That Cartoon - Re-Learning my technical skills here

Smart and funny! Just like I like them. Keep it coming. Love, E

WHEW

Happy Friday (mine anyway). I made it. We all made it. I'm off the next 5 days, but will be coming in to get updates from Amy and to finish of some cases. Attack that admin pile. Dust.

I asked Tina to put in a work order for Don - I'd seen him in the hall this morning while I was running to a needle in CT 4. It's the last to do decorate wise except to find a sweeping large piece of art to put in front of me in the left. That will be fun to look for. So anyway, Don, a handyman with much raw and emotional intelligence, we've known each other for six years and he did projects in my other office. He was worrying about his younger wife needing surgery - luckily not anything dire or life threatening just aging necessitates that things sag and droop. Especially on women who carry a lot of babies - they get uterine prolapse sooner. Don suggested something I hadn't thought to do - put the diplomas in chronological order of my time as an SP Fellow, AP/CP resident tenures, Chief Resident cert. and finally a fellow in cytopath. A square of four rectangles. A small sum of my past, my climb to get here.

At the end of the day I went downstairs to get more snacks and drinks from the Dr. Lounge - I'm sharing a bit with the admin assistants we made a little basket in the main area so they don't have to bug me to get a treat. Hopefully the camera that is installed to watch the doctors (I saw the Eye) and curb bad behavior will think, WOW. That girl is working out so much she can eat anything she wants and needs more to sustain her these days.There weren't enough barbecue chips left (homemade in a bowl with tongs) so I looked over at the hot food that was currently being broken down for the 3:00 lockdown. Chicken Fried Chicken. I hadn't eaten that since I was still dating my husband. I got some honey mustard sauce and put it in a styrofoam container (sorry, I'll reuse the next one). Forgetting utensils and being too hungry to wait, I ate it joyfully with my hands while releasing cases. Taking care to prevent the keyboard from getting grease on it.

Writing this blog is like an after dinner cigarette, like the ones I so brazenly enjoyed in front of everyone when I was in college and dating my first husband. We were both young and foolish then. When I started medical school I cut way back on that, and tried not to use it unless I really needed it. I try not to fault the close ones in my life their oral fixation blankets anymore either. My husband chews gum all day but oh god his breath always smells so good. I used to chew a lot of gum but after my jaw broke that didn't feel the same anymore. So now I'm addicted to altoids. And I just got some new Coconut Lime Velamints that are like a Pina Colada on a hot summer's day. That doesn't sound so good with the Cherry Coke Zero, so I'll wait until I'm done with that.

See, we are all perfect, and not so perfect in different areas of our lives so we need to cut each other all a little slack. Give ourselves grace, a pat on the back for a job well done, in parenting and in our work and our creative pursuit. Signing off with much love, E

Coming Out of the Dark

Happy Monday - it's my Thursday I'm so excited. And I'm about done with this day.

Weekend was kind of crazy but talking to my husband and Alyssa helped me get through it. And I'm glad because I've got to support another friend this afternoon and evening. 

So last Friday we were working  on some alternate means of testing. We didn't know we were getting 42 test kits and the clinicians will want to get back to doing surgeries ASAP. So we ran a couple of courier routes to a lab in Joplin and a lab in Memphis - American Esoteric Laboratories (What a great name!). Now we are no longer using Viracor - we are using AEL. We can get more than one courier up there to decrease the turn around time, and like that we are bringing the work more locally.

Friday at lunch I was commiserating about something going on with me all day - hot flashes. I asked a group of women "Do you think it could be menopause?" One micro tech said it sounded like what she experienced, another said that if you go to a male OB they will offer an antidepressant. "Oh that's freaking rich! I cannot believe it, but I can. Not that there is anything wrong with antidepressants, but to give a blanket offer, ugh." I wondered if prostate docs offered antidepressants with their prostate checks. Probably not.

The other day I went to a bathroom down by the cafeteria - hadn't been there  in a while. It is a four staller. Went to the handicapped bathroom stall. This place was usually so full it was weird having it to myself. Mid stream the lights went out. It was terrifying, to be caught in the dark with my pants down. I calmed myself down quickly - these were probably on motion detectors and I could get out of my predicament if I just moved, so I did, and I was right. Little did I know it was a premonition, but we are coming out of the woods now.

Jack won an award today! He is so happy. The 8th graders take these state-wide exams - I remember C got number one on Spanish. I was so confused - "Number one at your school hon?" "No mom, the state." "Wow." Now Jack has won the mythology award, and he didn't even have to study. I told him, "That's how it is with your passion. You could be an academic and study mythology and teach." But mom, cooking is my other passion, and I still might want to be a doctor I'm not sure." "Well you could talk to Uncle Mike and Aunt Effie. And there is this cool series on Netflix that S and I watched a little while back about the chefs with Michelin Stars, and about their journeys that would be good for you to watch. What a great mash up - cooking and mythology. I'm outta here. Much love, E

Out of Alignment

Well that was another Marathon Day but at least I had a little more fortitude to weather it. Yesterday I felt like I really was Alice in Wonderland. That brought to mind a long ago gift. One that, as you can imagine, was smashed to smithereens prior to being deposited in the Baptist bathroom trash can (they are bottomless). Speaking of Baptist trash cans, a few months ago Baptist reduced our daily trash removal to weekly - only on Monday. I've heard it's been taken away for good from all offices in the hospital. I certainly don't mind taking out my own trash, we just take it across the hall and dump it in the bathroom, and there is less waste - the staff are variable and it's weird how a lot of them will try to change out the bag when there is one thing in it I have to stop them. It's just the principle, you know?


In micro I learned we are getting 42 test kits on Monday!! That's 420 tests. We got 12 test kits on our first shipment April 9, 6 on 4/10, 24 on 4/14, 12 on 4/21, and will get our biggest shipment, a projected 42 on 4/27 in time to test patients for pre-elective surgeries starting the following Monday. Shaver and the clinicians will be happy - they are all over his back.


There was something off in my scope this morning, a shadow. I can usually fiddle with it enough to fix it, but I decided to get Rex for help. "YOU want ME to come help you with your scope?" "Yup I'm outta tricks." I like Rex for his quick wit and his musical proclivities. As he sat down he proclaimed, "You really are out of alignment here." I couldn't have said it better myself. While nice this is all still a little unsettling, as you can imagine it would be for you. My easy command of ICD codes, billing codes, passwords, etc. is not quite so easy right now. The days are busy. I was pleased when it took him longer than a second for him to fix the scope (a few minutes actually).


Luckily I learned in huddle that there was no lab rep bringing lunch for lab week, as there had been all week. I quickly rushed to tell Rex so we could remedy the situation. I got the days confused. He laughed. "Well, yesterday was my Monday, so there ya go." Tina got on it and the 63 employees that are here right now got Papa John's. Talk about a time stamp. I hadn't had that since college I think. I got two sausage pieces, squirted the juice from that green pepper on the pizza then ate the pepper. Dipped the crust in  THAT GARLIC BUTTER. I had forgotten about that. Fun fact: My husband used to delivered pizza for Papa John's when he was living in Seattle. He once delivered a pizza to EDDIE VEDDER!!! Vedder forgot he ordered a pizza - it was a big compound - and he had to wait a half hour but Vedder was so apologetic and gave him a $50 tip. And he got to meet EDDIE VEDDER.


They are opening the Baptist hotel to start testing employees through Viracor today I heard. The handling of the testing in the community is being handled in part by a doctor named Amanda, AKA Mandy. She is a stunning blonde. When she agreed to be Baptist's infectious disease specialist a couple of years ago she had no idea what she was getting into. And she has like 5 kids I think some of them are adopted. She was going to start trying to test inpatients randomly and then it hit before we figured out the testing so that idea went out the window. She's doing a really good job.


Baptist e-mail platform is GroupWise, which sucks, as you probably know. It's hard to send even a PDF file and it can't handle many platforms. We migrate to Google today actually, in an hour or so it will Go Live. There have been countless e-mails about videos to watch and passwords to use when our mail migrates over but I will not watch these ever or wait around for this today I'm tired, and I want to try to do a little exercise it might be good for my head. Much love, E

WHEW

I'm feeling a little overwhelmed. In a good way, but it's been a 24 hours. I have obviously turned this into my childhood diary over the years, processing things through writing, as I have done throughout my life in some way, shape or form.


After I blogged yesterday Negative Elizabeth came back in a huff. I drove to my friend Christy's and got the name of her therapist. After dinner during the family Zoom meaning I melted on the back porch in tears of despair and went to bed. When I woke up I played two albums, back to back. Calmed down. Okay, so here's what I think happened. I thought I was already through the rebirth thing. I warned myself that life and death are very close to each other on the Wheel of Life and you cannot always tell which is which. But psychological death still hit me like a ton of bricks.


The two albums I played - I google confirmed today what I already knew - were the albums I used to self comfort at a very traumatic time in my life. So I needed to stay calm. Things were going to be ok.


Then I opened the New York Times, which I haven't read in a few days. The first article I read was sounding familiar. Yesterday in the BHEC conference I proclaimed the New York Times had gone crazy and read a couple of the article names aloud, we were all laughing. But I hadn't read anything until this morning. I read and enjoyed a few more articles and my husband had to pick me up from a balled hug to myself off the couch this morning and remind me to shower.


This day has been hell. I've never had so many bug issues in my life. The computer services person told me that was normal, after a storm. And as I have snuck in a few more reads of NYTimes today I am alternating, between the hugging and the hitting. Still pretty new. But also I'm awed. Because these people are so smart and I don't deserve any of this, let alone this much.


After enjoying the beef lasagna from the Olive Garden, and the breadstick, I asked what was for dessert. There were social distance servers with gloves on. I chose the flavor Sock It To Me, a new name to me for lemon cake, because that was pretty much how my day was going.


Remember that parking lot rectangle thing I proudly boasted of avoiding once? Last year sometime it landed right on the top of my head. It smarted quite a bit. I had to sit down on the curb for a minute. I was glad to learn that I was so hard-headed. Like someone else I know. I took Advil - had to ask around cause I hardly ever use it. Today has felt like that so far.


The light at the end of the tunnel was opening up the Times at 5 am. I still have no idea how it is happening, and at one point between copious needles I became scared it was going to go away and tried to subscribe to it, learning that I was already a member. But now I'm finally breathing, and I have time, and I will go home and maybe it will still be there for me to read some more and learn about new formats and figure out what the Hell to do with it. I'm skipping my workout today - going straight to the oral fixation. I think I deserve it. Much love, E

Happy Earth Day! And Humpday!

Since I'm finding it tough to sleep at night, I've been getting busy. Cataloguing music. I've got a fairly large archive, and lost all of my lists during some platform change I don't really understand. I was making the lists because Jack told me yesterday that Cecelia makes the best lists. I have to show him  that I do. I told her that. It is now a challenge. I vow to win. I also chain drank about eight Ozarka waters last night. Lots of time in the bathroom. Breakfast at 4 am - smoked gouda and egg on toast drizzled with honey, red pepper, and salt. I walked into the dr. lounge at 6:45 am - my meeting was right by the lounge and I was 15 minutes early. It was nice to see what they were doing with social distancing. Tables set apart, no one at the same table. There were four middle to upper aged white male physicians in the room. They were animatedly discussing our brand new coffee machine. Kidding.

I only recognized one - Bob Searcy, a pulmonologist. He asked after my dad. I sat down listening to them talk about Covid. Bob talked the most. "I can't believe what they are doing in Georgia. And Texas!" Another masked Dr. scolded the Texas governor. "He's anti-abortion but he wants to open Texas!" Hah. The irony.

At the beginning of the meeting there were technical issues, so I went back to the Dr. Lounge to get more eggs, my stomach was growling. Bob chaired the meeting, and my good buddy Ken the radiologist sat next to me with a mask. The lab director, Greg, remarked on how well my mask matched my clothing. "I planned it that way, lol. My friend Christy's mom made it, it's an N95, and she gave me two. Isn't it amazing? I got to pick the fabric, and Christy and her best friend Kim independently chose the same pattern as me." Like minds think alike.

After the meeting I went to the micro huddle.  But first I learned from a piece of pink notebook paper that had cryptic numbers on it. I took a picture to remember. I looked at Amy questioningly. "That means we have done 365 tests, and 20 are positive. But it's not entirely accurate, because it turns out scrolling through the data that someone has tested the same patient three times. I was alarmed. "What? Who is the idiot that did that? That's a waste of text kits!" She shook her head and agreed. We all crowded into the small lab space, tucked into the nooks and crannies. I listened to Amy, the director, read the news.

It turns out that this is Lab Week, I didn't realize in all the craziness. The admin are finally thanking the lab effusively, in like five paragraphs, Amy almost lost her breath at one point. One of the techs rolled his eyes. "It takes a pandemic for the lab to get recognized." We all laughed.

After huddle I went into the transcription room. Our head transcriptionist, Tina, looked surprised to see me. "You are supposed to be off today. What are you doing here?" With my old worldview, I would have questioned my stupidity, but today I was certain that I looked at the schedule last Friday and saw I was coming back Wednesday. "It must have changed, and I didn't know, but no worries". I checked in with Laurie in the gross room, and gave her the other mask, she was so excited. "That is an amazing mask!!! I love it thank you so much." I showed her how to remove the filter and wash it.

Then I went home and went straight to the bedroom. Locked the door - my kids are at home and I can't remember ever it being mid-morning and them being at home and me napping - I don't want to be interrupted. Dressed down (not all the way!).  What happened next was indescribable. Finally a nap, a long one. I think I was in bed for an hour and fifteen minutes, and only the last half hour was the nap part. I was distracted by my thoughts for a while. I really only slept about five minutes. But overall, I'm getting better at this napping thing. Yesterday, alas, was a failed attempt. One that sent me to my friend Christy on where to get reading material on the internet to boost my napping skills. Three things should arrive in the next day or two, I cannot wait.

I dreamed during the sleep part. It was a really weird dream, but first I thought of my husband and how much he means to me (he literally turned me upside down and made me rain upward). I am only just now seeing how much reading this latest book a second time. Every freaking sentence makes me laugh with memories. Ack. Why did I have to throw that magazine away. Then I dreamt I was sick. I was dry heaving into a little plastic bin. Sand started coming out and swirling around. Was that really sand coming out of my mouth? Then my body hurt so bad, like all of the hurts I have ever had were being done to me again, but thankfully it was just these weird pinpricks everywhere hitting me randomly I could not predict a pattern. Then, only images. I simultaneously saw and breathed out a beautiful swirl of black smoke - it seemed to last forever. Anime heads - Jack likes anime. Then, a figure in a dark cloak. What did this all mean? If I thought too hard on it might drive me mad, so I got up to run. I've been doing short bursts of speed with my fast walking, as I'm getting stronger. I'm finally running in the right direction.

I was freaking ravenous so first I ate. More meatballs, some of Jack's gluten bread, and some pesto hummus I made from Trader's Joe - that's what my husband's mom calls it, she is from Germany, and it is an endearing colloquialism. We are all using the term now. It's nice to eat comfort food from your family. And to listen to them. Family is important. They need each other. They are teachers, and mentors to each other. No one is in control, just when you think you are you get very humbled, as I was today. The game of life is a fun challenge, and even when it takes its twists and turns, I'm still glad I am along for the ride. Sometimes driver, sometimes passenger, I cannot predict. It remains a mystery I will continue to try to solve. Much love, E

P.S. Secrets are only secrets if they are coveted - I was reminded of that by Jack in a conversation today. So before I wrote this book I took a group I'd been using to learn my religion from the back corner of the closet to loudly display on my upstairs bookshelf, for anyone to read, and for me to admire daily. Luckily I have five black sections. Great teachers. Shirley Jackson, "Hangsaman," Rilke, "Letters to a Young Poet," Joe Hill, "20th Century Ghosts," it is a dear one to me - I recently caught up with all his other works last fall. Sedaris, "Squirrel Seeks Chipmunk." Kaur, "milk and honey." See they are in good company. Unfortunately, they have been pared down a bit, something I will have to remedy soon.

I got a funny cartoon you would enjoy from the micro lab but I'm too tired to remember how to post pics - I know about airdrop but haven't figured it out if it even applies here. But that can wait. Much love again, lol, E

Negative Control

I blushed hard today. From a very bland, banal picture. Oh, what's in store.

I wanted to share this yesterday, but forgot. In one of my private pathology groups, this:

When I got to work this morning I found out that they were playing "Celebration" when Covid patients get discharged and "Don't Stop Believing" when Covid patients get extubated. I thought sure, great we should celebrate. Fast forward three hours to me up in my elbows in a perforated, crepitant small bowel resection. When it hits full (full load speaker volume) "Don't Stop Believing!" Thank you Universe, I guess I needed that." LOLOL. Best laugh all day.

What else today? Kids are so fun, I played with my ex's kid all morning. I swear they are planted here to teach as much to us as we have to learn from them, if we just stop to listen. She's a freaking intelligent as hell doll.

I go back to work tomorrow! Got a 7am meeting with BHEC QC. They have a social distancing policy in place. So it will be safe. And I think I can get to a 7am meeting, LOL And I can get caught up. We still have only 3 patients on the vent now 10 inpatient positive. My mom told me this morning Star City is having some issues so I thought about them today.

I've got so much to say but I just erased it because I'm tired as hell. Doesn't change my love. Music time. Much love, E.

I think I've got a Type

I think my internal clock is finally righting itself. That's a relief since I have to go back to work on Wednesday.

Yesterday I walked downstairs close to 9:00p.m. My son usually comes upstairs from gaming around 8:30 on a school night. He plays with his best friend Aiden, mostly - they met in first grade. Jack's an introvert like me, definitely an intellectual. His whole life he has been quiet and calm. I love talking to him about his WWII projects and sharing info I have learned from books.

I have talked to him about the danger of being an introvert. C emotes - which is quite alarming to me - I didn't do that. I internalized everything, much to my detriment. I've told him that if he needs to talk about things, which is tough for us introverts, I'm always a good ear. This makes us closer. And he has good perspective, I like to hear what he has to say.

He asked me if he could game until 10:00 p.m. This surprised me. Aiden is usually off social media long before any restrictions I have ever created for Jack. "What's going on in that house?"

"Paige is coughing, and Piper has a fever." His grandparents live in the house, so they have been very worried. Not going out at all. And Birmingham is a hotspot - I looked it up last night. Alabama is having issues. I checked in with the mom tonight. The fever went away, whew.

I told Jack, "You need to support Aiden and yourself - game as much as you want. Make your own limitations. You will be in high school soon, you make good grades, you need to start creating your own boundaries." Stepmom and I had talked a couple of weeks ago about loosening the restrictions on gaming in the time of corona. We all need our comfort stuff.

Today I learned we lost our newest hire in my department, the gross room. It wasn't her passion, and I text reassured her good luck in finding it for her. I was texting with the supervisor. Ugh. She reminded me, "We've got Michelle in the background." Oh yeah, I interviewed Michelle a couple of months ago. She's delightful. She's in her 30's but looks like a model in her 20's. She's single and childless, she takes care of her Mom. She trained in our histotech department. They are required to rotate through the gross room, and most of them hate it, but occasionally one will be drawn to it. I think, if I remember correctly, that's how we got one of my best friends Laurie.

Shaver is our chief. Jessica is going to check in with him on Michelle tomorrow. And to remind Shaver that we are in a very good place to train a new hire, get her ready for prime time, because we are dead now but things will be crazy soon.

Shaver texted me that as of today we are 8 inpatient positive and 3 on the vent. Worse than last week, but still pretty damn good. Music time. Much love, E

Instant Gratification

I figured out yesterday that I'm toddler age. I'm not super religious but my parents have delved into many different religions and I realize that when you have a rebirth, you go through another age process. I'm kind of excited because it means I still have a long way to go, more things to learn.

Did I tell you I'm writing to music lately? Wow. I've never done that before.
..
So today I was on the back porch reading that book and it suddenly started to spit rain. I was disappointed, but when I went into my bedroom to read, I thought, OH. This is good. I closed the door, turned the lights down low, and indulged myself by looking at a photo on the back cover. I continued to read.

BIG. FAST. HARD. That's how I would describe this book, and what happened next. When it was over I tried to read even more but my eyes did this swimmy thing and I couldn't focus on the words and I decided that must be what is passing for sleep for me, these days. I got up to change for yoga.

I don't think I've told you about Matt yet. He's easy on the eyes, which is nice. Elizabeth cubed took him out to dinner a few years ago, to get to know him better. He's got a long time partner - they are not married - he lives downtown in a cool district. It surprised me to learn how self-conscious he was - how he hated to have his picture taken. How he wasn't on social media. How much devoted he is to their cat. Beauty comes in a lot of different packages, and it often doesn't accompany self esteem.

My kids are back today! I made their favorite meal - a meatball recipe my mom shared during my divorce. I altered it a little, but it's a hit. They invite their friends to have it. C brings it to school with pimento for lunch and she tells me she shares it with her friends and they say it is the best thing they have ever tasted. My ex's wife Rachel, who I love, is a great cook, and I often compare myself to her. Worry that I am not enough. But we all bring different things to the table, and that is ok.

So during yoga I imagined all the free time I will have over the next few days and what I can do with them, with my books. Dress up. Dress down. Add imaging, maybe a little music. Learn new things. It's a pandemic after all. It may take some time to get out in the world.

I finished Ozark season 3 WOW. Another BIG. FAST. HARD. I started watching How to Fix a Drug Scandal tonight, based on the recommendations of my brothers, and I'm geeking out. I never knew heroin and cocaine looked so pretty under the scope. It made me grateful, watching the first episode, that we such have good people at our hospital - doing good practice and quality control. Music time. Much love, E

Time is Elastic

Don't you love vacation days? They stretch on forever. More than once in the last week, I've thought that it was a different day than it was. To be honest, you probably have guessed, I haven't been sleeping that much. That makes time even crazier. I actually had breakfast twice yesterday (I mean today!), once at 4am and again with my husband at 9am, LOL. Lots of eggs and smoked gouda toast. English muffins. Spicy chicken sausage.

Leaves me lots of time to think. I LOL'd in the shower yesterday, thinking about Elizabeth cubed. Poor thing. She found her religion and married her true love at the same freaking time (2016). How weird was that. She got the two confused a lot. Her paranoia, based on both nature and nurture, grew to extreme heights. She was giddy and wary. She read a group of books twice (I'm too embarrassed to say which ones), not only for enjoyment, but also searching for hidden meanings. Every random Facebook anonymous friend seemed like an omen, or a sign. Now that she realizes it was just storytelling, she should probably read them again. The ones she saved, anyway. Negative Elizabeth threw some of them away. She threw the baby away with the bathwater. Oops.

Yesterday, I mean today, I'm so confused, just particles floating in the ether, I went to a friends house for snacks and drinks. Amazing house - like a mansion. Way fancier than the one I just bought - more on that later (I found my dream house!!!). She's a new friend - going through a divorce. I toured her house - one that had no fewer than two game rooms in addition to many living areas and bedrooms for her college aged kids. I met one of them - he was super handsome and educated me a bit. We were talking about pot. I mentioned Willie Nelson - I read an article about him in Rolling Stone in the last year or so. He surprised me. "He had to quit. A few months ago. Something about a lung condition. Did you know that he was the only one that could out smoke Snoop and Wiz?"

I walked into one room and couldn't have been more surprised if she had hit me over the head with a sledgehammer. It was a theater room - complete with floor lights and fancy leather recliner seats, all in a row. There was even an old popcorn machine. Bohemian Rhapsody was playing on the large screen. I'd already seen that, so we rushed out into the beautiful sunshine by her pool to soak up the afternoon.

I can't believe how much time I have lately. I used to always feel pressure and rush around what I have to do in my life. Now I'm finding time to listen to albums, read in the sun, play with my text groups, talk to my family. I know it will get intense when I go back to work next week, and I'm excited my kids are coming back tomorrow, but in the meantime I'll just relax and enjoy. Hope you are too. Much love, E

Exsufflation

You probably think I'm crazy, after yesterday. Negative Elizabeth would agree with you. I poke fun at Elizabeth cubed, but I also have empathy for her. She was under the simultaneous realization that she had been seen by her Light, and she was also trying to see the LIGHT. She felt transparent, and invincible. She was like a cheese grater. The world was suddenly magical all at once, and also quite frightening. All of her oral fixations were working in overdrive. Her family, at one point, thought she was crazy. That was one of the most bitter pills she had to swallow in her entire life. But in retrospect, she can see all the angles. It was fear and love that drove them to that point, not anger and hatred.

She wasn't crazy - she was just finding her religion. I'm sure there are examples of this throughout history. She was coughing a lot. Exsufflation has been a sign of banishing evil demons throughout history - its very significant - I googled it yesterday. Banishing evil demons. Breathing in to bring in the light, breathing out to banish evil.

Yesterday I went to the hospital to check in on everyone. I walked into the micro lab. Amy said that we were using up all of the test kits - she gave me the stats. "We need more kits. I hope we get a big shipment on Monday." I also wandered into the gross room. One of my best friends, Laurie, was working solo. She was cutting in a breast.

"So I'm drinking too much." I laughed. Isn't everybody? I'm certainly not sleeping. This blog helps. I asked her, "What are you drinking?"

"Well you know red wine? It's too much." I empathized. Red wine can be too heavy and cloying. "I'm doing what the South Americans are doing. I cut it with Coke. Actually Dr. Pepper." I told her I hate Dr. Pepper, but that I love Coke, and that sounds interesting.  "It's a game changer. It tastes so good."

"I am drinking something new I tried a couple of weeks ago. Tanqueray rangpur gin. I drink it on ice, and cut it with a lemon elderflower soda I found at Trader Joe's. I think it's kind of funny, because I am also eating a lot of Indian food. I must have been an Indian at a very traumatic point in a former life." She laughed while she was slicing the fatty tissue with a fresh blade - putting the important pieces in cassettes for the pathologists to look at in the morning. She said, "That sounds amazing, I might steal your idea." And I hers.

At a certain point in your life, you take stock - inventory if you like. You decide who are the important people in your life, and who aren't. Family comes first. Whatever ills you have had with them in the past is hopefully superseded by love. Your important friends come first - those on the periphery can remain in the sidelines.

I've been doing that over the past few weeks, taking stock. And I find myself quite grateful. I couldn't have been born into better circumstances, and I couldn't  have a better group of people to support me into being what I am today. I'm finding myself overwhelmed with gratitude and love. It quiets me. I hope you are doing well too. Much love, E.

Belief System

Ok this is important. I'm going to get serious for a moment, then I will go back to entertaining.

So as crazy as Elizabeth cubed was, she had wrapped her head around something new, something important. Elizabeth Negative shoved her so down deep she was drowning for air. Threw away all her research. That's ok, we can take it from here. But I need you to pay attention to what she was up to. I can't imagine anyone following her - she was kind of like a bad trip. Not that I've ever tripped, but I supported those who have and it wasn't pretty.

I cannot adequately explain how wonderful it is to be here now. Just being myself. Not being here trying to impress. Not being scared. Feeling safe. The words finally flow. They come to me during the day, like a whisper or a promise. Delivered from the angels. It's nice - it's effortless.

Elizabeth cubed was onto something, like white on rice. I have been an atheist for most of my life. I have supported my kids in their own faith journeys - even plugged into a Methodist church for them. They wanted to be like their friends. Despite my hindrances, I supported that. I could see that Methodism provided a comfort to them. And it wasn't like they were worshipping the devil or swirling in snakes. They were just trying out something new, flexing their faith muscles. I've had an interesting faith journey, so I understand.

When I was in college at Hendrix, I took a world religion class. I was most drawn to Wiccan religion, and Zen Buddhism. It was fun to read about, and learn from. But life experiences drove all that into the ground. As life goes on, things you drive into the ground resurface naturally, whether you want them to or not.

This is a blog, not a super fancy research project, so I can wax eloquent here. It's not like I'm turning it in for a grade. So I'm just going to lay out what Elizabeth cubed learned.

I now believe in reincarnation. We come to this life in soul age. There are many different soul ages - look around you can see and determine them yourself. New souls are like toddlers - they compare and fight and try to impress. They are like the little kids on the playground fighting for that freaking ball. This realization  brought me a long way in tolerance. I can now support and love all of the people in my life. They don't mean harm - they are just working with what they've got, doing the best they can.

There are wise, old souls too. They don't have to be born into any certain religion. They can be born into Christianity, not even believing in reincarnation. They are masters. They aren't showy, they don't try to impress, but you can find them on google. They impart something important on the world. They do great things. They harness the energy of the universe to import good deeds.

There is something they have in common. They have a lot of raw intelligence, and a lot of emotional intelligence. As an aside, they also have great physical beauty that defies their age. They form strong connections to animals. They have a lot of trials and tribulations throughout their lives, but when they attain emotional maturity they shine. And they have a purpose. They are planted here to harness universal energy for a greater good.

There are couples that are planted on this Earth for a reason. You could google them - Elizabeth cubed could give you lots of examples, she did a lot of research, but she's gone. They often live in obscurity - they are not household names, but they do great things, especially in times of upheaval. They live long lives, and they urge each other on, often from afar, in order to achieve a greater goal. Their kindness and emotional intelligence are all important, but it's mostly their love that does it. It's a strong love.

So this new belief system I'm developing is informed by a lot of sources. Wiccan, Paganism, astrology (thanks Mom!), Zen Buddhism. Native American. Notice that it's drawn to religions that are female centered, and religions that are focused on the Earth and the animals and the plants.

This new religion is also informed by storytelling. I am not a master in this area, but I can see the hero's arc, and can apply it to my own life. It helps me out when my kids are in trouble. I realize that they have to go through their own shit in order to achieve their purpose. I am their guide, but I cannot control the storyline.

So this is a work in progress. Elizabeth cubed, crazy as she was, with her happiness and her 50 pound weight gain, was onto something. It is a comfort to me. I will welcome my deathbed, knowing that when I am vaulted into a new life, despite its trials and tribulations, I will encounter the same individuals in this life who are important to me in a new way, shape, or form. So we will truly be together until the end of time.

P.S. I got that book in the mail!! Earlier than Amazon promised. It's like that meme - I'm so excited. Got all day to read it on my back deck. I hope the weather is willing. I haven't checked.

Walking

I  can't remember I ever talked about my friend Christy. That maybe should have ended in ie, but I'm not sure, so we are going to stick to y. We have been friends since college. She lived three doors down from me when my kids were little, back when I was with my ex. I used to get home from residency, get the kids from the nanny, and rush them down to her house to go up to the third floor playroom and watch mine play with her boys while we had wine on the couch.

Yesterday we chatted on the phone a lot. I feel like I'm satisfying an oral fixation this week. Talking on the phone a lot more that usual, eating like I'm recovering from cachexia. I went into work yesterday to finish off a few cases and then went to her condo in Chenal for a social distance visit. It was a stunning day - the air was cool but the sun was warm. She has the sniffles so she brought down some boxes for me for a house project and we social distance visited. As I sat down I noticed a bunch of black hairs on my right leg, but not my left. I LOL'd. "I thought I shaved this morning, I must have missed a leg." She sat across from me in pajamas and flip flops. "This is the most I've dressed up in three weeks."

We decided to take about a mile walk around the Chenal golf course on a paved trail. The backdrop of the trees and a small stream and McMansions was stunning - I've never been around there before. As you can imagine, there were lots of golfers. Most were older, polite white men, respectful of us and careful with their golf carts as we jumped aside in the grass to let them by.

Christy is hilarious. We discussed everything from laser hair removal  to how they are doing porn on Zoom (of course she knew). As we neared the end of our walk, a golf cart came careening toward us on the paved trail and we jumped aside to the grass. Christy remarked, "See, some of these guys drive like crazy, you have to be careful." He was dressed in a tight royal blue golf shirt and had a mad demeanor. Instead of driving by, I was surprised when he pulled over right next to us.

"You girls need to not walk when there are so many people playing golf, you might get hit on the head." Had his features contained concern rather than contempt I would have been a little more kind. I'm not sure what Christy's reaction was, but it wasn't vocal. I shrugged my shoulder's nonchalantly and  we moved on as he drove away. As I told my husband the story at dinner, he LOL'd. "He was mansplaining how you should be on the golf course." Exactly. I asked my friend, "Did you know him? What an asshole." Christy said, "I've walked on the golf course many times and no one has ever said that to me."

I worried later if I should have challenged him. "Under what authority do you have to say that to us?" Was he security, was he the head of the golf course, or was he just a pissed off golfer who was used to getting his way around the board room and was quarantined at home miserably? "You never know," Christy said later as I talked to her on the phone. "He could have short man's syndrome. He could be living with his overbearing mother." I laughed. We agreed we acted best in not reacting. You don't want to engage an asshole.

As we neared the end of our walk we vowed to do it again soon, weather permitting. "This was so good for me, I haven't been out of the house in three weeks.  "Me too it's so good to see you. Thanks for the boxes." I climbed in the car to head home.

Oh! last night I had the same dinner - the Palak Paneer with mini ice cream cones, Indian has been our comfort food for the last week and a half, but I forgot to mention the garlic naan. Trader Joe's has the best frozen garlic naan on the planet. It's guaranteed to keep the vampires at bay. Never omitting the carbs again EVAR. And when I add a bit of the leftover spice level 8 sauce from the shrimp curry  from Taj Majal leftovers it cranks it up a bit. My kids like the naan from Taj Mahal better but its a tad flatter and greasier the garlic naan from Trader Joe's is better. The texture is like biting into a spiced pillow. I know, I should be on a commercial.

I couldn't help stopping by work yesterday to finish off a case. Amy, the micro supervisor, was as calm and maternal and in control as ever. I'd sent her a couple of articles earlier in the day and we discussed them. As of yesterday the inpatient positive count at Baptist was 4, and one guy was still on the vent. Still at a lull, thankfully. My ex told me the spike earlier in the week in the state was because it hit Cummins, not sure if I spelled that correctly and too tired to look it up, but I feel sorry for the prisoners.

Impatiently waiting on an Amazon delivery of a new book. It's supposed to come in on Monday - Wednesday. Music time. Much love, E

Update

Here I am again. Talking in my BIG VOICE. I feel like it's getting bigger every day.

Yesterday I joined the micro huddle again. And I learned an amazing thing. One of my techs - I knew she was getting bigger but we all wear lab coats so it's not easy to see - is pregnant! She is due in June. My son was born on June 3rd - so I was super excited. She told me she was having a boy. I'm pretty good a figuring out if it is a girl or a boy, but not in scrub pants and a lab coat - that is way too obscure. Her shower is in May, and she is registered at Amazon. I can't wait to attend - it's been a long time since I've been to a baby shower.

Speaking of scrub pants - they are the most amazingly comfortable pants on the planet. I've taken to pulling them back on after a workout. I wore them to Trader Joe's yesterday, to get my fave comfort food, Palak Paneer and mini dipped ice cream cones. Of course I found a million other things to buy there. The clerk I checked out with told me that I could search their site and find recipes with the products I bought. I was so thankful for his advice I shared what I was doing. He told me while he was packing my things to get some free things - try whatever I want - from the aisle. He must have registered my confusion by looking into my eyes -- I was spinning a bit. Wondering if this was some sort of promotional thing. "You are an essential worker. We appreciate you. Get whatever you want. Try some things out. We want you back." Well that is a foregone conclusion. I've been there four times in the last month and I keep finding reasons to return. I learned in yoga that if you develop a product there - all natural - that they pay top dollar. You can't put your name on it but it doesn't matter - you are making so much money you don't give a shit. So the best people on the planet are using the best ingredients to create products. My Cher group is also enamored. My gross room supervisor told me yesterday she is only doing Whole Foods and Trader Joe's, from now on. Sounds like good advice to me.

Speaking of the gross room - Jessica was in top form yesterday. I received a gross pic of a breast from a top breast surgeon yesterday - we were discussing a difficult case on the phone. I had seen the breast - it was nothing short of heart stopping - earlier in the week. I thought it looked like a volcano. I showed my secretary, and she said it looked like the thing growing out of the side of Igor's head.  A ten centimeter tumor!! Unprecedented there, for me. The pic will come  in handy when I present it a tumor board. I reviewed the core and aspirate from a lymph node with Shaver and Nelson. I thought it was atypical, but the expert called it benign. Sometimes the experts are wrong. I decided to stick to my malignant diagnosis, the one I told the surgeon yesterday, even if it comes back benign again.

I think I shared my favorite movie when I was little, The Resurrection. Ellen Burstyn is amazing. And she aged so gracefully, and continues to work. When I was googling her yesterday, I learned about her incredible life. Another film of hers I loved when I was little was Same Time Next Year, with Alan Alda. I must have watched that show ten times. TV was limited back then, so I didn't have as many choices, I must have bumped into it accidentally a lot. I had such empathy for the characters. I remember thinking - why wait a whole year? Why not meet as much as humanly possible? That's what I would do. Turns out I missed a lot of Ellyn Burstyn's other works. That would be a fun thing to do - watch some of her other films.

So at Baptist yesterday we were at 4 inpatient positives and one still on the vent. I was talking to my dad last night on the phone and he told me they were putting the New York patients prone to avoid them getting on the vent. That increases their lung capacity by 30%. He said they were doing that with neonates back in his day - before surfactant was developed. I did that with both of my kids - slept them prone, despite the current silly recommendations to sleep babies on their backs. It is much more intuitive, and obviously better for the kiddos, to sleep them prone. I enjoyed the affirmation, years later, especially coming from my dad. He's kind of a rock star, and one of my biggest mentors. I wouldn't be here if I didn't want to be so much like him.

So because of the COVID off days I'm actually off until next Wednesday!! I'm so excited. I'm glad the weather is warming up. I texted my micro supervisor last night with the latest recommendations about that crappy serology test I told you about. Someone smart is banning it in Maryland. And LOLOL, the White House is using it for screening visitors. We have been releasing mandatory EUA non FDA approved info about the PCR test to our clinicians, and they are confused. So I sent a memo out to the Baptist system on the physician fast fax yesterday saying basically in fancy lingo to : FACKING CHILL. We are using the gold standard. Our community needs to know that. I was talking to a cardiologist I trained with in the hall the other day about that test. "So Fauci is wrong?" He's not a pathologist. You consult the experts for a reason.

Even though I'm not at work I will continue to blog. I've got a wellspring of stories and it will be fun to think of them during my day. We will both catch up on the pandemic next Wednesday together, and I will continue to get daily updates from my chief and my micro supervisor if there is an important development. Soooo -- Happy Wednesday. Much love, E

P.S. I forgot to tell you I saw gout yesterday!! I couldn't write this stuff any better than it is happening in real life. I haven't seen it in so long. I got to geek out to the beautiful crystals. I hadn't seen it in so long I almost forgot the name of the stain to order and had to search it. Gout is an ugly term, but so beautiful under the scope.

Meanwhile, Back at the Pandemic

When I went to work yesterday I wandered into the micro lab and interrupted their huddle at 7:50 a.m. I decided to stay. Huddles are a thing the Baptist does - something I used to be hypercritical of. The clinical lab are not our employees - they belong to Baptist. They meet daily to talk about their situation - what's going on in their world - and they end with a prayer. It feels a little cheesy - but it's an important ritual and valuable information is conveyed. I learned that we are not just getting another 120 test kits for the PCR test this week - we are getting 240. "THEY" have already doubled their promised allotment. This can only be good. I  met a cute new micro tech named Rachel. I asked Amy "Do you do this everyday? At 7:45 am?" She said yes. I vowed to myself to attend as often as I could.

As I was leaving micro lab I bumped into Sara. Our new morgue tech. "How many deaths, so far?"
She said only five, which was reassuring. We discussed the orange COVID signs we were using on the body bags to identify the patients.  I think this is going to be manageable. Word on my street is that there are only 6 inpatient positives as of yesterday and only one on the vent. That's less than last week!! I know the crest is still rising, but we are on the low end of the curve.

I wandered into the gross room to evaluate their situation. Our chief, Dr. Shaver, is doing a very smart thing we discussed a couple of weeks ago. We are rotating ourselves off, 2 FTE's right now, and our employees. We have done a few voluntary furloughs, and plan to support the remainder of our about 50 employees with a small business loan we thankfully acquired through the government. I learned in a group text with my partners that it went through on Saturday. That was a big financial relief. Consequently, those of us working are busy. I had 120 blocks yesterday - not too shabby for a post call Monday. I've had up to 200 or so, but still. Lots of breasts. Hagans and Fant were busy on Friday. Jessica was busy on Saturday and Sunday.

Jesica is a fiery Southern redhead. She is the head of my department - the Gross Room - and I fought hard to get her there and to get her a pay raise to accompany her rise. Despite her fears - we are all scared right now - she is doing an incredible job. I learned yesterday she not only worked on Saturday, like me, but she also came in Sunday for a few hours to make Monday more palatable for her crew. "There were so many legs," she proclaimed yesterday morning, waving her hands wildly. "Legs are coming out of the woodwork." I guess atherosclerosis and gangrenous necrosis do not stall in a pandemic. Heart disease runs rampant.

So this is my Friday!! I'm so excited. After a record 10 days of call I had a nice post call Monday yesterday. And I got rotated off on Wednesday - we now have cute little COVID days off on the schedule with little o's and asteriks. Kind of like the actual virus. Shaver is doing an amazing job. I already took Thursday and Friday off - I love long weekends in the Spring and even thought I won't be going to Eureka or somewhere else there are lots of projects to do around the house and my back deck and the sunshine are screaming for me. I didn't go out in the sun at all last year. In retrospect, I must have been really low. I freaking love the sun, love to chase it on the porch with my deck chairs.

So happy Friday (mine) to everyone out there. Much love - E

I Don't Know What to Call This One

Ok. Since there are literally like 13 people reading this blog, most of whom are family here, I'm going to get a little bit intimate today.

A couple of years ago I fell into a deep, deep depression. I went from myself cubed, which was fun, but a bit unrealistic, to negative myself. I plunged into the depths of despair. Not like crazy suicidal or anything, I love my children and want to be here for them, but it felt like I was swimming through molasses - the world was suddenly hard to take. I felt crazy.

I've done this before. When I get stressed, I decide that I am crazy. I apply my bachelor's degree in psychology to myself  - much like a layperson might decide they are Dr. Google. It isn't pretty. It's very messy. During my divorce I once fearfully asked my therapist, no kidding I was really scared - if I had multiple personality disorder. I was relieved when she LOL'd. "Why do you think you have multiple personality disorder?" "Because I see other people at so many different angles it's like ten different people are living inside my head."  She replied, "You see everyone else but there is someone you don't see. Yourself."  Touche. I was paying for a reason.

But a couple of years ago the plunge was real. I became borderline anorexic. I gave up carbs - something I've never done and do not recommend. Two hard boiled eggs and a piece of tilapia from Taziki's a day brought me into the summer. I became strangely addicted to my weight, which alarmed me - I've had eating issues in the past. I ignored the dizzy spells I was having which was really bad in retrospect.

One night I fainted. I have fainted a lot in my life - we have talked about that here - but this was a doozy. The blood pressure meds I was taking were no longer necessary when the weight came off. I fainted on my chin. I became unconscious. When I woke up, my chin was bleeding and I hurt so bad I had that heat reaction and had to immediately strip my clothes and climb into bed. I took my blood pressure and once again, I was almost incompatible with life. I tried to ignore it. But it was one of the most restless nights I've ever had. It hurt really bad to sleep on one side of my face, but I forced myself to try to sleep.

At one point I googled masochism, and wondered if this was my new label. But those people get off on pain, and I was not happy at all, so I rejected that theory. I woke up to brush my teeth, and I alerted my husband. "You'd better call the dentist. I think I need an emergency appointment. Something's not right here. My teeth have shifted." He got me in, and she agreed. She sent me emergently to an oral surgeon, who took a panoramic view of my jaw. "You broke it in three places. You need to go to the OR to get your mouth wired shut this afternoon. It will be two months before you can eat again."

My first reaction was a little funny. I imagined someone digging up my skull in a hundred years or so and finding imperfection, and I was upset. Then I was like, "Hell yes. I've got a broken jaw. That's kind of cool. Not like I was in a major car wreck or a cage fight cool, I just fainted, but no one needs to know that. I can pull this off." So I did. I have the Xray in my office to admire. But I lost even more weight, which was not good.

When I am in a bad place in my head, I punish myself. Punish my body with lack of food. Punish my skin with overly hot water in the shower to make it red and angry. Punish my head with negative thoughts - overly self critical. It was my new norm, but not new entirely. I've been doing that to myself for my entire life. I decided, not for the first time, that myself cubed was hypomanic. Not truly bipolar, but just shy of that. And along with that, I was having delusions of grandeur.

My shame and depression was most hard to hide from my kids. You cannot hide things from your kids - you think you can but it doesn't work. Jack called me out last Spring Break in the Dominican Republic. "Mom, you aren't yourself, and you haven't been for a while. You don't even talk at the dinner table anymore. C and I are scared."

So I talked to them both about depression, and told them I was going to work on it, and if I thought I needed a therapist, I would plug in. But I didn't. I soldiered on, and got to a point in December when I decided to make some changes. I moved into a new bigger office at work, closer to my partners. I started fast walking/slow jogging again on the treadmill - two chiropractors have told me I'm way too kyphotic to run. Yesterday I zoomed yoga with my favorite yoga teacher Matt. I'm finally getting happy again. And I think my body and my head are in alignment, for the first time in a long time. I finally see myself, and consequently see everything. If this is heading into fifty - age, maturity, wisdom, what have you - I welcome it with open arms. Pandemic, Schmandemic. Life will go on. I'm excited to see what's next.

Happy Easter!

When I asked the Walgreen's clerk last weekend when Easter was, she told me it was next weekend. This is not my favorite holiday, but I want to get it right for the kids. My mother was the uber holiday queen - she set an unattainable precedent. I remember sitting in the kitchen as a kid staring at the tree outside our window marveling at the multicolored plastic eggs hanging from it. It wasn't just Easter - every freaking holiday was like a normal day times a hundred. I even liked Thanksgiving back then - I remember watching the Macy's Thanksgiving parade on television while my mom cooked mashed potatoes for our feast in the background. I was proud I helped peel those potatoes.

So on Tuesday of last week I was mortified to learn that Easter was today, not next weekend. I overheard it from the secretaries. I tried to be prepared! And I was sabotaged!! No, she was sweet and confused. I have had two weeks of call. I'm on the edge of myself. Nevertheless, on Thursday, I shouted as Melody and I finished early - "I'm going to the gift shop to shop for Easter."

The Baptist gift shop has been a treasure trove for me throughout the years. I have shopped for everything there from kid's birthday parties to holidays. It's weird - they have things that no ordinary store would have. And they have a clerk that sings randomly in the background like the most beautiful person on the planet. It's like when the world was surprised with that unremarkable looking woman on Britain's got Talent by singing a song from Les Mis - amazingly - and became an overnight sensation. I can walk down the hallway of my hospital and hear that from her every day. It's incongruous.

I was pleasantly surprised when Melody wanted to join me - we've had dinner together once, and shared uncountable cases, but never shopped together. We've been planning lunch for three years but it's never worked out. We walked down the empty hallways of Baptist chatting away hungrily for female connection. The gift shop was empty of people but full of Easter candy and gifts - we were filling our arms. She would find something for her teenage boys and I would marvel at how it would fit into my basket plans as well. We were the only ones in the gift shop - that has never happened to me in the past twelve years. We only bumped into a former CEO - Doug Weeks. He used to live down the street from me when I was married to my ex. He's so friendly - we chatted about our current times and he asked about my dad, who had a health scare over the summer. I proudly proclaimed him worry free.

But baskets. I haven't had baskets in a while, and I remember last year acquiescing two gift boxes purchased at Walgreen's to present the presents I found to my kids.. My Easter decorations fit in a small box - I think there are five in total. After call yesterday, I was determined to find baskets, at least for festivity. Much to my chagrin the people of Arkansas are hoarding Easter baskets as hard as they are toilet paper. They were out at Walgreen's and Kroger. I texted my group of Cher ladies.

"Where can I find an Easter basket?"  They immediately replied not only with where but with many creative and alternate suggestions. My eyes welled up with tears of gratitude for this group. Later in the day when I found a treasure trove of memes in a facebook group to share with them I got so excited. I headed to Michael's and found exactly what I needed - at 60% off!! I was happy to hear from the clerk that I avoided the massive crowds that were there on Friday - there were only a handful of people in the store on Saturday. It felt safe.

As I assembled the baskets yesterday evening I was proud of my haul, and presentation, and as I covered them up to hide them in a corner of my bedroom I felt  like despite the last two crazy call weekends I'd done my mother proud. I even made a basket for myself that would rival the ones she prepared for us when I was little. No, I'm too lazy, I did not design an Easter basket scavenger hunt around the house, we are just meeting at noon when I think they will be awake to unveil the baskets with their campy candy gifts, but still. Despite the pandemic, it's going to be a good Easter. I hope you all have a Happy Easter too. Much love.

Personal Protective Equipment (PPE)

I alluded to the weird temp checks yesterday. I am usually over 97, but often under, and as Hays claimed, sometimes incompatible with life. Someone in the gross room told me they were doing it wrong. They hold the thermometer up to our foreheads, not touching it, just shy of it, measuring. I hear it is more accurate if they do it around the ear - preauricular. Someone told me in another county they are placing the wand in the ear - that sounds much more accurate. Nevertheless, my hospital has impressed me. We are on top of it.

Everyday, I walk to the doctor's screening station near day surgery. Prior to getting temp screened, I am required to hand sanitize. Then I answer the questions as they look up my name and fill out my temp and answers in a large notebook. After this is done, I am allotted a surgical mask and a pair of gloves. I've been hoarding them in a drawer at work - and recently brought home four masks for my family for excursions to the grocery store. Yesterday Cecelia's car battery died, and we instructed her to go to Goodyear up the hill to get it fixed. I texted her "Wear a mask, when you walk into the store. It makes everybody feel more comfortable, these days."

I"m in a group text with seven gals - most of whom I only met a few weeks ago when the Cher concert we planned on attending was canceled so we gathered instead to drink and sing and play Cards Against Humanity. That night seems like a year ago. If anything intangible can be called lifesaving I would claim this group text. These gals are nothing short of massively supportive and overall hilarious. With their support, sharing memes and suggestions of where to buy toilet paper and what to cook for dinner - I sail through my day. We've been sharing selfies of ourselves in masks for our rare forays out in the community to support our families. We plan to gather when all this is over, our party plans involve food and drinks and arts and crafts and we will continue to plan for the entire quarantine which ensures the most well prepared potluck of the decade.

My ex has been pretty stressed out as an anesthesiologist. I feel it is my job to support him for my kids, and hell we were married for 13 years so I still worry for him and his new family. I mentioned he joined a team of docs and is cross training in the ICU for our peak. Four of his partners were furloughed. He proudly sent me a pic of himself the other night in full on N97.7. I laughed out loud. He looked like an astronaut!! Double gloved, face shield incorporated into the outfit, swathed in protective baby blue hazmat suit. Smiling behind the face shield. It's the first time I've seen him smile in two weeks. He proclaimed in text that his specialty is the only one in the hospital that get's N97.7, and that he is the envy of the pulmonologists. My biggest concern was comfort. I texted - "Is that hot??!!" He reassured me that there was a blower and a fan incorporated in the suit and one of them blew directly on the back of his head.

My hospital issued a hospital wide dictum over e-mail at the end of the day on Wednesday recommending PPE eyewear in addition to the masks. I was a holdout on the masks, just going to frozens this week, but relented when I started getting, as one of the girls in the gross room aptly put it, dirty looks in the hallway. I still start off going down the hallway mask free - remember, and then run back to my office to grab it. Another learning curve. I like the ones that tuck in behind your ears more than the ones with ties - they take too long. I often rip it off my ear with a sigh of relief to call the results of the frozen to the surgeon. I wondered the other day where to get PPE eyewear. They recommended it even if you wear glasses.

As I walked into Baptist hospital near the day surgery entrance to get screened yesterday morning I was pleasantly surprised to be issued, in addition to my mask and gloves, protective eyewear. Daily masks, N97.7s for vulnerable anesthetists, -- I could rail all day long against admin but extend my kudos because they are doing an AMAZING job here. In my doc mom group text I learned that hospital administrations all over the country are shaming their doctors and nurses for wearing masks and striking down screenings in fear of losing patient business. This is absolutely insane to me. Yes, our hospital is bleeding by the millions like everyone else all over the world but I feel supported, more so than I have ever felt. It's nice.

Gotta go in for call Saturday in a couple of hours. My turn to bring donuts for staff - Melody and I have shared call for two weeks in a row and she brought them last weekend. I'm hoping it is slow but last weekend was crazy so it's hard to tell. And I'm having lots of those record rare cases that seem to creep up and attack you during stressful times in your life - cool when you see them once in a decade but a little angsty when they cluster daily in a week.

Yesterday I walked in the gross room and saw a hand. I've only seen hands one other time in my career - at Children's - bilateral there and something to do with electric shock. This was necrotizing fasciitis, and as the gross room supervisor peeled back the bandage to reveal the damage I steeled myself. We see so much here that nothing fazes me - legs, lungs, breasts, etc. all day long. But there is something about a hand that is different - it is more humanizing and the loss feels especially dire. An unfamiliar wave of low level nausea passed through my system and was thankfully quelled as I visualized the specimen.

Protect yourselves out there, the small handful of people that are actually reading this LOL. I'm no longer worrying about talking too much. It's just a freaking essay, maybe a pseudo-essay, it's not like I'm asking anyone out there to read a whole book or anything. And it's helping me. The propulsion that blindingly urged me here a few days ago is morphing into desire and calm. So for the foreseeable future, your can count on me as a regular. Happy weekend:)

Tumor Board

The Thursday before Spring Break I had my last in person attendance of tumor board. It was also my first temperature screen to enter a hospital. It was still dark before 7 a.m., so it felt especially apocalyptic. I was surprised that my temperature was only 96 degrees. I lathered up with hand sanitizer and answered the requisite questions to enter CARTI, a routine that has now become familiar at my own hospital. No I have not coughed, ran a fever, etc. I signed into tumor board. Dr Hays was already fiddling with the laptop in attempt to load the radiographic images onto the large screen. He joked, "My temperature was 93.1. I'm pretty sure that is incompatible with life."

Yesterday at 10: 20 a.m I got a text from my microbiology supervisor. This was my first text from her - I gave her my cell when the whole pandemic thing began. Her predecessor had my cell, as well has the previous infection control nurse, but I just hadn't thought to relay it to her when she took over around a year ago. "We got the GeneXpert test for COVID in, we may be able to go live as early as this afternoon." I'd already had six frozens. It was a crazy morning, so I hadn't checked in with her like I have over the rest of the week. I jumped up from my scope and ran into the micro lab. We celebrated with smiles and incredulous looks. My body felt like it was vibrating. I ran to my chief's office to relay the news. He asked, "How many test kits did we get?"

"I don't know. I didn't ask her. I'm just so excited!!! Finally we've been waiting forever. Let's go back together and ask her." We walked back in to the lab to query Amy. We learned that we are getting 120 test kits, to start, with more promised. This is the PCR test that will turn around results in house in under an hour. We will only use the in house test on inpatients - ED patients and outpatients will still go to outside labs. It will take 32 kits to validate the test, which shouldn't be a problem because we've had the validation lined up for weeks. Sixty tests kits were allocated to North Little Rock, and 60 to Fort Smith. That doesn't sound like a lot, but to us it's gold. Shaver asked, "How good is the test? All the clinicians have been asking me for weeks. I keep telling them it's good, but I need the details."

I replied, "It has a false negative rate of around 30%, from my research. But it's good!! It's freaking PCR. If the virus is there, it will detect it. All the clinicians are worried about the test because of the cited false negative rate. But it's not the test problem, it's the acquisition of the sample. The OP and NP swabs don't always get a good limit of detection to allow the PCR test to work. It's a wonky virus - it doesn't like to be seen easily for some reason. Another kink in the testing process." We went over our plans again for the serologic test, in case we should acquire it. Amy showed us some hard data about the test, and I took pictures of the charts in case I got any questions.

The other night at dinner - Cecelia was over at one of the three friends we are allowing her to hang out with during this thing - Jack was asking me to explain PCR. We had a sort of DYI dinner of leftovers - I was eating my favorite palak paneer and garlic naan from Trader Joe's and they were having more beef tamales. I kind of laughed because my DNA research days are so remote, and nowadays you just stick the sample in the machine and it does all the work. In my explanation I slowly remembered being in my friend Katie's dad's research lab prior to medical school, building primers and going through painstaking work to replicate our target at the time - markers  that would hopefully be early detectors of ovarian cancer. Hard to believe I was only 20 back then - freshly graduated from Hendrix College. When I got into the part about matching adenosine to thiamine and guanine to cytosine, Jack said, "Never mind, it sounds really complicated. I'm in chemistry. We are studying atoms right now. Nothing like this." I said, "You will soon. and it's not complicated, it's fascinating. You will love it. I can't wait for you to learn about it."

Yesterday morning I went to work at 6 a.m. I beat Dr. Bell into work for the first time in 12 years, and I lorded it over to him on text. I was nervous, because I had to chime into tumor board remotely, and I hadn't figured out the technology yet. I started by loading the URL into Google Chrome - Melody had told me the day before that you couldn't download the app in Explorer. It was Global Meet - something I was completely unfamiliar with. I fiddled around for a bit, and ended up being the first one at the meeting at 6:15 a.m. I laughed at myself and read a couple of chapters in my book club book. I'm reading American Dirt, a book we selected at our last meeting after discussing the controversy and battering the author got after her launch a couple of months ago. I felt sorry for her, but I also understood the point of view those that criticized her. Still, it went too far. Death threats causing someone to cancel a book tour? We decided to read and discuss. It's a fascinating book - a thrilling tale of a mother and son escaping a Mexican cartel.  Once again this week, I have a theme. We are watching the third season of Ozark. The other day when I was getting out of the shower, I worried over the pandemic, but gained relief in the thought that I wasn't being targeted by a Mexican cartel. Friday night I have my first ever Zoom meeting for book club. I'd better finish the book by then so I don't have any spoilers. I'm usually the first one done but the last few weeks have found me distracted.

Hearing the familiar voices of Dr. Hays and Dr. Wilder, the only docs at the actual tumor board at CARTI, was reassuring. I enjoyed hearing him cuss in his Southern twang (THIS IS BULLSHIT) when the radiology took 20 minutes to share on the webcam. I figured out I could sync with my dictation machine and talk to them - I didn't need my laptop or my phone like my other partners suggested I might. I got to watch as other oncologists and radiologists chimed in remotely - I was able to see who was there on my computer screen. I worried about no one realizing I was leaving when I had to pee during a discussion of treatment of Waldenstrom's macroglobulinemia, but realized that no one would really care, or probably notice,  if I muted myself to briefly to run across the hall. I chimed in when they were talking about the convalescent plasmid COVID treatment, to pass along information in case they needed it for their cancer patients. There was a funny moment when someone who had connected by phone, a doc who was muted and probably attending to other matters, picked up the hold pattern at CARTI and briefly sabotaged the entire meeting with a loud soothing voice. "Welcome to CARTI. Our mission is too . . . etc. etc." We found out who's phone was responsible, and someone texted him so he could fix it and we could resume the meeting.

I liked the format. I was a little frustrated with tumor board a couple of years ago because they don't routinely use or ask for path like they do radiology, and we often sit there like bumps on a log, answering the occasional path question or looking into something confusing. I rotate going to the meeting now, once a month, with three of my other partners. But I like this remote format - it will allow me to attend more often while covering needles or frozens, and I can work while attending, so I e-mailed the contact person and asked her if we could continue to go to the meeting this way after COVID. I was happy when she replied yes.

Spring Break

Was that only three weeks ago? It seems like a year ago. We were supposed to rent an SUV and drive the kids and two of their best friends to Crested Butte, one of their favorite SB haunts, to ski. I don't ski any more; my advancing age hinders me from experimenting with heights and rapid downhill glides, but snowshoeing and resort spas and picturesque, pastoral landscapes from the safety of hearthside airbnb's are still a draw.

Instead, like the rest of the nation, I canceled at the last minute. Airbnb was thankfully liberal with their return policies - I'm still using the return credit on my credit card as petty cash for groceries and Amazon buys. I've been using the same pair of three scrubs on and off at work depending on my mood for dressing up to keep up with my female Little Rock partners (both of whom dress impeccably) for 10 years, so I finally ordered the same size/make of scrubs online last week. Nine pairs cost me a little over a hundred bucks - there are discount galore these days for healthcare/sacrificial workers. After washing them when they arrived the other night, I was a tad frustrated to find the same size and brand I tried on many years ago was at least a size bigger and a few inches longer. Has America grown that much in a decade? Oh well. I rolled them up yesterday morning at the hem after washing them and fancied myself my 90's version of me -- full on baggy grunge.

I'm in a group text with four other doc/moms I'm in a book club with. Over Spring Break we all decided dry cleaner clothes were wise to put on hold - safer to wear scrubs that could be washed in hot water as soon as we got home. Our closet could wait until COVID was over. They are two radiologists, a family doc, and an oncologist. They have varying degrees of anxiety over COVID based on their personal histories and workplace exposures but we are all anxious, and their intelligent approach to this process has been a balm over the last few weeks. They are all like minded politically so we share memes and information and check in with each other every other day or so.

I spent Spring Break largely on my back porch touring, of all places, Kentucky. One of the doc moms recommended The Giver of Stars by Jojo Moyes, which was a lovely historical fiction about the packhorse librarians in rural Kentucky. Unknowingly and funny in retrospect, I also read another historical fiction about packhorse librarians recommended by someone in my other book club called The Book Woman of Troublesome Creek. I rounded out the Kentucky tour with a nonfiction called Hill Women: Finding Family and a Way Forward in the Appalachian Mountains by Cassie Chambers -  a nonfiction I ordered after reading a Slate article about it a week or two earlier. It was a nice antidote to Hillbilly Elegy - she rises from Kentucky poverty while celebrating the amazing women who lifted her up into the halls of Harvard and returns as a lawyer to fight for the women in poverty that represent her family. It really wasn't a bad alternative to the Spring Break we planned. I probably would have been doing the same thing by the fireplace while the kids were skiing.

Hard to believe that was only two weeks ago. We continue to do lots of cancer surgeries at work. Rotating two docs off every day - we decided to do the same thing to our staff that we do for ourselves - keeps the numbers of cases about normal. Our new ENT doc had a record number of cases yesterday and I was doing late frozens on a mandibulectomy - he had already done a laryngectomy and a wide local resection on the scalp. It was reassuring to learn that the ENT society had mandated that all head and neck surgical patients be screened and rendered COVID negative prior to operation. That society is keeping its docs safe. I worried again for my ex, an anesthesiologist. That is another specialty that works closely with the airway, risking exposure with every intubation. He's been pulled into a special team of seven docs - pulmonologists, anesthesia, infectious disease, etc., that are the forefront of this advancing pandemic at our hospital. He is now rounding as an ICU doc. My partner over blood bank was on a conference call with some of the members of this team last night planning our first convalescent plasma COVID treatment, which might take place tomorrow night. If so, it will be the first one done in the state.

Fear and worries aside, Arkansas seems to still be doing well. As of yesterday, we only have 8 inpatient positives and only one is on the vent. I know that there are a million sources out there, but mine project the peak to be April 27 here and projected deaths are 300 as of right now. That sounds terrible, but it is way under the curve and we will hopefully avoid crisis mode. I see online they are writing names of patients on body bags in New York, in fear of losing ID tags. Hopefully our planned use of bright yellow COVID positive/suspicious signs to attach to body bags will be kept to a minimum. And I'm looking forward to next Spring Break, which I anticipate looking a lot better for our entire nation.

Start Button

I guess 3:30 is my new start button so at the risk of talking too much I suppose I'll continue.

We all got less than 24 hours notice about three weeks ago when they converted the doctor's parking lot into an outdoor COVID-19 testing site. But first, they painted sequential numbers in each spot. As I pulled into work some were still dripping and smudged with white paint. I walked into Bell's office. "What the holy hell?" 

"I guess they are giving us assigned spots."

I suppose the reasoning is that if enough people present to the ED with symptoms they can give them an assigned number to wait for the lonely (tech? nurse?) they have assigned to the lot to walk over and test them in the safety of their car. Whoever that is sits at a large table in full PPE. There's a port a potty by the stairwell. I've never seen more than three cars in the testing site. One of my employee/friends said she instinctively holds her breath every time she passes the lot on the way into work, but I reason, since I now park right above the doctor's lot and pass it on the way into work, that I am far enough away that social distance rules allow me to keep breathing. That may or may not change in the next couple of weeks.

I researched online and the outdoor testing site is a thing, so it makes sense - keep the symptomatic patients out of the hospital, send them home if you can, make them wait for test results. My best friend from med school's husband, who is an ICU nurse in Jonesboro, is currently grounded at home for 48 hours awaiting test results. It's funny - he's got cough and sinus and GI symptoms, so he got tested. She had to pass along her ED call for ophthalmology to another partner and ground herself until he is cleared. Yet our cytology supervisor, who has been grounded for a week with sinus symptoms, could not get a test in Little Rock because she didn't have a fever. She ended up going to some third party lab in NLR to alleviate her anxiety. And as far as I know, outpatient and ED testing is still with Quest, so there is a 5-7 day turnaround here in LR. The 24 hour Viracor is only if you are inpatient.

I follow a pathologist online who's medical husband tested positive a couple of weeks ago. He's nearing the end of his quarantine. It was scary for a while - he has some medical issues and they freaked around day 10-11 when the cytokine storm can happen, but he made it through at home and is now working in the yard with a cough. But the thing is he was not notified by the HD that he had the bug until a week after he tested. And she wasn't notified by the HD to stay home until he was almost over his quarantine. So without medical knowledge she might have been out and about as an asymptomatic carrier.

We've got our clinicians pushing hard for the serologic test - the one for the antibodies - but there isn't a good one out there yet. I was stressed about it when I checked on the status of the Cepheid PCR test with the micro supervisor yesterday. "Is it coming?" She rolled her eyes. "They are saying maybe by the end of the week. We've heard that a lot in the past few weeks, haven't we?" I asked her, "What are we going to do about the serologic test? I'm worried. The danger is, if we release the results of a bed test, and there is a false negative, that person can go walking around with a false sense of security and infect a bunch of other people. Then we are just creating a more dangerous situation during this thing." She replied, "If we get a serologic test, we are looking into it to make them happy, I agree there's nothing out there CAP recommends, we will only do it alongside the PCR test and release the results together. They have to submit the NP swabs alongside the blood sample. That way they can use the information together, instead of using the bad test as a solo piece of information." That makes sense, and gave me a lot of relief.

Surgical cancer cases are still running at a steady pace, but apparently a reporter called our hospital out on Sunday to our governor during a press conference for starting the OR back up so there was an emergency meeting and they were going to allow the cases this week to go through but next week is going to be dead again. This is just a public shaming technique. We are running very few OR's, and they are all cancer cases. Cancer should not have to wait a month for COVID to go through. I was talking about it with my partner Melody - if I was a patient with cancer during this pandemic I'd be freaking out. There is a point, there must be, when the invasive cells cross a lymphatic space and hit the bloodstream, rendering the tumor metastatic and high stage. It's gotta happen in an instant, overnight, what have you. It's a ticking time bomb, and it's not fair to put those patients on hold.

But decisions seem haphazard during a pandemic. Rules are not applied, at least in our country. This thing is rolling out so fast and our response is all over the map. So my thinking is that decisions made based on yesterday's information could change based on tomorrows. And all we can do is put one foot in front of the other and take it as it comes.

Coping Skills

Last night while cooking, I was discussing healthy vs. non-healthy coping skills with my kids - Cecelia, now 17 and Jack, 14. It was two separate  one on ones, because when do you ever have two teenagers and a mom in the same room, on the same wavelength, in the mood for such a conversation. Jack was perfecting the cheese bread from the Brazilian bakery he learned to make last month to please his sister, and I was adding various ingredients to the canned refried beans to make them fit for serving with the frozen tamales from Trader Joe's. Oregano, Persian lime olive oil, cumin, fresh salsa, garlic salt. Not too spicy this week because my daughter's taste buds cannot handle it. Fresh sliced jalapenos on the side instead.

We came up with a few. Healthy - running, reading, gaming with your friends, art,  cooking. Unhealthy - drinking too much, working too much, over or under eating. Jack tossed in heroin, I had to agree. Cecelia listened silently, she seemed tired. Hell I'm not judging - we've all tried both sides of the coin. I guess that's why I find myself in front of this old somewhat healthy coping mechanism in the middle of the night.

Because what else are you going to do, in this ever-changing, unprecedented landscape? For two weeks our work ground to a halt. Then it cranked up slowly at the end of last week. Yesterday was insanely busy for a call Monday - I had 12 frozens between 9:30 and noon. Surgeries are slowly increasing - cancer is not an elective. Nor are appendices. Babies keep coming, so placentas are plenty. Gallbladders - debatable. Breast reductions can probably wait, but these are murky ethical waters, which will ebb and flow against the backdrop of the swell of this virus.

So there's normal work, and then there's new stuff. I met our new morgue attendant yesterday, and we discussed morgue capacity. I was impressed that she was aware that we could order a refrigerated morgue truck from FEMA and could get free delivery within the week. We discussed the worry about the funeral homes getting overwhelmed. I worried with a partner when to pull the trigger. I know of a hospital in Brooklyn that has two trucks. One in Tulsa that just ordered one. They have 12 deaths at that hospital. We have none. It can wait today.

The daily counts my chief group texts us suggest we are flattening the curve, but with the severe lack of testing who knows? We were supposed to bring the PCR test live in house Monday, but the DoD demanded 8% of the test from the company so they had a complete halt in shipping and an emergency meeting to re-allocate what they had already promised to labs across the country. Once again, as it has seemed for 2.5 weeks, we got our hopes up and are in another holding pattern. Our 24 hour turnaround through Viracor has been great, but we want on site testing with more rapid turnaround.

I was talking with two of my transcriptionists yesterday afternoon. One had a relative that was shaming Arkansas, like the rest of the country is right now, for not having shelter in place rules yet. But we shut the schools down before New York. And I'm just not certain we can control how all of this is going to pan out in certain regions. In China, it hit the male smokers hard. The Atlantic and The New York Times had cringey articles predicting doom for the unprepared, rural obese South. But our entire country is obese. If there's one thing I've seen over the past twelve years, it's that disease processes have predilections for certain regions, and they are often unexplainable, on the front end and on the back end. "Why does everyone in Searcy get bladder cancer," a respected urologist bemoaned once in tumor board.  I once read GI slides for a clinic up in Northeast Arkansas. I had never seen so much collagenous colitis in my life. "There's something in the water," I told a partner. The transcriptionist said, "It's like Erin Brokovich." Exactly. But we aren't going to get to the bottom of it. We have little control. We just have to sit back and see how it all pans out.

But control, or at least the illusion, is an  inevitable coping mechanism. So I read, and try to find information that will help our little corner of the hospital I find myself increasingly hunkered down in. I have not been to the doctor's lounge or the cafeteria in over a week. Contrary to popular belief it's like a ghost town with the restrictions and no visitors. Security is tight. When someone was praying over the code call intercom last week while I was running to the gross room for a frozen it felt apocalyptic. When I go to procedures in bronch lab wearing my N95 I curse myself when I pull out my phone or reach to move my glasses to alleviate the fog from the mask so I can see through the scope. I'm getting better, it's a learning curve. And we are adopting the best practices around for everything from rapid on site evaluation to developing protocols for Convalescent Plasma COVID-19 treatment.

I think the kids are doing ok. I worry about the lack of schedule and interaction but Cecelia is so type A part of me thinks this might be a good pressure release valve for her. An early, somewhat constricted summer. Jack's private school is creating more schedule by the week, much to his chagrin, but he seems to be getting in the groove. I'm lucky my kids are on autopilot. My mom friends with elementary aged kids seem super stressed and overworked. A micro tech was manically describing her 7 and eleven year olds school at home schedule last week. It seemed crazy. They need to just give up for the year, at that age.

Well now that the birds are chirping I'm going to try to squeeze in an hour of sleep before the OR cranks up again. Whew. That helped. Might have to keep that in mind over the next few weeks.