Armageddon

I walked into work, unceremoniously, after over a week off.

Palmer: We've been hit by a Ukranian virus! No dictation. I've had to live dictate for three days. The entire hospital is incapacitated. Surgeons are telling me it is ruining them. They hit Nuance, which is the superior of our system InSync.

Me: Doubled over in laughter.

Palmer: What's so funny?

Me: I've been angry about this system all year. Why did we change? Who's in bed with who? I have worked here 10 years, and over the last year, I've complained a ton. Got a Butterfinger and latte from the lab director, but no follow up. Dropped cases, system freeze in the middle of the day requiring redictation. It sucks. I don't know why they changed a good thing. When is it supposed to go back online?

Palmer: They don't know. Maybe a few days, maybe weeks.

I showed a challenging GI case to Dr. Woods early this morning.

Dr. Woods: I'm going Melody. Typing all of my own cases. Much quicker than live dictate.

Me: Please teach me that system- I'm a fast typer - would love to bypass it.

So I did. Much to the chagrin of the transcriptionists. This was a day of unprecedented chaos. I hear it was supposed to target banks. Whatever the target - it maimed hospitals in a new way that I've never experienced.

Alaska Wildlife Conservation Center

Tlingit Indians

"In the beginning, they say, was water and sky. Here on high you could find Nesaru the sky spirit, and Wolf and Lucky-man. Below lay a watery vastness, empty, it seemed, with only two small ducks swimming about, making eternal, small ripples. Envisioning another kind of earth, with space and variety for myriad creatures, Wolf and Lucky-man asked the ducks to dive down for mud. Using his endless energy, Wolf took half of the mud to build a great prairie for hunting beasts like himself. Lucky-man, his partner in creation, built hills and valleys where the Indians could hunt and live. Last they pushed up the remaining mud into banks of a river, which you can still see, to divide their territories. 

 

Earth was ready. Wolf and Lucky-man understood that large creatures must emerge from the reproduction of smaller, humble ones. They enter deep into the earth to find two Spiders who are meant to begin propagating the world. Imagine their disgust when they find the Spiders to be not only ignorant of the business of reproduction, but so dirty and ugly that they aren't interested in each other. Wolf and Lucky-man scrub down their charges and explain the pleasures and responsibilities of fertilization. Clean and enlightened, the Spiders give birth to earth's many creatures - the eight-legged like themselves, the six, the four, and finally the two-legged ones." 

 

      - Cottie Burland

ALASKA

I'm here. And it's a little anticlimactic. Very middle America. But I've been researching this for years, and we are traveling to four different hotels around the Kenai Peninsula, so I'm hopeful.

This is a bucket list trip. Back when I first got divorced I was trying to figure out how this could work, how I might do it, when the kids might like it.

Now. We had hotel dinner of fish chowder and crab cakes and fish and chips. Not good for my diet, but oh well.

This moment is just Embassy Suites but day after tomorrow - summer solstice - we will head out on the adventure of a lifetime. Glacier hiking, kayaking, biking, and dogsledding.

So it's 10:30 at night here, 3 hours behind Arkansas time, and it's still light. Does it ever get dark around here? I asked the drunk in the parking lot. He said no, it never does, and offered me some rum.

I'm a whiskey girl.

Is that whiskey in your cup?

No, it's wine. Chardonnay.

Ok can I add rum.

No, I'm fine with wine.

Ship's Hull

Standing at the forefront
Hand touches weathered wood
Scent of ocean salt washes
Over me

Tumor Board

Newest onc, I remember her pregnant. She just had her third baby. Long dark hair, eyes you can trust: So I want to present a case. I sent a pic to rad.

Rad: Yes, I remember - you sent it last night while I was at dinner! How do we get it to project on the big screen? Should I just pass my phone around?

Assist: If you can send it to a CARTI email I can get it on the big screen.

Hushed anticipation by twenty docs.

Onc: I'll tell the story while we are waiting. So this guy comes in the ED with a sternal wound. Seems he was biopsy proven squamous cell carcinoma of the skin four years ago. He didn't tell his wife, and it grew. Now it smells. I debrided it, and am wondering what to do from here.

Ancient crusty surgeon with a pronounced Southern drawl: Call wound care. Let them get it real clean. We can see where it goes from there.

Rad: Here's the pic.

Collective gasp. Wow. This is like half an orange depressed wound right in the center of the sternum, in the middle of both nipples. Red and raw, but no pus.

Surgeon: Pretty impressive Grace. I imagine that was taken after you cleaned it out. Let me give you a bit of advice, if you are going to be doing this on night call. Get some cinnamon extract - local store should carry it. Put it under your nose if you encounter this again. All the best surgeons carry it around.

Everyone laughed, but it got me thinking. We pathologists use menthol for the autopsy suite, but I've only really needed it for the decomp room at the Crime Lab. Cinnamon might be a nice change.

Surgeon: Seeing it, It might be amenable to surgery. Gotta get the bad cells out, but we could fill that in. Get some tissue from another site, do some grafting. But I'd get wound care first. That might not be necessary.

Onc: Thanks a bunch. I'll start there. His wife was so mad.

I was thinking, how could you hide that from a spouse for four years?!!?

Other onc: Seeing that pic, makes me feel brave enough to want to show you all my Stage III squamous cell carcinoma of the anus.

Me: Only if you send it to rad while he is eating dinner.

Rad laughing: Yes send it to me at dinner!

Everyone else: No thank you.

The Nightingale: Next case?

Interventional Radiology

Rad: So what are you seeing? Lung mass. Spiculated. Suspicious.

Me: I'm looking. There's no frank cancer here.

Rad: So what are you telling me? It's unfrank cancer?

Me: No. It's not Frank cancer. It's Joe cancer. No, kidding. It's not cancer. There is inflammation. Get cultures.

Next morning at the scope, looking at the core. It's cancer. Well differentiated. Bronchioloalveolar type. Lepidic. But definitely invasive. Stains support pulmonary origin. Frank cancer.

This Just Happened

I'm so excited I have to share! Started watching House of Cards and obsessed over Robin Wright's hair. Props to Deidre - love it! Now who's overusing exclamation points.

Deeds sold me a product made of volcanic clay to help style it. I hope I can figure it out in time for tumor board. If not, oh well.

Interventional Radiology

Me: She's way up in there. What are you sticking?

Rad: Hello! It's you! Where's Shaver??!!

Everything this guy says ends in an exclamation point. He's jovial.

Me: He went on vacation. I switched from frozens to needles. We have started splitting cytology weeks because they are incredibly busy.

Like today. I'll be back. I need to go do an EUS in the OR. Already had two bronchs and radiology. At least I'm getting exercise.

Damn pancreas is hard. Fried egg looking cells could be a number of things. Back to IR.

Rad: We are in the apex of the lung! Hey, who are you?

Cytotech: That's our new cytotech student.

Rad: What's your name? Where are you from?!

Cytotech student: I'm Crystal. I was born in California.

Rad: I knew it!! You look way too fancy for Arkansas.

Me: I'm going to LA in a few weeks.

Rad: I've been there.(You can imagine the exclamations now I'm sick of typing them). That's a crazy place. We were at that Kardashian store, well, my wife and daughter went in, I sat outside, everything is so expensive there.

Me: Your daughter in med school? The one I met?

Rad: No, the youngest one. She's obsessed. We've been to Dash in New York City too. She loves the Kardashians. We are Kardashian stalkers! Never seen one though. We will keep trying.

Cytotech: Who are the Kardashians?

Rad: You don't know who the Kardashians are? Where are you living, under a rock?

Me: I've heard of them, but I don't know them very well. I'm not sure what Dash is.

Crystal: That's me too, just heard of them. Isn't there a show or something?

Me: One of them is married to a famous artist, or musician . . . wait? Kanye West?

Crystal: Yes! That's Kim I think? And there's a Chloe maybe?

Cytotech: How are they famous?

Me: Not sure, aren't they related to that famous guy, who just turned into a girl? The Olympic athlete? Can't think of the name.

Cytotech: Bruce Jenner! Finally a name I recognize. Man, I remember when he was on the Wheaties box. Maybe they should do another Wheaties box with him, I mean her on it.

Me: Yes! 2017 LGBTQ version. This is just, macrophages. Inflammation. Get cultures.

Crystal: I know there is a Kylie Jenner, but I'm not sure if they are related to the Kardashians.

Rad: Man, you guys need to pick up a People magazine every now and again. But I guess I wouldn't know anything about them either if it wasn't for my daughter.

Off to bronch lab.

Eir

The path from fear to love
Is letting go of control (ego, self)
And connecting to the Universe
We are but vessels for our souls
Seeking purpose on this Earth, at this time
I am you and you are me

Eir, Norse Goddess of Healing

Stay at home Starchitect

New post, over at MiM


Man I slept 30 hours this weekend. Never saw darkness. I think that's a first since childhood.
Re-reading old faves, just because.

Mirror

Backlit leaves
Shadows in the fading sunlight
Hold promise of a New Day

Tumor Board

Plastic surgeon: I haven't been to a tumor board - It's been 15 years.

Breast surgeon: Tell the story.

Plastic surgeon: Look at her left breast. It's about to explode.

The Nightingale: This is fascinating. Where is the fluid accumulation? Near the pectoralis?

Plastics: No, in between the implant and the capsule.

Me: What exactly is the capsule? Is it that part we receive during implant removal that is a rind of fibrosis and calcification?

Plastics: Yes, that's it. It's the reaction to the implant. The scar tissue. It varies - different with textured implants.

Rad: Why do you want a textured implant?

Plastics: It prevents contracture.

We see pics. Of the breast. Of the mammogram. Of the surgery. Of the path, some of which I present.

Syd texts me: Longest case ever.

Me (text): My good friend used him. He's the best in the South. Girls fly in from Vegas to get implants from him.

Syd (text): Wow. Great niche.

Plastics: We were worried about Anaplastic Large Cell Lymphoma (ALCL). It happens. It bled like hell. It was a Friday afternoon. I had to rush it to Breast Surgeon for help.

Breast Surgeon: We had two different path specimens. Conclusion up to path.

Me and other path: Carcinosarcoma. Here's pics.

Breast Surgeon: She's so young. It's in your court now onc. What do we do?

Weightless

A translucent wing
Soars upward into space
Bright white soul, detached
Winking at gravity

Cajun Sno

So Jack and I have this game. I bought these sayings, painted onto wood, and we try to surprise each other with them. Kind of like Elf on the Shelf but all year long. Most of the time we really aren't that creative. But occasionally he catches me off guard. This time in my closet. I was surprised and overjoyed.

Making online friends become IRL friends is a bit of an effort. But it pays off. We took Mr. Are You Living the Spicy Life (a walking meme, according to his lawyer mom, and yes I agree) and the infamous maybe a like interest Izzy to dinner tonight after they played all day in the pool - a rendezvous initiated by my almost twelve year old and his encouraging older sister. Their conversation was indelible.

Russ: "So you've never done the cinnamon challenge? It hurts."

J: "What's up with all these people taking those new Cheetos to school? Flaming Cheetos are ok. But that new lime twist? So fake. Some guy took a family size version the other day and ate the whole thing. Disgusting."

Russ: "Is that a mushroom on your salad? Can I have one?"

Me: "Sure, take two."

Russ: Proceeds to torture Jack with the mushrooms . . .

Me: "Am I missing something?"

Russ: "Jack hates mushrooms. This is so fun."

Izzy: "Did you know that we just played three rounds of Mortal Kombat in the back room? Two with Russ and one with Jack. I won all three."

She said this with ultimate humility and pleasure.

Me: "Congrats. You rock."

Russ: "She had a superior character to us."

Izzy: "No I didn't."

Me: "Accept your failure with grace. Grace makes the world go round. That, and Flaming Cheetos."

Russ, Izzy and Jack, in that order 

Tiger's blood (not in my car!), lemonade, and wedding cake mixed with homeade ice cream (Jack learned well from me at a young age - we all agreed his was the best).