point across. I could go into way more detail but I value confidence. Last question:

"So you don't think it was too much for her to ask where her son was."

"I'm a mother. I like to know where my kids are."