Friday, December 22, 2017

The Most Wonderful Time of the Year

Whoever coined that term was not a healthcare professional in the 21st century.

I was on call last week, and I am on call next week starting Christmas Day, and it has been extremely busy. I had more brain frozens last week than I'd had in the last six months, the culmination of which was 9:30 PM stressor on Friday night in between carpooling children to and from where they wanted to go. I had to cut the frozen myself, which is not so easy when you are out of the habit - we are spoiled with our P.A.s I learned after the surgery it was not a resection but a thing new to our institution which I later learned in PMG pathology is a thing some places - a fine needle aspirate of a brain tumor. Which explained why the surgeon wanted me to freeze something that looked like a sneeze on a piece of shiny surgical paper. Not a sick, colored sneeze, just a few clear droplets and some blood. Luckily I had the forethought to do a squash prep first - where I touched the tissue with a slide and smeared it with another - because the frozen yielded nothing but the squash prep was a field of diagnostic information - necrosis, hypercellular pleomorphic cells, giant blood vessels that resembled octopus tentacles - the triad of Glioblastoma Multiforme. I called it suspicious, expected much more tissue, got another sneeze, and a local expert confirmed my diagnosis a few days later. He told me the FNA is much better for the patient, and text updated me throughout his own progression of stains and levels with what I provided him. I alerted the other members of my group of the new procedure - the gross room told me another neurosurgeon did one a couple of weeks ago. If that was the only case I had last week we would be living in an episode of House. But with thirty - sixty cases a day I can't worry over one too much, luckily. Just triage, do my best with what I've got, send the stuff I'm uncomfortable with to the experts, and move on.

One thing good about being on call over the holidays is you don't have any obligations to anyone. I kind of like that. "Nope, sorry, I'm on call." But the way the holiday fell this year Christmas and New Year's Eve are crammed into one week and that doesn't usually happen. I heard from a nurse in bronch lab that Benton schools are out not this week, but the next two weeks, and I think that's a lot smarter than Little Rock, we get an extra week to stress and present shop and make Christmas a little more crazy (or just go to work) then rush back to school after New Year's Day.

Everyone in PMG pathology is lamenting end of the year insurance deductibles. It really does cause a crunch in November and December, but the worst is the last two weeks of the year. I was talking to my friend who is an opthalmologist on Monday and she said she has people coming in on December 15 expecting to get their cataracts done before New Year's Day and when they learn she's booked she has to talk them off of a ledge. Someone in PMG pathology smartly suggested that we switch the cutoff to people's birthday so the work is more spread out. Seems like getting something that monumentally entrenched to change won't come easily.

I can't believe I finally have a lull in my day. Partly because I finished a book I got last week, one that I've been sneaking into whatever gap I can find. I learned new words, elision and benthic. Ha! Look at that spell check doesn't even know benthic. Now I can get back to my other two books I'm juggling, but first I've got to address Christmas cards, a yearly chore but worth it for every one I receive.

I'm starting to think that you get the most out of life by just relaxing into what is, and not worrying too much about what isn't. It certainly yields happiness, I've found.

Wednesday, December 6, 2017