The Mythical Elizabeth

     S started his job in February before the pandemic. As you know, Christmas parties were cancelled last year, but we had one last night in the party room at Samantha's Tap Room. There weren't over 20 people, it felt safe. We cancelled the PLA Christmas party this year bc with over 50 employees, it didn't feel safe. So I had never met the principals Tim and David or the draftsmen Dick and Riley or their lovely wives. Last night we all remedied that over food and drinks and it was a blast. I was surprised that they all thought I was a myth, since they hadn't met me before. I got super quizzed over Covid and that was a softball. 

    Another strange thing happened last week I didn't tell you about. I got a gross only report on a penile discharge/penile foreign object. I'm not even a guy, but I cringed. What the holy hell. We get a lot of rectal foreign objects but never penile? Was this person sane I wondered? I looked at the age. Four. I wandered into the gross room and asked about it. Savanna, our mouse in the house sex toy expert, said it looked like an apple stem. I LOL'd. I guess if something can come out of it something might go in. Savanna said he probably hoped he could shoot it out. Hahaha. Like I gun, I said. The stem was a bullet. Those little men start early with their dreams of projectiles. 

    My intake is so much less than my output lately I'm amazed that I'm not stick skinny. But I love the curves and that's the way of the world lately right? Moving into a curvy future. Tipton and Hurst at Baptist went the way of many stores during the pandemic but they are putting in a new scrub store and it's exciting watching it go up. The inventory is all there it looks like it will open soon and none too late. I'm through with trying to fit into my small tall scrubs it's not in the stars I decided. Certainly the tops will never fit no much how exercise I do. Time to explore medium, maybe large even. I'm pretty tall. 

    I had to go to the family doc this week (it's been three years!) bc when I was in the ED a few weeks ago they picked up incidental hypertension. It's returned. Sigh. Back on daily beta blockers and I bought a new sphygmomanometer at Walgreen's to chart my blood pressure, which was 167 over 115 on Monday after a restful non-eventful day (it was 206 over 120 after the traffic arm fell on me). That's pretty crazy high. This does not run in my family not sure where it came from. My family doc Kent Covert (he's highly recommended Melody uses him too) LOL'd when I told him the story of the ED trip. He said he always worried about it falling on his car but never imagined it falling on a head. I told him Staggs was so alarmed it happened to me twice he wondered aloud that I should not tell anyone that it's kind of embarrassing. Much? 

    Having a relaxing week I got a massage today and had lunch with Christy. Trio's requires vaccine cards I fing love that. I heard from Maddy when I got my hair done yesterday that 42 and the Rep require them too. I need to get out more. Monday shopping with Jack and Rennie was fun at Belle and Blush but scary as fuck in Gearhead Outfitters and Big Orange there were way too many people and no one is masking what are they thinking? Batshit crazy. Who knows what the next possible mutation will bring. Ebola nastiness? I wanted to scream get your Vax. But the world is crazy, so response to the pandemic is not surprising.

    Best ever show Bo Burnham Inside on Netflix. I died laughing at White Women Instagram and Sexting and empathized to the point of tears when he was talking panic attacks. I have about one a decade since my twenties - to the point of physical terror - and it happened last Thursday out of the blue. Shaking, perioral numbness, phalangeal numbness, you name it. 0 to 100 in a second it scared the holy shit outta me prompting a visit to Yousef yesterday for the first time in nine months. Turns out one a decade isn't really that bad. I'm gonna be ok. Interstate travel might be dicey for a little bit but it's a small sacrifice for sanity.

    Got a big grocery trip planned for the am our Christmas Eve potluck looms. S is cooking the beef chili and Jack wrestled the turkey chili from me so after I shop I'm home free just hosting. C gave me a list so long I think I'm going to be shopping for her whole spring semester so I'm hoping I can limit it all to one cart. Sunday we are leaving for Nashville to see Rainbow Kitten Surprise. LOL I'm on call Monday and am covering frozens I realized and turfed that to Shaver last Friday. I'll get up early and play catch up in the afternoon. Merry Christmas! Much love, Elizabeth

Hand Presentation

     I had two interesting placenta's this week, which is saying a lot, because I rarely get one a year. They are junk surgicals. Back in residency I cut my hand on a placenta. Unfortunately the histo director Marty saw me and made me initiate the reporting of it to workman's comp and HR. About thirty minutes into that process I could tell it was going to take a long time so I was like fuck this and went back to gross. Took a deep dive into the charts and Mom didn't seem high risk. When I was planning my first pregnancy I told my OB Cindy to check for all the things, AIDS, whatnot. I can handle putting myself in harm's way but not a kid. It was all negative, thank goodness.

    Anyway, the first one had chorioamnionitis. This is the most common placental problem but the requisition was what piqued my interest. It said hand presentation. I normally don't open Epic for a placenta but I did. Mom was of the young age that the prerequisite effort for her current predicament was possibly criminal and not recreational. She had no idea she was pregnant and called 911 bc there was a hand protruding from her vagina. I think I would have had a coronary before I was able to call 911. But she did, and delivered a viable 25 week old female infant in the ED. What a way to enter the world, I marveled. Maybe this chick will be president someday.

    The second one was today. We document the amount of placental villous infarct - it is estimated grossly - and they are usually under 5% which is normal. This one was 85% infarcted, which I've never seen. Mom had asymptomatic Covid, she was in town from a small town bc hubs was on ECMO with Covid. A closer examination of the req showed the baby was IUFD - intrauterine fetal demise. 33 weeks. I learned there are case reports out there that show that having Covid can cause massive fetal malperfusion and placental infarct. So it can bypass Mom and be terminal to fetus. Melody and I marveled - I printed out a case report for us to read.

    Mandee Novack did a Covid update for us last night and I watched the video today. The Omicron variant, which is plaguing South Africa and Europe, is just hitting the US and Mandee thinks it will cause massive problems in January (after my Christmas Eve party thank goodness). It's more transmissible than Delta and OG Covid but less virulent. Meaning vax boosted people will probably be ok. She showed lots of charts and graphs and where the other two VOC - variants of concern - were like a steady climb Omicron is like a straight up peak. 

    We had a plateau in April but there was no plateau after Delta there was just a nadir and we are on the rise again. Omicron is definitely here, if not yet detected. She got all sciency and nerdy in a good way but the gist is that Omicron has never before been seen molecular variants on it's spike protein. It has S dropout, and we have Thermofisher which is the only machine in the state to record S dropout so she's been charting it since Thanksgiving. No big spikes it that yet, but it's coming. BioFire and Thermofisher have the ability to identify the Omicron variant in the pipeline - it's coming soon. 

    Mandee predicts that while it may not be as virulent or cause as much problems as Delta it will be a crisis, if a more abbreviated one. It will wreak havoc on staffing - those L&D nurses who throw baby showers and have breakfast after a night shift could catch it and wipe out 40% of a department for 10 days. Whereas Delta and OG have a transmission rate of one it has a transmission rate of 5 so that might cause, and already is in Europe, exponential disaster. If one person infects 5 and they go onto infect five more it's a real problem.

    There will be testing issues and shortages. At the peak of Delta we were testing 500 a day in the drive through and this is worse. We have shortages on monoclonal antibodies and that's bad too. Our ICU's have remained full through Delta's waning and if there are asymptomatic people transmitting it to already sick patients they won't do well. Child care will be a big issue - Omicron doesn't care if you are vaccinated, although you will probably be ok you will still be a problem and there will be lots of shut downs of day care units. She illustrated the transmissibility with an article about a person from South Africa staying on the same floor as a person from Canada. Camera footage showed they never even passed in the hallway but the person from Canada got it anyway. So it can go through walls and HVAC units. Delta and OG could not do that.

    Cecelia came home today - I got two tubs of pimento to celebrate and she is happily diving into one with Ruffles. Jack excitedly texted that he got all A's this semester - I'm proud of his hard work. I've had a rough week physically but I'm excited to be off for a whole week. Got lots of boring doc appointments and OT but that's ok. Boring is better than exciting sometimes. Hope you are well, much love, Elizabeth

Snake Oil

     Well Jack is better. He's over at his dad and stepmom's this week so I haven't heard from him but no news is good news. He was prescribed a new antiviral for the flu - Effluvox I think? That cost about 200 bucks insurance did not cover. It was interesting watching the cyclic nature of the virus. One minute he was eating and wanting to watch Merlin, a couple of hours later he had a blinding headache and was breaking out in new hives. He texted me at 2am Friday morning saying he wouldn't wish this on his worst enemy. So we filled the script Friday morning, and two hours later after a hard sleep he was right as rain. Worth every penny. He got the first dose Baptist gave this year.

    This week has been my week to suffer - I had such horrible dry heaves Monday and puked a bunch. Kimberly had to drive me home at noon. Tuesday was a little better but similar. Luckily the week has been slowing down a bit and my GI system has been somewhat normalizing. I was super pissed to see a flyer in my box Wednesday morning from a molecular rep asking me to go to Arthur's and view a lecture. I did a double take - the name was the same as the one who invited us to an Afirma dinner about four or five years ago. 

    Pam and I went - she is the head of cytology. It was in a private back room and the food and wine was abundant and lovely. The lecturer was from Dallas - she looked like she belonged to an affluent country club. ENT surgeon specializing in thyroids. About three fourths of the way through the lecture she showed pics of her pathology thyroid team and marketed our work out. I side-eyed Pam. WTF. At this stage in my career I would have stood up and called her out and left but I was still trying to be polite.

    Dr. Kirsch was there from Conway. A very vocal ENT, I met him first at Laura Lamps' house when I was a resident helping her host an international famous GI crew. He is tough to get off of a conversation with, I learned, and have continued to on the phone over the years. But he's sweet. He defended us. We like our pathology, we don't need to farm it out. As we were walking out, he was dissing her. Why do you need to be a thyroid expert if you are an ENT anyone can do that? I said, yeah, most of our general surgeons do the thyroids. She's moving backwards, and pretending that she is moving forwards. They aren't tough, surgically or pathologically. Most of them, 98%, are benign colloid nodules. It's not rocket science, it's job security. She's a slave to who she's crawled in bed with.

    A couple of weeks later Pam and I were doing a bronch for Cidney and she was there marketing lung technology. Passing out fliers for another dinner at Arthur's. She apologized to us for her guest speaker. I didn't know she was going to do that, I'm so sorry. She walked away. Sorry not sorry, I said to Pam, screw her and her dinners. Cidney said that lung molecular is like snake oil right now I wouldn't go if she paid me. He threw the flier in the trash. I laughed. I did the same thing this week. Tossed that bullshit.

    I started Heart of a Dog last night and am about 3/4 of the way through it is so good. Amanda is going to drive me to book club Saturday night I told her my night driving was sketchy right now. I was laughing so hard today when the dog was morphing into a human I had to put the book down to breathe and dry my eyes. Can't wait to see Natalya's home. Other than that it's just finishing unboxing and putting up and starting to wrap for Christmas. Can't wait for a weekend - I'm not on call again until New Year's week.

    Cecelia is doing good - she nailed an interview with a doc to work in a lab called TEMPT and she is so excited. Also got some travel abroad honor award. I was worried about her bc she called in agony on Monday in the midst of my physical distress. Sometimes a girl's gotta cry to her momma and it makes everything better. S is excited there is some retired hedge fund guy who researched water for 10 years and is building a plant in Hot Springs. Also restoring a dilapidated barn as a visitor center for lectures and museum. He wants to enter it in magazines and make a splash and win awards. He loves S's design. 

    We have some exciting things brewing in our company that are too early to talk about but I'm vibrating with possibility. Pathology is moving into some amazing new technology and we are trying to be proactive so we don't become obsolete. I think we are on the forefront. Rex and Dianne both heard about it at the party and said they are glad they are retired but I'm happy to be a part of it. Hope you are having a good week. Much love, Elizabeth

The Flu and the Feud

     This call week has been so crazy. Monday started off slow, but Tuesday I got bad dry heaves during Conway QRC Zoom meeting I kept checking the monitor to make sure my sound was off. I ended up expelling demons in the Dr. parking lot on the way to my car and had to catch a ride home from my head transcriptionist Tina. That was a prelude to the craziest two days at work I've had in a while. I did more frozens in the past two days - at least 20, and ordered more immunos on hard cases than I usually do in a month. Collision tumors, rare parapharyngeal masses I didn't remember existed (1% of all salivary gland tumors and in the minor glands - that's even more rare). And I had a breast core that has a low grade ductal cancer and a lobular cancer and high grade DCIS? What are the odds.

    Jack woke up yesterday morning with fever and chills and I took him an Icee and some Benadryl to knock him out before I headed to work. He slept some, but called me throughout the day with new confusing sx. Hives. Terrible headaches. He's not a complainer, so when he complains, we take notice. Mike called him in a Zpac and I stopped on the way home to get him some topical steroid cream. DayQuil. The hives calmed down then returned in the evening I was calling Eric Bravo and texted Ahmad Brown some pics of his skin. Ahmad is in Vegas now. Hope to see him when Christy and I go. He confirmed urticaria. Said it could be viral exanthem. I started Jack on a steroid dose pack I abandoned a few years ago. 

    This morning he called me again to say he was having the worst headache of his life. No more armchair doctoring, I said, make an appointment at the Children's clinic. He did for 1:30 and I met him. In the meantime Cecelia called and said that all of her friends in Fayetteville were deathly ill with the flu. She had her vaccine so hers only lasted three days but Woody was so sick he was in bed all day on his birthday and her un flu vaccinated friends were laid out. We are all worrying about Covid, but flu is really bad this year. Sure enough, Jack tested positive. But he's already on the mend (got vaxxed three weeks ago at well child visit). It's a breakthrough strain, I told him. They don't always get it right. But the vaccine will still protect you some, like Covid. He wanted to go back to school tomorrow but I told him wait until Monday. You might still be contagious. So, moral is, get you and your loved ones flu vaxxed. 

    Monday when I visited the gross room Jessica told me a funny story. We just got this new 17K fridge for the OR to put specimens in. It's totally glass - transparent to the OR. An anesthesiologist wandered in to complain. Did not even introduce himself. You have to cover up the legs. Maybe build a cardboard thing. This is insulting to so many of the OR staff. The legs are in a big bucket on the bottom shelf.

    But they are already covered, I said. We put them in red biohazard bags. Isn't that enough? These people went into medicine how can they be offended by bagged amputated legs. She said fifteen minutes ago, someone put that blue OR blanket over the legs. LOLOL. So it's a feud, I said, like the Hatfield's and the McCoy's (her maiden name happens to be McCoy). I think it was Brian Jansen, she said. I think he is offended and using his staff as an excuse.

    I rushed to his defense. Brian is one of the number one if not best anesthesiologists in the group. Mike hand picked him to do my anesthesia when I broke my jaw and my dad's when he had his heart surgery. He's quirky, I acknowledged, but in a savant like way. He saved my dad's life. On the year anniversary of my dad's almost fatal surgery, I bought the entire department (70 some it was over a grand) Taziki's and wrote a letter of thanks. They wanted me to stay and read it but I was too choked up so I asked Mike to. I credited Jansen and Morelle, the PA, in the letter. He was nice to me after that - asks about my dad, but half the time I say hi to him in the hallway he doesn't acknowledge me he is often in another world, I think. OK I'll cut him some slack, she said. Won't move the blanket. But still.

    I was checking the OR for late frozens and bumped into McCall Hogan, another anesthesiologist, last night. I joked about the feud and he laughed and said he knew about it. It's a full on war between y'all and the gross room, I said. We are gonna win.

    In other news, I got my first tattoo on Friday! C has been planning it for over a year she designed it off of pics on the internet. They are matching we did it together. Howard from Lucky Bella said I did amazing - I told him it was a lot easier than getting hammered on the head by a traffic gate arm or breaking your jaw in three places. C got a little woozy in the beginning but I told her to take her socks and shoes off and touch toes to tile and Howard got her a bottle of water and she revived. It's a moon design. She wanted to do it based on a song I always sang when she was little - you know it - I love you in the morning, and in the afternoon, I love you in the evening, and underneath the moon.

    I always thought my first tattoo would be a dragonfly. During my first Reiki session with Lisa years ago she told me I had dragonfly wings. Turns out that dragonflies are a traditional sign of resilience. Well based on what I have gone through this year I'm hella resilient LOL. I'm a little addicted. I think I'll start planning that one next year.

    Excited about Rex's party I'm throwing Saturday I've got Boulevard catering and Christmas decorations going up (except the tree - always a live tree) and a couple of people can't come but Dianne is really excited. Need to start reading Heart of the Dog for book club the next weekend. My attention span has been like a squirrel's lately maybe this will jump start me back into books. S and I have been revisiting old movies. Resurrection and Say Anything aged a lot better than Lost Boys and Silver Bullet but it's fun watching horror turn to comedy. Happy Friday Eve, much love, Elizabeth

Accident Prone

     Yesterday I was headed to OT at about 10:55 and I got distracted. I was chasing the sun bc it was a little too cold in the shade and there was a scary looking dude by the admin suites. The parking lot area where I walk to the Dr. lot and BRI is a perfect circle of hell. There is the lab parking lot, and the ER area, and a lot of psych patients hang out at the bus stop to smoke when they are discharged - mostly homeless I guess. So you gotta be wary. I was doing a double take on the guy when the traffic arm, for the second time in 15 years, smacked me on the head.

    This was a new traffic arm - the old one that did it before was rectangular wood this was cylindrical and metal I think. I startled and started sweating but I didn't drop the dozen cookies I was bringing to OT I shook and trudged to the waiting room. But my head was hurting so I dropped off the cookies with the secretary in the full waiting room and tried to chill. Not working. I told the secretary what happened and asked for some Ibuprofen. She went to hunt and in the meantime Stephanie, who had waved to me earlier and noticed I was a little out of it (I think I was borderline fainting) grabbed me and took me into the larger empty space and asked what happened. After an ice pack on my head and me dry heaving into a trash can and all the other PT's worrying she finally convinced me to go to the ER. I'll walk you, she said.

    I really didn't want to burden my partners but if there is one thing my rotator cuff tear taught me it is that you don't ignore this shit at your age it might get worse. I started thinking if I have a small subdural bleed it could get worse and turn into a large hematoma and the last thing I want is a craniotomy. The sad thing is that this was supposed to be my graduation from OT and here I am gaining a new ailment. This year has been crazy. First foot surgery, then rotator cuff tear with first MRI, now I'm in the ER texting my partners that I am slated for my first CT of my head. Oh and the seven stitches in my brow. Ridiculous.

    I had some of my work family bringing me water and cough drops and hugs in my almost four hour experience. I was terrified of the CT. Bruce, who was amazingly attentive, told me it would be way easier than the MRI. I loved the MRI, I said. The cacophony of sounds almost put me to sleep. You are the first person I've ever known to love the MRI. Most people hate it. I'm incredulous. You will be out of here in five minutes we will move your head in and out three times.

    The Aleve the OT secretary found killed my pain but the Zofran they gave me for nausea made me thoroughly exhausted it was all I could do to sign out my morning cases after I was discharged around 2:30. But I got a second wind when I got home and did lots of Christmas decorating shopping. I'm off tomorrow but I work Friday. Still. Nice to have a holiday. I'm feeling a little ambiguous about it all since I follow a lot of Native American activists on Instagram but hell it's family and the country seems to slowly be moving from the wrong direction (Kyle Rittenhouse) to the right direction (Ahmaud Abery).

    We are headed to Mike and Rachel's new lake house tomorrow for a blended family Thanksgiving and Annie and Dave are coming too. I'm so excited I bought some gingerbread house and farm kits for William and Adele and Rennie at the gift shop today. I haven't seen Will or Adele since they were toddlers and a baby. Rachel told me to just bring wine and she always does fried chicken it's so good. God bless my late grandma Loretta her turkey was always dry but she did it with love. Got a house full of kids and friends and Jack is cooking and Cecelia is headed to Harry Styles. I asked her who was opening. She said Harry Styles. I looked at Jack's friends Izzy and Alyssa and said clearly I haven't let my kids go to enough concerts LOL. C said well I guess I don't know. She will have fun anyway. Happy Turkey Eve! Much love, Elizabeth

Awaiting the Arrival

     Jack is home sick reacting from vaccines - three yesterday. Meningitis and Flu and I forget the other. It kicked his ass. The doctor was nice but the wait was tedious. We had lunch prior at Boulevard - he met Anna and that made me happy. We just cleaned out some drawers and closet space in Cecelia's room - Izzy is coming at three and she will be here for three weeks. I'm over the moon because he is cleaning his room and the laundry area - that normally doesn't happen on its own.

    Izzy is a friend of Jack's from camp. I met her once about a year ago. Her family moved to the Northeast and they aren't happy there. She is doing school virtually - and she needs to move back three weeks ahead of them to care for her grandparents in Benton. When Jack asked if she could stay here I was like of course. We have plenty of room. Although she didn't ask for anything I shopped today at Edward's after my doctor's appointments with her in mind. Maybe she will like pumpkin bread. Maybe watermelon. It will be fun to have a fresh young face around the house.

    I've been buying extra treats at Boulevard - Jack likes blueberry muffins and S likes scones. Yesterday he told me he gave a muffin to his friend C. Did she like it? I asked. Did they like it, he said. I was momentarily confused. Did two people share it, I wondered. He noticed it and said mom, she identifies as nonbinary. Oh! Have I met them? Yes, at Boulevard. They had on the nice outfit. Oh yes, they were so fancy I thought they might be a hostess. Or out for a fancy brunch. Black pantsuit right? Yes mom. This new generation has so much to teach. 

    Gross room is doing good Shelby is great they are getting things in order. Baptist has turfed biohazard disposal to us so we are figuring that out. I'm a new superstar in OT I might graduate soon. My range of motion has skyrocketed in the last two weeks. Stephanie is floored. I've never seen you do this much before. I gleamed. She's coming to a brunch I planned on January 8 for my Sunday school class. Christy too. I also invited Christina Bash - we talked yesterday she's catering Rex's retirement party and we got a little intimate about being single moms. It's a hurdle. Guys get set up but we just get sidelined and work and take care of the kids. 

    Christy is planning Vegas and it's going to be a blast. She texted me a bunch of possible opportunities for day trips. My favorite is a helicopter trip over Joshua tree and landing in the Grand Canyon for a champagne brunch. She said there are people in the pictures wearing stilettos. That makes me think I could do it in regular shoes. They pick you up in a limo and take you to a private airport they have the highest safety rating the government dishes out. Beats hiking or a burro. Happy Wednesday, much love, Elizabeth

Penthouse Suite

     Christy just booked the penthouse suite at the Bellagio in April and I'm over the moon, so is she. Two king bedrooms, two full baths, a shared living area and a half bath. I spent about a half hour researching restaurants today and made a list of eight. We are only going three nights at the end of April - I said let's do Sunday through Wednesday so we can get a better chance at getting into the good restaurants. After this blog I'm going to go on their website and geek out over the room. She said they have villas, with butler service, but you have to buy them. And I told them I want good room service but I don't want a butler crawling up my ass. This is your compromise, they assured her.

    There was a fourth autopsy last week, actually a third, bc one of them was canceled due to their only needing chromosome analysis and we can do that on formalin fixed paraffin embedded tissue. No need for formal autopsy. When I went into the gross room this morning Jessica said I finally sent the baby over to UAMS. It was from another hospital, a 37 week stillborn. I cussed last week when she told me it would fall to me. I haven't done an almost full term baby since I was a resident at Children's. When was the last time you did one that far along?

    In 2018, she said. Well that is morgue material, and I'm not doing it. Shaver said we do babies, she said, and I said he can do all the babies he wants but Becky over at SVI told me their cutoff is 20 weeks and that is what mine is going to be. Send it over. It took quite a bit of finagling, but it finally happened. 

    My GI sx have ramped up in the past two weeks which is disheartening. I had to leave Rennie's bday party early and I didn’t make the concert past one song from the headliners. But Adam Faucett was good and S and I chatted with Jon Palmer Kricia's husband and Kevin Hefner a nephrologist so it was fun. Had a couple of beers. Enjoyed the evening. I slept like a log when I got home. 

    We are taking C and J and their friends Joelle and Sef (Yousef's kids!) to see Rainbow Kitten Surprise in Nashville after Christmas. They are over the moon - I'm glad my kids are addicted to Indie bands and not Harry Styles Amy Weidower told me the tickets were over 600 bucks ours were only 50 plus bucks a person. So reasonable we got our own lane - the venue is Brooklyn Bowl - with up to 200 of food and drinks. I perused the menu today and placed my order. S and I plan to get the kids established and pay the credit card and listen for a bit then head back to the hotel and let them have fun on their own. RKS plays in my head sometimes it was so ubiquitous for a while. 

    Enjoying more Merlin with Jack and the third season of Succession and more Invasion, which we almost abandoned, but it picked back up after a while. So happy tomorrow is my Friday. I've got OT lined up (which I aced on Friday - might finally graduate) and Ruby on Wednesday and Maddy on Friday morning. Then Eureka. Hope your week is going well. Much love, Elizabeth

Pole Dancing

     Christy and I are planning a trip to Vegas, in April or May. I'm dying to go - I said, I've only been to the airport. I want to stay at the Bellagio. Let's find out who is playing and see some shows and shop and spa. I've been there once, she said, it's truly five stars. We should find some pole dancing classes. I'm pretty sure my OT would recommend against that, I said.

    A few years ago Christy took pole dancing classes. She even arranged a group one for some of us but it was in NLR if I recall and there was a storm of the ages so we all canceled. Girl, you could do it. I'm the only one who has failed pole dancing class four times. I never got off the ground. But it was fun! You need booty shorts, I told her I'm pretty sure I'm past my booty short prime. She said she could lend me some. I was in the class with strippers, she said, they were all wearing them so even though I'm pretty sure I looked bad I wore them to keep up.

    Did I ever tell you about the sticky spray? She asked. No, please tell. Well, they use this sticky spray to help you stick to the pole. Which I never did. But it turns you into a human lint brush. Dirt, dog hair, you name it. You really need to shower right away. But it's ok if you stay on the floor, you still learn things. Good kitty and bad kitty. With bad kitty you have your back up and with good kitty you relax on your thighs and squeeze your arms together and push up your tits and toss your hair. I LOLOL'd.

    She started some new exercise program with some NFL superstar who is retired and lives in her complex. She's excited - she wants me to come to her session next Thursday and meet him. Well, I don't want to do an intake interview, but I'll watch you and see if it is something I might be interested in and see if he offers one on one sessions in the evening it would be tough for me to get to Rahling Road from Baptist in rush hour. David is his name, I forget the last, but I googled him at her urgency a few months ago and he is very legit. And awfully cute. He and his wife have two young kids Christy gifted them with toys when they moved in.

    This week has been hard, but Cecelia is better so I'm better. She's invited her three new friends she is planning to live off campus with next year to come to Spring Break with us so I've got to e-mail the person in charge of the luxury rental and tell her I want the luxury apartment out back too. Rennie is turning eight this weekend - Rachel planned a party at Maumelle Park in a pavilion so I shopped at the Baptist gift shop and scored and just wrapped presents. I'm so excited.

    We had a partner meeting Monday night. We don't do this often enough - I need to change that when I am Chief, so whenever we do it becomes heated. Once, years ago, in the private party room at Cheers, I thought I was going to have to fight off blows between a couple of them. We are trying to decide if we want to hire or not that bonus without Rex was nice but I'm sick of having to take a beta blocker by noon to finish off the stressful day so my vote is hire. We will see where that goes. It's moving in a positive direction.

    We had three autopsy requests last week - the PA at UAMS who is taking them wondered overwhelmingly how many of these do you get in a year? This is the only three, Jessica told her. Bad things happen in threes. Good things also happen in threes. I'm glad to be off call. Full week of work but I'm off next Wed through Friday and we are heading back to Eureka to the Emily Dickinson suite - never been to that one but the pics online look amazing. Happy Tuesday. Much love, Elizabeth.

Covid Update

     This call week has been hell but today was the best day we got all our cases on time and I had a decent lunch break. Then I finally had time to check my email and some CAP person said I was overdue for an inspection and I had three months to complete it. Not true. I never agreed to inspect that lab. Well Staggs did, and he said you would do it. WTF. I told her I've been doing inspections for over 12 years and we just lost our lab director there and the second in command and we are not equipped to do that. And please send me the form that I usually sign with Stagg's signature because he has never done that before. This is a waste of my time.

    She deep dived into her emails and said that I was right, it was her mistake, but would we still do it. Plan an inspection in three months over the holidays with a lab in complete chaos? Hell no. I will provide backup if you can send five people. Luckily in the meantime I had called Mary and she said we were not even equipped to handle that lab from NLR, it had tons of AP that they don't even do. She pressed and pressed and I pushed back kindly but firmly and when she offered to take me off of the assignment bc it was her mistake I gladly took her up on it. 

    In the meantime I had time to watch Mandee's Covid update - we have to watch and sign a form that we did in order to participate in some incentive stuff. I gladly did - I learned a lot about the upcoming new horizon on Covid - even though we are declining we are not out of the woods. We are only 48% fully vaxxed in AR. Any new variant could knock us back on our ass. They are flailing in the UK, but good news is that most of the new cases aren't sending people to the hospital there. 

    Stephanie was busy with her yearly C.E's so I had Maude on Tuesday. She is a grandmother and asked me all about Covid. I told her that it's definitely not as prevalent and our ICU's, while still full, are not mostly Covid. She wondered if we are out of the woods. I told her there are a lot of other species, not just human, that are vying to live and Covid is not an exception. It's not personal, I said, it's Darwinism. Then I read an article over lunch that was called Gaia theory I think? I loved it. The Earth is a living organism, and if we humans abuse it it will push back. That's part of what's going on here. The Earth, the animals, the bacteria, the viruses, they are pushing back on our abuse and if we think we will win, we are stupid.

    Mandee said there was a recent update by the ADH that said the invasive fungal species - Mucormycosis and the like - are seeing a resurgence in post Covid patients. They are getting a lot more reports than usual of its presence attacking humans. And Strongyloides is attacking the Hamptons and immigrant Texas communities. Parasites that normally plague third world countries. Ones that plagued the South at the beginning of the 20th century. Earth is fighting back. Go Earth.

    Cecelia is doing well - she is coming in town this weekend to volunteer at Camp Aldersgate and we are planning brunch at SOM on Sunday. I hear the weather is supposed to be amazing from the guy that works at the liquor store. He raved about the pumpkin roll planned in Hillcrest but I've got work on Saturday and a gross room party planned at Laurie's on Saturday night. Jessica is going to drive me I've been invited to the game. I'd rather sleep in on Sunday than go to a pumpkin roll.

    I was bragging to Jeff I had a game invite - he is always trying to talk sports but that's not my forte. Who are we playing? I wondered. Mississippi State, he said. Are we going to win? He's not optimistic but said it could be close. Savanna is like you, Jessica said during a frozen, she doesn't know football. Well we will either sit in the corner and talk about something else or pretend to know what is happening. Savanna laughed. RAH RAH RAH. I can pretend too, I said. Might be fun.

    Deep diving now into a box of wine. Boxes are so much more financially prudent. They kind of remind me of the prostate. At the beginning they are young and have a strong stream but when you reach the end they flag and spit like a hypertrophic prostate that is blocking the urethra and needs surgery to relieve the issue. Finished Clickbait it was so good. Kimberly recommended Invasion it's on Apple TV and we started it last night it was really good. Looking forward to watching more. Happy Friday Eve, much love, Elizabeth.

The End of the Awfultopsy

     Yesterday late morning I walked into the gross room for frozens - I had earlier learned I was on call this week and there were 200 blocks so it was already a hectic day. Jessica was in a frenzy. There's an autopsy! Good god, I sighed and she must have noticed I looked like a deer in headlights because she immediately said, it goes to Hal. You did the last one Christmas Eve. That's how long it has been. Didn't we get rid of these in the new contract?

    We did, I said, but the logistics have not yet been set up. I'm having too crazy of a day to even get involved. Just talk to Hal. Can you ask Shaver? He's off, she said. I'd better stop talking and go do the frozen. I cracked her up with a story of it - Peter Kim, who I was friends with before med school he did my dad's hiatal hernia repair years ago and married a pediatrician named Elizabeth, was doing a Whipple resection. He needed the pancreatic margin. The margin was negative and the tumor was two cm from the margin grossly. I called the OR bat phone to tell him and the nurse said Oh! Let me go tell him you have the frozen results. 

    WTH? I told Jess. Does she think I have all day to be on hold for a frozen? Put me on speaker immediately like the rest of the world. She came back. Tell me, she said, and I'll tell him. Oh lord. Damn travelers, like Bandy said. I heard her say SHE SAID THAT THE TUMOR IS NEGATIVE. I yelled into the phone no! no! That's not what I said. I repeated the diagnosis like three times before she finally got it right. 

    Hal tried to come talk to me about the autopsy over lunch but I was having a hard, intimate conversation on the phone so I told him I couldn't help him he needed to figure it out. Let's just say when your kids aren't all right you aren't either. I almost chartered a plane to Fville yesterday. When we got off the phone I called Jessica and said if Hal wants me involved it's not happening today tell him not to bug me I've got a family emergency. I shut the door and locked it and worked for two hours.

    When I came out Hal was checking billing charges and I apologized and he was like no, I get it. You were shaking. His son Michael, who was born on the same day as Cecelia, decided to join the special forces of some military unit I forget. Halfway into training, he broke his foot. Now he's out six to eight weeks in some med unit and won't be home for Christmas. He has to resume his place with a new unit. That's good he doesn't have to start over, I said. But I bet he's sad he can't graduate with his class. He's making some of the best friend of his life, Hal said. And they take away their cell phones. He's allowed to call once a week, and if I miss the call I miss it. I'm now married to my phone. 

    While I was locked in my office Brent managed to call UAMS and get transportation and billing and logistics for the body. Jessica was on cloud nine. She was talking to the nurses in the ICU and a PA contact at UAMS. Today I went into the gross room around three to do five Sims frozens and a sixth one for a new doc Bareto that Laurie said was real nice. Jessica was problem solving - UAMS wanted a negative Covid test on the patient within the last 14 days and he had been in our ICU for 30 days and hadn't been tested since day one. What do I do? She asked. I'll help.

    I took her to Amy in micro and we got a swab and she gave us a verbal order form and we went down to the morgue - I hadn't been there since Christmas Eve and was glad Jessica was with me I always get lost going to the morgue. I was kind of excited to be a part of the last experience there. We denied a bunch of Covid autopsies bc there is no negative pressure and it hasn't been updated since the 60's. Becky was the one who gave me the idea to ship them to UAMS years ago - she got their accrediting organization to ding them - but after three years of trying I gave up and trashed my research.

    I can't remember if I told you about an autopsy I did - can't remember which one - where the rusty circular bone saw broke while we were cutting the skull and the saw part flew off of the base and hit the wall. If this was just a regular wall it would have stuck, but it was a tile wall so it bounced off and skittered all over the morgue before it expired. Someone could have been seriously hurt. 

    Sarah, the morgue attendant had opened the bag of our patient in the cooler just enough so we could get the swab into his nose. Jess and I gloved up and she started trying to break the swab in half (think glow stick - I guess this activates it?) and I said I think you have to remove the plastic seal first. She struggled with this for a while - I said it's probably at the non-swab end so you don't contaminate it. I struggle with those too, take your time. Then she spent almost a minute twisting it in half. How far do you put it up? She had asked Amy earlier. Until you hit resistance. At least he won't complain, we joked. He had a sweet face, and I silently prayed for his peace in resting.

    I told Jessica, well for one thing you can be certain Baptist won't be rotating you on the swab station. Sarah laughed. I had a late possibility of frozen with Sims but just got cleared yippee. Watching Clickbait on the recommendation of Alyssa highly recommend. Eureka was wonderful but I tested gluten - could not resist the perfectly toasted English muffin and the soft creamy butter served to the Sara Bernhardt suite (hell it rhymes with Amelia I was close) and paid for it dearly for the past two days almost to the point of passing out from dehydration. Canceled dinner plans tonight. Need to relax. Happy Tuesday - hope yours is a good one. Much love, Elizabeth

Apocalyptic Melrose Place

     I just had lunch with Christie it was lovely. Guacamole and pumpkin soup and Kahlua cake I'm probably not spelling that right but too tired to look it up. It's been a hard couple of days. Sometimes when you have a lot of time to yourself you start processing shit that you had to stuff. In the past 48 hours I've been not drunk dialing way to many people to get me out of a bad headspace. Mary, Daniel's wife really helped yesterday. And I reconnected with Marcie and Conley - we are having dinner next week at The Terrace. Caught up with Deidre last night late - she was working in her new business space. Christy and I plan to throw a party there after the holidays.

    I've told Sean that Christie's apartment complex is like an apocalyptic Melrose Place, since the pandemic. The neighbors are all rich widows and divorcees and they take care of each other. Christie is a guardian for a 4 or 5 year old Monroe, and sees him every Wednesday with his mother, who is going through a tough divorce. Monroe is precious - I met him a year and a half ago and their bond has strengthened over time she is besotted. Last week they went to the fair and yesterday she staged a Halloween he will never forget. Christy texted all of her neighbors and she took him to every door where he was received warmly and treated. He dressed as a duck - his mom Haley made the costume it is so cute.

    I remember being about that age and my Dad taking me trick or treating. We lived on 3217 Shenandoah Valley Drive I was at the age your address was a mantra. I still think of it as a song. That space across from The Terrace that was a Blockbuster for years, not sure what it is now, used to be an office building. There were various businesses mostly insurance and maybe a dentist. Every year they had a big safe Halloween that was especially fun in the rain because there was an overhang you didn't get wet. Although there are plenty of times I remember my dad driving us around in the rain - Sara and I would jump out of the car with our baby umbrellas to trick or treat. I was super shy but the office workers dressed up and decorated their spaces and gave us candy and oohed and aahhed over our costumes. Monroe is going to remember last night forever, I told her.

    At her condo there is plenty of adult fun too (some to spicy to mention) - they all text and meet at the cabana for drinks. Some host Cajun nights. Christy is usually in her pj's by nine - the preferred witching hour of those around 50. She bragged over lunch - Monroe's Halloween was over by 5. I planned it. Isn't that perfect? Halloween should be over by 5. I agreed. Give the adults time to wind down and relax. She said she prescreened the gift baskets and made sure most of the offensive toys were sent back to bio dad. Remember those gooey things you throw around. Yes, I cringed. They got stuck on ceilings and made permanent spots on the paint. He got all the pixie sticks too, and I made sure Monroe knew how to open them. I laughed.

    My massage got canceled - I was going to go with a new girl named Courtney, but she had a death in the family. I told Christy over lunch she said she would go through with it if I really wanted and I texted back hell no I'm sending love take care of you. Can you imagine, said Christie (I'm not sure if it's y or ie can you tell?), a guilt massage? Hell no. She bent over backwards to reschedule for tomorrow. But I'm seeing Yousef for the first time in months in the morning and want to have time to pack in a relaxing fashion. Courtney said she was sorry to be the bearer of bad news on my anniversary. Well bad news is relative, right? I'm not dealing with death, just stress.

    Cecelia is good though so it's a good time to process supporting her. She is wanting to bring three friends to Colorado for the Grand Social Experiment and she's almost talked her dad into letting them rent the luxury apartment out back. It's not much extra and I want to meet Bailey and Harper and the other kid she is signing a lease with right now to live with next year. If we sign at lease this week, mom, we get a discount. That kid is so frugal but I love the organization. I'm not a helicopter parent, I wasn't helicopter parented, and I think they are better for it. Needing to figure out some podcast thing, it might not happen today bc it intimidates me as much as the breastpump machine many years ago but it's on the radar. Happy Thursday, much love, Elizabeth.

    

Monday Madness

     I only had four cases to finish this morning which should have taken me a half hour. I came in all sunny bringing the secretaries gifts from Walgreen's - nuts this time cause you gotta balance the candy out. Honey roasted pistachios, chili lime ones, smoked BBQ, and some corn nuts too. We chatted and I looked at my immunos - three of the cases were hard and I had to dole them out for consult. No worries - I visited Savanna and Joe and Laurie in the gross room and Shelby and Avery at BVD - noticed they were training a new guy. Shelby is coming to work for us November 8. She was sweating the application last Friday I told her no worries it's an ancient form. Give your two weeks and take a little time for yourself. She was taking her cat Eclipse to a vet in Hot Springs for a second opinion and it was good to hear he was gonna be ok.

    I went to release in CoPath and there was this funky mode - the secretaries couldn't figure it out but I did eventually on my own. Then I went to release cases and none were typed. Where are my cases? I asked. I dictated one almost an hour ago. One of them got on the other two and I waited impatiently cause it took her almost a half hour to do what I could have done in five minutes. Shaver came with the third consult as I was walking out the door. I'll be back I'm done here. Do you want me to do it for you? Suspicious is where I landed. That's where I was too. Please. I'm way to mad on my day off to wait around another half hour. This is ridiculous I have call days that take me less time.

    Wound down at Edward's - planning a meatball dinner for C's send off back to college. Just the four of us. I desperately need a pedicure but I've got all week there will be no more driving today. Got lunch planned with Christy on Thursday - long one at Trio's - then we both have 90 minute massages. That day is S and I's five year anniversary! We are headed to Eureka for a long weekend on Friday and I'm so excited got the Amelia Earhart room again that one has the best back patio it's really excluded perfect for wine and music. I might take a nap this afternoon. Took one yesterday and it was lovely. Never to late to become a napper. 

    Looking forward to domestic activity as well. I had to get some dishwasher pods at Edwards bc I  accidentally bought clothes washing pods for the dishwasher. All these damn pods look the same these days. And it's easy to screw up at the grocery bc masks and no glasses - it's hard to read the fine print. A couple of glasses of wine and a long overdue chat with Christy has me in a better mood. Happy Monday - hope yours is less stressful. Much love, Elizabeth

BHEC quarterly meeting 7am Friday

     I took over going to Baptist Health Extended Care quarterly meeting years ago, when Shaver became chief. We get paid 150 bucks per meeting so I try to attend. Gail McCracken used to run it, but Bob Searcy took over a couple of years ago. It used to be at BHEC, then it was where the vaccines are given out now near the Dr. Lounge. Now it's in a new place every time, and this time it was quite cryptic. Behind the glass door. In the small conference room. I found it, in the admin suite, and made it on time. Greg is the admin - he used to run the lab before Cody took over. 

    Ken Robbins is always there, and Greg Zawada. Ali usually comes, but he was absent. There is a pharmacist - she is constant, but the three nurses, all of whom I respect, were new to me. Damn travelers, said Bandy last week, when he sent for frozens but it was not communicated to the gross room and so they didn't get done. The entire hospital is made up of travelers. Radiology is a complete mess - it's a wonder we actually get specimens.

    The meetings have a routine - first the pharm approves new meds and we motion to approve and second the changes. Bob wandered in late because he got lost. One of the nurses presented a routine they were doing to measure the room cleanliness. She was talking about ATP and call buttons and phones and we were all lost. Bob stopped her. You mean Adenosine triphosphate? And what phones? Telephones, I told him and he incredulously wondered if there were telephones in the patient rooms. Yes, said the head nurse. Who uses these phones? Zawada googled ATP measurements and sure enough it was a thing. Bob said no disrespect, but we need more information here. The nurse said none taken, I'll bring more information to the next meeting.

    So then the infection control nurse presents the CLAUDIs and the CLABSIs and she mentioned there was a C.Diff. Admin Greg said we get a 2% ding from Medicare for that. Bob wondered for just that patient? Or the whole year? The whole year, Greg confirmed and we all gasped. Bob said who is making this stupid rule? Tony Fauci? Clearly no one that knows anything about medicine. It's like we are living in Infinite Jest.

    That played out again when Greg said our Case Mix Index is going down  and that is bad for reimbursement. What is CMI? We all wondered, and Greg said patient acuity. There's been a lot of young patients with COVID being admitted and they don't have as many comorbidities. Value based care! I announced. Didn't we have a mandatory meeting about that last night? I have yet to watch it, but I have two weeks.

    Greg explained that they needed more critical patients to get better reimbursement. Bob said well I could probably diagnose everyone in this room with sepsis. Anxiety. Depression. I see you Greg, I'm not asking you to cheat the system (we all laughed) but we need smart people to help us game the system. They've got all the Ivy Leagues, none of whom know medicine, so we've got to get those too. It's a new game, it's terrible, but we've got to play it.

    The meeting adjourned and I asked Bob if he'd ever watched the movie about David Foster Wallace. He remembered yes! The reporter who goes to interview him. They talked about tennis. I tried to start Infinite Jest but decided to save it for retirement. It's like Finnegan's Wake. Same here, I told him. Couldn't get past the first chapter. But that Kenyon College graduation speech? I read it in residency it's one of my favorite pieces on the planet, I told him. Yes I read that too. 

    Having an amazing weekend. Pool is heated and family gatherings are aplenty. So happy to be off next week. I've got three cling on cases to finish up Monday but going in when you are not actually on is a pleasure. Happy Sunday, much love, Elizabeth

Put the Petal to the Mettle

     The first three days of this week were nonstop batshit crazy. Needles, double the cases, you name it. So it was nice to have a slower day - a day to walk outside on breaks and read the news. Take a decent lunch break. No needles today - so hoping tomorrow will be the same. I take over chief duties in January, gives me time to finish out the year and party plan. Ease on in. 

      I hadn't been to general CARTI tumor board in a while - mostly covering ENT, so it was good to see Diane and Tom Sneed it's been awhile. And Joe Beck - he's a card. There was a case Tom presented - some guy that had a painful nasal mass. Two biopsies have been attempted but the first was read as a Schneiderian papilloma and the second was inconclusive for cancer according to Tom and he was trying to decide what to do. This isn't growing like a benign thing, but we cannot get a cancer diagnosis. Both read by our group, but not me.

    Joe Beck likened it to sticking a needle in raisin bread. Sometimes you get the juicy bit, but sometimes you get just fluff. Eww I hate raisins but it was nice not to be blamed. He's right though. Some nuts are harder to crack. They decided to treat it like it was malignant and try to shrink it with their fancy named drugs before they operated, which at this point would require extensive forehead flaps and more pain. Sometimes you have to treat the lesion, and not the diagnosis.

    Jessica finally got badge required restricted access to the gross room. They are all over the moon. I was in there yesterday and someone was trying to get in and they were giggling. They opened the door and accepted the specimens but told the messengers that in the future, they needed to use their badge to access the OR and deliver it though the window. Weeding out the interruptions slowly. I was in there even though I was covering needles bc Kimberly got some rye bread from BVD and was trying to get rid of it. The secretaries weren't biting, so I told her let me see if Jess wants it she loves rye. 

    She was so excited Joe Shaver made fun of her. How can you be over the moon about week old rye? It's the German in me, she said. I could do lots with that bread. Reubens, homemade croutons, it would be great with a fried egg in the morning. She texted me a pic last night of her dinner with rye bread and soup. I showed Kimberly this morning and she was gleeful. I'll never forget that - can't wait to treat Jess in the future. 

    Kimberly treats everyone. She's had a hard life, and she loves working for us. She's so positive and giving and hardworking. She's a lesson in how to be a person. She often texts me pics of what she's meditating over early in the morning - long before work. She's transformed transcription into a place of joy. She waits on the transcriptionists hand and foot - bringing them ice and doing a lot of the dirty work with pleasure. What others would consider dirty work, anyway. She offered to take my trash today and I said sorry girl I beat you to it. She tells me about Jacinda and another new cook at Boulevard - they are harder to get to know with the language barrier - and how amazing they are. So I gift them too. 

    I talked to Mom and Dad just now their house is really coming together. I'm on call New Year's week so cannot go this year but am planning a solo long weekend in February. I'm working a lot harder than I ever have, but it's kind of worth it. Got the biggest bonus in history this month and planning lots of house projects. Need to get in touch with my financial officer next week - I often give but I'd like to do some planned tithing so I can be organized about it. 

    Speaking of I got a weird fax earlier in the week. Kimberly brought it. It was to Elizabeth Nestrud. It was from a law firm that said I had a relative in Canada - another Dr. Nestrud, who was in a car crash 9 years ago and no one had claimed the money from this ancient stone dealer (that made me giggle). 11.9 million dollars. That is so fake, I told her,  but I have to check it out? I got a similar letter from a law firm in California a few years back but I knew Uncle Lorne and it was 5K so it made more sense and they sent lots of paperwork to claim it.

    I couldn't not check it out. Kimberly's brother Kyle is a PI so she gave me his contact info to look into it - I did not have the time. Another red flag was that I only had 30 days to claim it. I texted Kyle a pic of the fax and said I am 99.9% sure this is a hoax. But the point 000001 chance had me in a bit of a daydream for a half hour. The first thing I'd do, I decided, was buy Kimberly a car her van crapped out on her and she's been struggling. Then I'd contact my financial advisor and figure out how to give. I told Kimberly, at least the fax moved my bowels. She laughed and said if that's the only benefit it's worth it.

    Sure enough Kyle texted and told me it was a scam. I wasn't surprised. I told him my family moved from Norway to Canada - that's where the fax was from/unknown deceased relative resided. I said it had just enough truth to keep me mildly intrigued. He said it was an old scam. Surprised it was still in use. You would be amazed, he texted, how much info you can get on someone for just 12 bucks. I tried to pay him but he waived the fee. Thanks a bunch, I said. 

    Happy almost Friday. I'm booking lots of relaxing appointments for next week, looking forward to it. Cecelia is coming in town this weekend (YAY!) and she's got quite an agenda but it involves staying here Friday night and grocery shopping with her Saturday morning and spending a few hours as a blended family at the fair in the afternoon. Rach will host brunch on Sunday. Big social experiment in the works - we decided to book a luxury home in Crested Butte together for Spring Break. I promised Rach first dibs on a room - there is more than one King. It's actually the same place I went with Katie and Becky and the kids when I first got divorced - when they first learned to ski. I remember staring at the snowy hills at night marveling at the snowplows and enjoying reading by the fire with the snow raging outside. It's a beautiful home. Much love, Elizabeth

Toilet Talk

     When I went to Orlando to a conference with my friend Trish pre-pandemic we were walking and talking and wondering why the hell it took so long for guys to use the bathroom. When you have to go, you go. Once my Chief Shaver incredulously posited who wouldn't take their phone to the bathroom. Who would? I wondered. S says that most of the time is spent on the phone. But wouldn't that time be better spent in your office on the phone? Or on the couch? 

    My ex told me that when he is in a group stall they are all wondering and talking. How's it going? That seemed so cringy to me. The bathroom across the hall, the one that doesn't have the security lock to protect the public from the heinous of it all, has been my go to. Occasionally you enter and there is a girl in the stall or a guy in the urinal and you are like WTF? But most of the time it's ok. 1990's, not 1960's with no cleaning crew. 

    S is the opposite he still likes to take his time but he's OCD as hell and cannot stand public bathrooms. I empathize. He waits until he gets home and it takes some time but I like alone time so I'm  not complaining. 

    When Jack was in elementary school he would leave the table at the end of a meal out, like 75% of the time. I guess the GI tract was still developing. He got a load, and he had to get rid of it. Sometimes he wouldn't tell us. We would be looking for the check and he was nowhere in sight and we would all just roll our eyes. Gonna be another half hour at least. Forget the check order another glass of wine. Get dessert. 

    It was a horrendously crazy day. But hell, I'm getting the best bonus days of my career and still leaving at a decent time. So there's that. Happy Thursday Eve. Much love, Elizabeth

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

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

    

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

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

    

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.

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