Tuesday, October 19, 2021

Harvest Moon

     I'm not sure if it's tonight or last night but it sure felt like a full moon today. Things got a little crazy from about 11-3. Jack had to leave school because he was seeing spots and getting dizzy and hypertensive. I had scheduled the job interview for Shelby at 1pm and learned yesterday I had to run a micro QA from 1-2. And I was covering needles. I couldn't clone myself, and I was worried about Jack. I told Marti and Amy I'd be late to the QA and to start without me. I went outside before I picked up Shelby at Boulevard at 5 to one and walked. Paced, stared at the trees to calm down. Micro QA used to be just lab but lately they've added all the ID docs and it's stressful. There was a strange guy, and old man in a black tracksuit with a black and fluorescent yellow backpack that was pacing erratically. I wondered if he was a geri psych patient. He unnerved me, so I went to the gift shop to peruse the merch.

    I walked over to BV to get a water and wait for Shelby. I walked right past the CEO, waiting on his coffee, and decompressed talking to Avery. You are a sight for sore eyes, she said, and we commiserated about our day. Then we talked about the fair. She hasn't been in a while, me neither, and we talked about wanting to go this weekend. She never liked scary rides, and I've had to step back from them as I have aged from vertigo. But the other stuff. The corn dogs. The funnel cakes. Both don't fit into my gluten free diet right now but to smell them would be enough. The turkey legs, she said. The livestock shows, I thought. We were going to heat the pool this weekend, but it looks cloudy so maybe I will go to the fair if I can talk S into it. 

    I got Shelby settled in to meet Jessica and Keith was late, so I called him. Oh! I forgot. I've got to do this thing and I'll be there ASAP. He showed up about 1:10 and said he did something he has never had to do in his career. A patient, coming from Hope, did not want to drive an extra two blocks to deliver a bill so Keith had to meet him at the hospital with a receipt to receive the payment. Was he wearing a black tracksuit? I wondered. That's the guy, Keith said. He had those things women use to put their hair up on his pockets. Bobby pins? Jessica and Shelby and I finally guessed and he said yes. The man said if you ever were pickpocketed in Chicago you would do the same it works. He painstakingly removed one and gave Keith cash - he showed us the proof in his front pocket. He then went for the 77 cent change owed in the other pocket and Keith said no worries, we will eat that. 

    Then I got called to rad for a thyroid. Sarah told me earlier when I went to the first one that there would be three. So we get to bond. Bond we did. I tried unsuccessfully to join the Microbiology Google meet and decided it was fate. I needed to chill and ponytail and breathe. Marti came later with the minutes to review and sign and we talked about what I had missed, which was nothing bc I attend huddle every day. I learned this morning Greg Crain finally approved the WASP. I saw a presentation on that like 7 years ago I said. Change does move at a glacial pace but this is HUGE. I googled it this morning geeking out before cases came and I cannot remember what the acronym stands for but it is super amazing. Revolutionizing specimen processing. It's a Biomerieux product. 

    Jack made us watch the first two episodes of Maid with him last night and it was super intense. So much so that my left eye kept leaking and I was filled with emotion. I told Kimberly this morning I always felt guilty if I felt sorry for myself as a single mom bc I had the financial means to secure aid. But it was hard, and that show brought it back. Working. Supporting. Attending all of the school functions - getting covered. My neighbor at the time, Birdie, told me I needed to get friends. I have friends, I said, but I'm too exhausted for friends. Work and kids and books and wine were all I had time for. An opportunity for growth, Kimberly said, and I agreed.

    I'm off next week - a staycation - and I texted Yousef and Lisa today to set up appointments it's been months. Need to plug in with chiropractor too my upper back is killing me. I did the best ever in OT today I think all that Marco Polo and racing underwater with Rennie over the weekend really loosened things up and helped me heal. Whitney and Steph were also watching Maid - Steph is a single mom to a 3 and 14 year old - and even though Whitney has no kids and has never been a single mom she said she was bawling. She told me that the daughter in the show is Andie McDowell's daughter IRL and it makes me even more excited to watch it. If Jack hadn't told me it had a happy ending I'd have to quit. 

    I assume Chief duties in January. I volunteered my house for Christmas Eve this week for all the Nestrud's and Dickinson's in town - I'm off. I also planned a retirement party for docs on December 4 for Rex. Crawling out of the pandemic, slowly but surely. Jeff from security - he's becoming fishing friends with Tina's husband Reggie - asked me what I was going to do next week. It's my fifth anniversary, I said, and we are headed to Eureka for a long weekend Friday. He has never been, so I launched into a diatribe about its attributes. 

    There's this restaurant called the Grotto built in the side of a cave. They have this appetizer, quail poppers, that is one of my favorite foods on the planet. Jeff grinned. I love quail! My college roommate and I hunted it all the time. It used to be easy to find, but now it is scarce. We baked it we grilled it you name it we enjoyed it so much. I hear they have good quail in Brinkley, if you are interested. I love the memories of my dad taking us to the Passion Play too, and staying in the Crescent and getting those cheesy old time photos were you dress up like you lived in the 1800's. Good times. 

    Planning to wind down and grill maybe when S is back from his bike ride. Just watched a Merlin with J. Went on an Epic shopping trip yesterday to feed these hungry boys - I won't let them touch the pantry or the fridge that is my territory to keep organized even though they offer. They have strengths in other areas that I depend on. I want to be one of them in my next life - the endless energy, the bottomless pits for food. Happy almost hump day. Much love, Elizabeth

Thursday, October 14, 2021

Hail to the Chief

     I wandered into the gross room around 3:45 after I had checked the board for late frozens. Jessica and Savanna were the only ones left - they were hunched over a catalogue. Jessica said we just grossed in two large dead bowels and are taking a break. Looking for stuff to buy. This catalogue is amazing! Tell me about it, I said. It's called Uline if I recall? Endless office supplies. Oh look! We need this. They were swooning. Zip ties!

    Jessica told me there was a woman that tried to sell them a 10,000 dollar piece of equipment a couple of weeks ago. It fit under the cassette labeler, and spit out something that attached a zip tie to all the cassettes to keep them in order while they were waiting in the queue and to keep them organized when they spit out cassettes for the PA's. She was like hell! Great idea. But I can get zip ties for 2 bucks at Home Depot and do that myself. We all laughed and I congratulated them on their ingenuity. They were also looking at cookie sheets. Something to use at the grossing station to gross on that will catch the blood and contain it and keep it from making such a mess. Genius, I told them. Go for it.

    Lindsey walked in from NLR - she is on call with me. I told her it looked like we were clear for late frozens and bonus! We are limping toward the weekend finally. Limping is about right, she said. She was looking at the schedule for tomorrow and exclaimed hell yes! Hagans and Fant are both off tomorrow. I didn't know about Hagans but Fant called me earlier in the day to fix a typo on a case and told me she was on her way out of town for a long weekend. We scored, I told Lindsey. Knock on wood for a good call weekend. Jessica said she cannot remember when both of the breast surgeons were off at the same time.

    Poor me, said Savanna, I am on call next week. You will be drowning in boobs, I told her, and Jessica guffawed. Savanna deadpanned, yes but not the good ones. LOLOL. They told me that once, about ten years ago, some visiting student walked into the lab when they were grossing in a dead bowel and said Wow! It smells like moist cherries in here. That is their running joke for dead bowel. What the heck is a moist cherry, I asked. Reminds me of the restaurant Juicy Seafood. S and I ate there once years ago and it was decent but we haven't returned. The name is off putting. They were looking for potent air fresheners for dead bowel. I told them the plants they have are supposed to help - they have three NASA air clearing plants - Jess is a green thumb she inspires me. Jess said we would need at least one for every grossing station. Savanna said no, we'd need a forest to combat that smell. 

    Another busy day but I joked to the girls that 130 blocks used to be a crazy hell day but now I'm like yay! Only 130! At least it's not 170 or 200, which is becoming a new norm. Savanna marveled when I told her we used to have 70 block days once a week, twice if we were lucky. No more. It's a grind. In other small news, I will be the next chief. I'm kind of secretly beating my chest and getting drunk on the possibility of power. I'll be the first female chief in PLA history. The staff doesn't even know it yet.

    To be fair, I'm kind of chief by default. Shaver has been doing it for years - he's going through a divorce, poor guy, and we commiserate about that. He's done. Hal, who is vice, doesn't want it. All the other guys who have been working ten years or more than me aren't interested. Melody, as head of clin lab in LR, is too busy for the extra meetings. There has been no fanfare. When I got elected chief resident many years ago it was much more of a big deal. Then they tried to take it away from me, because I was going to be gone on maternity leave for the first month. Such a toxic, misogynist environ. I pleaded my case (I got the most votes!) and suggested that the runner up co-chief with me to make it more palatable to them. They reluctantly agreed. 

    So I get to be in the room where it happens. A room, Shaver assured me, would become quite boring and too much. But I'm excited to be with all the other chiefs and the admins. Change might not happen with me, but I've got opportunity. My grandpa Jack on my mom's side, he was in the Navy, was nicknamed Chief. My brother Matt carries that nickname too. Move over, make some room, there is a new Chief in town. Happy Friday Eve, much love, Elizabeth

    

Tuesday, October 12, 2021

What is in the Water?

     I had OT at 10:00 today. It's like my Calgon Take Me Away moment, especially on a busy call week. Maria traded me an hour of morning frozens for an hour of afternoon frozens. I met a new girl, Susan - she is the Director of the Covid Unit at Baptist. WOW. She was fun and salty as hell. She injured her left hand on a car wreck and was getting therapy. She unapologetically had a take out container with French toast and bacon then set up her laptop and phone to work while she was getting therapy. She talked about Covid burnout and her history of working that belied her youthful appearance - she was director of a hospice in Dallas but worried she wasn't doing enough to help in the pandemic. She also helped process sexual assault victims at UAMS before she took this position. She managed to command the audience of OT with stories and work and entertain at the same time.

    Me, not so much. I told Stephanie I needed a light session like Friday. Recovery is not a straight line, mentally or physically, and I'm moving backwards. I got nerve impingement moving my mouse this morning, which never happened before. I told her I was picking up a brain from a bottom shelf in the corner to show a potential employee yesterday and someone must have poured more formalin on it, because was heavy as shit and it hurt my rotator cuff like hell and I had to get Savanna's help. 

    Shelby loved touching the brain, though, as a lot of people do. I though it would be softer, she said, and I told her it is when it's fresh this is some research brain that has been sitting on the shelf for at least a decade. Abby Normal, it says on the bucket. So the real brain owner is a mystery. She put on the gloves I gave her and caressed the cerebellum and corpus callosum in awe. She's going to be a great addition to the team. Sharp as a freaking tack, and helped me a lot with IT issues when I was trying to show her cases on my new computer over lunch. I marveled, and handed her the mouse to take over. I've been putting computers together and learning code since preschool. An untapped gold mine, this girl. We meet on Thursday to assess the needs of our group and my input is we need to hire her ASAP.

    Especially since IT is still a freaking mess - Jessica actually exploded yesterday in the gross room dealing with issues. She's kind of back together. I was supposed to meet them at Local Lime for drinks during happy hour this evening but it's been a day. Not just work. Jack texted the family gressage at 12:30 and told us there was a school shooting at Central and they were on school shooting protocol and lockdown. My blood pressure went into outer orbit and I was not able to concentrate until we had ascertained that 1) it came from outside the school - two bullets had hit a portable school unit and 2) the picture of the dead body with head pooling blood on social media was a fake. I had to take a beta blocker for the first time in a while. Nancy assured us on a school robocall message that they were working with the police and school security to find the shooter and find the person who made the fake picture. She actually sighed on the recording. This is the hardest day of my career. I'll say.

    Stephanie asked if I was up for adjustment even though I was historically too guarded and I was game. She kept telling me to relax. She's got one cold hand on my inner shoulder while I am lying supine and one holding my hand sticking it in her underarm and moving it around holding it between her ample cleavage. Who can relax?? With this state? I was thinking I was glad I wasn't a guy I'd need to cover my pelvis with a pillow. Jessica tried to come talk to me and she said no, she's in time out she needs to relax. I closed my eyes and thought of a dream I had last night, one that I desperately tried to hold on to at 5:30 am when I woke up but sleep was done with me. Five minutes later she was like wow. You've never relaxed that much before. Great job. You ready for some rowing? Remember, bring it to the girls. Then you get rest and ice and electrodes. Good thing, I felt much better and it prepared me for stress to come.

    Then as I was finishing up some hard cases Kimmie, Christy's other BFF, told me she was bringing her son Tristan to the ED - he'd had a work injury and fractured the tip of his finger so the clinic said he had to go to the ED. So I plugged in there and talked to all my docs and met the APN he was assigned to and made sure he was taken care of in a well and timely fashion. Our poor sons, I told Kim. Is this craziness ever going to end. I can't even. After I released my cases I told the secretaries I've got lots more work, but this day is done with me. I have to go home. Call week and it seems like Friday on a Tuesday. Enjoyed the last episode of Squid Games last night. Need to find and new show. Happy day, thank God none of the students got hurt. Much love, Elizabeth

Saturday, October 9, 2021

Friday

     I walked into the Dr. Lounge yesterday morning. Bit of a kerfluffle. Geisha - I haven't mentioned her I think - is leaving in a huff. Top secret where she is going. She's a little worried and paranoid. Shay and Tammish aren't talking either - about that anyway. I ducked behind the counter earlier in the week and talked to her. We aren't them. They don't care about us either. We commiserated. She's super cute and spunky. A few months ago I wandered into the dr. lounge and she was ranting to Tam, then me. Then she stopped, and left. I laughed at Tam. She does that? Just goes off and then leaves? It's her signature, said Tammy, and we both LOL'd. Tammy lives in England. She's got a daughter about my age. She isn't going anywhere, thank goodness. When the Dr. lounge moved with the new admin a few years ago everyone fought for her. They tried to replace her. She's irreplaceable. 

    Then I went to get a water or two and John Sims was the only doc eating. How are you? I said. I haven't seen you this week. I've been at an ENT conference in LA, he said. I'm making up for it in the OR today. I'd better warn Shaver, I told him. He's on call. John is the freezer, if you remember. No, tell him it's ok, I only have one case with frozens and I won't go past four. Shaver said I hope he holds up to his promise.

    I had five consults before 8, it sucked. Hard cases. Sometimes I don't have five consults in a week. I felt like the gross room earmarked me for bone and soft tissue, which is super rare and I abhor. C texted me at 9:16. Your therapist is calling me. I was super confused. I haven't used Yousef in months. She's from Baptist, C said. I grabbed a piece of paper with OT on it. Yeah, Stephanie was trying to call you. Wondering where you are. I was coming at 10? I got covered? Oh, we had you at 9 but that works she's free then. How in the holy hell she had C's number remains a hellacious mystery to me. 

    I had called Shaver at 9 to ask him to cover me for OT. He said sure, who are you having tea with? Good god me and the secretaries LOLOLd over that. I explained, and he said he thought I was really fancy going to have tea. But he was up to cover? What's next, I asked Tina and the gals. Massage? Hair did? Take the day off for fun? He opened a door that cannot be closed. 

    Stephanie said I was up for reassessment but I was so stressed and tight she decided to put it off. She took it easy on me. I brought pimento and cookies bc it was  Chris's last day (bawl). We made lists of our fave books for each other. It's gonna take me a year or so to get through his. I love that one of his faves is The Story of Edgar Sawtelle - I told him I loved that so much I read it twice. I didn't see him last week bc he was out due to migraines. He and his gf are headed to Kalahari next weekend on my rec I told him he has to tell me all about it. That buffet. The candied jalapenos. The smoked salmon. The capers. YUM. Planning to take Jack and a friend next summer. I think I'm going to invite Chris to the next book club. Gender be damned. He's a card.

    S is grouting and J is sleeping and I'm headed out to the pool. S heated it for the weekend and I cannot wait to read and relax. Recently started following Annika on Insta - she's a weight lifter like J. She spotted him two hundred this week. I graduated to three pounds LOL. I told Carrie to come over and see the house and catch up it's been way too long. Looking forward to that. Happy weekend, Much love E

    

Thursday, October 7, 2021

Gold Star

     Jack's here this week, which is AH-mazing. We've watched two episodes of Merlin in the past two days. We laugh about the cheesiness of it and the ancient special effects. He's downstairs studying right now, but I asked him tonight how many times have you watched this? And what age did you start? I was 11, he said, and this is my third go around. I love that he's sharing something that comforted him at a younger age and ages well and not so well with time.

    Learning more about boobs from Christy. She said as long as your boobs aren't bigger than your stomach you can eat as much as you want. Love that, wouldn't work well with size small B but leaves me lots of room for eating at a DD. Another good tip I learned from Monday afternoon from her was a rule of thumb. If your nipples sag below your elbows you don't have enough support and need to seek more to gain higher ground. At my stature I gain that status without any support so I feel like I've achieved something. A gold star.

    Work was crazy as hell - I had 5 needles before noon prompting me to convert from kitten heels to flats for the rest of the day. Sarah is the PA who does thyroids. Her first was a bust - a subcentimeter nodule that yielded nothing but blood. She wasn't surprised. It's one of those patients, she said, that is moaning and screaming before you do anything. I'll get a little more for cell block and be done. When I was summoned to her second thyroid, she informed me that if it wasn't adequate she would take it personally. So she was pleasantly surprised when I told her she had plenty of cells and colloid. Is it B9? she asked. I told her I thought so but FLUS's can sneak up on us when we see the cell block and the paps so don't get too reassured.

    Pam, the head of cytology, is on needles this week and I told her I was a little enraged. I had a case that was paratracheal mass vs parathyroid vs thyroid. I thought it was thyroid, but the history was so confusing I showed it to Shaver. He pointed out that there was no requisition - we need a req to accept a specimen. He agreed is was a FLUS (follicular lesion of undetermined significance - these go out for Afirma testing - that's a molecular panel - to further guide treatment). Oh! I was so locked up in Epic trying to figure out the location I failed to notice that.

    I called Beth and told her to find the req. She called me back and said Tony sent it up with you. I was like hell no there is no req I'm putting it in the cytology box he needs to find it and send it up. I was telling this to Pam and as I finished the thyroid got called to bronch lab by Tony. It was slam dunk malignant and he sheepishly told me that he changed his dx and sent the req to the recycle bin, where he recovered it. I'm so sorry, he said. Tony is a gem. He sees people, and helps out when needed. I'd risk my life before throwing him under the bus. We all make mistakes, I said, no worries.

    Speaking of mistakes I threw a huge fit yesterday when Van sent a case to Hal in NLR that needed flow. Pay attention to the damn schedule we are short staffed and we need to not make mistakes that cost us almost a whole day and cost us time problem solving. Poor Melody was so confused - she was taking day call duty bc Maria was acting as an expert molecular pathologist in a court case. She was so stressed I asked Shaver for a ride home instead of her. Luckily she was able to order and find the flow and take care of the patient. Van owned up to the mistake - he's pretty amazing too.

    I'm so excited on Monday Shelby from BVD is going to shadow me - she reads Judy Melenik and other pathologists and is so jealous of Kimberly for inhabiting our world. I hope we find a space for her ASAP I've been promising her for months. I want her to meet all the dept heads we may have an opening soon. She had a ganglion cyst removed a few weeks ago and I took pics and sent them to her - her response was so animated you'd have thought I saved her from a fire. She's sunny and wonderful. Hope she joins us. 

    The new girl at BVD is named Anna and she studied geology at Colorado Springs. She's brown haired and introverted but once I learned she loved rocks I was totally hooked. I showed her my trilobite and my crinoid and my angel's wings and we had an animated discussion of rocks this week - she said I have them all over my windowsills. ME TOO. 

    Saw some good articles on up and coming horror movies this week so excited about The Maid (Thai) and The Lamb (or maybe just lamb?) and The Manor - love Barbara Hershey. Seems she got the wrong end of the stick twice in her life - first for breastfeeding at 25 on a talk show (in 1973 - the year I was born) and another time for getting lip injections for a role and becoming the butt of ridicule about plastic surgery around the nation. Effing patriarchy. Strengthens her, doesn't diminish her, in my mind. Happy almost Friday. I start a week of call Monday so this weekend will be sweet. Take care, much love, Elizabeth.

Tuesday, October 5, 2021

Testicles and Car Trouble

     Well my car didn't start this morning and it sucks anyway bc no music but I think it's just the battery. My friend Sean was T-boned last week - not his fault, and understandably the insurance companies are a pain in the ass to deal with. Kimberly recently got her van fixed after the brakes failed. Shaver told me that our business manager, Keith, fell out of his fishing boat over the weekend and has a huge hematoma on his thigh, so he has officially joined Hal and I's club. I was group texting Kimberly and Sean this morning asking what the hell is going on with the Universe. Sean posited that Arkansas was narrowly balancing over a fiery pit of Hell. Makes sense.

    Ugh there was some video I had to watch to meet my performance metrics for reimbursement due by Thursday called Value Based Care. I listened to about 20 minutes and then put it on mute. I'm scared to attest that I watched it without playing the whole thing because that's just the kind of money wasting Big Brother thing that might happen - them monitoring us in a lie. Like today when I was in OT and Jessica (Stephanie had way too many patients but Jess is sweet she teaches pilates or aerobics or something and gently guides my form to correct it while I'm exercising) told me she had a zit forming at the base of her nose. I was like hell no that's the worst the last time that happened to me was at a Lollapalooza I was with my friend Kallie and kept hitting the bathroom to pop it all day and it kept growing. It almost ruined the concert but I finally got relief by nightfall, and with a little beer on board. She said yeah it's so painful I've almost got referred pain to the top of my nose? Like it's involving a nerve. Ouch.

    Jessica mentioned that the paper masks she feels like dry her out and cause more acne. Why don't you use a cloth one, I said, and learned that a couple of weeks ago paper masks were mandated. What?? I told her I noticed everyone was wearing them in micro huddle and thought it was a little weird but had not realized the etiology of the new sameness. Sheep. I learned today when I glanced at a slide that ACO labels me as a proceduralist. That's almost, if not as insulting, as calling me a provider (which they did frequently in the video). I didn't go to school for 10 years after college to be called an effing provider. I'm a doctor.

    Luckily the cases weren't to bad until I got to the last tray - a bunch of placentas and amputated toes and gallbladders and easy things. Then I got to the testicle and sighed. By the time I had spent a half hour on it I took it into Shaver's office for a consult. I told him I went into Melody's office - she has the latest books - and asked her if she had a good testicle book - I thought I had a tumor fascicle but didn't. She gave me a male GU tome with a little bit of testicle at the end. After I played matching wallpaper (that's what Dr. Waldron called it may he RIP) and it matched three different tumors I decided I'd show it to him and send it out. I haven't had a testicle in 6 months! I lamented, and the last one I had I sent to Jesse. He said he got one today today too and hadn't had one in over a year. I went from no testicles to two testicles in one day. Haha he grew a pair too. We laughed. He wondered aloud that I might be looking at the wrong parts of the internet if I was having trouble finding testicles. I just want a book, I said. A testicle book.

    He came back and said I think it looks like a Sertoli-Leydig? Or a juvenile granulosa cell? Maybe stain it? I'm not smart enough for that tumor. I said that was the exact differential I'd landed on in Melody's book but there was a new entity maybe tumor related to adrenogenital syndrome and it looked like that too. I told him I was just going to get a block and send it - Jesse trained me not to stain testicles and if I do he would wonder aloud how I strayed so far from his wisdom at the scope. We commiserated. If it's not a straightforward seminoma or yolk sac/germinoma it's not in our wheelhouse. Melody agreed. Off it goes tomorrow with the block. 

    Well Kimberly and Sean and I decided if life's rough you just gotta hop on and enjoy the ride. She's calling I'd better run. Happy Tuesday! Much love, Elizabeth

    

Wednesday, September 29, 2021

Day Three

         That's the day when you really suffer the sequelae of an accident. I was planning to take Kimberly and Tina out to dinner tonight - we had to postpone last time bc Kimberly's car was on the blink. But at about 11am I started having searing pain in my neck and my rib worse than even after the fall. An extra dose of prescription Ibuprofen didn't touch it - it was nerve pain. It hurt to breathe - I was compensating with shallow breaths. Yawning, belching (thanks Cherry Coke Zero) were excruciating. I was called to the OR to read a GI needle for Ali at 2 and it was tough to walk down the hall. I had Pam check the schedule - I was in the clear - and left early to rest. I told Hal I was going and why - he commiserated. I'm in terrible back pain, but still feel lucky to be alive, he said. 

    When I was complaining about the computer stuff to S the other night he remarked that he never saw someone so frustrated at getting a new computer. I thought they just added a monitor. I was incredulous when the mouse arrow went from one monitor to the next seamlessly - I still don't know what I'm going to do with the extra monitor but S uses three in his job and today I was thinking it might not be a bad thing to have Epic open on one and CoPath on another. Possibilities. I once told a venting Lucy, who has a fresh start at The Pantry (I need to go) that she needs to hold her cards closer to her chest. So I didn't tell S I wasn't sure about the new computer - I didn't want to look like an idiot. The next morning I looked under my desk and sure enough S was right - the black rectangle thing (hard drive? processor?) was brand new and about a fifth the size of its Draconian predecessor. 

    So I've been noticing the change - in CoPath the words I type glide rather than jumping staccato-like on the page. And in Excel there is a cool added visual feature when I order my special stains. And everything is faster. Still, dictation went down twice today and we were crippled. Jessica said it has wreaked hell in the gross room all week. The only reason they coughed up the bills to upgrade was because our computers only supported Windows 7, and we needed Windows 10 to continue to generate the reports. You'd think with such a major change they would station IT folks to help with the transition. Nope.

    When you have such a visible accident you get a lot of stories. Before my black eye came through on Tuesday I got a couple of people wondering if I was waxing my brow and left the strip on. I didn't even know that was a thing or what it might look like, but I was certain it was worse than what actually happened. I'll take klutzy over dementia any day. Stephanie my OT - I brought a dozen Boulevard cookies to the department yesterday - looked at me and asked if I had to fight for the cookies. My story is not so sexy, I told her, it's rather embarrassing. Whitney, the OT student, told me about her friend who broke her ankle over the weekend in a volleyball scrimmage. Cydney told me about the time he got a stray shotgun pellet in the skin under his eye while hunting - it caused bilateral black eyes for weeks and prompted his high school friends to text - we always knew you would be shot in the face but we never thought it would be by accident. But these people were doing things - sports. I'm just accident prone. But I'll gladly join that club.

    Speaking of clubs I told my head transcriptionist Tina about the D situation and she laughed and said Welcome to the Club! Christy has been giving me a lot of advice too. Strapless is apparently out, but demi cups are a thing? Need to google that. I walked in one morning last week and Tina called me D. It was early, I was wondering why she didn't call me E. Then I got it and LOL'd. Steph said you are Dr. D. She was demonstrating an exercise with stretchy bands anchored at the top of a door with a belt and said do this. Bring them down so, just to your girls. I smiled. My girls are a lot different these days. I asked Amanda at book club, she's breast rad, for an explanation she said if your girth is the same I have no physiologic explanation. So it's a miracle LOL.

    So excited to be heading up to Fville to see C on Friday - I'm off. Planning hair with Maddy in the am then driving in pm. Never stayed at the Chancellor (Graduate?) hotel it looks nice. Got reservations at Theo's early Saturday and C wants to take us to her favorite brunch place Arsagas on Sunday. She's calling less, which is a good sign. Amassing a huge care package to bring. So it's my almost Friday. Happy long weekend to me. Much love, Elizabeth

    

Monday, September 27, 2021

I'm a Walking Disaster

     So much has happened over the weekend I'm not sure where to begin. I guess the obvious place is Saturday night. Tumor board - oops that's what I was preparing for just now for the am I mean book club was fun. Natalya is going to host the next one and she sent an email last night that had me over the moon. Heart of a Dog by Mikhail Bulgakov is one of her favorite Russian authors during Soviet times. There's also a movie adaptation (after the book of course) available on YouTube. She said it has it all - political satire, science fiction, and a great history overview of post-revolutionary Russia. I just ordered the book. 

    After book club wound down relatively early S and I decided on a night swim. The music was fun, the pool was heated, the hot tub was even cozier. At some point I got out and slipped and fell hard. I decided to get back in the hot tub real quick to try to assess and mitigate the damage and I think I must have passed out a little bc when I came to sitting up everything had a halo and it was suddenly raining? No, that was blood drops dripping down my face to my chest and in the pool from where? Got a little woozy. After S got me a bandage or two and got me back up safely to bed he smartly called Alyssa. 

    My best friend from med school is one of the most analytical, intelligent stable people I know. She recently bought a lake house that looks amazing reminds me of mine - a contemporary with lots of updates utilizing the space very well to showcase the view. She's the one I decided years ago to be in charge of my kids finances and emotional parenting in the unlikely event that Rachel, Mike, and I perished early when I was still single. Head wounds bleed a lot, so they can be scarier than they really are. Lys told Stephan it needs stitches keep it moist and call me in the am I've got some friends that owe me a favor in Little Rock or you can come here.

    When I woke up at 2am my left side had excruciating pain I must have damaged a rib or at least severely strained some intercostal muscles. I was able to breathe without too much pain except on deep inspiration and exhalation and if there was a pneumothorax I would have not been doing so well so I reassured myself. S was still awake worried about concussion so I sent him for Advil and told him I was fine he needed to sleep. I haven't slept that fitfully since I broke my jaw. I called Lys at 8am and told her I wanted to come to Jonesboro. S was so relieved for her offer of help and her reassurances the night before he happily drove me. 

    It was a little rough getting out of bed and the sight of the caked up blood and bandages on my face made me so woozy I had to avoid mirrors while getting ready and lay down a bit before I cooked breakfast. On the road I had so much adrenaline and fear of stitches I was happy to be going to see Alyssa for the first time since the pandemic, despite the circumstances. She met us at her building around 11 and escorted us to a room. The first part was the saturation of the wound with water and gauze to clean it and decide how close it was to the eyelid. Luckily, it was mostly on the brow. If you had gone to urgent care or the ER, she said, I would call this a 50/50. Half of the staff would have called an ophthalmologist and half would have sewed it on their own.

    I was starting to sweat a little so she got me a fan and a cold compress. We don't keep the A/C on as high on the weekend to save air. It was plenty cold, but the circumstances. When she started the numbing medicine I got pretty woozy and had to take breaks. At one point I woke up and surprisingly S was standing near and Alyssa was bustling around with supplies and I said I think maybe I passed out? Lys said yes you did. Twice. S said it was so weird you were just sitting there with your eyes open but you were gone.

    Once I was numb though I was all in and I became the entertainer while Lys was approximating the wound and deciding the best way to place the seven sutures. She was laughing but I was most impressed with her concentration and thinking how lucky I was to have a good smelling person working so close to my nose for so long if this was some old halitosis dude I would have had to bail. We went to tour her massive downtown house renovation and took her family to lunch at a Mexican Cantina. God that was so much easier and more pleasant than Urgent Care or ED. How can we move healthcare in this direction.

    Today was a total shit show Baptist IT predictably did not successfully complete the CoPath upgrade but we did get fancy new computers and a second monitor. Result was that our old system was put on the new computers and was incapacitated - I didn't get dictation until late morning and ability to order stains online until mid afternoon. Pam fixed my internet, which wasn't working I had to google phthisis bulbi on my phone. Rick was helpful too. It's good to have tech savvy people in our company. 

    Hal told me a story that had me LOLing all the way home. He's a deer hunter and he was off last week. He was on the deer stand and a cloud of red wasps emerged from nowhere. He jumped backwards on instinct and fell off of the 15 foot stand. He landed on the roof of his ATV on his ass, which had a metal rack with some give. It bounced him onto the ground prone. Aside from a few bruises he is good as gold. I of course wouldn't be laughing if he was hurt, but damn, I wish I had been a fly on the wall. 

    Tomorrow OT is going to start calling me Dr. Klutz. The first student Bailey noticed the big bruises on me after Alanis Morissette - I had to explain that I got up to pee in the middle of the night, thought I was back home, and navigated poorly. I just finished tending to a burn on my arm from the French fry sheet in the oven a month ago - that was nasty. And with the rotator cuff and now stitches and rib injury it's getting a little ridiculous. At least the GI thing is getting better or I might throw in the towel. Happy Monday, much love, Elizabeth

Thursday, September 23, 2021

RANT

     I think I talked already about CAP trying to get me to do an inspection with a month's notice in freaking June. I staved them off, and they gave me a new assignment to a Memphis lab in October through the beginning of December, which I accepted. We worked hard to assemble a team from NLR and despite the fact that Polly, the head of the lab there, resigned early, we settled on the dates November 9 and 10th. In the pandemic world inspections are no longer a surprise. So I was on a group email with the director of the Memphis lab and CAP. 

    The director emailed me directly earlier this week - seems he has accepted another job and wondered if we could move the inspection to October. No, I said, not possible. How about the week after Thanksgiving? Hell to the no (but I was more polite). See, the way this works, we get a window, they give blackout dates, and we plan. It's tough to assemble a team with lab shortages in a freaking pandemic. Talk to CAP if you have a problem, I said. 

    So today CAP emailed me and wondered if I could do an inspection in October. NO. I already told him NO. Well we could help you, she said, if there are shortages. NO. I'm not available the entire month of October. Why don't you tell me your availability, she queried? (Are you fing serious?!!) We planned the inspection for November 9/10, he said he will be available by phone, I cannot reassemble a team on such short notice. 

    This is such a waste of my time. CAP knows we planned a team to go - she could have consulted with her office, but was bending over backwards to accommodate Memphis. As an aside, I also got an email from CAP this week asking me to go above and beyond to do more inspections. Which I promptly deleted without answer. I told her I cannot provide extra services at a lab's whim at last notice with low staffing. We will be there November 9/10 unless you tell me otherwise. Ok I'll investigate and let you know. UGH. I got so shaking mad after a lovely and productive morning I had to vent and spit anger to my chief and the gross room and go outside to try to chill.

    Even the water feature at Baptist is not designed to chill it looks like a giant ejaculating dick angering all of the water in the pool. Figures. I told Shaver we are working so much harder and it seems like admin and our accrediting institutions are pissing on us. There is no love, only productivity!!! Let's give them candy bars and Girl Scout cookies and keep them short staffed. I learned today that admin is groomed. Get your masters in health admin and you too can be a VP and make ten times more than the people that actually spent almost twenty years of their lives training for their role. I was so shaking mad. Let's not even get into the daily emails from ABP reminding me to do my monkey CME questions before they are due at the end of the quarter (September 30). Yeah, I'll get on that ASAP.

    CoPath is finally getting a 15 year overdue update this weekend our reporting will be incapacitated from Friday at 5 to Monday morning. Seems I'm supposed to move everything I don't want lost on my desktop to a J Drive (How the hell? Show me!). Shaver thinks they will save it all and restore but after losing a bunch of stuff on my desktop a few years ago (no warning back then) with an unplanned upgrade I'm not as trusting. Looks like I will be going in Sunday to make sure I can actually work on Monday. 

    Surgical Pavilion dumped like 50 specimens on the gross room this afternoon despite Jessica begging for more trips to keep us from getting bogged down. I'm so over it all. Admin (none of whom have any idea of what the hell we do or our needs but hey! Here's a Hershey bar!), our accrediting institutions - seems like we are in the same hell as everyone else. One of my lab directors was lamenting - we could be growing weed in the lab and no one would know or care - LOL - and I just commiserated. They have no idea what we do. The people in charge. The state of healthcare is mimicking the apocalyptic conditions of the world. Bad decisions are being made - ones that cost more money. No one asks me. If they did I'm sure my opinion would fall on deaf ears.

    On a good note Jack and I are watching a series together - he's already seen it twice and is loving sharing it with me. Merlin on Netflix. Planning to take C and Joelle to dinner in Conway tomorrow night. OT will be fun even though I have to get covered bc I'm surprise covering all day frozens. I hope we get a good turnout at book club Saturday night. Weather is amazing and I told them all I'd heat up the pool. Happy Thursday, much love, Elizabeth

Tuesday, September 21, 2021

OT

     I just love OT. I had my two month follow up with Dr. Gilliam today and I told him can I please have more OT. I want to be an OT in my next life. He seemed as amused as a stern graying white orthopedic surgeon could muster and wrote me a script for a few more weeks, along with some Ibuprofen. I know you don't need it for the pain, he said, but please consider taking it to reduce persisting inflammation. That might improve your OT sessions and your range of motion. Makes sense.

    This morning I had OT and Stephanie has astutely noticed the connection between me and Chris, I forgot his last name, the English prof at UALR, and has scheduled us together. I told him how much I liked The Boy Who Drew Auschwitz - I gave it to S's dad who is a big reader we love to talk books. I told him I'm hosting my second pandemic book club this Saturday and of course he read the memoir. I just finished scouring my bookshelves making a list for him - authors I know he's probably read to discuss and authors I think he hasn't to try to surprise him with. He told me he would make me a list for Friday too I'm over the moon. Our impressions of the two books I read on Trish's rec were spot on similar. He's a kindred spirit.

    As is Stephanie, I gave Gilliam glowing reviews. Was showing everyone in OT picks of the amazing resort I stayed at last week. Stephanie had been asked to a Zoo Wine night by her boyfriend when I last saw her and she was showing me pics of dresses asking my opinion. She gushed today about the event and showed me pics of them. Last week I was telling her and Whitney about my expansion. Stephanie has been a 34DD since puberty and was still wondering today if I had ever been measured before. Oh yes, I said, girl, I have been made fun of bc of my small size. But it's weird, doesn't make sense right? I guess I finally grew a pair. She LOL'd. You are so funny. And that dress is amazing! Going out of business Steinmart sale, I told her, RIP I loved that place. I told her I needed to find a strapless bra bc none of mine fit and this dress works well off the shoulder too. She warned me that it is very difficult, almost impossible, to find a good strapless bra in our size. Another challenge. I'm up for it. I graduated to the arm cycle today, I didn't know there was such a thing. I attacked it with gusto. Steph warned me to slow down - she prescribed me two minutes forward and two minutes backwards. 

    Did a thyroid frozen today for Sims and I was telling the girls all about the new drink C told me about called Celsius. It strenghthens your metabolism, is zero calories, and helps you burn fat. You are supposed to drink it before a workout, I said, I wonder if OT counts? That garnered a laugh. Laurie showed me a new drink called The Rowdy Mermaid she got at Whole Foods. The flavors looked incredible. There was another one called the Rowdy GI or something like that I told her if it calms a rowdy GI I'm all in but I've had a rowdy GI for over a year I'm just slowing so I'm not interested in a reawakening. I'm already woke.

    C is still having highs and lows adjusting and Heather in pharmacy and I were commiserating today. Her son Jake is a Freshman and she feels like a punching bag every time he calls. Isn't that funny, boys and girls with such different reactions to transition and homesickness, I said. C is depressed and anxious. She called me the other week in tears bc she GPS'd to a new class and got lost and showed up late and the teacher said she had to go change bc no shorts were allowed in lab. Total meltdown. Mom, it's going to take me 40 minutes turnaround time to get there! Heather said I know a girl mom describing the exact same story as you. But today was a happy day she made a new friend in a Freshman leadership group she has been attending weekly. We have a family gressage - Rachel named it a few weeks ago and I was like WTH? C explained group message mom. Duh. I told C today when she texted us that I love having a front row seat to her college transition and it takes time to make meaningful relationships so be patient. 

    Last year I was worried about J and now he's flying - won Sophomore Senator with the most votes by a landslide and is busy working out with friends. Last night he was meal prepping rice and chicken for lunches for the week. Where do these kids come from, I wonder. Now C is struggling but it's all a part of life and learning I think she will do ok. Work is still hella busy - it's raining uterine cancer this week - but it's doable. Happy Tuesday, much love, Elizabeth

    

Saturday, September 11, 2021

Expansion

     I have always been a proud card-carrying member of what Rex would call The Itty Bitty Titty Club. And I've never been upset about it - I've been happy with my lot and a healthy fear of losing sensation in that area after surgical enhancement (it happens, I've queried tons of people) has kept me from going down that road, amid other reasons. 

    So imagine my surprise a few years ago to spontaneously go from a B to a C cup. I squashed into the same bras I've had for 20 years for a while and when it became unbearable I solicited Christy to come with me to get new ones at Dillard's - this was the February before the pandemic started. There was a huge sale, which was nice since good bras really cost between 50 and 80 bucks. Not chump change. We scored. I got a bunch of nice ones.

    Fast forward to a couple of months ago - my 36C's have been stretched to the limit and the underwire is currently being lifted off of my chest by my boobs - not the most comfortable way to manage your day. And last weekend a white bikini I bought before the pandemic that fit me fine in July looked horrible on my chest. I can see why adolescent girls getting boobs might get a fat complex because if you try to host them in a too small receptacle it just looks like you grew a bunch of arm fat. Not aesthetically pleasing. 

    I wandered into the lingerie section at Dillard's and a woman with a heavy Eastern European accent asked if she could help. She was smartly dressed in black and white pants with a white t and a black blazer. I told her my dilemma and said the only bra that I like is a 38C I bought two years ago. She said flatly there is no way you are a 38 you are smaller than that and I liked her so much in that moment I decided to blindly follow her advice. We measured and I was a 36 - I told her I measured as a 37 at Victoria's Secret with C within the last year. But I have been a 36 my whole life before that.

    As I was in the dressing room and she was handing me bras to try on - she had another client; a third woman walked in and said Luda?!! I want you to help me please. Many people have referred me to you they say you are the best in Little Rock. I smiled happily at the support of my gut instinct. Knowing I was in good hands. Not literally. But she has an amazing eye and a knowledge of the brands. 

    As I was trying more on I noticed the sizes were D and DD. I was confused, we had debated my girth but not my cup size. I decided it must be some UK size or Australia it didn't make sense. When she came back to look at a new one I said are these D cups? She said of course. You coulda knocked me over with a feather. But I have all C's, I told her. She shook her head and gave my chest a cold, calculated look. No. You are not a C. You are a D or a DD. LOLOL. I haven't been this big since I was nursing. Better get that mammogram I'm due for soon.

    So of course I had to shop for new bikinis and even though the bras were painfully full price the bathing suits were 65% off - that made me so happy. I texted Lucy and told her she was gonna get half a wardrobe tomorrow because there are things that have zipped up on me since the age of 16 that no longer zip and I would like nothing more for her to wear the clothes or sell them for money. She is trying to save up to move to Ventura CA (she's got a chosen family there) and model and she's 20 and plucky as hell. She has people that could bankroll her but she prefers to work multiple jobs I told her about when I held three or four at a time in my 20's trying to reach my life goals. She looks a lot like Amy Winehouse but taller and definitely unique. I told her someday when she makes it she will have to remember the doc from LR, AR who thought she was amazing before the world did. Happy Saturday, much love, Elizabeth

Friday, September 10, 2021

Gnats

     So I've had gnats in my office for a few months. So much so that I googled their meaning. In Native American culture they are all about transformation (what bug isn't?) but they didn't date back to Celtic times. The cool thing is that they feed off of dead things. They are the ultimate recyclers. I tried not to kill them but having a bug flying around you and your microscope is annoying. Staggs came in a couple of weeks ago to return a consult, and I was complaining, and he said he killed it. Five minutes later another one was plaguing me.

    I learned a couple of weeks ago it wasn't just me, they were bothering all the secretaries too and even Melody. My husband had some advice. He said an overturned glass of wine is the perfect receptacle to trap them. I bought a single serving cardboard box last week, intending for him to drink most of it and bringing the rest to work. He said it would not work unless it was a clear receptacle - they would find their way out of a cardboard vehicle looking for the light. So he packed me a glass of wine in a Coke Zero bottle.

    This morning I was looking for a Coke Zero and I saw a half drunk one in my fridge. Took a big swig and LOL'd. Wine at work! That's a new one in my fifteen years there. I told Melody and she said she bought a contraption that works well at her home to trap gnats. It looked like a tennis racquet with electric  capabilities. Weird thing is, as soon as she got it in the mail, the gnats went away. I told her I experienced the same thing with the bottle of Coke wine. Not needed. No more gnats. 

    Conway frozen was crazy. Probably malignant, but I didn't notice at first bc I was just counting neutrophils at high power. All of a sudden I hit an alien mitosis and was like WTH. Backed off to a lower power and realized that septic joint was the least of her problems. Bc it might be lymphoma we sent it to Staggs, who sent it off bc it was so weird. Maybe sarcoma. Maybe carcinoma. Time will tell.

    I'm off for a whole week so excited. S and I are planning to entertain again on Sunday - Lucy and Christy are coming and Sean and Avery and Alex are invited. Leaving for Austin on Tuesday to help prepare for his stepsister's wedding on Friday. We are staying at a fancy resort in Round Rock just a couple of miles from his dad and stepmom. Kalahari maybe? It has indoor bowling alley and amazing spa and 14 restaurants and indoor amusement and water parks. 

    So much breast cancer. Usually when I get seven cores half of them are B9 but not this week. All cancer. This morning I had bilateral masses - both cancer. A record for me. Happy getting to sleep in this weekend. Much love, Elizabeth

Wednesday, September 8, 2021

Conway Frozens

     Cases were coming out late today and I was kinda pissed and raising hell about it with Shaver bc I was due in Conway at one. He assured me he would do any of my late cases, which ultimately turned out not to be necessary, but it was a scramble to get the bulk of 140 slides between 10:30 and 11:00. Pounded all of them out but one. 

    Melody is under a lot of stress, more than usual. On Tuesday I made her teach me how to check the billing charges (Rex would freak knowing I was taking that on - I was a bit reckless a few years ago in objection to the whole process) so I could relieve her of that duty until she is not drowning. I told Melody that a couple of years ago I told Rex that he needs to watch out in 10 years our practice would wear Melody down (Christopher Robin remember) and she would start popping off just like me. He gasped, "No, never Melody. Not like you." At least I made her laugh.

    I drove to Conway for the frozen and arrived there just before one. Bob didn't show up until 1:30, which I learned was the intended surgery time (sigh no worries could have used that extra half hour in LR but foraged for snacks so no big loss). At about 10 til one a peppy surgery tech I had never seen entered our suite - gross room/sign out. 

    "I'm so glad y'all are here!" she squealed, and I suddenly felt like a newbie in kindergarten class. She had on green scrubs and her bleach blond hair was leaking out around her mask and her scrub hat. Bob and I looked at each other like, um bc you asked us? She said, "We just got the patient in a room and she has a suspected PE!!!!" Bob said she has a what and I said so she has a rule out pulmonary embolus so that means we aren't doing a frozen right? "EXACTLY! But y'all stick around as long as you want to! We are trying to reschedule the frozen for noon tomorrow after clinic!!" Does she think we have time for Cokes and a sleepover? When I called Shaver to tell him he groaned. Like we have so many pathologists to spare, right now. 

    I always try to spin things positively, at least out loud. I said, well, it wasn't your fault she has a possible PE. Let's just see what the workup shows and play it by ear. And hey! Thanks for telling us what was happening so promptly. A lot of y'all just leave us in the lurch waiting for something that is never going to happen. When she left Bob said, I don't wish bad things on people? But I don't want to come back tomorrow at noon? I LOL'd. Same same. Maybe we can wish she doesn't have a life threatening PE but maybe she gets something that keeps her from surgery until I am off next week. It was just a joint check for PJI. Something I have done less than five times but a quick google will tell you if there are over 5 neurtrophils in a 40X HPF it's diagnostic. Been the same criteria since 1976.

    When I finally got back to LR I was finishing up some big cancer cases and one of the higher maintenance docs was crawling around. I told my head secretary tell him I was busy doing frozens and we problem solved to try to catch some inconsistencies (that no other doctor has a problem with and is well within the two week CAP standard turnaround - our average is 1.6 days I calculate that for Q/A). I crafted a polite text addressing that I took action points to try to solve the issue on our end before the clinic caught it. You catch more flies with honey than venom. No response. I'll take that as a good thing, maybe I'm wrong - I'll find out tomorrow. 

    C is still struggling adjusting to college and it breaks my heart a little but struggle brings growth so I'll continue to plug in and support and not get sucked into codependency just like when I was dropping her off at preschool when she was little. She flew then, she'll eventually fly now. S and I cooked meatballs tonight and I'm sending them and BV pimento and a big care package with Mike and Rachel this weekend. 

    Sean recommended Gunpowder Milkshake and Brand New Cherry Flavor and I texted him over the weekend that he should charge for curating and recommending good content. Both were a lot better than the book I read but I did learn what mudlarking meant even though I was disinterested in the characters (but interested enough to skim to the end) halfway through. Happy Wednesday, much love, Elizabeth

Tuesday, September 7, 2021

A Monday on a Tuesday

     As I was driving into work this morning Shaver sent a group text to the group. Apparently Quinn had a minor procedure while he was off last week and it reactivated his Covid neuro sx. Amnesia, insomnia, etc.  The doctors today said they think the anesthesia sparked an encephalitis that activated long Covid. So he was supposed to be on call this week but Melody took it for the team. Quinn is in more pain by missing work than attending so it's hard to be frustrated - he's probably spent more hours at Baptist over the years than all of us combined. Shaver divvied up his work to us all and it wasn't horrendous, but Melody reiterated what a lot of us are thinking - we desperately need to hire. 

    Then Jack called while I was in huddle and said that he had a sore throat. I called him into school and told him to rest. Spent much of the day worrying and trying to find a Covid test to make sure he was negative but two Walgreen's later we were SOL. "They sell out as soon as we get them in." I wondered aloud how us parents were expected to send our kids to school safely after being symptomatic when you can't get ahold of a freaking test. He was fine tonight. Ate two family servings of frozen Korean food. So I'm just gonna hold my breath on that one.

    Shaver told me today that Conway needs a frozen at one pm tomorrow can you go? Of course, I said, I've got lots to sign in the lab and Misty and I keep missing each other. He's going to get my afternoon frozens in LR covered and take care of anything that arrives past noon. It's a skeleton crew these days. 

    I had gastric and omental biopsies today the clinicians were calling about - the biopsies were done at 7pm Friday evening. It's always like this on a long holiday weekend - everyone clamoring for their dx. I was problem solving with the gross room how to get these done quicker on three day weekends - maybe they could call us and assess the need for short cycle. Nevertheless I got it signed out this afternoon. Both metastatic ovarian cancer - in the stomach? That's another one for the books. Fungating mass I would have placed my bet on a new primary but the stains said otherwise and Hal agreed. I'm starting to think weird is not weird it's the new norm and I'm wrapping my head around trying to get used to it. Hell I never would have guessed that bounty hunters on women in Texas would be a part of the smashing of the patriarchy so who's to say what cancer is going to do in the next couple of years.

    Jack asked for help making posters for his campaign for sophomore council this evening - we spent three hours perfecting his block letters and cutting and pasting his slogan for tomorrow. I love his slogan - love that it is his. When he asked for pics he said he wanted some without C because he didn't want to appear to ride on her coattails. And he admits his slogan is goofy, but it's also wonderful - I can't help thinking that if a girl campaigning described herself as a snack it would be much more delicate than a cis white male. Role reversal. We need to upend things.

    And I told Jack, campaigning as your wonderful self is a lot better than trying to be slick or cocky as a front. This applies to more things in life than sophomore senator - it is true of anything you ever campaign for including your friends or your love interest. We laughed that we could have used the computer to be more efficient but I loved that he executed his idea and I was his sous chef and we bonded. Happy Tuesday, much love, Elizabeth

    

Thursday, September 2, 2021

Cancer and OT and Porn

     Up until today this week has been so crazy case heavy - as Melody said - I've been having the kind of days where it's like trying to drink from a fire hydrant. And weird ones too - which makes high workloads even tougher. There was this one case of a guy in his mid 40's who presented to a breast surgeon with nipple discharge and redness and pain. The surgeon figured it was an abscess - he expressed white pus-like discharge from the nipple - and gave him some abx to calm it down before surgery. Nope. The most high grade multifocal cancer on the planet I've never seen anything that bad in a chic. It wasn't pus it was necrosis - they both look the same. I was mulling it over with Staggs and he winced in all the appropriate places when I was telling the history. He grabbed his own chest wall, and I said hell no nobody's getting 9x7x4cm off of you lol. How big is the guy? Staggs wondered and I said the surgeon didn't mention it in the H&P. But it's on the demographics on the left, he said, and we both raised our eyebrows - he was over 500 pounds. Ugh poor guy. I did some stains to make sure it was breast etiology because it was so weird - the cancers were TNTC I've never seen anything like it.

    Then there was another mid-40's guy from Conway who had a TURP for prostate hypertrophy (that's a new one on me they are usually at least in their 60's) and it was wall to wall high grade ugly prostate carcinoma - honestly the ugliest I've ever seen in my practice. Gleason 9. I never call that. Did some stains to rule out urothelial and when I was showing it to Melody she gasped in awe. 

    OT has been fun this week there is a new guy who I overlapped with on Tuesday and today who is the most stereotypical chatty batty English professor you have ever endearingly met - he's probably about 15 years older than me. We bonded over books on Tuesday - he read 99% of the ones I mentioned and recommended The Boy Who Drew Auschwitz, which I ordered and is coming tomorrow. His mania and chattiness were infectious and I matched it. He has traveled the world and seems so interesting.

    Today he revealed - Stephanie and I were talking about our kids - that he lost a son at 16 to a drunk driver who crossed the median and lived without a scratch. His birthday is three days from now so this is a particularly hard time of year for him. My eyes welled up with tears as I was lying on the therapy table. I asked if he had read Wave or The Year of Magical Thinking he said yes both, but they were very hard to get through. I was thinking maybe healing but I can see PTSD too I told him let's change the subject. He has the same injury as my mom - she had a commuted fracture of the wrist requiring external hardware and he did too. He said after this I'm going back to tennis (he fell playing and chose his left hand to protect his head) are you going back to paddleboarding? I said not in the ocean, maybe in the lake. He approved. I also showed him the other two novels my friend Trishie recommended and he had read both and told me which one he liked better. I'll start with that then, I said.

    Stephanie was a little concerned despite my progress I was still in a lot of pain when she manipulates me. She said that she prefers me to stretch with the solo exercises bc I guard too much with her manipulations. She grew up with horses. She's a single mom. I've entertained her with online dating stories. Her teen is obsessed with car detailing and her three year old is obsessed with horses. She told me she was going to have to give me a horse tranquilizer to manipulate me I was so tense. I'm glad I've got another couple of weeks with her, at least.

    She asked me today if I had seen my MRI embarrassingly I said no so she pulled it up on Epic. She said that I not only tore my supraspinatus (over 50%, not 50%) but I also tore my deltoid and possible another muscle - she was reading about bursae and footprints it was all a little confusing and I got hot and sweaty imagining my insides being torn. So no wonder you are still in pain, she said. That's a lot. I told her my resting pain is zero and I haven't used a biofreeze patch since Monday so we are making progress it's just slow. 

    Ugh I got so frustrated today I somehow followed a porn ig I thought it was body positivity and it kept popping up in my feed and I was too busy to figure out how to unfollow it. When I tried tonight the ig internet was out - then I checked my email and I had my first ever porn email ewww - I didn't click on it just unsubscribed. Then I unfollowed the porn and hopefully that is the end of that. Not judging, but I like to choose my porn and not have it pop up unbidden in my personal spaces. Happy almost long weekend with no freaking plans and lots of tv and books and pool time hopefully. Much love, Elizabeth

Monday, August 30, 2021

Post Call Monday

     I've got three meetings tomorrow - starting with ENT conference at 7am. Luckily the three cases are either out at Cleveland Clinic or weren't done in time to take pics so I can just go and be present and not present. I'm tired. Call wasn't that busy but it's still call and we are down a pathologist which sucks. The other meetings are top secret but I'm taking Tina and Kimberly to dinner tomorrow night and that is the most fun thing on my schedule. 

    Everyone was getting the booster today - Staggs was recommending it but I'm gonna wait until Friday based on my experience with Amanda and S's mom - it kicked her ass too. Hal and Melody both got it I told them they would be my guinea pigs. I took a poll in the Dr. Lounge this morning. Eric is not due yet - since he had OG Covid he didn't get his vax until March, but nephrologist whose name I'm blanking on had a lymph node swell to the size of a baseball for four days. Planning to have lots of Advil on tap and a long weekend to recover. 

    When I went into the gross room to check out last Friday there were frozens and the circulating nurse - don't know her name either but she has short bleach blonde hair and ice blue eyes and always has my back. She was trying to give frozens to Jess and the window wasn't working. Can't you get it up? Asked J over and over we were cracking up. The circulator said she was checking on a room a week ago and asked if they were done - they said yes we are pulling out now. We all died laughing. Not the right words for surgery, but hell, it's an apocalyptic pandemic, we will take what comes. 

    Avery and hell me too were a little wrecked this morning despite going to bed rather early. But the get together was a blast. She recommended Broad City - S and I are thoroughly enjoying it. A nice wind down after a hard day. Happy Monday, much love, Elizabeth

Sunday, August 29, 2021

Rooster Booster

     So Doc Book Club got canceled. Amanda got the booster shot and it kicked her ass. I'm going to wait to get mine until next Friday when I'm not on call so I can recover if it does the same to me. Plus the community transmission rates are high, 20% someone said, so not so safe for gathering. I offered my backyard as backup to try to gather in September or October and the reception was good. 

    When I went to Shipley's to get donuts for the lab this morning the line was out the door and no one was wearing a mask. Felt like a septic tank as I observed from my car so I went to Edward's and got bfast food there. Luckily call Saturday was light - I finished up before 10 am and ran errands. Picked up some shoes from the cobbler. Went by Boulevard in the Heights. Avery was working - she said she was so happy to see me. I told her I was going to get coffee but that line looks daunting - she said I'll make you whatever you want. I said what are you making? Iced chai. I want that.

    She said her new fave is iced matcha tea with lavender I told her I'd order that next week at BVD Baptist. I told her book club was canceled and why she LOL'd. I wondered why. Was it the fact that I mentioned breast rad? We throw breasts around in medicine so casually I imagine no one else mentions them as much except in the porn industry and even there they have to bring them up heavy with mood. We get to be cold and clinical. But no, Avery thought I said Amanda got a rooster that kicked her ass LOL. Masks create silly chaos. Especially with me - I cannot hear worth shit and depend on lip reading so this whole pandemic thing has been challenging.

    The smaller doc book club text group was lamenting over delta Covid. Apparently a lot of clinicians, vaccinated ones, have been getting breakthrough Covid and while they are staying out of the hospital it is creating hell for scheduling since they have to convalesce at home. Jauss told us that she had an unvaccinated patient die last week who was retired and building his dream home. Such a waste. I told them about my unvaccinated work family that was decimating our departments. Such a societal ill.

    C called today with great news - she found some friends finally on Bumble friends - I didn't even know that was a thing. Normally it's a dating app mom, but you can find friends there. She found a girl named Trinity from Dallas with pink hair who is anti Greek and a yoga meditation friend  - they ended up being in the same house. They had coffee in the am and shopping plans and are probably out right now at a bar C told me about that ignores fake ID's. I told her to be safe. I trust that she will. I'm so happy that she is happier than she has been in two weeks. When your kids are sad, it eats you up. 

    Avery worried that she invited her BF to dinner tomorrow I was like no - I want him to come girl I was gonna ask you to bring him. It will be a celebration and a send off for the both of you. When you get to Fayetteville you gotta take care of C. I also talked to Shannon from book club today - she's rad and has two kids pre-med at Fayetteville. Shared C's contact with her. Building a network of support is so important. Happy Sunday I guess? Much love, Elizabeth

Thursday, August 26, 2021

Friday Eve

     Walked into the Dr.'s lounge for coffee after huddle this morning - nothing new there, except warnings about Ransomware and not opening fishy e-mails and IT sending out pseudofishy emails to determine what employees will open them and which ones will click on the link. I guess they are collecting data and looking for doorway entries to squash the danger. Amy told me some hospital in Europe was shut down bc of Ransomware. I had no idea it was such an issue. 

    Bob Searcy was in the Dr. Lounge, and after I greeted Shay and Tammish and Geisha he walked over to me while I was making coffee for me and Kimberly (her car is on the blink and she's bummed so I'm trying to lift her up a bit). She loved my adding Cinnamon to the coffee - I told her it tastes good and I think it's healthy too. Anyway, Bob was in a rant, which he often is - I used to be intimidated by him but now I find his fiery personality endearing. And he always asks about my dad, which makes me happy. He's a pulmonologist in the SICU and said he's taking care of a pregnant patient with Covid who has a 21 week old baby. She's prone and on the vent. He learned he has to keep her alive for three more weeks to give the baby a chance - her's are not good. 

    You don't have to tell me that, I said. 23 and 1/2 weeks to 24 are the edge of viability. When my dad first started practicing years ago, it was 27 weeks but the advent of surfactant and advanced vent technology changed all of that in his career. Can you keep her alive for that long? Not likely, but he's going to try. He's got another patient who is about my age who survived breast cancer. Husband, who he clearly has contempt for, is all "Don't tread on me" and wouldn't let her get the vaccine. She will die today or tomorrow from Covid. I told him about my department's issue with the unvaccinated. I said I have to reframe it all as a societal ill in my head (my gut wants to judge and be angry) and it helps. And I've got patient's loved ones asking me to use Ivermectin he raged. SMH.

    OT was lovely I gifted them chocolate and Stephanie was so apologetic and worried about the last session. I told her no worries it was only painful for 15 minutes I'm still progressing. I graduated to a pound today. I was so happy with my pain free performance of all the exercises - still no zero gravity video games though - but I told Steph, who was mealy mouthed behind her mask enjoying the truffles, that she could go to the break room and I would write myself up about how well I was doing, LOL.

    It's been so weird with frozens I've walked into the gross room to check on my crew right at 4 every day this week and it's like I anticipated them. Yesterday Sims was doing a rhinectomy for squamous cell carcinoma - wear your damned sunscreen - and he was chasing positive margins. Must have been pretty deep bc there was a lot of cartilage. Today Bandy was doing a case - he had opened the uterus - and it looked like a giant infarcted polyp or fibroid (circulator warning as she passed it through our gross room drive through window - watch out it stinks!). Jess and I were trying to reconstruct it and realized it was probably protruding from the cervix (no wonder it was bloody and dead at the tip). Luckily B9. 

    Planning a grilled dinner as we speak with Sean and Avery and Avery's BF Alex and Christie for Sunday night. So excited I've been trying to nail Sean and Avery down for dinner for months. Avery and Alex are moving to Fayetteville and I'm all over plugging them into the support system I'm creating for C. S got a new grill he's dying to use and impress. I'm so happy it's almost Friday. Cydney and Ali almost killed me yesterday four bronchs and four ERCP's I was regretting my choice of kitten heels. But it's all good. Lots of cancer. What's new. Happy Thursday, much love, Elizabeth

    

Tuesday, August 24, 2021

Field Trip

 OT was at 8:00 today and Bailey the student took me downstairs for a change of pace - Stephanie was working with someone there. The room where I get OT is lackluster and industrial but the space downstairs for PT and OT is mind blowing. I remember touring there when I was looking at BRI for my dad - there are faux marketplaces and partial cars and all sorts of fancy props to guide the downtrodden back into normal society.

    Steph was working with a teenager - he was in some contraption that Bailey described as "zero gravity" and "guided by video games" that made me honestly jealous. I was sweating from the heat pad Bailey put on my shoulder on the way down and as Stephanie was engaged with the teen she instructed Bailey to put me on the pulley system against the wall. Only it wasn't against the wall, it was against a door, which was abruptly and surprisingly opened; stretching the holy shit out of my shoulder.

    When Steph finally got around to me (on the bench, no video games or zero gravity or even simulated grocery stores) the manipulations hurt like hell. I reported an 8 outta 10 when I normally report maybe a 3 or 4 at most. She inquired if I wanted her to do an incident report (Was it the heat? Or the door opening? Or both?) I said hell no, I won't obstruct you if you want to but please don't make a fuss. By the end of the session I was bench pressing and curling one pound weights. She was over the moon. You are progressing!!! But I just want to do what that teenager is doing? How do I get to that level? She laughed, but didn't explain. I want an explanation.

    Book club is this Saturday and I'm sooo excited it's at Amanda's house and her SAHD is an amazing cook he did paella once. We were instructed to bring dessert (not my strong suit - give me cheese and I'll fly but since I'm on call Fresh Market will do). It's that Mike Jollet book I read a month or two ago but it was so good I still remember. It used to be a doc mom book club, then I invited Natalya and she is faithful and not a mom so just Doc girl book club? Ali Khan expressed an interest in joining a year ago and I was a little too rigid at the time - he is a guy but the nicest guy in the world. About a month ago when I was in Conway I asked the core group if I could invite him and they said yes (so now Doc book club) and I'm really hoping he can attend he's on call like me.

    I bumped into Kahn yesterday in the OR when I was checking on Sims, God love him, he's restricted his frozens to 8-4 this week knock on wood. Khan told me he was listening to the book on audiobooks - he said the author was reading it which enhanced the experience. I effing hate audiobooks. Same as med school lectures. The audio version of anything is way too slow my mind wanders and I cannot concentrate. I didn't tell him that, just relayed that I heard wonderful things about Michelle Obama's audiobook on her own autobiography. Which I have not visited. Because I have PTSD from attempting it in the past. Enough people sing its praises I maybe should try again but maybe not. I'm almost 50, and stuck in my ways. 

    Speaking of painful listening, we had some BHPP required lecture that I listened to regarding coding - I say I listened but I maybe 10% gave it my attention while I worked. It was so painful - the insurance companies require all this ridiculous documentation for reimbursement. Such a useless battle, I told Melody, and she agreed. Floods, wildfires, pandemics, too much to even process so you just jump through the effing hoops and move on. I'm getting a little cheeky with my feedback lately. When they asked what I thought of the required hour I said nothing pertains to pathology. But it makes me glad I'm a pathologist. What a fucking headache. They were talking about using certain pronouns and conjunctions to increase reimbursement for higher risk assessment. Big WTF. My friend Laura Sanders says her peds hub is up documenting until midnight. No wonder physician suicide is at an all time high.

    I had a late in the day Covid patient have tons of budding variably sized yeast on the GMS stain I called Kathy Parnell and she gave my cell to new ID doc in Pine Bluff Jesse Frazier. I told her the new guard (i.e. Melody's training) was to not try to speciate on morphology but the old guard (me now LOL) suggested a specific bug if we could bc growth takes time and critically ill patients don't have that. I think she is fresh out of training and lamented the fact that she couldn't get fungal PCR right away like she could at UAMS. I'm doing a mucin stain to rule out Crypto overnight, I said, and I will compare with mycology in am. Honestly I am all over the map here. Could be Candida! That would be a big change in treatment. I think it might be a mixed bag. It's a wash, not a BAL, so more risk for contamination (but it looked real). 

    I told Jesse that they can't support the blanket testing in a private system that they do in a government supported who cares if you go in the hole system. We are more judicious, because we get charged and have to bite the bullet. It sucks, but I also think it's more prudent overall. The mass testing that ignores the financial consequences is not allowed. I've had oncologists, I told her, that want me to order all the molecular markers on all the tumors. Not cool. What if the patient is DNR? What if the parameters of the test don't apply to them ( because they move and shift monthly, the parameters, not the patients). So we watch, and care, and try to be the best stewards of medicine we can be. What else are you going to do. Happy Tuesday, Much love, Elizabeth

    

    

Monday, August 23, 2021

Call Monday

     It kinda sucked. I was up in the middle of the night and overslept. Needed to be in Conway for frozens, which was ok, I made it there by 8:30 and the frozen didn't come until after 10:00. Made it back to Baptist LR by 11:00.

    I love my daughter so much. She's been struggling with health issues - unusual for her - and the last week was hell. Couple homesickness with not going Greek - something I'm so proud of - almost did her in. She started classes today and met up with a mentee - she signed up to be a mentor for a sophomore with Down's Syndrome. His name is Jack, she's enamored. I'm not judging the Greek life but it's so all pervasive at Fayetteville; it's ridiculous. The balloons alone must have cost an arm and a leg. Mike and I totally supported her decision, whichever way it went. She's got a full ride complete with a huge living stipend, cell phone paid for, 10K a year for travel abroad. She's an fing badass. I told her I would be happy to help pay for a Greek life. Her response: "Mom, I didn't leave for college to be tied to a new institution giving me new rules." Kudos. Apple doesn't fall far from the tree.

    She's an ENFJ and I'm an INFJ. I told her that she would have a much harder transition since she was an extrovert (sitting in the dorm alone with a book for a week would have been my dream). I hooked her up with a single mom from Sunday school who moved to Fayetteville a couple of years ago. She volunteers for a nonprofit (Pathway maybe) that rescues girls and women who are victims of sex traffic. Locally. C texted her. I'm glad they made the connection.

    Work is kind of screwy Shaver called in sick today, luckily he didn't test positive for Covid, but he did test positive for RSV and will be out again tomorrow. More sucking up work. I was supposed to be on morning frozens for call but now will be on EV. Staggs is covering. 

    Hal recently changed our pap smear review to only EV. For the past what, 15 years, it has rotated on the AP surgicals. Now I get paps daily on EV. It's terrible, and I'm confused, bc Hal hates change, but I think we are here for the long haul. So I was complaining, we can't call it EV anymore, bc it's no longer extravaginal, it's all up in the vagina. I'm getting maybe two trays of paps a day - more than I've ever done since I joined the group. Unless you look at it differently. EXTRA vaginal. So you get lots of vagina. Go figure. 

    Had a fun time tonight cooking with J. He's a master chef talking about flavor profiles it cracks me up. Got OT tomorrow in the am and switching to EV since Shaver is taking time off to combat RSV. Sending lots of love. Elizabeth

Tuesday, August 17, 2021

Happy Friday!!

     Yesterday was a shit show. Not work wise, only 100 blocks yesterday and today which used to be a decent load of work but now is a walk in the park. When I walked in I learned one of the unvaxxed secretaries tested positive for Covid Thursday night and one of the girls in the gross room tested positive for Covid on Saturday. Turns out, if someone tests positive for Covid, all the unvaxxed close contacts need to go home for a few days (maybe 7-10?) and not return to work until they have a negative test.

    Which decimated transcription and the gross room. We lost 75% in both departments and although we were able to call in reserves in the gross room (retired folk) Tina and Kimberly have been going it alone for the past two days. I was frantically arranging pizza lunch and brought in a bunch of chocolate today - I told Tina she and Kim deserved Bonefish meal from me when this is all over like when she went it alone during the snow storm. Looking forward to that.

    I know that we can't really mandate the vaccine at this point - it's still under EUA. Until it's FDA approved (Fauci says maybe September) or Baptist mandates it we won't in our business. This has become such a polar issue - as or more sensitive than abortion - that we don't bring it up but I can't help being annoyed. When one of the girls in the gross room said "Why didn't we have a plan for this" in despair Monday morning I had to bite my tongue not so say in front of the unvaxxed that we did have a plan. Fauci had a plan. And now we are ignoring the plan and becoming human petri dishes for mutants, here in the South. 

    I get it, there are reasons to choose not to vax. Most of which are wrongly political but some of which are legit (my bro in law got Guillain Barre from Covid so according to sis vaccine is contraindicated). Haven't researched this, but it makes sense that you wouldn't want to reintroduce any antigens that stimulated a war on your nervous system by your own autoimmune system. I had to discipline an employee a couple of weeks ago for shaming a non-vaxxed employee to tears. It's not ok. Baptist's reason for holding off on requirement is that they will lose already low staff numbers to other local hospitals that don't require the vax. Makes sense - we lost four micro techs last month to local hospitals recruiting heavily with fancy packages. Seatbelts are the law. Vaccines are not yet, to Covid anyway. SMH why you wouldn't take it but it's not my business (HIPPAA violation) to know and grill everyone who doesn't. 

    So even though it's my Friday (yippee!) I'm going in to finish off a case tomorrow and Thursday to go to OT. OT is cracking me up. We are in the same room as PT, and there are about 10 patients every hour. A therapist gets assigned two patients so it's often a struggle and they use a student to fill in. I finally had the same therapist my fourth visit (The first guy was a floater and Molly was filling in too). Stephanie is good but you can tell she's juggling a lot and so Bailey the student was assigned to me for the first 45 minutes. She said she was told to continue the same exercises and I was like, but no one has ever used the same exercises I'm so confused. She read my chart and ascertained the same thing. I bench pressed a half pound walking stick (the metal kind with the rubber stopper) for almost 45 minutes with brief adjustments and nice TENS unit at the end. Something is working. I'm getting better. 

    Watching the people doing PT across the room is fascinating. They work so much harder than me. Grizzly veteran looking guys and women that have clearly been through a lot. One guy was navigating cones with a walking stick - he looked good - another was trying to learn how to walk without a wheelchair. He looked like a marionette trying to turn into a real boy. I don't mean this in a derogative fashion, just descriptive. I admired everyone I saw and sent lots of love and support. Getting old isn't easy. Happy Friday on a Tuesday. Much love, Elizabeth