Friday, July 23, 2021

Variants

     So much happened today I don't know if there is a beginning or an end there were just endless cases. I worked my fing ass off. BHEC committee was underwhelming, I was ten minutes late; forgot it had moved from down by the Doctor's lounge to the Admin suite. I was talking with Ali afterwards - he was asking about my KT tape on my arm and I told him about my MRI fears and he said, don't worry - I fell asleep, it's not bad. GTK bc it's set up for next Wednesday at 6am. Lucy worked the kitchen at Baptist Boulevard today - hadn't seen her in too long - and we hugged and planned a girl's shopping trip next Thursday so excited. But that's an aside.

    As Ali and I were walking up the stairs after BHEC meeting we bumped into Wayne Lyle. He's an ED doc - I told Ali we went to med school together and we were blood draw lab partners. Told them I drew his blood fine but when he drew mine I passed out cold. Ali laughed and Wayne did too - said he didn't remember that until just now. Ali checked in on Wayne. How are y'all doing in the ED. With the delta variant. 

    Wayne said I've still got lots of compassion for my patients - that's my job, but I'm losing my compassion for the employees who won't vaccinate. I'm so angry and I try not to be but I am. I told him not all of our employees are vaccinated and some still don't believe that the unvaxxed are the root of the new variants - it angers me. Especially when so much of that movement, if you call it that, wants to blame the Hispanics, which Wayne and Melody assured my instincts today that the Hispanic population are not in the ED with Covid and are overwhelmingly vaccinated compared to our population. I learned that only 48% of our hospital employees are vaccinated, and it almost brought me to my knees. Physician vax rate is 95-98%, which makes the others even lower percentage wise. The floating reason for not requiring the vax is that we are so short of nursing staff that if we require it they bail and we are crippled. I kinda get that - there is talk of a coordinated effort to all require vax at the same time so there is no "safe hospital" for the unvaxxed but at the same time I just want to call bullshit like Emmanuel Macron.

    Went to huddle and was glad I did Amy did an amazing inservice on sequencing. There's not just Covid and a delta variant; we were looking at graphs and sequences of the entire evolution of the virus, which mutates daily, over the past year. I was supposed to be at the Zoom meeting Wednesday but call duties prevailed. The doctor in charge in Arkansas admits we are the 48th in the country for sequencing Covid cases (just like the vaccine, I joked with Olivia). When there was a geri psych outbreak last year at the beginning of Covid - I researched the contacts for admin - the sequences of the virus were all the same. B.1.1 maybe? I had Amy send me the Power Point but it's a little late to delve into that I've got to work tomorrow. Anyway, all the current infections - kids and adults - are overwhelmingly Delta. The bad news makes the news. If it bleeds, it leads. 

    Kids are going out of town next week - C to Mexico and Jack to camp. Already texting friends for plans - there are no triple surgicals or even pluses on the schedule next week (thank god) so hopefully work will be manageable. Happy Friday. Much love, Elizabeth

    

Thursday, July 22, 2021

Breast Care

     I walked into Staggs' office Monday morning to chat, whatever, I can't remember, it was before the onslaught of needles. We were catching up. Tara from histology brought some slides into his office. There was a red stamp on top of a requisition about a centimeter high in bold. It said breast care. I looked at Staggs incredulously. Do you mean breast case? I asked Tara, and she said yes as she receded down the hall. 

    WTH? I asked Staggs. Dunno, he said, I've never seen that before. I wondered aloud if it meant for us to do a self exam. Not that you really need to, I told him, but guys can get breast cancer too. Later I told the story to Melody, and she said that Tina had ordered a stamp last week from the business office announcing breast cases (these are time sensitive to some of our clinicians) and they had f'ed it up. LOL. 

    A day later I was getting cases announcing breast case (in capital red bold letters), so I guess they finally got it right. Yesterday Tina got a white sac package from the business office. "I'm scared of this," she said. I wandered into transcription. "Why? Open it." 

    It was another stamp that announced breast cases. But we've already got it right, she beleaguered. Why are they sending us another one? I guess I could stamp it on my breasts, she said, might be kinda sexy. I told her that breast care stamped across the chest would be even more sexy. Less clinical, I was thinking, and more of an invitation. She laughed. I headed to CT. Keep up. Happy Thursday. Much love, E.




Wednesday, July 21, 2021

Preaching to the Choir

     Monday after I read an EBUS for Cydney Tony and I were talking about Covid. Wondering why people don't get vaccinated. Today he rejoiced that one of his cousins got vaccinated when he signed up for a cruise and they told him if he didn't, he would be quarantined in his room all week. No dinners. No community. No excursions. It was a win win, but God the lengths we are going through to get people to get the shot in this strange climate is mind boggling. 

    I walked into the Dr. Lounge to get a water after I read the slides - it is right next to the pulmonology lab. I ran into Bob Searcy - a seasoned and highly opinionated pulmonologist. He used to intimidate the hell outta me but when I told him who my dad was a year ago he took a shine to me and always asks me about how my dad is doing. He told me that one of the SICU workers (he is in critical care pulmonology) who refused to get the vaccine was on a large outing last weekend and a bunch of them, including her, got Covid. He was livid and ranting. I don't want anyone unvaccinated taking care of my patients, they are already critical, and Covid would be a death sentence for most of them.

    I told him I heard a hospital in NW AR was requiring the vaccine for health care workers. These are murky waters - it's not yet FDA approved, but I agree, we need to mandate it, and so does he. This new variant is so much more virulent and Melody and I wondered this afternoon about the ethicality of even having a sore throat and coming to work without a test. As vaccinated asymptomatic or mildly symptomatic carriers we can wreak havoc to those who aren't protected. Yes, I'm frustrated but not entirely hostile to the community who disagrees with my point of view. But the children. They are succumbing much more rapidly to the delta variant, and haven't yet been approved for the vaccine. If that isn't argument enough to mask up, I don't know what is.

    Laurie and I got called to a late brain frozen in NLR today and I was explaining my angle - who wouldn't want to protect the children? She is cynical in a good way, often more so than me. "Well hell you know who it is. They don't want to do anything to help the children when they are outside of the womb." But that's a control issue, I said, entirely separate. But not really, I sheepishly admitted. It's such a shit show. Luckily it was an easy frozen and we were back at work to finish up and be home by the decent hour of 7pm.

    Shay is one of the workers in the Doctor's Lounge - we have gotten friendly since she started working there about a year ago. When Breezes opened back up Geisha had to go back and Shay was her replacement. A spunky lady in her late 50's or early 60's not sure but her colored hair and smooth skin belie her age. She has 34 grandchildren! She lost a great friend to Covid last week, was showing me pictures on Facebook as the automatic Starbucks coffee machine was brewing my morning mojo. The funeral is this weekend. I told her I've had close people contract the disease and suffer greatly but had not yet had a close casualty. I sympathized.

    But it's bound to happen soon. I read the lambda variant popped up in Texas the other day and what even is that? We are like a Petri dish; all of our misinformation brewing opportunists. And our blissfully unaware (or so they claim to be - machination vs. ignorance is tough to snuff out these days) legislators are touting the vaccine (finally, some of them at least) but it's too damn late for that. Melody sent the numbers tonight in our hospital system - they are rising as predicted. On July 14 it was 163 hospitalized 47 in ICU. Today it is 185 hospitalized 61 in ICU. According to Mandee, we are at the tip of a disaster.

    In micro huddle we plot and plan to decide which machines to use on which patients - vaccinated vs. unvaccinated, asymptomatic vs. symptomatic, exposed vs. unexposed. Trying to get the information to the clinicians in the most efficient and expedient way possible - some are batched, some are not, some add other PCR viral tests that may be of use to rule in or out Covid. I'm noticing when I look in the charts that a lot of Covid inpatients are overdue for their second vaccination. The hospitalists I bump into in the Dr. Lounge are more frazzled than they were in the winter. I hear our patient count is over the maximum bed capacity - we are at 614 (max 600) and we are now converting private Covid rooms to shared ones for patients with mild symptoms to accommodate everyone. 

    I escape from it all by looking at science articles on The Guardian over lunch - they first talked about pyrocumulonimbus clouds last week and now the NY Times has jumped on board. Dangerous but fascinating. Family dinner over meatballs tonight also helped. I find that if I just reason that everything, no matter how awful or contrary to what I wish, is happening (oh god I resist to say for a reason that is so fing cliche) but if it just is, and I just go with the flow, me and mine will be ok. Maybe fairy fantasy stuff, but if it helps you sleep at night, use it. Happy Wednesday. Keep up. Much love, Elizabeth.

Tuesday, July 20, 2021

Interventional Radiology

      I walked into radiology for the sixth time this afternoon. Which was an unexpected nuisance - the new guys don't call us much anymore so we are used to maybe one a day from them. But I'd had a bunch of thyroids and Ken was on, he always still uses us and it's to his credit - he gets good material and we get good radiographic correlation for working up the case the next morning. I signed out over 50 cases today - a record I hadn't reached in years. That's what made it such a distraction. It was a Monday on a Tuesday. 

    There were only three rad assistants - none of whom I recognized other than earlier today. Tony, my cytotech, was staining the slides. I looked at the specimen name. Left groind node. I knew it was a typo, but I was having a day - already bitched about some changes I didn't agree with that were made in cytology when I was off last week. Back when I started, when the rad room wasn't a rotating bumbling cast of characters, I would have had my secretaries fix it the next day. But I was in the mood to ruffle feathers.

    Um, what is this specimen source? I asked the blond with braids. I'm pretty sure the groind is something I never learned about in medical school. Is that a new anatomy term? She giggled. The male assistant apologized, appeared embarrassed, and said he would fix it right away in the computer and get me a new rec and sticker for the patient. I sat down to read the dif quik. It was cellular, and looked like metastatic malignancy.

    So what's the history, I asked. The male assistant said, oh, I'm not sure, let me look in Epic (they used to always have the history pulled up back in the day - I sound ancient and crotchety lol) and said the thyroid was removed at one point? Maybe he had thyroid carcinoma? Tony and I, who are in a separate sort of antechamber looked at each other and rolled our eyes. I'm pretty sure no thyroid cancer ever has leaped to a groin node, I muttered under my breath, and he laughed. The brunette, who had also pulled up Epic, said there are liver masses! Over twenty they say. Too many to count, but then they say over twenty. Oh, and something about a lung mass? I muttered, "How many rad assistants does it take to get a patient history right?" Tony laughed again and I said louder, so they could hear me, "Who did this needle anyway?" Apparently Ken was out of the room working on another case.

    I don't fault the staff here - it's frustrating as hell but it's like this everywhere. No more consistency - and the blame should start at the top not the bottom. This constant staff shuffle has got to be one of those cost saving measures that makes the system infinitely less efficient and more prone to error. To her credit, the brunette asked me as I was leaving what was the purpose of Cytorich Red and did it have something to do with cell counts in the lab. Bless her heart she was trying to learn and wrap her head around the media and what our role was - she has a long way to go - but today was not the day for me to find the patience to explain it to her so I pointed to Tony to answer her questions and walked back to my office. 

    Watching Lisey's story and jeez it's a little much at times but good so far. I started a book by an Arkansas author - Michael Ray Taylor - called Southern Caves on the way back from Vail. Unfortunately managed to lose it somehow halfway through so ordered a new one on Amazon today it is fascinating. The chapter on the evolution of a new way of thinking about cave development with the assistance of heretofore undiscovered bacteria, some of the likes of which mimic the ones they are seeing on other planets, just about blew me away. It's not just chemicals, which was heresy to say 20 years ago, but now that myth is being debunked. Caves would not exist without the assistance of biolife. 

    Michael wore teflon suits to go into caves with scientists to study the bacteria that hides in invisible spiderweb form on the ground but if it touches skin the acid it (emits? Can't remember) will burn badly. And this guy, I researched him last night, is a freaking communications/theater professor at Henderson. Go figure. Genius springs forth from unlikely places. 

    Hoping that my surprise call week post vacay slows down (but with Rex retired and us being short staffed in summer months not keeping my fingers crossed on that one). I actually have triple surgical load on Friday. Yikes a first if I remember correctly. Oh well I'm taking it in stride I scheduled a chiropracter appointment tomorrow to address the mound of concrete that my upper back and neck have reverted to in the past 24 hours and luckily going to orthopod to address the right arm issues on Thursday afternoon. In good news on that front, my ambidextrous origins have come in handy over the past two weeks, especially with my ADL's. Aging is such a joy. Happy Tuesday. Much love, Elizabeth

Thursday, July 15, 2021

Angel Wings

    It's weird being in another state vacationing while your home state is making national headlines because of a new delta variant wave. Sunday I texted Annie because her hospital system, Missouri Cox, was on the cover of the New York Times and today I read quotes by Jennifer Dilaha, of Arkansas Department of Health and recent physician Covid inservice fame, in The Guardian. NBC even did a piece on us, according to the Arkansas Times. And we have been banned from Chicago, along with Missouri, unless we produce a negative Covid test 72 hours before arrival or something like that. Eye roll. I've been second guessing my decision not to bring my vaccination card to prove I'm vaccinated even though they aren't yet required for travel. But I take solace knowing I could tell Melody where it is in my office - she could take a picture and text it to me if necessary. I asked her to send out the Baptist numbers again - it's been awhile - since we are a new hotspot. Systemwide there are 163 inpatients with 47 in the ICU. That's a lot.
    Other than hiking and shopping and reading and eating fabulous food not much going on here. We had a spa day yesterday and my masseuse was fascinating - I watched her walk in with her cowboy boots and cutoffs and half shaved head covered with tattoos and thought I hope that badass is the Sara that is supposed to give me a 105 minute treatment after my hour scrub/hydration with Krista. I got lucky. She had changed into appropriate professional scrubs but I complimented her on her previous outfit to get us off on the right foot. Sometimes I'm chatty, sometimes I'm silent. We did not stop talking the entire time.
    Turns out Sara, despite being in her early 30's, has traveled the world. She entertained me with stories of Cambodia, Australia, Germany, Egypt, and the Philippines, the latter of which is one of her favorite places to go - friendly people, amazing cheap food. She often works in hostels or volunteers for non-profits in order to pay for her room and board. She told me the best place to stay in Egypt that is right across from the pyramids - it is a family owned hotel for generations and she got to meet the patriarch before he passed. You can sit on the roof and watch the sunset, she told me. It is incredible. Of course I forgot the name, sphinx was a part of it, but we became Instagram friends after the session (I entertained her with some Dr. stories too) so when I plan a trip to Egypt I can message her. She told me most of her IMs are travel questions but she doesn't mind. I told her I get a lot of medical questions but I don't mind either - it's fun to share your area of expertise. 
    She plans to move to Costa Rica soon but has never been there - I told her I've been three times and we bonded politically over how much better women led countries are run -Jacinda Ardern! Etc, etc, - New Zealand is one place she's never been to but has heard a lot about Kiwis. I told her about Judy Melenik and how I'm waiting for Dawn to migrate us over to wordpress to write that article. We preached to our own choirs about the shifting climate from patriarchy to matriarchy, and how it's a frustrating but amazing time to be alive. 
    I also met a guy named Jack in the fossil shop in Lionshead - it is one of the most amazing fossil shops I've ever been to I've already been twice. I had a few half off smaller items shipped - I found these stunning blue quartz candle holders that were listed for almost $300 apiece in Vail Village on Sunday (ack too much) and they were half off in Lionshead Village at $70. I prided myself in getting out of there without a huge purchase - my last big one was in Aspen buying matching trilobite fossils about six years ago. Then I saw the quartz angel wings. Jack appropriately ascertained my emotional pull and described the artist and looked at the ticket and offered me 2K off of the list price. He said they had already sold out in Utah. I talked it over with S and his advice was to sleep on it - good advice for big purchases.
    I told Jack I'd be there until Saturday but he said he was leaving Thursday for the Ukraine to meet a friend - they are planning to hike the Carpathian Mountains. I told him quartz was big where I was from in Arkansas and he said come look at this piece from Arkansas. It was surrounded by Columbian quartz but it was twice as beautiful because it was spotted with gold. He also showed me an amazing museum quality dinosaur skeleton embedded in stone worth over a million dollars. When I went back today to seal the deal (turns out I dreamt about the angel wings - Sara agreed there are things that pull you and it is meant to be) I made sure Jack would get the commission since I spent yesterday at the hotel. The worker, surprised that I knew Jack was going to the Ukraine, assured me he would, and verified the price he gave me with her boss on the phone. 
    Dinner tonight is at Montauk in Lionshead the menu looks amazing - hoping it's as good as the Veal Chophouse the other night. Lionshead is a little more charming than Vail Village; I'm sure there are a lot of good restaurants there but it's closer and has plenty. We arranged a float trip for tomorrow - nothing too scary since I have been ignoring (like a doctor, I joked with Sara) a pulled muscle in my right deltoid for two weeks (paddle boarding incident) and it has not gotten better. It's either a badly pulled muscle or a hairline fracture of the humerus, mid-shaft. The orthopedic clinic in Vail, world renowned, was booked this week so I'll got to OrthoArkansas to get it x-rayed next week. I almost started crying in yoga last week and it wakes me up at night. Advil and Ace wrapping aren't helping. I'll take this though over the vastly improving GI issues that plagued me over the last year any day. I'm finally feeling normal again. Practically cough drop free, unless I want one. No longer dependent. Wine is good again. Happy Friday Eve, much love, Elizabeth



Friday, July 9, 2021

Gross Room

     I still don't know what the hell that arm thing was. I told Jessica to give it to me for today, but Bob reassigned it yesterday evening. Not his fault, their job is to make the block count even however they so choose, but by the time I realized that I wasn't getting it and figured out who was they were already gone for the day. Oh well, I'm off for a week so I'll figure it out when I get back. 

    I was on afternoon frozens this week and the first two days were quiet but then it ramped up. Yesterday I got called to a brain frozen mid afternoon. This neurosurgeon has worked there for years, but he's pretty stoic - I can pick him out in the hallway but I've never met him. Bob said the radiology looked like a 4 cm GBM but I was hard pressed to call anything besides normal brain on the sliver of tissue he sent to freeze. I called Staggs for a consult, he agreed. 

    I called back the surgeon on the bat phone and told him he did not have diagnostic tissue. He loudly asked in front of all the OR staff how long it would take to do the next frozen. Confusedly, I asked what? He said I'm sitting here waiting for your result with the patient on the table not being able to make a next move can you tell me how long next time? I channelled my inner Michelle Obama. When they go low, we go high. I told him the average frozen takes 15-20 minutes (this is not an arbitrary number these are the CAP standards) and that if it is difficult we sometimes, like I did on his, get a consult and it takes a little longer. I apologized for his wait. 

    After I hung up the phone I walked back into the gross room and told Jessica what a dickhead! I haven't been treated like that since training - what an ego. She told me way before 15 minutes his staff was calling the gross room wondering when they would get a result. She was seething. If you call, she wanted to say but held her tongue, I have to stop doing the frozen and answer your call so you are chopping off your own leg here. 

    I went back to Stagg's office to vent. He told me yeah, that's the guy who idolizes John Wilson. John is a neuropath expert over at nephropath at Arkana - we send him rare difficult brain cases. I met John and his wife at Martha's Friday night sip and sit yoga a few years ago - he is an amazing individual who trained all over the country and he's humble as hell. He also goes to great lenghths not to step on our toes, which is different from a lot of consultants (Jesse McKenney is good about this too). A lot of consultant's mission is to steal our business with a lot of fear mongering over, basically, bullshit. 95% of what we see in our practice on brains is cookie cutter - either metastatic lung or GBM. Not rocket science, but if it's hard, we send it to John.

    Staggs told me about five years ago he had a frozen from this guy about like mine, non-diagnostic and the surgeon got so angry he didn't get an answer he asked Staggs to take it to John. At the time Arkana was behind the Heart Hospital. I called him on his bluff, Staggs said, and told him it would be an hour turnaround. Luckily John said the same thing - non-diagnostic. This surgeon is a young soul, I decided. The next two frozens he sent were similar. Luckily he got the tumor on permanents today. I bumped into him in the hallway today and introduced myself. Told him he got the diagnosis on the perms. He looked like a deer in headlights, and I wondered where his headspace was. So it will be out Monday? He asked. But I just told the patient I didn't get a diagnosis. I gave up on frozens. No, I said, it will be out today. I got a second, it's a done deal. Necrosis, prominent vasculature, nuclear pleomorphism, atypical mitoses, it's a shoe in for GBM. He startled, thanked me, and walked away.

    Bob had the best retort. Next time, he said, you should tell him you are waiting and twiddling your thumbs for the next frozen bc he isn't getting good tissue he needs to speed up his turnaround too. LOLOL. I would never. I get it - they are working in the brain looking through loops it's gotta be tough. But no excuse to shit all over your help. This afternoon Sims sent nine frozens. It was all good, mostly negative margins on a glossectomy, and the positive one that he had to send a supplemental margin on was negative. Promise to follow up on the arm mass sometime this week. So excited to leave for Vail in the early afternoon - time to wake and pack and clean the fridge. Happy Friday - much love, Elizabeth

Wednesday, July 7, 2021

Denial

     I got a call at 6:45am Tuesday from Jessica. She said you are on the schedule to go to Conway tomorrow for frozens, but the surgeon moved the surgery to today. So you need to go to Conway. Oh, I said, thanks for the heads up. She told me he was starting at 8:00. He's usually a slow starter, so I figured I had time to eat breakfast and head to Baptist to get my early biopsies and diagnostics before I hit the road. I asked her to call the histology lab and tell them and to please notify the business office I needed  to have the courier, John, bring me a run at 10. Emily in histology assured me I would have most, if not all of my 120 blocks by then. 

    I texted Misty on the way up I would be there if she needed me to sign anything. I didn't hear back but bumped in to her when I was looking for a water at 9:45 - the surgeon was having a time finding the offending parathyroid (adenomas and hyperplasia can cause hypercalcemia, it's an easy frozen) and we weren't released to go back to Little Rock until early afternoon. Bob lives in Conway, one of our PA's, so he showed up to do the frozens. Thank goodness because the frozen machine broke and he had to perform miracles to get a section. Misty asked if I would like to have lunch, and I was excited. She's gluten free too. After the lab inspection we shared a philly cheese chicken sandwich, sans bread, over french fries. We talk process. Yesterday we did the same. She was upset. 

    We bumped into the CEO, Tim, he's so nice, getting food. He asked if she was on vacation last week because he didn't see her. No, I was in Little Rock, she said. He asked about our holiday weekend, and she replied that she was in Conway Baptist every day catching up. Oh god I offended him, she worried over lunch. I'm usually not that blunt. But I would never just take a week off? Without telling him? WTH? Turns out Covid is ramping back up with the re-opening, I'm sure you've read all about it in the news. Delta, Delta plus, Delta schmus. Luckily it's not so dangerous for vaccinated people, but so many are unvaccinated. 

    Misty started dishing on the real reason she is frustrated. She told me she was instructed by a doc to bring up the antigen test again, Sofia, for employee testing. But that's a bad test, I said. If there is a false positive, we have to quarantine them for two weeks and it is a waste of resources. Inefficient. If it's a false negative, we are exposing the other employees for 7 days, the amount of time recommended in the doctor generated algorithm before we do a PCR test. She crafted an intelligent, non-emotional e-mail to the doc and showed me it and his response over lunch. Did he even read your e-mail? I asked. It doesn't look like it from his response. She wanted them to do the PCR test day one and day 7, and do the antigen test in between.

    I was texting her today worried - Amy and Olivia in micro (two seniors) are off this week so I couldn't run it by them. She told me that it would probably be ok. We take care of our employees, she said. If there is an exposure or a symptomatic employee, we usually bypass protocol and do the PCR test. Whew. What a relief. Hopefully they do that in LR too, I know Mandee Novack does not trust the antigen test either. The gift shop worker at Conway - we have chatted about divorce and kids in the past - said her unvaccinated nurse kiddo was calling her worried. There was another exposed nurse that worked half a day exposing everyone before he tested positive for Covid. Gift shop manager said I'm vaccinated, but my adult kids are opposed.

    I get it, I told her, I'm not judgmental. It's not FDA approved, it's still under EUA. We cannot really mandate it yet. But from everything I read the side effects are less than .1%. That is dwarfed by the side effects of getting Covid. It's a gamble I am willing to take. Despite the relaxations in public, we are all still masking at the hospital. 

    While I was waiting on another frozen around 1 yesterday a surgical tech walked a specimen into the gross room. Y'all gotta see this, she said. Just hold your nose. It's an arm mass. I held my nose and looked in the white bucket. It was a 15 x 5 cm cylindrical shaped mass that was flaky and grey-green and gangrenous with an ulcer on the top. Gosh, I said. I've never seen anything like that let me see the name so I can look it up in Epic. The doc had taken a pic in situ and I asked Bob, where is that? On the shoulder? He said no it is protruding from her arm right above the elbow, according to the surgical tech.  In the H&P she said it had been there two months and was the result of a minor scrape.

    I went into the gross room in LR today and was telling them about it - Michelle said we just got it and accessioned it I told her and the rest of the crew the story and showed them the pics and told them to give it to me for tomorrow. Jessica asked do you think it's a squame? I said like none I've ever seen but I'll lyk tomorrow. If it's weird I'll send it out. I had heard there were a lot of frozens over the holiday weekend - more than usual. Jessica said one was a young woman diagnosed with a 3cm cervical tumor at UAMS last year and she went to a natural healing place in another state for a year to get treated. She presented with total ureteral obstruction - the mass had grown to 10 cm and there were implants all over the pelvis. Ugh, I said, poor thing. I get denial too, I've been there. But modern medicine has a lot to offer, despite its downfalls. Do the natural thing, I'm all about that, but in conjunction with us. Surgery, immunotherapy, radiation, there is a lot out there to combat cancer these days. We don't have all the answers, but we have a lot of good science driven tools in our toolbox. 

    On the home front, things are looking up. I haven't expelled any demons in two weeks. I started drinking and enjoying hot coffee for the first time in a year on vacation last week. TMI, but lower GI tract is normalizing as well, giving me the energy to walk and exercise. I went to my first gym yoga class in over a year tonight. It was Monique, who is amazing, nice and slow. Cecelia and Joelle went with me, which was ecstasy. I saw Shelly, an old supper club friend from Foxcroft, and we crazily hugged. My body temp is normalizing back to the colder side of things. I'm cautiously optimistic. 

    Misty told me that Covid numbers in our hospital system are rising. We were down in the 40's in June. She said last week we jumped to 60's and this week we are in the 80's. Makes sense, as C would say. Probably over half of our state is unvaccinated. Hopefully we can get control, but I'm not holding my breath. Or planning any European vacations in the next year. Got CARTI tumor board in am looking forward to seeing that crew it's been a bit. Happy Wednesday. Much love, Elizabeth

Monday, July 5, 2021

Respite

     Florida was unrecognizable for June/July. It made me feel guilty, all the lush green surroundings, as I thought about California and Arizona - made me wish I could lend them some rain. There were daily frequent pop-up storms; it felt like we were on a Caribbean Island. And the color of the ocean on the bay was new to me. Ink black ocean turned amber as it was approaching the shore and the crashing waves were the color of honey. My brother and I first noticed it on our arrival evening walk, and I marveled at it all week. The only time it turned sea green and clear were on two sunny mornings. The resulting weather from all the rain was pleasant for excursions and walks and sunning and reading on the third floor roof balcony. Once Cecelia and I had a long walk interrupted by a downpour - it was cold but I'll never forget the sight of the raindrops pelting the ocean while hanging out with one of my favorite people on the planet.

    It was fun to get to know their friends - both new fast ones. Noah looks like an Abercrombie and Fitch model (if that store still exists) so it is surprising to look into his dark eyes - they are like a doe's - and see introversion and even insecurity. He, at the young age of sixteen, has sworn off alcohol and drugs and tobacco for the same reason my partner Michelle did - early overexposure. His caretaker of two years, Ms. Candy, is a social worker for crime victims. She works for the state government. When I learned this on the phone a couple of weeks ago - she rightly wanted to talk to me before she sent Noah with me for a week - I told her she was a Saint. My brief background in psychology left me raw and wounded, I told her, and she assured me it took her a bit of time to build her own boundaries. 

    As Cecelia and I walked in the rain we assessed Noah glowingly. She told me that all his other friends are mean - I mentioned a couple who I knew had a tendency to tear others down. Not pathologically, but probably insecurely. She said all the Episcopal boys trash talked each other. In stark contrast Noah was very kind to Jack. Jack is also a kind, sensitive soul so they meshed well. They were always checking in on each other and making sure if there was a plan, everyone was ok with it. In the middle of the week we were on our way for lunch and shopping and we went in to get the boys a one week gym membership at Port St. Joe - they work out together in Little Rock and were missing that. As we walked back to the car  Noah grabbed a door so I walked to the other side of the car and looked up at him confused when I realized I was on his side. "I was holding the door for you," he said, and I was floored. Cecelia called out from the back seat "Gallantry is not dead!" and I told the girls expect nothing less from anyone you date. He worries that he is not as book smart as his older brother and sister; I assured him kindness is more important and he already has that in spades. 

    And Joelle (Yousef's daughter!) was wonderful to hang out with. She is heading to Hendrix in the fall to major in poli sci and to minor in French. She, like Cecelia and Jack, comes from a blended family - she told me on the plane on the way back she was about the same age as C when the divorce happened. She speaks highly of both her mother and her father - makes me think they did it right like we did. I'm not glamorizing divorce.  I know the kids have their frustrations especially having to pack up every week and move to a new house; but the benefits I see are great, especially if the marriage wasn't working. Four adult heads to bounce things off of. Seeing more than one way to do family and picking your favorite parts for your future self. Joelle seemed very wise and grounded. An old soul. I'm glad C has her as a friend. I told C the other night I had friends from Fayetteville come stay at Hendrix for the weekend; I'm sure it won't be hard for them to keep in touch over the next four years.

    Being sans a husband - he's saving his much less vacation for Vail next week and already visited my parents last New Year's - I had a lot of time to read. I finished Melody's thriller Mother-in-Law on the plane and resumed one I started a few months ago called Vesper Flights. I had read the author's first NYT bestseller H is for Hawk when it came out - a lovely book about grieving her beloved father's premature death by becoming a falconer. This is a book of essays on animals and political and climate commentary. Turns out I have a saturation point for that, even though they are wonderful think pieces. I took a break and turned to the doc mom book club pick - Amanda Ferrell's turn.

    Hollywood Park is one of my favorite memoirs I've ever read. He's my age, we grew up listening to the same music. The book starts with his mother running away from a cult with about 7 year old him and his older brother. I won't ruin it in case you want to read it - I finished it in under 24 hours (was up until 2am reading and woke up at 6am to finish). There was prison and addiction and poverty and love and happiness and family despite all the hardship. It grabbed my by the shoulders and didn't spit me out until I was done. Mikel Jollett was in a band I've never heard of.  They must have achieved brief fame during my med school and residency, in other words, The Cultural Dearth. I look forward to looking up and listening to Airborne Toxic Event.

    I'm still working my way through an anthology that was recommended by a Native American activist I follow on Instagram. Love After the End. It's a mash up of Native American culture and sci-fi and LGBTQ culture. I never thought I would like it when I saw the sci-fi part in the intro but these stories are blowing me away and a couple have brought me to tears at the end. Looking forward to getting through the second half. Just had ten days off and looking toward a short week before the next adventure. Can't wait to see my work family tomorrow I miss them. Was joking with Rex on group path text that I haven't missed him yet since I've been on vacation but I will start building his shrine on Tuesday. Happy Monday, much love, Elizabeth

Thursday, June 24, 2021

Rules

     It was Baptist's 100th anniversary on Tuesday, and big festivities were planned. Every employee was to receive a gift, and there were a lot of food trucks out in the parking lot.




In the gift shop on Monday the sales girls were blowing up big 1-0-0 balloons. Amy read the news in huddle on Monday and transcription  was all abuzz. 

    When Amber and Janet came up with their gift box and showed us the stainless steel water bottle and umbrella and pen and journal set we got so excited to get our own - I grabbed Tina and Kimberly and Jan and we walked down to the cafeteria. There were rules. You had to get a number at the front and go get your badge swiped then go to the correctly numbered table. There were six tables with pyramids of gift boxes and more and more pyramids of gift boxes behind to re-load the tables. I haven't seen that many people in the cafeteria since they gave out free food during snow week. 

    When we walked up to the ladies giving out numbers - admin, I recognized them - they gave me a number and turned my secretaries away. Told them contract workers do not get a gift box. We all recoiled, and I told Tina I would give her mine - she has worked for Baptist for over 20 years only recently became PLA. Tina turned away in disgust and Jan followed her. The ever positive Kimberly, who Rex loudly wondered if she was running for governor last week (we all had a good laugh) decided to stay with me and see if she could find a back door. I was angrily telling her this smacks of lab week WTH. If they are going to offer gifts and turn people away they should warn them in advance so they don't get hurt.

    Sure enough the crowds were thick and the lines were long but they happily swiped her badge - she excitedly called Tina and told her and Jan to return and told them exactly what to do. I got my gift at table number one and smiled at the CEO Troy Wells in the receiving line and Mayor Scott was there as well. I got a little sweaty in the crowds and was unsure of the outcome and lost Kimberly so I texted Tina that I was going back upstairs. 

    We were all triumphant when the girls returned with gift boxes and everyone was praising Kimberly's genius. I told Melody and Quinn and Shaver about it - they didn't know. Melody missed the cafeteria, but when she was finishing up an apheresis consult today she walked into admin suite and asked Laura for a box - Laura gave her one from under her table. At about noon Quinn came in my office with a story.

    He told me a little later in the evening on Tuesday - they were giving boxes out until 8:00 - he went down to get one. He stood in line and showed his badge to someone from human resources - there were about 10 people scanning badges. She asked about his u number, like me he said I don't have a u number I have a p number I'm with PLA. She gave him this long rigamarole about how contract workers cannot get a gift box and kept persisting - he said people were looking at him it was really embarrassing. His badge said Dr. Quinn. We are on medical staff that makes us Baptist. He told it in a funny way that had me laughing so hard all day today thinking about it - some random chic following a blanket rule that should not be black and white (or even exist). I told him about Melody's success and told him he should go to admin suite he said I don't know. I still have a lot of PTSD from that incident. LOLOL.

    Arbitrary ignorant rules inferiorate me. The dress code at Episcopal comes to mind. The first thing Jack's teacher told him on the first day of school in first grade was that his shirt was on inside out there was a bathroom across the hall go change it. I hadn't even noticed. No praise for putting it on by himself? No hug welcome to my classroom? We grew to love her, but that institution had some of its priorities backwards. Give my daughter detention for not following the exact dress code? When she decided to go to Central, she was so nervous about what to shop for and wear. I told her let's buy a few basics you like, and when you see what everyone else is wearing we can branch out. She quickly caught on, created her own look, and eclipsed mine.

    I called in sick Monday for the second time in fifteen years - first was when I broke my jaw. I woke up at 3am with alternate chills and fever feeling so bad I wondered if I needed to be carted off to a death hut. This was last year's experience times one hundred. I told S I wouldn't shower but he would need to dress me in a t-shirt dress and get me to work somehow - I was imaging him putting me on a dolly like that movie years ago with Ryan what's his name and the mannequin. Probably a little delirious? In retrospect that would have been poor patient care. He called in too and took good care of me. 

    I was telling Rex about it this morning and he said he's called in once in 31 years in hypertensive crisis. Competitive much? You beat my track record, I said. I told him last night's ejection was so epic it was no longer just retching I think I'm expelling demons. Sure sounds like it. He said maybe you should get on with the Conjuring? He hadn't seen any of them but I love every one but the last was not very memorable. I said they would love to record my voice for expelling the demon possession parts it hurt my ears but by now I'm used to it so I just try to enjoy it - it only lasts a minute or two. Then I can dry my tears and blow my nose and enjoy a drink. I stopped on the way home to get him a bottle of wine - tomorrow is his last day and I've got a good wall around it but I'll break down at some point when it's safe. S is safe in Austin after a long drive. Visiting dad and stepmom. I'm flying out Saturday with the kids. Kallie may come spend a few days with us so excited. Alone in the house for the first time in a long time - kids are at dad and stepmoms grilling cheeseburgers. Think I'm going to tuck into a book Melody lent me that I read half of the other night. Intellectual brain candy thriller. Happy Friday Eve, much love, Elizabeth

Saturday, June 19, 2021

New BFF

     I don't think I've told you about Jeff. He's the security guard who works at the front desk at Med Towers 2. I've been friendly with him for years. A couple of weeks ago at Boulevard he alluded to an incident in the ER that was hairy - some psych patient he had to help subdue. So I started thinking, if I go to his desk and share stories with him he will share some with me and I'll get some juicy gossip.

    Well I did just that and we started talking about psych and I mentioned my experience at the child and adolescent ward at Turning Point back in the day when I was taking pre-med classes at UALR and he exclaimed I knew you were familiar! I know you from somewhere. When were you there? I told him I was there in 1994 and he said he was security at ACH at that time. It blew me away I recognize his voice but not his face. We reminisced about Joe and Penny and Randy and all the nurses and techs it was a wonderful trip down memory lane. We shared gossip from back in the day. He told me that one of ours, we both cannot remember the name, he was from Africa (amazing accent) and he was well respected by the patients. He was killed by a patient. Head slammed into a desk. I kind of started crying I really respected him. 

    I asked if he knew about the teen gunshot wound in the flank he did not but he knew about another teen gunshot wound last week in the leg. He was so mad because he told the mom to get a police report and not to allow any family members to show up because of Covid. Well guess what an hour later the ER entrance was gummed up with cars of family members coming to see him. Tommy in mycology told me that at UAMS (his son works there) they put the whole hospital on lockdown if there is a gang shooting in fear of retaliation. I was wondering why, as I have left the hospital the past few days, there were so many cars in the ER. 

    Jeff and I were talking about the resurgence in gangs - it was heavy back in 1994 (there was an HBO special). He said that the Latino gangs are more organized - they move drugs and make money - but the gangs behind the hospital just do drugs and shoot guns it's a mess. I told him about the young teen patient back then that was proudly a queen in the gang because she was pregnant as a result of being sexed in (gang raped). It really woke me up to what a privileged life I have. 

    He lost a daughter at 29 - he showed me pictures yesterday - to lupus. I had a former nanny with that disease it can be brutal. She was a gymnast - he and his wife took her all over the country to competitions. She once danced with Paula Abdul. Losing a child. I cannot imagine.  I shared about the funeral I attended of my friend Carmen from Sunday school. I saw a meme recently, about grief, that I shared with him. Grief doesn't shrink over time. We grow around it. 

    He's a fisherman, and I hope to benefit from that in the near future. He gave a cousin and a friend a bounty of catfish for a fish fry last weekend. The friend recipient was from Chicago and was so grateful he gave Jeff a bass boat. Jeff and I were problem solving how to get it from Chicago to Little Rock yesterday. Hire someone, I said, and he agreed. Happy Saturday, much love, Elizabeth

Thursday, June 17, 2021

Gross Room

     I'd just settled down to my lunch today - Kimberley has been bringing in Boulevard's Kale salad for the girls in transcription and I was formerly addicted but hadn't had it in years was dying to try it again. So many pine nuts. Kimberly adds chopped up boiled egg whites; I excitedly got two boiled eggs from the Dr lounge this morning in anticipation. Then I got paged for frozens.

    Two different frozens on two different patients, Jessica told me, and the first one was a Scott Stern. We were reading the history on Epic. Jessica said Wow! He's had a sore throat for 1014 days. I looked and sure enough that was in the H&P. That's pretty specific, I said, do you think it's a typo? She said maybe not, that's a little over three years. We all belly laughed so hard and I wondered why it took so long for him to address it. I told her I needed the laugh after a funeral, my second one in a month. Jay Clark did a wonderful service. I texted him this evening, and he thanked me for my kind words.

    The patient had a history of squamous cell carcinoma, it was a tongue lesion, and I was relieved when I looked in the scope that it was normal lymphoid tissue. Waldeyer's ring, I gathered. When I called the OR to tell him he was so flabbergasted - I guess he thought it was recurrent cancer - that I physically recoiled in paranoia. Was there a specimen mix-up? Did someone give me the wrong slide? But no, it all checked out. Meanwhile Laurie announced from her grossing table that she's had a bad attitude for 48,579 days. We all laughed. Then she said I think there is a blues song in this sore throat thing, and started singing about a guy with a sore throat for 1014 days. We all joined in, except Savannah, who was on break watching boxing matches on her phone. But she was smiling.

    The other one was a 20 something year old with endometrial cancer - luckily it was superficial so she will probably do ok. I learned from an ob on the way home that she had a BMI of 88. If you are storing that much estrogen in your fat you will inevitably grow an endometrial cancer. So she's a victim of the food industry, I said. We were problem solving another case of a 30 something year old with mucinous carcinoma of the ovary. His wife is an oncologist and wants to know how to treat - this was all over the abdomen. I assured him I was confident of my diagnosis, but since there is a clinical question that will make a difference I will pull everything tomorrow and re-evaluate and stain and give him feedback ASAP.

    I had another gyn/onc Bandy frozen later in the afternoon. Gross only. I cringed calling the OR. I told Melody earlier in the day can we just replace that OR tech that answers the phone? He is often in some robotic equipment so he depends on her to take the frozen diagnosis. I told her very superficial cancer on the frozen at the most inner one half of the myometrium. This helps him make a decision to take pelvic lymph nodes or not. She said let me write it down, speaking slowly and asking me to repeat every word. She said in or one half? I said no inner one half. She said inner or one half? I said no, there is no or, only inner. Melody said she asked her to wait on hold so she could relay the information to Bandy in case he had any questions. I said hell no, she's done that to me before, I learned to hang up the phone as soon as I get her to write it down. If there are questions they know how to find me. Luckily the tech in the late afternoon was a competent guy he said thanks and I was done. 

    Jessica said she had entertained Joe with the story about the guy with the sore throat - he works in cytology in the mornings and in the gross room in the afternoons. Apparently after I left she and Laurie made a parody of it to Red House. She couldn't remember all the lyrics, but relayed a few, and it was genius.

    In the Guardian over lunch I read the title to some review of the Friends reunion and their stint on James Cordon's Car Karaoke - neither of which I have seen - and knew it was Stuart Heritage. Another good laugh, and good replacement for any latent desire to watch either. Happy Friday Eve. Much love, Elizabeth

Tuesday, June 15, 2021

In Extremis

     Ugh. I am so mad about white patriarchal construct and belief system right now I could puke. Wait, I already did. Yesterday and today. Zofran helping, but I'm still yakking my guts up. But that's depressing. 

    I was looking at a teen's stomach and omentum today and these kids are getting gastric bypasses earlier and earlier but I wondered why the omentum too? I feel like every case deserves a delve into the charts. Turns out he came in last night with a gunshot to the gastric flank. One of our general surgeons - he's really good - worked like hell to save him. The chart came in saying he was "in extremis" - a medical term that was new for me I had to google it. On the verge of death, apparently. Luckily he came through the surgery fine and is doing OK so far. We don't get those very often, but Christy said there was a rash of crime the other night after an anti crime rally in LR; two stabbings and two shootings. 

    Got plane tickets today to go visit mom and dad with the kids and their friends I'm super excited but they cost an arm and a leg. With my track record lately for needing Uber for prevention of panic attacks it was a necessary cost. We leave the 26 and get back July 3rd. So in need of a vacay. S and I are going to Vail for a conference two weeks later we are staying at the Grand Hyatt. It looks incredible. I was hoping after a healthy weekend to start to hike and kayak but it's a little iffy after the last two days. Hopefully it won't be like Chicago where I slept most of the trip in the hotel but if so, it is what it is.

    I'm not sure who Stuart Heritage is but he cracked me up so hard over lunch with his article in the Guardian called The Celebrity Dating Game; haven't we suffered enough already - it made me want to google him and read other stuff. I was laughing so hard my eyes welled up. That's what we need more, to get through the day. Laughter and song. So addicted to Nightbirde's performance on AGT. She's like an angel. Way more wisdom than any of her audience. 

    Another funeral on Thursday morning for Sunday school member Carmen. She's another beautiful soul. We had a good gathering on Sunday to start to heal and plan to do something for her kids. Two cancer funerals in a month - this is a little ridiculous. My chief said we are getting of the age, but I disagree. We are not of the age. Cancer is getting us at a younger age. 

    Shaking righteous anger when I was on call last - I was not shy - is finally leading to process change that is making our group more efficient. The head of cytology is crediting me I told her it wasn't intentional it was natural and a long time coming. Everyone is happier so far I'm cautiously optimistic. We were marveling at the results this afternoon and she wants to have more events outside of work, like the girl's night outs I have had, to make us even more familial. Excited on that front. Happy Tuesday. Much love, Elizabeth

Sunday, June 13, 2021

Winding Down

     Luckily I have no call for four or five weeks. I can't stop watching Nightbirde on America's Got Talent. It's kind of ridiculous. She's like an angel. The cats are afoot. We rehomed the piano to a woman in Maumelle who teaches underprivileged kids. Rex and my parents approved. Rex said I don't like the idea of kids learning on a junky piano. I shared pics of mine he said it's worth 2-3K and it's one of his top five fave brands, a Kawai.

    My friend Deidre is stopping doing hair. This is significant - she's done my hair for over 18 years. She and Jerry are starting a top secret business - she relayed the difficulty of getting federal loans when I saw her on Thursday. I broke down a little bit in the middle of the session recalling the past - her opening her salon, etc. But I'm happy for her - she needs a new chapter. The freak storms that occurred caused me to get an Uber home - I don't like driving in that shit - and I met a new friend, a retired nurse. She recommended Zofran, for my dry heaving, which seems to be working so far. 9 months of hell and multiple doctors consulted and a freaking Uber driver saves the day. 

    Single mom Sunday school is starting up again and I recently learned one of ours, Carmen, had breast cancer and was fighting mets she died a couple of nights ago. Kind of fell apart at lunch the other day. She has an 11 year old and a 14 year old we are all, as a group, going to figure out how to do something to support them. The Sunday school group is coming over tomorrow for brunch I invited kids can't wait to see them swimming in the pool. It's a potluck. I shopped at Fresh Market yesterday got lots of Prosecco and Rose and cake and sparkling water and orange juice and lemonade and croissants and fresh fruit can't wait to entertain. Happy Sunday. Much love, Elizabeth

Tuesday, June 8, 2021

ENT Tumor Board

     Who knew how hard it is to get rid of a piano? We've been trying to get rid of our upright - donate to a charity - for two weeks. Our House, who has picked up stuff from our old house before - is not answering the phone. Habitat said they didn't take pianos. I wandered into the gross room this afternoon complaining. Joe said he had a piano, no one else wanted it. Jessica said that she watches enough HGTV to know people walk into a house and see a piano and say UGH. She said a lot of people buy them and don't use them. I told her my Mom and Dad gave me this one it's really nice and she said yeah, they got rid of it to you. I laughed touch in point. I want a baby grand in this house. Rex said there are some really nice ones that are a fancy version of a player piano. Technology has elevated it so much you can just plug in a playlist at a dinner party and it sounds like you have a personal pianist. I also want to take lessons again. I was really good as a kid, but it is not intuitive for me. S's partner David is getting in touch with a friend from Knights of Columbus who knows a piano teacher that works with underprivileged kids and only works in studios with donated pianos. Hopefully that will pan out. 

    Luckily the open lung was a softball - early DAD pattern (diffuse alveolar damage) but I had Staggs look at it Monday to agree with me and he did. Nothing here to treat, I told Muesse on Sunday. I got a pleural fluid from the patient today - he's still on the vent - and looked in the chart. New theory, according to Cidney, is that it's vaping related. I went to read a ROSE for Cidney today in the bronch lab and he told me it happens, he's read papers. I had no idea. I read about vapes blowing up in people's mouth and causing major trauma but not this. It's not common. I asked Cidney what happens to these patients. He said they usually recover and do well with support. Good news. 

    ENT tumor board this morning was good - I presented three cases. Was so exhausted from call weekend I forgot to edit and migrate my pics from my phone to a jump. Discovered when I woke at 1:40 am I had left my jump at the last tumor board and panicked. Luckily S plugged in and found a new jump and helped. One of the cases was a rare one - adenoid cystic carcinoma. It has a tendency for nerves - likes to travel down them and spread. 

    After I presented it I told them I had another interesting case this week that is probably adenoid cystic of the breast. I've only seen it twice in my career in the breast - super rare. Strange thing is she had a history of multiple cylindromas. I had to google that it's rare too - there is a syndrome I forgot the name but they happen mostly on the temple this lady had them on her temple and her torso. It's a benign tumor, very different from adenoid cystic but the weird thing is that morphologically they look the same and are each other's number one differential. Rex and I were working on that case together. It's gotta be related, he said. But I'd send it out anyway. So I did. Happy Tuesday - much love, Elizabeth

Friday, June 4, 2021

Open Lung

     I walked into the Dr. Lounge this morning to stock up on bottled water and greeted one of the long time servers Tammish - told her about the funeral I was going to for my son's friend's mother at 10am. Way too young to pass. Funny you should mention that, she said, I am going to a wake tonight for a 24 year old who died from cancer. I shook my head in despair and told her I've been doing this for 12 plus years and they are getting younger and younger. We are doing it to ourselves somehow. She agreed. 

    At the funeral I didn't allow myself the space to grieve - I was there to support Jack and I knew I would be returning to a lot of cases that demanded my full attention. The space was beautiful and the service was very similar to a Catholic mass I grew up attending. The Apostles' Creed felt like rote soothing memory on my tongue. I remember being at one of my parent's friends funeral as a child and hearing On Eagle's Wings for the first time - such a beautiful send off. Jay Clark did the service and his wife Karen sang a song I'd never heard before - You Say by Daigle - she sounded like an angel. 

    Debbie's dad, who was going through chemotherapy and needed assistance to get to the altar, gave a beautiful eulogy. A retired undercover police investigator. He was born on January 27, 1947 and his daughter was born on January 27, 1974. He admitted he was a little long-winded, but I didn't mind it was only about 15 minutes. He shared about himself being diagnosed while she was fighting cancer and their same symptoms from the poisonous treatment. Brain fog. Fatigue. Body aches and pains. He'd lost two brothers to cancer, had four daughters himself, and he discussed the devastating event of a parent losing a child. 

    Jack looked very handsome - I'd encouraged him to go to his dad and stepmom's to get a suit when he asked and assured him I'd get there early and save him a space. It wasn't that crowded. Jacob has been his friend since he first arrived at Episcopal. He hasn't been the easiest kid, but his friend group has always supported him. He used to wake up in the middle of the night during sleepovers spectacularly wanting to go home and I finally gave Debbie my house door code so he could call her to get him so he didn't have to wake me. He's matured quite a bit, thanks to Debbie's unwavering support. He looks like an Adonis, as a teenager. I was proud of Jack - despite his self proclaimed fever (I gave him some clean tissues from my purse to wipe his sweaty forehead and told him to call in for work today) he was the first kid to walk up to Jacob when the family was receiving guests on the steps of the church. I watched them exchange private words and felt proud I raised a son that will inevitably continue to support his friend. The grandmother has been a huge support to Debbie, who was a single mom since I met her, and Jacob. She bear hugged Jack. 

    This morning I finished huddle and was discussing a challenging mycology case with Tommy, the mycology tech, when Jason Muesse called. We've had a lot of hard cases over the past year or so since he came here as a thoracic surgeon but he's never called. I excused myself from Tommy to answer the phone. A nurse's spouse, only 30, got sick on May 29 and is tanking fast with no diagnosis or cure. He's going to do an open lung wedge biopsy in the morning and wanted to know if it could be processed over the weekend. I'm on call, I said, of course, if it's too big we might not be able to short cycle it but I can look at it Sunday the latest. I'll keep you updated. The head of histology is coming in to help decide the best way to handle the tissue. Muesse texted this afternoon I know these are hard, and have to be sent out sometimes. I said yes, only half of us look at them, I'm one of them, and hopefully I can see something treatable right away but if not I'll send it out first thing Monday. Happy Friday. Much love, Elizabeth

Wednesday, June 2, 2021

Volcanic Eruptions

     It was a Tuesday on a Monday yesterday, and those are honestly worse because everyone is trying to cram a 5 day week into a 4 day one and not sure what the deal is lately but we've had record block counts for the last two weeks we are all frazzled. Hopefully everyone will go on vacay and it will all calm down. SO. MANY. PLACENTAS. Forget the beginning of Covid 3 months in was when everyone started going stir crazy it is evident by the overflowing pile of placentas on the placenta cart.

    I felt like a bi-mouthed volcano yesterday last week I started erupting at work and I'm really hoping yesterday was the peak because I lost count at a dozen. Luckily everything hit an appropriate receptacle and I was able to do all my work. Last week my head secretary brought me water in alarm until I assured her yes, it sucks, I'm shaking, but it's been happening for almost a year. You want to keep stuff at home private though, so the work family leak has been a little distressing. Yesterday I had to get Melody to cover a frozen because I was actively emitting into my trash can. It is what it is, but it's exhausting. 

    Today, though, what a relief! I went into Melody's office and told her I'd only dry heaved twice and she laughed. Sad that you have such a low bar for happiness, but I'm happy for you. We shared a lot of consults throughout the day and problem solved some disorienting issues with Whipple's. At one point I was reading a gross on a BKA - I've had a lot of them lately - and LOL'd. I remember back when I started that I was surprised at the amount of detail our PA's put into the gross on BKA's. When I was a resident four to five sentences sufficed - they do like three paragraphs. 

    I wandered into Melody's office to share. I said have you ever noticed how overboard the BKA grosses are? I never studied a gangrenous leg that closely in residency. She said yes they are particularly in tune to the vessels and they know all their names and like to describe where they are we never did that. I had to call Jessica earlier to fix a typo in the gross because I couldn't possibly tell what subcapture conference might mean it was calf circumference. There were also all these measurements and descriptures of lesions ranging from red pink to red brown to sloughing off grey green with exactly where they all were! Also thick and distorted nails and crusty tan white lesions it's like they were conjuring the actual leg onto my desktop and it was hilariously unsettling. I guess if God forbid my leg is ever BKA'd I'd enjoy reading them wax eloquently about it. Wonder who trained them to do that.

    The Zoom meeting Friday with KC and Terry was great I finally used my camera for the first time. I learned that the reason I hated how I looked and pretended my camera didn't work for the last year is that I was sitting way too close I looked like I was looking down on my iPhone and accidentally opened the camera in reverse. I studied them and learned how you really need to sit back and create a tableau. For next time. We got Dawn involved and she's tech savvy - wants to migrate us over to wordpress and Liz crafted a shout out for new authors when that happens. Exciting stuff. I want my interview with Judy to be the next blog - I've embarrassingly dropped that ball with all the Spring craziness but promised Jill and Judy it was the next thing on my horizon. Happy Wednesday. Much love, Elizabeth

Tuesday, May 25, 2021

Monthly QA

     We've been plugging in a little more lately to improve morning efficiency - it is so inconsistent - I was proud of the progress and communication we had today in the histology, gross room, and cytology department Q/A meeting. I got so burned waiting two hours on slides Saturday for a still unknown reason I was glad Shaver was there to chair the meeting he was stern but amazingly diplomatic. My anger was seething when I walked into the room but breathing and letting him run the show this time helped. I was called off before it was over to bronch lab and then a thyroid but before that happened I learned something so ridiculous it's incredulous.

    Baptist is slow to upgrade our computers and so we were really happy when IT came yesterday to install a new one, which was sorely needed, in the gross room and for our head transcriptionist. We've had requests in for months. This morning, when they tried to get on, they couldn't get anything to work. So apparently in trying to problem solve we were told that they weren't installing Microsoft Office onto any new computers it was too expensive. This is the biggest WTF. Our reporting system, CoPath, that goes into Epic depends on Word and so does MediaLab, which we use to store all our procedures electronically. The last CAP inspection our transcription and lab directors spent countless hours - Misty was burning the midnight oil for months before the one last week in Conway - getting over 900 procedures converted from paper. That's like a slap in the face, I said. And what is the point of installing a computer that doesn't work in the system? That is an ironic attempt to save money that just spends it. Rick said yeah sounds like just a fancy typewriter. We have to work with IT to resolve this. 

    Jessica said she figured out how to convert the procedures to Google Docs - they want everything on Google now, but it is cumbersome and will take time. It's not intuitive. Oh don't get me started on that I said I've had invitations to edit so many documents that are really not necessary for me to see junking up my inbox. And they've also converted all the micro lab errors formerly paper and simple to read and sign to Google docs. I get sometimes 8 or 10 of those a week. I've had to be taught the method to sign twice. I used to just read and sign and now I have to push response, then push some eye icon, then push next 8-10 times, then go back to response, then sign it's driving me batshit crazy.

    Cecelia is graduating tomorrow at 1:00 WTF Central? It's at War Memorial so I suppose we will roast. It's supposedly shortened to an hour or so I plan to Uber so I don't have to worry about parking. There are only 4 tickets per kid. I heard Episcopal got 10 and was on a respectable weekend not a work day. Each graduate gets a bottle of water with their ticket - they'll need it with those black gowns on in the sun. She has pre-recorded her president speech I'm excited to see it. Celebration dinner with her bf's family is at Sonny Williams. 

    On the plus side I got a lot of compliments on my dress today and noticed a few wandering eyes. My fave compliment was from Lucy - I went in the prep room to say hello and talk about the full moon and the lunar eclipse on Wednesday - of course she knew more about it than me but she was impressed with my attempt to understand it. I feel like her tutee. She said I meant to say earlier how much I love your dress it's perfect for your cleavage. As she was saying it she traced her own neckline and then charmingly made her hand into an OK sign and kissed her connected thumb and forefinger through her mask, signaling her approval. I said yeah, looking down in this dress is all I really have to do to turn my own self on LOL. Her turkey sandwich wrapped in Romaine was amazing. I swear she gave me more than just a half. Happy Tuesday, Much love, Elizabeth

    

Sunday, May 23, 2021

Doc Book Club

     I really can't call it Doc Mom Book Club anymore because Natalya isn't a mother - she came again - and there was a new girl named Sirinya who is not yet a mother in her words. It was at Jauss' house last night (love how that rhymes). She's in one of those three Tudors in the middle of Kavanaugh between the Heights and Hillcrest. The middle one, to be precise - she and her stay at home Ph.D. husband gutted it and renovated it years ago it looks like it should be a featured home in Architectural Digest. My husband and I looked at the house to the right not long before we made an offer on our current house and it needed way too much attention. I do not have the stamina for renovation. Jauss told me someone bought it and is giving it the attention it needs good for them.

    Sirinya - I just googled her to get the spelling of her beautiful name right - is a breast surgeon at St. Vincent's. Her husband is Rad Onc at CARTI - that's how Jauss met her. They are from Memphis and Nashville; I was gushing about how I grew up going to Memphis bc that's where my dad is from. I told her he held state records in the butterfly - all of their family were swimmers. With a dad in sales and a stay at home mom they all needed to excel for scholarships and they did. To Iowa - one of the top ten schools for swim scholarship. I asked her if she knew Becky, of course I knew she did.

    She said she talks to Becky almost daily - I told her we were at Hendrix together, she won the President's Medal, and she trained for breast with David Page at Vanderbilt who is an international breast guru. I asked her if she knew Perkins and she said he is so nice. I love Perkins, I trained with him, he is one of my favorite people on the planet. Sirinya is stunning, I google imaged her and her static appearance is just as striking but doesn't do her justice. It was so lovely to meet her.

    I was happy that everyone hated the book about as much as me. Sometimes politics dominates the bestsellers and they just aren't that great. My husband and I were lamenting about that this morning. The only redeeming quality was the excessive amount of sex when the couple was getting along. But if I want good porn I'll turn to Anais Nin. Which I was ironically introduced to by a gift from my ex-husbands mother after our divorce. Little Birds. She was a reader like me. I miss her, our brunches, she was so surprising and such a good conversationalist. 

But the food, OMG, Jauss' husband is a gourmand. We had split pea soup served in little shot glasses with artful creme fraiche on a mirrored tray and there was a lot of gluten dishes I couldn't eat but the orzo one looked incredible. We all brought stuff too - Shannon's shrimp dip was incredible. I admired the homemade desserts and longed for the day I can tolerate gluten again. Kewen served homemade bubble tea for dessert I didn't know it could be kind of like a milkshake it was so yummy. I'm so sad Pose is over cried and cried. Onto Sackler documentary. Happy Sunday. Book/pool time. Much love, Elizabeth

Friday, May 21, 2021

Happy Friday

     Good god finally. What a long stressful week.

    When I was getting my colonoscopy my pee cheerleader nurse told me her daughter was applying to med school and I told her she could have my number - she indicated that her daughter might be very interested in pathology. She gave me her and her daughter's cell instead and I group texted them about a week or so later and set something up with Emily for today. I wandered into Med Towers lobby at 10:45 to collect her and begin the tour and the only person in the lobby was chatting amicably with Jeff the security guard. That cannot be Emily, I thought and was searching around when she waved me over.

    Jeff said hey doc this girl is here to see you! I said Emily how do you know Jeff? Turns out she used to work at Baptist Boulevard - it must have been at a time I was addicted to the dr. lounge but I did recognize her once she told me - her eyes are so unique. One of them has a patch of brown iris interrupting the pale green. We chatted excitedly about Sean and Lucy (I love Lucy I gushed - she said me too) and Avery and Brian and I told her I had poached Kimberly and when she saw Kimberly in the transcription area they bear hugged for a minute. Her boyfriend Gordy is a bartender at BV Heights and his Dad is Peter Brave of well, you know. If you are from Little Rock anyway. This is such a small world and there are patterns. 

    She saw my diploma from Hendrix and said she went there too. She double majored in Biochem and French, how freaking impressive, and spent a year in France after college teaching. I told her I want to re-learn French and go to Paris she's gonna be my inside connection to that someday she knows lots of people over there. For a year and a half she's been a research assistant at Children's and UAMS I told her of my wobbly path to med school that included the same job. Assured her that they like that. People who bring something different and new and aren't just hyper focused on a straight path. I told her I got in early decision.

    She loved my world and I told her to definitely keep in touch. It was truly the highlight of my week. That, and when Melody threw me a curveball at 4:15. She had showed me an orbital mass earlier that she thought was something but she didn't want to bias me and I said schwannoma and she agreed but the stains didn't quite match up. There is this entity neither of us have ever heard of called a hybrid peripheral nerve sheath tumor we were researching independently. I found out they were all B9, uncommon, and the most common one was a hybrid schwannoma/perineurioma. I was looking at articles on NIH and she was looking in her good new book series that I like to borrow and we came to the same conclusion. It was a Eureka moment.

    God I've been reading this book for book club Saturday night called Normal People, and I had to stop this morning bc I hate the characters and the writing style and it was depressing my mood and making me feel out of sorts. I usually find redeeming qualities in characters and finish books but I'll have to find out what happened after Italy in book club. I was googling around looking for a summary and this blogpost eloquently describes how painful the book is and a lot of commenters agree with me. Well holy hell I'm having trouble with the link and I'm too tired to problem solve but it is the bibliofiles review if you are interested. I was so impressed with the review I commented. Back to Raphael by Stephanie Storey she's an Arkansas author with an impressive Wiki page it's soo much fun to read. She not only knows her shit she makes it super relatable. Happy Friday, much love, Elizabeth

Oh BTW today I drew Kuan Yin she's my new favorite goddess I found some good information about her on a goddess blog and a link to a six minute YouTube dance dedicated to her by beautiful children in China who are deaf and mute. It was so moving. 

Wednesday, May 19, 2021

Let Me Tell You What I Learned About Malaria

     The lab inspection was intense - I've never been on the receiving end as a medical director, and I'm brand new, but I think I nailed it. Told Jack earlier when I interview the lab director peer to peer it's usually super laid back they threw some hardballs but luckily I'm plugged in so much it wasn't an issue. Stressful? Yes. Impossible? No. 

    At lunch one of the CAP inspectors, there were two one was training another one, were talking about travels. Marti Favorite - an employee of Baptist who helps out with all these regulations in our Baptist Health system and fights for unreasonable citations (she won one today and got called out and respected at summation for it) said her retirement dream is to be a CAP inspector. I was like right? If they have protected time, like my friend Eric who works at the U, they get dream assignments all over the world.

    One of the inspectors talked about a trip to Mali. She said they all stayed at a hotel in the NIH system other than one excursion that exposed them to extreme poverty. Women were walking miles with children on their backs and pots of water on their heads to get clean water. For cooking. I didn't say this out loud, but if you are born into a loving family in a beautiful country who cares about financial status and A/C. Family or friend love is much richer than finances, and can give you much more success in life.

    This is the golden point, the one that I have been pondering all day and it might take me a while to extrapolate and apply and I might fail but I got super excited. The one that went to Mali talked about a new vaccine being tested and I googled the story I was so fascinated and confused she had it half right and half wrong. Some chic named Jessica in another country came up with the crazy wild idea to target the vector not the pathogen with the vaccine. So they are basically using mosquito spit to target a variety of mosquito borne illnesses. Which is novel, bc malaria has been too heterogeneous to target. It's working in animal models. Zika, Dengue, Ebola - the possibilities are endless. 

    I wondered - can we apply this to cancer? So many are viral driven. Obviously it will take me more than five minutes to think this through and I'm no academic researcher but this is great food for fodder. She said eliminating cancer will seriously hamper your job. I was like in my head what? I do more than cancer and yes, that is most of my job, but something else will come along and eliminating it in my lifetime is like a  crazy pipe dream. Isn't this part of some golden rule? The health and happiness of the many trumps the individual. Happy Wednesday. Much love, Elizabeth

Tuesday, May 18, 2021

Let Me Tell You What I Learned About Bees


     So we close on the house on Friday, thank God, what a financial relief, and one of the issues we disclosed was that there was a beehive in the side of the house. We noticed it last year during the pandemic but it was far enough away from the front door it wasn't hurting anyone so we ignored it. The buyer was trying to decide if he wanted to take care of it or if he wanted us to, and two weeks ago, he charged us with the removal and said he would let us give him money to handle the repairs.

    Last Thursday while I was in Chicago our realtor met the bee guy. We really didn't want to kill the bees, just relocate them, and there's someone who loves bees so much he does this for free. That is the honeycomb he removed above. It took four hours - noon to four - and he left such a mess our saint of a realtor helped our tenant clean it for over an hour - big hole in the ceiling in the corner of C's room. So apparently the buyer went to the house two days ago and there are still hundreds of bees - he doused the hole with pesticide but Amy told me Caroline, her daughter who took C's room, has been sleeping in the downstairs playroom since Thursday it's so bad. She had to duct tape it up. The bees were still getting in the room somehow. Fifty the first day, she said, now down to eight or ten. Thank goodness they are moving from a farm they've had to deal with rat issues and bee issues she took it in stride but I was glad I sent a big order from Milk Bar a few weeks ago to thank her family for taking care of our house. The last six months would have been hell if we had to attend all of that daily.

    So when you relocate a hive, I learned on the internet today, it's best to do it in the early morning or late evening because the workers are not yet sent out by the queen or back in the hive to sleep. So noon to four was not ideal. Not complaining, but it leaves lots of what they call straggler bees. They come back to try to find the hive and usually die within one to two weeks without the queen. GD. We saved as many as we could and they are going to die anyway so our plan was to seal the house with insect proof foam to keep them away. If it doesn't work I texted Heather we will bring in a pest company ASAP to fix the problem. 

    No frozens today yay I was dealing with that and worrying about Mom and her compound fracture to the wrist - she will have external hardware for 10 weeks I was dry heaving in empathy. Jack said all his teachers loved the treats. Cecelia is good. I'm hoping I don't puke on the lab inspector tomorrow based on how this week has been going GI wise. Happy Tuesday, much love, Elizabeth

Monday, May 17, 2021

Mondays are Here to Stay

     Ugh Call Monday had me hit the ground running with reviewing and signing my name to procedures in Media Lab and paper copies over 100 times. And that's nothing to compare to the last month. Taking over an entire lab directorship is a daunting endeavor. I had two Zoom meetings for micro today - big dread - I hate Zoom even with my camera off worse than standing up and presenting in front of a semi crowd (tumor boards have maybe 30 at the most). One of them I had to chair. It went fine.

    Lab inspection at Conway is tomorrow and Wednesday don't get me started on CAP I have been fit to be tied. So much anger leaking out of me maybe even disproportionate to the situations but I guess it's about fing time. Jack texted me today - he wanted to spend time together doing a cooking project tonight we just completed. He wanted to make Oreo truffles and lemon bars for all of his teachers he did the recipe research and Cecelia offered to do the shopping for the week today (did I wake up in an alternate reality? I felt so blessed and relieved). Jack made peppermint bark for all his teachers a couple of years ago cooking is truly his love language. Not mine (except for meatballs) but I was super excited to spend time with him it more than made up for the nine frozens and Conway lab stress and I was proud of myself for holding in some anger I almost vented inappropriately - I saved it for a safe space. There was family emergency stuff going on too - the icing on the cake. Everyone is ok, but jeez. 

    Chicago was a blast although I'm struggling with my energy level on vacation lately I slept over 13 hours a night and napped in the afternoon (even in the airport?!! On a bench?!! With Christy watching over my stuff, of course, But WTH?). I feel like a bear struggling to awaken from hibernation. But definitely traveling with her again we had such fun. She has a handle on things that aren't in my skill set like the fact that the first floor at Tiffany's is the super expensive one the second one is more accessible to shopping even though still pricey. Sure enough Michigan Mile mimicked 5th Avenue in New York I bought gifts for everyone in my immediate family but me. 

    I cannot emphasize how funny Christy is and how much I belly laughed which was sorely needed. We had a room at the EMC2 on the 18th floor and as we were ooing and aahing she saw a rooftop bar across the view. She was like "Oh! That looks amazing!" I looked over and cased the roof and looking down the building to the street (this took effort) - there were plants and lights but the fencing was less than adequate. I said maybe maybe not? She said, yeah, I agree. My vestibular system is wildly activated even though I'm motionless. Mike and Effie were amazing dinner hosts and their place is adorable I've been bragging to my family can't wait for more jaunts to what my friend Ahmad Brown, who has relocated to a suburb in Vegas and recently shared the property he and his wife are building on, called "Our Paris." Much quicker travel experience than Boston (if you ignore the 7 hour delay yesterday ugh again). Happy Monday! Much love, Elizabeth

Wednesday, May 12, 2021

Ascension Day

     Is tomorrow. It's also the day Jupiter enters Pisces. I'm understanding more and more of this the more I read. It's illuminating.

    Tim is amazing. We talked and talked about Conway - he didn't know I went to Hendrix and spent years covering Conway Regional and knew all the docs there. I told him I had an issue with CoPath and InSync not working he assured me he would try to resolve. His nephew is graduating from med school today and entering the path residency at UAMS. I told him we have some outsiders, and they are wonderful, but we like home grown too - the combo keeps us on our toes. Told him I've perfected a two hour tour and lunch and gave him my cell to share.

    I also told him in a text I sent tonight - dictation and reporting are on the blink and it's a problem - that despite my love for Big Baptist LR it is a machine and I would love to have first dibs on Conway Baptist if we can ever justify an FTE. Something about small hospitals feel more like a family to me. 

    Lots of craziness and angst around here but looking forward to heading to Chicago in the am for a girl's weekend. Trying to pack. Looks like good weather. Hope you have an amazing weekend. Much love, Elizabeth