Heart Only

     Christmas Eve was quite a day it started off at CARTI tumor board at 7 Diane had so many cases to present cancer doesn't rest on the holiday. On the way over to Baptist autopsy doc texted me a consent and I replied this is not my job contact Jessica. Well he was probably feeling bad so he had his resident contact her that guy was really nice and she texted me a little after 8 that the consent was legit and we would proceed with the procedure in an hour.

    Got my cases triaged and went downstairs to the morgue. We all get in a tizzy and bitch and moan about autopsies but there is something so sacred and serene about the performance. Jessica and Evans were recording the external exam as I walked in - noting the scars and the details about her nails and I would describe it to you in better detail but it seems like sacrilege. We do a U shaped incision on women instead of Y for obvious reasons. As Jessica was getting into the chest someone from Central Processing accidentally wandered in, and jumped and shrieked and apologized as if she walked in on someone going to the bathroom.

    She opened the door back up a minute or two later and asked if she could watch. I said I had no problem with that and asked Evans and Jessica if they objected they did not. As we opened the rib cage and started to dissect the heart from the surrounding vessels - Jessica and I had to use a lot of suction to clear the area of blood for better visibility - she swooned. "I was having such a bad day, week really, and to see this - I feel like I am the luckiest girl in the world. This is so amazing. Thank you so much." I told her a little about the history and what we were going to look for and her awe was infectious. 

    It was a short autopsy since it was heart only. Evans weighed it and cut into the ventricles a little so it would get adequate fixation when we gross it in week after next. It will be easy to answer docs question and I told him that the autopsy went well it should be signed out in a couple of weeks. So I got my easy autopsy after all.

    Got home a little after 3 and prepared the catered meal from Boulevard. When you have a little one - Rennie - things start and end early and I was grateful for that I was exhausted. Rachel watches It's a Wonderful Life with the kids every year S and I have never seen it so we started it on Christmas Eve and ended it on Christmas morning it's so long I'm surprised the kids sat through it Jack only remembered a few key parts when we discussed it Christmas afternoon. It came out in 1946 years before any one of us was born. 

    S and J and C and Woody all got tested for Covid when I went to work today and I was proven right - they were all negative. You pray for negativity sometimes - cancer margins and Covid tests. It's nice when your prayers are answered and you can travel and visit loved ones in relative security that you aren't a threat to them. Since I had the vaccine I didn't get tested. Thinking despite not yet receiving the second dose I'm ok too. Christmas on the couch in yoga pants and comfy t-shirt was lovely. Hope yours was too. Much love, Elizabeth.

Ocular Migraine

     I suppose I will be filling you in on more of the day sleep is eluding me.

    At about 2:45 I ran to get my afternoon coffee and water and visit Sean and Avery and Kim for emotional sustenance and as I was walking back I started experiencing sharp pains in my abdomen. Damnit, I thought, I don't have time for this. I got back to my office and held my fan in my lap and blew it directly on my face and knew that there was only one thing that would work.

    Melody knew I was in the weeds - I had been telling her about autopsy request doc and trying to save 33 yo dude in another town and cases had piled up and were threatening to keep me as late as on Tuesday. She had offered her help earlier but she's CP I'm AP and I'd already done all my surgicals I only had cytology left (she can't do that) but her recognition of my stress was honestly enough. It's so nice to have female partners male ones seem to avoid tough emotion.

    I called Melody after I closed the door of my office and said let me take you up on that offer for help please come to my office. A couple months back she was on the verge of passing out after giving blood if I remember correctly and I ran to the gift shop to get her a Powerade she let me in so I figured we reached a new level and I can do the same. She opened the door and shut it and noticed aloud that I was on the floor and asked me if I fell or if it was on purpose. I told her I was having sharp abdominal pains it was on purpose. She said that happens to her do I need some GasX she keeps it on hand. I told her yes please I used to keep it on hand but this doesn't happen to me as often anymore and I've gotten lazy about it.

    I was lying on my right side chewing the cherry flavored tablets - she adjusted the fan so it was blowing right on me - and she was wondering aloud if I was ok with cherry flavored I told her I was. Then she started talking about abdominal migraines I assured her in my experience with my body this was probably just gas even though it felt like I needed to have an appendectomy or a cholecystectomy. She told me that in med school she used to have a lot of ocular migraines. I looked up from the floor at my angel savior and said what is that I've never heard of that.

    She demonstrated with her hands. It starts like a fleck. In front of your eye. I guess it always happened in my right eye. You doubt it's existence. I was really lucky to only have the visual and not the pain. Then it grows larger, like a ring, and the borders of the ring get fuzzy like electricity. At this point you cannot ignore it. If you are talking to someone, you cannot see them bc the center of the ring obscures your vision but the periphery is really weird. The ring gets bigger and bigger and eventually goes out of your peripheral vision and goes away. But the sequelae is what I always dreaded it's like postictal.

    Well I've never had a seizure so I have no idea what postictal sequelae is. I wondered if it was like pre-panic attack or fugue state for me when I start tingling all over my body like electricity is happening. She said it's like you've just run a marathon you have to sleep it off so it was always exhausting to experience it knowing you are going to have to deal with the aftermath.

    I thanked her for the GasX and she left. Thankfully, bc the GasX sped up the process and I started belching. And we won't speak of what else happened in my office when I finally got off the floor. My ex-husband, when we were first dating, gave me one of my favorite compliments on the planet. In the company of someone else I cannot remember he said Elizabeth doesn't fart, she blows rose petals. 

    And of course despite my backlog I google imaged ocular migraine and WOW. I asked Melody how long they lasted she said 20-30 minutes. They, like fugue states, are exceedingly rare. Then I hammered out my cases and when Evans texted me that Sims was sending margins - it's like crazy we have 12 to 3 o'clock 3-6 o'clock all the way around the clock we mark one edge blue and one edge green to orient it and the deep margin is black Sims came in to make sure we got the new margin (duh) and they were so long I became practiced in giving him a breakdown. Your 7:30 to 9 is full of basal cell but your 6 to 7:30 is clear send another in that area. He trained at Mayo he's super sweet expecting his first kiddo Jan 3 so hard to get frustrated at him I want to help. When we finally got the all clear I called the OR on the bat phone and we all cheered.

    Well I just hugged Jack and I'm outlasting him that's a bad sign he can sleep in all day I gotta work. Hope you are sleeping better than me. Much love. E

    

Avoiding Awfultopsy on Christmas Eve

     Oh God today is like 10 blogs. Or ten days. Jessica agreed. This is like the worst Christmas call ever. I would tell it all but I need to space it out or I would be blogging all night.

    After I visited my chiropractor, Darren Beavers, for the third time in three days I got a call from Jessica. An autopsy. We are too reactive around them - they don't happen very often - and we tend to ignore them until they ruin our world. Jessica gave me the name of the doc I didn't know at a different hospital (Baptist serves like six now I think) in a different town and I was determined to divert it. I had some other shit going down - there was a thirty something year old in another town with wall to wall pneumocystis on his BAL and that was more important I was trying to get in touch with the docs there bc it was obvious on Epic they had thought of everything except AIDS. Pneumocystis is a hallmark presentation, like Kaposi's sarcoma. But you can't see it like purple birthmarks bc it is on the inside. The offices were closed and the secretaries couldn't find them so I took drastic measures to get their cell phones and relay the information to treat and turn it all around.

    In the meantime I called autopsy doc. He was super sweet and excited to the point of mania. He shared articles with me in text. I managed to get him to limit it to heart only. Thing is, he let the body go to the funeral home before he got consent so I told him he needed to get consent and he assured me his resident was on it. We had the body transferred to Baptist LR from small town. At 11 Jessica called him but four hours later she still hadn't heard from him so she called again and when he didn't have consent on paper she told him it would not work. He said he would mail the paperwork to the husband who consented to someone he knew and they would mail it to us. It doesn't work that way, she said, and he got a little belligerent and asked to talk to her boss. 

    I learned this bc Sims was doing late frozens on a scalp basal cell that had been previously removed with positive margins on Moh's. Evans is on call with me but Jessica stayed late to help bc Sims. I was like why didn't you tell me she was too busy and angry to be treated that way. I texted doc with autopsy request and said we cannot do an autopsy without consent in hand it's against the law. He texted it will be mailed to you when husband signs he agreed to it. I texted we will not break the law to do an autopsy sorry. Then he called and with his moderately Spanish accent (it was honestly lovely) and tried to talk me into doing it without consent, he said "medicine is flexible" like a Spanish surfer dude well damnit the law is not and I started getting angry and he said you are obviously stressed I'm going to go and hung up on me. Well that pissed me off even more I texted him I'm not stressed I'm angry you are pushing us. A lot of the frozens were positive and so more were sent and I was telling Evans and Jess what he said to me and Evans said I'm surprised then he didn't ask you if you were on your. I laughed period? F you asshole I haven't had one in 15 years sorry Evans that's TMI but he is nice he texted me in a group text at 5am Baptist was giving us hell about getting vaccine for our employees who are separate and we fixed that today by going to admin. So Evans has my back.

    Autopsy request doc sent me two more texts and I was so riled up and busy I didn't look at them for a half hour while I was reading the frozens. When I finally did I realized he relented. He said he will not push he will stick with the law instead of science and that he understood. I texted back thanks so much we cannot put our professional licenses on the line and subject ourselves to liability Merry Christmas. Then on the way home he asked let me try tomorrow? I said if we have a consent in hand we can do what he wants. I wanted to reprimand him for yelling at Jessica but I refrained just told him he would have to work through her she is a seasoned professional and my gross room supervisor. (hopefully he got the hint that I knew how he had treated her). The great thing is if he does get the consent prob too late for tomorrow and we don't do autopsies on Xmas or over the weekend and I'm off next week going to visit fam so autopsy avoided (but heart only is pretty sweet sad to miss that in the autopsy queue).

    I've been pretty upset bc partner Brian had third hospitalization in a month he tested positive for Covid and was hospitalized for that I was so scared I've been a little depressed. But Ginger texted today he was going home best Christmas present ever I was elated mid morning. I've got tumor board in the morning should probably wind down. Hope you are doing well. Much love, E

Object Permanence

     One of my first memories from childhood was having an existential crisis. I was four or five maybe, and I was in the kitchen my parents were so excited my dad had been interviewed he was going to be on the news they both were my mom had been with him. I probably expressed this dread as one of those adorable things adults think kids say like, "If you are going to be in the TV then how will you be here to take care of me and Sara" but believe me I was dead serious. I thought my parents had to physically disappear and I wasn't sure they would make their way back to me from that small box did they shrink them to get them there? What if they didn't come back to normal size things needed to be done around here like cooking and driving to work and school. I couldn't handle all that myself yet I was just learning to read for God's sake. My relief was palpable when they were not in fact aired on the 5 o'clock story or six they weren't on until 10 pm I was long asleep by then and they were there when I woke up in the morning so it was a non-issue by then and I could go back to worrying about normal kid things and not abandonment. They of course do not remember this. Just like I don't remember things my kids bring up and say MOM HOW COULD YOU FORGET?

    I was so fascinated by the idea of object permanence when I first learned about it in college. My advisor Tim Maxwell was young and he brought his son in to demonstrate it - the first time the kid didn't look for the hidden object but a few months later he was crying and grasping when Dr. Maxwell hid the toy. Talk about hands on learning. I of course was well  beyond that stage at 4 or 5 but not having any concept of recording or airing or how all that worked threw me into outer orbit.

    I had another minor existential crisis this morning when at 5 am I tried to get out of bed and could not. Luckily I had peed in the middle of the night because my lower back was like nope. I waited until 6:30 to ask my husband to get me a Coke Zero and an Ibuprofen (or three). While he went back to sleep (I'd been in bed since 5:30 pm so none for me) I stared at the negative space between the branches of the tree outside my window and conjured images and wondered if I would eventually need a bedpan. I did not anticipate this being a part of my life for at least thirty more years. He woke at 7:30 and still could not get me out of bed so I called my ex. My first muscle relaxer, Flexaril, and steroids are in my future and I promised chiropractor ASAP and did some stretches in bed my husband smartly suggested and triumphantly arose a little after 8. Whew! Bedpan averted.

    We got this gift on our porch yesterday - I think it was for the former owners but I don't know them and it was a bag of pretzels I didn't think it was worth tracking them down but it was this kind I have been putting in Stephan's lunch for about a month Dot's Homestyle they are everywhere Fresh Market and Kroger. I decided to have a gluten fest and try them - it's the original seasoning have not yet tried the Southwest - with a couple of nice thick slices of cheddar cheese for lunch and OMG they are amazing. S said they are even better than Nacho Flavored Doritos and that's a lot from him those are his fave. Something about the texture too as well as the flavor they are perfect. I won't be doing that again today because as soon as I was  back on two feet I spent some time in the bathroom in between cooking breakfast and I was thinking between my GI stuff and my back and the fact I've been wearing the same outfit for the third day in a row I am becoming that person they say needs to be put out to pasture. 

    I'm going to spend all day on the couch watching TV but a shower must happen at some point. And given the fact that I'm taking a steroid and I haven't done that in four years I'm hoping to sleep as good as I did last night. Jupiter is moving into Aquarius today it changes once a year. That's significant because Jupiter is the biggest planet and has the magical quality of expanding everything it touches. There's a bunch more I signed up for Astro Butterfly's weekly e-mail after I read about the Age of Aquarius the other day. If you think I'm silly for being fascinated by all this you can blame my mom she read me my horoscope every day until I was a teenager. It was so fun. Happy Saturday - much love, E

Midnight Mass

     One of my favorite memories of Christmas is midnight mass. I passed the church today on the way back from getting my hair done and thought about my 7 year old self lined up out front at midnight waiting for entry. My grandparents were orthodox even though my parents weren't. Same same with my ex - his grandparents were orthodox Jews and I remember meeting and staying with them in Greensborough SC at their home. We walked outside - we weren't allowed to stay in the same room. A few months later she perished by fire. 

    But Catholic church redux I still love to attend the ceremonies it brings back amazing memories despite my issues with the politics of it all. Communion is one of my favorite things - I still hesitate to take it because you truly need to believe and I'm still in the skeptic category. The smell of the incense and the repetition of the liturgy though I swear I will seek out ceremonies in new cities to re-experience my childhood. The pomp and circumstance is so beautiful.

    It's nice being off but I feel like I'm in this weird state I should not indulge in. Like I don't deserve to relax. Even though I know I really do. I'm on call next week, and I'm hosting Christmas Eve, and Rachel texted me today and said, "Who all is there should I dress up or can I wear yoga pants.?" I definitely said yoga pants it's just us our small blended family I am working all week it's gonna be hell. But I ordered a beef tenderloin with horseradish sauce from Boulevard and a smoked salmon platter and egg nog bread (JACK) and chocolate ganache pies it will be a wonderful pandemic Christmas.

    Did you know we are entering the Age of Aquarius on December 21? I didn't either Lisa told me last week I had an amazing session where I wasn't even journeying but I did and the first 3D thing that popped up on my floor was sturgeon. Turns out the last sturgeon moon was August 20 2019 that's my fing bday and the Native Americans used it to harvest spawning prehistoric amazing fish. One fed many.

    So I googled the first historic age recorded was Leo they worshipped the sun. Every 2000 years it changes. I laughed when I learned my ex, an Aries, a literal bull in a china shop, was the ruler of the Iron Age. I'm excited to enter the Age of Aqauarius it sounds lovely. Celebrating diversity and letting go of individualism to greet collectivism. It's about fing time. Much love, E

Joseph

     When I was twenty I graduated from college and worked at Turning Point - an inpatient child and adolescent psychiatric unit at Arkansas Children's Hospital. It was there that I met Joe - a psych nurse. He was in his thirties, was short and sturdy with a pockmarked face and a long dark brown ponytail. Avery and I - she's another barista at Boulevard I count as a friend - were reflecting today on crushes Joe was a huge one. He had been a first responder to Columbine and was so adept at counseling. He had a history of cocaine addiction and was in recovery. Flaws are appealing to me in a person. Perfection, not so much.

    My divorce therapist, Diane O'Rourke, taught me that you are usually attracted to people because they have something you desire for yourself. Joe had amazing powers of empathy. He once told me in an evaluation that I should not go into psych because I didn't have good boundaries. I was powerfully good at it, but it would eat me alive with all I took home (pot kettle in reflection). He married the head nurse Penny, we used to all hang out together (she had a wicked British accent) and I was so jealous. I wanted him all for myself. 

    Diane's observation made me reflect. I was attracted to my first husband Mike because he was a doctor and I wanted to be one. He is also lighthearted and fun and I enjoy watching the kids experience this - we get along a lot better now that we aren't married and although I sometimes wish I had the emotional maturity to go back and fix that I wouldn't change Rachel and Stephan and Rennie for the world. I was attracted to Stephan because he was humble and had a circumferential route to his current path - he was a starving artist then an architect. His OCD was also appealing. He is a caretaker and he doesn't know or acknowledge his own worth despite my adoration. But he's getting there.

    The other day I was putting up Christmas decor and I pulled out the nativity I put up every year that my mom bought 40 plus years ago at Tipton & Hurst. One of the figurines crashed on the brick floor of my keeping room and smashed to smithereens. I wondered if it was a wise man or Jesus and Stephan hilariously commented, "I don't know much about the Bible, but I'm pretty sure Jesus was the baby in the Nativity scene. Oh, I was thinking of grown Jesus he was right. It was Joseph who perished. My cleaning guy Charles (he's amazing a future blog upon itself) found a part we hadn't it was Joseph's hand on the staff. I put it in the Nativity Scene to commemorate the loss.

    When  I was a med student I bumped into Penny - she was a head nurse on an onc ward at ACH. We  caught up. Turns out she divorced Joe he relapsed and eventually overdosed. I burst into tears. Sometimes the people we admire the most and learn from aren't good self caretakers. 

    It's much easier being sleepless when you don't have to work the next day yay!!! Music time happy Thursday much much love take care, E

 

Deadly Dump

     It's my Friday tomorrow (no today) and I was really hoping to have a full night sleep but it is what it is.

    In PMG pathology today someone asked for help filling out a death cert for a woman found dead on the side of the toilet. Lots of people chimed in, some advocating for autopsy, others talking about their expertise in this niche area. One said it is common for elderly to have PE (pulmonary emboli) while taking a dump and her husband wrote about this and presented to his hospital he titled his talk "The Deadly Dump."

    Another bragged about her article on commode cardia - she literally wrote the paper on death by valsalva maneuver her name is Amanda Fisher-Hubbard you can totally google it she sarcastically bragged "I'm so famous." LOL. Everyone was chiming in on ruptured berry aneurysms and determining COD (cause of death) and someone posted a link to a skit called Toilet Death Ejector on SNL which I had never seen and OMG I just had four needles back to back and I was sweaty and hungry but I laughed so hard I was thinking the secretaries probably thought I lost it.

    Speaking of sweaty my office is hot as shit. I've always been a chilly space heater girl but not this year others have pointed out to me it's like ten degrees warmer in my office than the rest of the hospital. I bought a fan at Walgreen's this summer and I still get iced coffee in 28 degree weather. Melody is having the same problem next door we commiserate. Today I had a nice morning then I had like five needles in one hour I was running around like a chicken with my head cut off. I told the secretaries don't be surprised if I show up tomorrow in my bathing suit I am so fing hot. 

    My partner Brian was readmitted for post surgical complications and it's hard to type this without crying. I know he's in good hands bc the people taking care of him saved my dad but I'm having PTSD and I was texting Ginger last night about how amazing rad Ken Robbins is (he's doing procedure on him today) about how he has two daughters and they love the Kardashians so he jumped right in and followed them around the world and when Marie Osmond came here for a fundraiser a couple of years ago he hosted her and was starstruck. He gets the best damn cores on the planet I was telling him yesterday the young ones need to step it up we need more material for molecular studies. 

    I guess I'd better check out and listen to music and go back to bed my daughter is good she signed up for guitar lessons and my new best friend Sean is good I need to pick him up tomorrow so all my people are good so I can relax and listen to music and  chill hope you are having a good week. Wanted to do yoga last night Matt shared a Zoom link but dry heaving took over and hopefully soon but not now. Thinking of everyone in my inner circle and loving and supporting. Much love, E

Midnight Snow

     Last night I fell asleep early and woke at 11 pm or so - went outside and it was snowing! So magical. I danced in the courtyard and watched for over an hour and failed to take pictures oh well. It looks like it's getting so cold we may get more. 

    OMG Lindsey was lovely. Melody came and picked me up Sunday evening and we took her out to dinner and I toured and interviewed her this morning. She was a contemporary of Annie, my sister-in-law, so I was texting her seeing if she was as good as she appeared. She is from Fort Smith and seemed to have a connection to every single person I mentioned or ran into. "Brandon Walser? He's out on quarantine? I grew up with him in Fort Smith." We bumped into my ex when I briefly showed her the Dr. lounge - a place I've been avoiding for the past few months bc it seems like there is a new Dr. out with Covid every week. Bravo, Abochale, the list goes on. She not only knew one of my ex's partners she was staying with her last night and she lived three doors down from where me and my ex last lived before the divorce on S. Lookout - such a small world. She cooks  biscuits from scratch. She idolizes her nieces and nephews. She is the oldest of four - just like me. She even knows my mentor Gene Singleton and his family they have a connection. She's dermpath fellowed and working in Nashville and wanting to return to her roots. Three amazing candidates in three weeks I wish we could hire them all.

    After huddle yesterday I bumped into Krista I used to buy fresh eggs from her a while back but her chickens were mass murdered (her daughter accidentally left the gate open and I think a dog or wolf got them I can't remember correctly) then she moved and the new place is not in a raising chickens zone. God those fresh eggs were amazing. She is a secretary for the lab and I told her RESOUNDING YES from me I really want the vaccine (we were supposed to tell her yes we wanted vaccine or no we didn't) and she said I was not considered a lab worker since I was from PLA. GRRRR. I told her that I heard over the weekend from my friend Jauss at CARTI that active medical staff could get the vaccine and she said not through me you had better contact admin to see how that works. So frustrating but I'm determined so I'll figure it out. 

    My son called last night wanting privileges to my blog for some sort of secret I have no idea what the password is I haven't used it in years but I gave him a couple of options we will see what this is all about in three to four weeks he promised me. I'm off Thursday and Friday so excited looking forward to hair and massage and therapy and buying more masks from my amazing hair stylist she's selling out on her website she can barely keep up I'm so happy for her. So happy Wednesday:). Much love, E

Panic Attacks

     Yousef teaches me that there are some people that are reactive and there are some people that are proactive. Reactive people like to please everyone but when you try to please everyone you end up pleasing no one you just accommodate the latest person that talked to you and if you don't follow through you can't build trust. This is poignant - I can apply it to my own circle.

    Rex Bell once told me that when people in our department want change they are loud about it. But not you. You make change sneakily. You are insidious. Yousef says that I'm not insidious, I just don't need the credit, and I realize that if I want change it is better to create the impression that others are responsible because then they can own it. Big egos need credit, some people don't need the credit they realize that the change is more important. I think that is the biggest compliment I have ever received, but I still don't own it. 

    I hate this time of year because you are driving to work in the dark and you are coming home in the dark. I think it overwhelmed me after this crazy call week because after I was getting on the on ramp and reflecting over the fact that frozen ENT guy was starting a laryngectomy at 5:30 pm and probably didn't need me but might I started to do this thing (Yousef calls it dissociation - I call it panic attack) where I was freaking out about the rain and the night and my body was tingling and I realized I could not handle the interstate. I pulled off onto John Barrow and went left across the bridge and BRIDGE OMG I was going 20 miles an hour in the left lane. Was silently apologizing to all the people passing me in the right lane I could not EVEN I was looking for a place to pull over should have put my hazards on. Finally pulled over in Burlington parking lot and called my husband he and my daughter rescued me and my car from my imminent panic attack (second one this year it always happens while driving) and Christy talked me through it.

    Funny because on my way to my first appointment with Yousef in three weeks I was driving way over the speed limit on the interstate listening to Lithium at full blast. He said he was proud of me for expressing my anger (I tend to stuff emotions and took this praise like one from a parent I was so pleased). I was red and angry for over two hours raging at inequity and hurt and pain. I would have been embarrassed by the color that keeps me from talking publicly and exercising in public and general introversion but somehow he doesn't make me feel ashamed by it I talked through it and became un-red. 

    I've got to work in the morning but my cytotech Tony told me it was looking light fingers crossed Hal got brutalized last weekend. Bestie Laurie on call with me made it home ok I made her text me projecting my own stuff. We've plans to get a Christmas tree up tomorrow afternoon and I signed up for that blasted Boulevard Christmas cocktail class at 6:30 again on call hoping the one in Jan finds me better rested. I was joking with Tina - my head transcriptionist - that it seems like every other house is just too Christmas or not at all. She was sharing a pic of her husband's pic (It looks like Charlie Brown but at least he did it himself) of a tree and we were laughing and loving. She said her neighborhood is the same it needs to even out.

    I'd better wind down with music S and kids do a much better job than me I was venting about work stuff tonight and I'm wired as hell. Hope you are all more relaxed. Much love, E

Bullet and Skull

     I've had lots of specimen types in my years as a pathologist. Appendices, lung lobes, breasts, but never ever until this week have I had bullet and skull. Jessica even equivocated in the gross - we usually don't take bullets, there were no police to receive it - the neurosurgeon insisted firmly. Apparently she was homeless, transferred from another small hospital, accidentally shot herself in the head. Hell no something is missing here. When they tried to follow up after discharge guess who didn't answer the phone.

    This call week has lasted a year. When I went into the gross room yesterday to check on things before I went home to Christmas shop online with my daughter I got a great story from my good friend Laurie. Her brother in law - Wendy's husband - has worked at Con Agra for 40 years. Wendy is over a decade older than her so kind of like a second mom. They pulled him in on Monday and told him, I shit you not, that he would be replaced by a college student to save money and starting January first he would be responsible for training his replacement. He's paid fairly well but 40 years. He's in quality control. He called in sick on Tuesday and landed a job two minutes from his house in Adkins AR as a plant manager - a bit of a pay cut but he's only really in need of the insurance for five more years Wendy retired from her lifelong school teacher job last year and he's not far behind her. Wendy called Laurie on Tuesday so happy Laurie thought she was drunk. But it was Karma. Her husband called his lifelong employer on Wednesday and told them he got a new job, he was taking four weeks vacay and he wished them luck in training his successor he would not be helping out. Sick burn. God I love Karma.

    What else? Nothing enlightening been doing lots of frozens and kind of in a tizzy over something I can't really talk about online but I'm trying to take over another department to fix dysfunction. Work people are like family. Sharing dysfunctional stories is not gossip it's rooting out dysfunction. If everyone doesn't feel supported no one can work as a team, no matter how much money you throw at them. I fixed the gross room, I'm working on transcription, now it's time to tackle histo. It takes time, for me I get angry things seem to move at a glacial pace, but I need to relax and breathe and plug in. It's not appropriate to ignore the mentally ill elephant in the room anymore you have to acknowledge and tackle it. 

    My partner Brian is doing great we sent him flowers and we got a pic of him next to them I've been sharing happily and profusely. A transcriptionist Jan said something that made me LOL "He looks a little pensive." I imagine he was a reluctant poser of the photo Ginger probably insisted. Nevertheless it's heartwarming to see him in full recovery.

    Good news in huddle yesterday Baptist is the first hospital in AR to receive the vaccine and it's happening next Thursday and there is a complicated algorithm on who receives it when I'm sure lab is not the first on the list but they will start giving it out on a week from Monday Hallelujah. I know I won't be first on the list - I'm scared as shit and haven't been to Dr lounge in two months - but hoping to get it before Xmas. Seems like there is a new Dr. every week falling to Covid thank God I work in the lab. 

    Happy happy 3 am music time here hope you are doing well I am surviving kind of a hell week but it's coming to a close thankfully. Much love, E

    

Rectal Foreign Objects

     I should not be writing at 3am but I cannot sleep and it seems smarter than slamming drinks, I've got ENT tumor board at 7am, so here goes.

    We are hiring two pathologists, and we have already interviewed two for one of the slots and will interview a third for the same slot next Monday. All women. I wish we could hire them all, because they all are amazing but the one today (yesterday?) grabbed me so much that I called my friend Becky at St. Vincent's and told her she had to interview this girl because my desire for her to land in a good position supersedes my desire to have her for myself. I was honest - told her what she was up against and that it wasn't entirely up to me we have to make the decision as a group based upon our needs. Selfishly I'd hire her in a heartbeat - her accomplishments include fellowships at Mayo and MD Anderson and I want to learn from her but I love the other too and Melody's good friend is coming next week - anyone Melody loves must be amazing so I'm just going to leave this one up to the Universe and hope everything works out.

    Natalya, the woman I interviewed and toured and lunched with today, is from the Ukraine, but she is a citizen here and has been here for twenty years so she counts the US as her home. She is beautiful and soft spoken and I cannot ascertain her age but she doesn't have kids and seems not to plan to but maybe I'm wrong on that I just intuit it. She loves to read and told me when she was in med school at the University of Iowa (that is a kick ass med school) there was a library with books in Russian and she would read the Russian and the English version. I told her about my mom's volunteering work in Russian orphanages and how she brought her translator Sergei over and put him through Hendrix. She marveled at how unusual of a story that was. I told her that I used to lament that Sergei (he was super cute) would never go out he studied all the time and in my youth I failed to realize the magnitude of what he was trying to accomplish. He was learning to learn in a new language and studying psychology and he didn't have the time to indulge in frivolities granted to me by my privilege. I follow him on Instagram - he's a social psychologist in CA who works for ad companies - and am happy to see he now has time to enjoy travel and fun.

    One of my best friends from residency - Kadria Sayed, is from Syria. She came to the US when her husband did ophthalmology residency and learned English by watching soap operas and retook her boards over here to qualify for a residency position. She is tall and majestically beautiful and one of five daughters she has two herself. She always pumped me up about how smart I was but I balked. I was born at the same hospital I trained at it was like intellectual incest. I was lucky to have some greats pass through but hell I didn't tackle another language. She ended up going back to Syria she was born of great privilege there and frankly wasn't treated very well here and missed that. She told me she used to have to ask her patients if they could afford/wanted her to perform immunos on their cases that shocked the hell outta me. When Syria fell apart she moved to Dubai. When she learned I was getting married she said, "Lizzie, you need to honeymoon in the Maldives and stop over in Dubai to see me." Well that didn't happen but I googled the Maldives and it seems like a good idea for the future.

    When I took Natalya to meet the gross room staff today Jessica was puzzling over something I was like what the heck is that. She said it's a rectal foreign object, we haven't quite figured out what, they seem to self manufacture things a lot. I laughed and said don't drive Natalya away I like her. A new hire who was absent today is named Savanna she is like 4'10" and when my chief Shaver met her he said, "There's a new mouse in the house!" and that's probably not very PC but hilarious my friend Laurie at 5' held the former title. Savanna is tough as nails and Jessica told me she's the new identifier of sex toys she used to work at Adam and Eve. A few weeks ago Jessica was puzzling over something submitted for gross only and Savanna strode over after watching her and said, "It goes like this. This is how it works." Like a boss.

    So Jessica is saving the RFO for Savanna to ID and I asked my doc mom book club last night if I could invite a non-mom to join when we resume post Covid and their overwhelming response was YES. There is a Christmas tree in the front yard of 18 Tallyho to add ornaments to to remember Deborah so I plan to shop at the Baptist gift shop tomorrow (today?) it is my fave place to shop on the planet. Hope you all are sleeping better than I am. Much love, E

Bathrooms and Elevators

     I've talked about my work bathroom on Instagram but quick recap - 1960's, doesn't get cleaned, trash often overflowing, toilet once flushed for hours, tar once bubbled from the drain. There are also a bunch of lockers for the lab techs so there's lots of traffic flow even by those not using the bathroom. Very little privacy. So when I was walking back from a frozen about a month ago and the secretaries told me that they made the boy's bathroom boy/girl and put a lock on the front door (there are two doors so even though I've worked there for years I've never even gotten an accidental glimpse inside) I volunteered to be the guinea pig and check it out.

    It blew my eyes out. 1990's decor,  no lockers, clean, two stalls and a urinal, updated way more than ours. Privacy. I used it once or twice then the third time there was pee all over the seats and that's what happens when you let the boys in so yuck I haven't been back. But I still rage at the inequity of it all.

    I also mentioned on Insta that they are starting to socially distance at the elevators in Med Towers 1 and only allow two on at a time. I was getting cash at the ATM nearby last week when the elevator door opened and a dozen people spilled out I reflexively turned my head and thought what. is. the. point. if you don't practice the same guidelines going down. But when I was up there later in the week (guaranteed all access private nice updated clean bathroom) I noticed some people had good sense and that made me happy.

    Not so much in Big Baptist. There are NO elevator rules there. My partner Hal said he was on his way to do a frozen  last week and thirty people were shoulder to shoulder waiting. Many had on those blue gowns you wear to go into infected people's rooms did I mention we have ninety Covid pos patients at Baptist the ICU is full they are creating spillover ICU's in pre-op and other plans are being made it's truly emergent at this point. Hal stood there wondering how to get through and put his arms out in a t shape to silently communicate PLEASE SOCIALLY DISTANCE and guess what everyone just laughed. He said it took all of his self-restraint to not verbally play teacher to a crowded pack of adult toddlers.

    I was on my way down the elevators in Med Towers last week bumped into Amy Wiedower she's a cute ob and when I just googled to get her name right Amy Winehouse came up she actually kind of reminds me of Amy Winehouse she's quite angular visually. Anyway we talk twice a year but she's always got a good story she said her daughter had a golf cart roll over on her a few days ago. I made her repeat that I misunderstood the first time bc mask. She was just off the phone with the guy that read the MRI he said she had a fracture in something maybe tibia I forget. The funny part is that she told her daughter she was fine and made her play in two basketball games since the event with a broken leg. I laughed and said, "Doctor's kids - they never get any sympathy right?"

    I had big plans to cook and shop but I've abandoned them bc Sunday shopping with Covid sounds scary and even though I slept until 3 pm yesterday I'm still needing more couch time I'm on call next week and the week of Christmas. With Covid and a partner down and people trying to meet their deductibles it's gonna be batshit crazy I need my rest we can do Bite Squad all week. Or soup. Jack's fancy Ramen came in he will be so excited when he gets here tonight he won't miss the cooking plans I never told him about. My friend passed peacefully on Saturday morning so sending lots of love to that family and planning gifts to drop off on the porch. Man that was fast, knowing how bad that looks under the scope I shouldn't have been surprised but I was. My partner is doing well. So that's good news. 

    Highly recommend the Euphoria Christmas special that guy needs an Oscar. Hope you all are having an equally lazy Sunday. Much love, E

Blog Review

     I'd like to welcome a new reader today my son Jack has been expressing interest in reading the blog and I told him no rush he's got his whole life and it's quite a lot to read. Today he asked me to send him a link to this one and MiM, so I did, and about twenty minutes later I got an I love them already I just read two of them! text and he doesn't exclamation point in text so my heart melted. Then he texted, "I feel like I am reading a profound author. Your vocab is great!!! Had to look up a word to fully grasp the meaning." Then I got worried and texted, "Some older ones embarrass me but I decided to keep them as is like a record. Also I used to obsess over minor typos and errors but recently I'm using it more as a journal so I don't reread and obsess anymore." He expressed his approval and I smiled with pride as I returned to my cases thinking if that's the only review of my writing I ever get I will die happy.

    I had breast conference this morning and there was a new format I hadn't been assigned to cover yet it's called Oncolens it's very confusing and I had to call out the rad onc's secretary a few months ago bc the platform was sending daily email 😀😬😁😂😃😄😅😆😇😉😊🙂🙃☺️😋😌😍😘😗😙😚😜😝😛🤑🤓😎🤗😏😶😐😑😒🙄🤔😳😞😟😠😡😔😕🙁☹️😣😖😫😩😤😮😱😨😰😯😦😧😢😥😪😓😭😵😲🤐😷🤒🤕😴💤💩😈👿👹👺💀👻👽🤖😺😸😹😻😼😽🙀😿😾🙌👏👋👍👎👊✊✌👌✋👐💪🙏☝👆👇👈👉🖕🖐🤘🖖✍💅👄👅👂👃👁👀👤👥🗣👶👦👧👨👩👱👴👵👲👳👮👷💂🕵🎅👼👸👰🚶🏃💃👯👫👬👭🙇💁🙅🙆🙋🙎🙍💇💆💑👩‍❤️‍👩👨‍❤️‍👨💏👩‍❤️‍💋‍👩👨‍❤️‍💋‍👨👪👨‍👩‍👧👨‍👩‍👧‍👦👨‍👩‍👦‍👦👨‍👩‍👧‍👧👩‍👩‍👦👩‍👩‍👧👩‍👩‍👧‍👦👩‍👩‍👦‍👦👩‍👩‍👧‍👧👨‍👨‍👦👨‍👨‍👧👨‍👨‍👧‍👦👨‍👨‍👦‍👦👨‍👨‍👧‍👧👚👕👖👔👗👙👘💄💋👣👠👡👢👞👟👒🎩🎓👑⛑🎒👝👛👜💼👓🕶💍🌂GOD that's the third time it's done that and I'm too tired to erase it again cannot figure out how to prevent it sorry. Anyway Melody already warned me not to try to upload the pics into Onclens like they want you to bc it's way too hard and it doesn't look good in the Zoom-ish meeting (no one uses their camera). She makes a Power Point and shares her screen I tried to do that this morning at 6:30 a.m. but couldn't find Power Point so decided just to put the pics on my desktop and share my screen how hard could that be. Everyone was very welcoming and indulgent and helpful when I tried seven or eight times to share my screen when I presented the first patient's pathology and I finally said, "Look guys I'm just going to describe it we need to move on I'll work on it for next time. Lobular carcinoma is like Medusa. It has tendrils like snakes and it goes everywhere it is a bad actor." Jerri Fant wondered how it could be so metastatic when it was low grade and I chimed in. "I don't believe the Bloom-Richardson Nottingham grade system should be applied to lobular. It doesn't fit. You never see low grade ductal go all over the place, hell even high grade ductal, I've seen low grade lobular in the small bowel, in the ovaries, in the uterus, it's so sneaky." Rad onc agreed, "It doesn't quite fit the paradigm."

    About halfway through the meeting at a break in patients I said, "Guys, I need to tell you if you don't already know my partner Brian Quinn had semi-emergent bypass surgery yesterday seven heart vessels he is going to be out for a while." Two of the doctors, Fant and Wilder gasped they are quite close to him a lot of clinicians are he lives at work he's a genius he's who I named this blog after. They wondered what happened and long story short he was symptomatic over the weekend before Thanksgiving and had a cath and then yesterday. The breast conference discussion ended with lots of thoughts and prayers and we moved on. I was using my ex as an inside connection to see what was going on why the surgery was taking two hours longer than expected (almost 7 hours) at the behest of Rex and I had this sweaty PTSD reaction and almost fell apart. My dad. That's a story for another blog. But luckily he made it through ok I'm sure the recovery will be slow and as a group we are stressing and worrying and praying and towing the line and it's all a little much but isn't that typical of 2020.

    I read a headline at lunch today that made me LOL Covid superspreader event at a freaking swingers conference in New Orleans I had to click. Apparently there's an annual convention "Naughty in N'awlins" that drew 2000 swingers last year but only 250 this year but that was still enough to create a problem. The head of the convention expressed regret in the article and then said "We didn't have a dance floor but I know from Footloose that you cannot prevent dancing" so I questioned his sincereness. That reminds me of an article I read last Friday in the Huffington Post it's a long read but well worth it the author obviously did their research and it took some time. Dr. Opioid just googled found out it was published October 28. Forget the Frye Festival and the Tiger King and that cheerleading one where the plucky boy got famous then turned out to be engaged in pedophile activity or tweenophile activity whatever you call it he fell hard. If this was made into a documentary it would eclipse them all. It was full of doctors and motorcycle gangs and opioid diversion and divorce and strippers. My favorite line was when the doctor got the strippers posing as patients for opioid diversion addicted to Xanax and they would come in asking for more and he said, "A blue for a blow." And they complied. Disgusting but intriguing. That article was bawdier than an entertainment lounge at a brothel.

    Ok that's all I've got in me again welcome Jack to my 25 readers (now 26!) and happy Tuesday to you all. Much love, E