Catching Up

     Well I just sessioned with Lisa for the first time in over a month and it was good, Reiki, energy clearing, but she said I needed to write more. Good god I've been clocking in daily lately but ok. Since I imagine Christy and I's surgical shoe decorating and sleepover plans will not be conducive to writing I'd better say something this afternoon before I go to my 4:30 massage with Leah. She's new and I really like her we bonded on a psychic level I learned a lot from her and hope to learn more.

    MaryGrace is on her way over with Girl Scout cookies the kids will be so excited and I'm excited to see her she is the pilot who works for Falcon Jet and she is tough as nails and super handy she's always doing home projects like Laurie it's fun for her if you can believe that. She's the kind of gal you would want to have along if you had to walk down a dark creepy ally in the middle of the night. Whenever someone in Super Girls Survival group asks about something like flooring she chimes in like she memorized the encyclopedia on the subject and it's very impressive. 

    Speaking of women pilots there aren't that many and I happen to know three - my Great Aunt Genevieve was a WASP, well she passed, but my friend from residency Mellificent got her license a few years ago she and her Urologist husband Walt did it for fun together. Sounds a little scary to me but whatever floats your boat. We caught up recently when I was off a couple of weeks ago and she casually alluded to some big surgery she had and I was like What? She said oh Betty I told you about that and I said I'm pretty sure I would remember no you didn't. Turns out she didn't know about my jaw either and she made me tell that story first and we laughed about how doctors are the worst patients we ignore shit forever. Our shared mishaps happened the same year, in 2016. What a terrible year that was.

    Turns out she started having leg weakness and ignored it for a long time then she was having trouble starting to pee. When that happened she got a little worried and mentioned it to her husband and they decided it needed to be checked out. What ensued was a trip to numerous specialists all over the Southeast - it's a good thing she had her license because she was flying around all over. She had some extremely rare disc herniation - usually they herniate out but hers was herniating inward and bumping up against her transverse spinal cord. She learned that the traditional surgery was to crack open the chest and go behind the heart to fix it and the morbidity and mortality rate for that was super high but some young whippersnapper in Tennessee (Betty I didn't like the thought of someone that young working on me but I was slowly convinced) had just trained in a new surgery where they go through your back. Apparently the recovery was like 6 weeks in ICU and three months in rehab she had lots of swim meets and society commitments. She was in Junior League when she was here in Arkansas that was super impressive to me way over the top they make you jump through tons of hoops not for me.

    Anyway it was November she said and she planned to have it done in January after the holidays because it would be more convenient and the kids had tons of swim meets coming up. She went to one and she was talking to a coach and passed out but she ignored that too. She was getting lightheaded a lot. She was speaking to 600 people at a society function (wow!) on November 10th and after the speech was over she passed out. When she came to her friends were trying to get her to call Walt and take her to the ED she was like no it's fine I just need to go home and go to bed but rationality prevailed and Walt took her to the ED and she had to have emergent surgery by Doogie back doctor on November 11 because the herniation had progressed so much it was bumping up against her parasympathetic ganglia and causing bad issues.

    Then she said well Betty guess what I was out of the ICU in just a few days and home by the next week. Typical Mel, beating all the odds. She was my mother mentor and my breast pump mentor and her daughter Corinne is now a Freshman in Chicago hard to believe I remember holding her at 8 months once while babysitting playing with a mirror for almost an hour she loved it. We commiserated over how hard Freshman are having it with the pandemic they have no social network (Jack too) at their new schools and going all virtual is so bad for their mental health. They struggle with grades too. Jack is catching up he's back in real school and at least he has family support nearby Mel said they are flying to Chicago a lot. Jack cracked me up the other day saying he finally ate with a couple of guys at lunch he really needs guy friends he's getting sick of hanging out with the girls. They get all mad when he says something to one of them on social media they feel ignored. Oh the problems with being a 15 yo hottie lol.

    Ok I'd better go I need to pack up for my sleepover I think I'm going to use my $700 Brave bag I haven't used it yet and I know Christie will appreciate it she's into all the fancy bags she owns a full set of Louis Vuitton luggage. Oh well if I'm in tie dye and sneakers it will be an interesting contrast. Hope you are having a good Saturday. Much love, Elizabeth

Happy Friday

     Uggh I'm exhausted. It feels like midnight and it's only 8:30 something. Just off phone with my friend Christy we are planning sleepover tomorrow night to watch Billie Eilish doc and decorate my surgical shoe it is desperately in need of overhaul. I'm super excited. Lots happening this week planned doc mom book club next Saturday and Kricia is coming over during the day to help me make the place presentable. 

    Not much today? Huddle anticlimactic. Amy asked me where I got my shirt I told her lululemon and my pants were Baptist gift shop which cracked everyone up. They are super soft and tummy supportive I told them. They are all excited to check out the clothes.

    Today was super slow I was thinking about ICD-10 codes. Like tonsils and sinuses are J.35.01 and J.32.9 what's up with that logic is ENT a J jurisdiction? And too much boob (reduction mammoplasty) is N62 and too much bleeding out of the uterus is N92 who coordinated this? History of cancers and breast implant removals have some Z's how is this related? Or maybe I'm confused? Breast cancer on the right is C50.11 and on the left is C50.12 I've long ago designated my breasts 11 and 12 to help me remember. Just grab em and get illuminated. 

    Cidney was super frustrated in bronch lab at noon. Was getting blood only on multiple lymph node biopsies. The techs told me it was a new needle that costs 3 times more they discontinued the old one. Cid was having none of it he angrily called a rep and learned the old ones were just on back order. He said, "I will never use these again the yield was crappy the sheath fell off during the procedure I hate these needles." I overheard him telling his new nurse that was elementary school shit those nodes were over two centimeters it should have been easy.

    Ok C is calling me again about something that is funny as shit that will take me too long to write about so I'm gonna plug into her and wind down. Happy Friday! Much love, Elizabeth 

Nurse Ratched

     Got to work this morning and received an e-mail directly from Judy!! To me! She regretted the call failing and told me to email if I have any more questions. I honestly got enough content I need to transcribe the call this weekend and start working on the article. I told her that and told her I would pull blocks from the autopsy I did Christmas Eve she listened and had new ideas I need to send for extra studies. I googled and it was 3:25 am in NZ when I e-mailed her at 7:30 am but she still sent me a note back this afternoon telling me I'd better send her a note about the test results. If I'm right, she said, you need to publish. I told her about the cray cardiologist but it would be worth working with him to get this info out there. 

    As I was leaving work today (early finally 3:30) I asked Hal if he would cover me I had to get Jack and get to my week late due to weather follow up surgical appointment. He said of course and I told him (it's honestly the first time I've mentioned it out loud not even to family) that I was worried this white plastic ball that has become exposed was in my foot. He looked and said surely not which was reassuring I told him I've had nightmares about it and he laughed. It's part of the dressing, he said.

    Jesse Burks, podiatrist and horror writer and director and brewery creator (another triple threat) was super kind. He said yes that is a pin it's in your bone. We will pull it slowly with a hemostat it's not painful. His nurse, however, had a different agenda. I've talked to her on the past couple of visits she's super sweet so she must have been going through something today Jack agreed she was over the top. She told me the white round plastic thing was the pinhead and without warning twirled it around in her hands right after I had enough courage to look at my toe and pin and stitches. I want to show you it doesn't hurt, she said, as she twirled it around incessantly. Jack even confirmed that once should have been enough she was pushing the limit by doing it over and over. Playing with a pin in my bone without explaining or asking. I got hot and had to take my coat off.

    Jesse was super kind and answered all my questions I'm sure he explained them before but you know how it is when you are the patient you can't absorb all the info. But then Nurse Ratched came in to take the stitches out - there were only five, but after the first two she was tugging and pulling so much I got hot and told her I was going to go from my lounge elbow position on the side to lying on my back. That was better and we got to talking about tattoos and I was a little ashamed and angry when she said if you are having this much trouble with stitches forget tattoos. I've got a huge pain tolerance I assured her I'm just struggling with the mental image. And her callousness. But of course I didn't say this. One of the biggest measures of compassion is maintaining it in spite of whatever shit you are experiencing. If this is true, I won big time today.

    Once again I complained of my surgical shoe and was told it was my fault how I was walking with the dressing (how tf is this my fault) and after a new dressing same same. She said you will have to pay for a new one like it was a grand I asked how much it was only twenty dollars. After the new dressing post stitch removal I got two forms to say if my insurance doesn’t pay the twenty bucks I will (I was honestly prepared to write a check) and she demanded my signature and accused me of not signing it (after I had) and asked me as I was fastening the new surgical shoe to give her the paperwork right away. I sighed as I worked on the velcro and reached over and gave it to her. 

    Happy almost Friday so glad I'm not on call this weekend. Much love, Elizabeth

    

Elevation

     So I got to work this morning and forgot Huddle!! I had a few leftover lung cancers with a bunch of immunos and it was nothing weird enough to send out but they didn't quite fit the mold so I had to do a lot of internal consultation before dictating and releasing. At 8am I went to micro to apologize to Amy and she showed me a spread sheet of the Geri/Psych patients. 12 out of 14 were positive and interestingly there was no S dropout. But in addition - we ran the samples on two separate machines - the threshold for detection was alarmingly low even lower than the UK strain I'm talking 8K and 10K for nucleocapsid and ORF it was so confusing. I asked Amy to share the patient spreadsheet with me so I could research it later in the day.

    Morning was batshit crazy but things calmed down around lunchtime. The PR agent for Judy emailed me to confirm the conference call interview at 6 and asked for a bio to share with Judy. I finally googled her Jill Siegel good thing I didn't earlier she is equally as intimidating I told her I should interview her too based on all of her accomplishments lol. S helped me research a call recorder app called Rev and let me test drive it on him this morning I was more nervous about that than anything else. I told Jill I wanted to record so I didn't accidentally misrepresent Judy but apparently she didn't pass this along bc Judy was surprised, but accommodating. Also Judy didn't read my bio bc three questions in she expressed surprise that I was a pathologist. After that the interview got much chummier and collegiate I drove home at seven on a crazy high like I just passed my boards or got married or something similarly amazing.

    She's a forensic pathologist, and a NYT Bestselling author, and a platform for change, and I can't wait to read the new novel Jill sent me for my efforts. She had such incredible insight into the pandemic and creating noir out of her experiences and I don't want to tell too much bc I want this to be a surprise. I told Jill I can share widely on social media but I was googling Judy today and she is kind of a badass I said I'm gonna write something up and share it with you and Judy so I don't accidentally misrepresent her (queue her reaction to Guardian misquoting her on Twitter eff no she will rip me to shreds). We commiserated over the poor representation of pathology, especially forensics, on social media and she said OMG you've got to google my blog about 7 bad things on CSI (it was more eloquent but I forget I need to transcribe the interview soon).

    The research into Geri/Psych is more confusing than illuminating I'm going to be interested to see how those guys do. Man teenagers and pandemic can be hard as shit. Judy agreed I've only two kids she has four. Our interview ended abruptly at the 47 minute mark when the call failed I regret that I couldn't thank her but I have enough material to work with. When things slow down. Happy almost Thursday. Much love, Elizabeth

Super Spreader Event

     So I bumped into Mandee Novack in the Dr. Lounge this morning and she beat me to the coffee machine. We chatted. I told her that her lecture was so good in a text over the weekend and she thanked me. I told her this morning that all of what she said was in my wheelhouse I'd be happy to help her in any future talks I could be an underwriter I don't want any glory I would love to support her though. She appreciated that and cracked me up by saying this is not what I signed up for all the S drop and PCR (exaggerated drawn out drawl) was not her area of expertise. She looks like a beauty queen insomniac in scrubs I mean this in the best possible way if she ever reads this which is highly doubtful. Her coffee was a size bigger than mine. She needed it.

    She said there was an outbreak in GeriPsych in the middle of the night 12 people tested positive it was alarming like a super spreader event. I was like what? Again? I followed the GeriPsych outbreak at the beginning of the pandemic for the head of the lab Paula Dick and read charts extensively to try to follow the event. She said yeah that was a trickle phenomenon but this is all at once. I said one thing I learned was that moving the patients to general med surg was a nightmare they can't handle psych patients there. Some died, some did fine and were transferred to another facility after quarantine. There are no boundaries, I told her, I hope you didn't move them to med surg. She said no we didn't and I think it was the right decision but I'm worried that there were so many positive all at once I might need sequencing. Looking for that S drop, another variant. You are right, she said. No boundaries in psych. No masks. Or they are eating the masks. They are definitely coughing all over each other in group, I replied. I LOL'd she's a triple threat brains and beauty and humor I hope to become her friend someday when this is all over.

    I was busy running around doing needles - there's a catch up phase to weather and pandemics - and so was head of micro Amy she told us in huddle she had no less than four conference calls today she would be largely unavailable so I texted her about the outbreak and she promised she would alert Marti. Conference calls were about new anaerobic detection machine (does it or doesn't it require propane like the old one I'm still not clear). Also new WASP info and other stuff. She explained but it was a lot of new info and I forgot.

    The head of Conway lab Misty got together all the yearly blood product usage info to present at QRC at five pm today and I was there to support her. It was a Google Meet and most people used their cameras (unlike tumor board virtuals we are audio only) but I disabled mine it was a new environ with a bunch of docs and admins that looked like they had aged well ten years after being the star of their colleges best fraternity. Misty was fantastic I texted her so and it turns out we are the highest in platelet usage in the state when compared to hospitals of equal beds (100-299). When she asked for questions I said 1) Would the trauma staff like ED and gen surg be ok with us not keeping platelets on hand (doubting this clinicians all want more blood products) as a trauma center and 2) Can you get info on ABI if other hospitals in our cohort that are trauma centers - what do they do to keep from wasting platelets? She said she would and was texting me OMG I was so stressed was I red I was so hot and I said no you were amazing why do you think I disabled my camera? She honestly did better than most of the guys. 

    I got my endoscopy and colonoscopy rescheduled from my daughter's bday to the end of April whew. Christy said she would take me and she would entertain me with stories of penile implants? I was like whoa. I saw them on autopsy patients. She said the there is the air pump kind and the ones like slinky's that sound like rice krispies in milk? I said I just observed and documented never touched so no experience there. She assured me she will regale me with more info on penile implants during my colonoscopy prep I'm not sure if I want to know? But it's kind of funny so bring it on. She has a barky dog that annoys her kids sometimes but whenever they complain she says would you trade Sonny in for a bad stepdad? Resounding no. She is one of the smartest people I know on the planet.

    Happy almost Wednesday hope you all are happy and safe much love, Elizabeth

Overpissed

     Is that a word? I'm experiencing it on this Monday. Got an email from the American Board of Pathology seems I'm delinquent on my every two years reporting cycle. It's not really an issue until December I have plenty of time to report but WTF. If you send me weekly emails on my quarterly tests (I am so freaking jealous of everyone who grandfathered out of this shit) why can't you send me a heads up before I owe you extra money? I've only been remiss during the divorce and the pandemic I'm a good person I promise. I had to do a survey last week on the quarterly tests yes it is infinitely better than re-taking your boards every ten years but still it's a load of shit. Googling esoteric questions with a five minute time limit does not fing advance any part of my education. Give me some good articles to read and answer questions about to further my knowledge like those ASCP ones and you are back in my good graces. 

    Called my podiatrists office today to get a new shoe that fits and learned, contrary to the new hire who guided me last week, that I had to go back to Arkansas Surgical Hospital bc they charged me for the too small shoe in the first place. To avoid paying for a new one. So I trekked there after work and the new shoe was way too big it slipped off my heel way worse than a few toes hanging off of the top. Why is it that we women feel like we are asking too much for something that works? I battled that demon and learned that there was no other shoe in between it was the one I had or the worse one. The PACU nurse explained that it was probably my dressing that made my toes hang off the shoe.. I rolled my eyes inside of my head. This is a freaking surgical shoe. It should fit and accommodate dressings. But I smiled graciously and thanked her for her time and told her I had a post op on Thursday and would pay for a new shoe if I could find a good fit. Ugh.

    Covid scares the shit outta me. I was in Radiology today - doing a ROSE on a needle, and Ken Robbins asked me about my partner Brian. I haven't updated you in a while. He's definitely a Covid long hauler. He's doing PT and OT and the weather last week was hindering this but I sent him a heartfelt text today after a long update about his neuro tests and his shortness of breath and his inability to perform as nearly as well as he did a year ago I almost cried when he replied I was at Walgreen's. He's hoping to return March 8 after a sleep study and a neuro study he thinks we are suffering covering him but holy hell he is fighting the fight of his life. Rad told me about a 50 year old previously healthy who was doing mountain bike races last fall and is now struggling for breath crossing the room. They had a 19 year old last month present with a cold leg (clot) went straight to her brain she was dead before she got to the hospital. Previously healthy. My therapist told me about a colleague whose daughter got Covid from Fville in August she had transverse myelitis she is trying to learn to walk again.

    If Gwyneth Paltrow makes a single dime advertising herself as a Covid long hauler selling blankets that cost a grand I will be. Overpissed. Can't do much about it but be angry. In good news I'm interviewing the J.Lo of pathology Judy Melinek this Wednesday. I will probably need a beat blocker to calm me down I'm so excited. Thank god Monday is almost over. Much love, Elizabeth

Culture Consumption

     After a week of dealing with weather I just crashed. Slept most of Saturday which I already said and mainlined horror shows on Netflix. I'd highly recommend Alive and His House (my fave so far) The Endless was an interesting concept carried out by B list actors that looked like they just stepped out of an Ambercrombie and Fitch catalog. Started Veronica tonight based on internet reviews and it was so scary I had to stop a half hour ago to wind down. Cause that kind of movie will keep you amped up and tomorrow is Monday I'm covering EV all week and when I told Jack that at dinner he asked what was EV and that was an awkward convo. Funny though. He agreed.

    Speaking of Jack he has been bugging me about finding a new young adult series for weeks I told him I'd research or we could go to B&N but that hasn't happened yet. Usually I spend tons of time researching and he is uber skeptical of my finds it's kind of exhausting. So last weekend I was like here. There is this AR author who wrote a young adult series. You used to hang out with his kids but you don't remember you were so young. This is the first of three. He gave me his stink eye and asked me to describe it to him I was like read the freaking jacket. He bounded upstairs overjoyed holding the book up in front of everyone saying he loves it so much. When I checked in with him today he was halfway through (he's struggling, as are many freshmen, with time management during the pandemic and has lots of assignments to catch up on. I'm not worried, he's learning important life lessons, but gaming has been put on the back burner for now. And reading.) 

    Can't think of much else time to wind down and listen to music. Hope you had a good Sunday. Ugh back to full work week tomorrow hoping it isn't as crazy yet with the weather keeping people grounded. It will slowly pick up, that's a certainty. Stay safe, much love, Elizabeth

Edited to add I also read a book called Writers and Lovers. It was so good. Love a good story about a down and out girl pulling herself up by her bootstraps. The love interest is a nice add, but secondary to her story. 

I'm So Excited

 I just got off the phone with Samu Queen, a friend from FB. She is primary care in Portland Oregon. She invited me to Bad Mom Docs, which has been cracking me up all week. I reached out to her because a PR rep wants me to interview Judy Melinek next week. OMG Judy! I read Working Stiff years ago and trolled her website after I was so enamored. I told the PR rep I didn't think my blog was appropriate bc no readers ( I see the stats) but I would talk to my FB friends and see how I could get her a wider audience.

    Judy moved her family to New Zealand in the wake of the pandemic. So it will  be interesting to see how that bore out. Alameda County to NZ wow. I messaged Samu to get ideas and she's going to add me to some groups that she thinks will be appropriate. 

    Good god I slept all day. S is sleeping and C is hanging out with Woody after work and I'm just happy to be plugging in with all these amazing people. Hope everyone is safe and happy as me. Much love, Elizabeth

Happy Friday

     Well we were going to spend one more night at the hotel near the hospital but it aggressively ejected us. The fire alarm was going off on the fourth floor and the manager told us he was trying to relocate all the guests to another hotel because a sprinkler head had burst and according to code the fire alarm could not be turned off until the fire department arrived and that wasn't going to happen anytime soon. Packing with the noise pollution was intense they design those things to make you very uncomfortable. I had to turn the air on high to keep from passing out. Despite S having turned the water off at our house earlier due to a burst pipe in an exterior storage room we decided to head home.

    Despite your plans and intentions, sometimes the Universe has alternate design. I'm glad. I realized as we were heading up Southridge that I will probably never in my lifetime have a chance to see my neighborhood this covered in snow. I was just watching the sunrise over the river and taking pictures it's heavenly up here. I regret that the work week contains one more day but if the last few days are much of a precedent it won't be very hard at all. I caught up to Q/A December yesterday so I can tackle January today and plan an epic Q/A meeting next week. 

    I went down to the cafeteria yesterday evening for food - I've been foraging there all week and it has been surprisingly good I think I'm gonna switch back from BV to Dr. Lounge and cafeteria most days. The line was long - I forgot about the early morning e-mail from admin promising free pasta to hospital employees for their service in the storm. It moved quickly - somehow the pasta hadn't managed to arrive so two people were serving chili and chicken noodle soup. The normally full shelves of chips and prepared food and drinks were sparse - no service trucks have managed to make it to replenish supplies this week. I was happy to have made it early enough to grab a couple of bags of Fritos - they were gone by the time I was served.

    Jessica has been going it alone in the gross room for most of the week. She is the only department that has had no help - Van brought Laurie in on Wednesday but he had so much trouble getting out of her neighborhood after dropping her off he said he couldn't pick her up Thursday. And Thursday was obviously the hardest to get in. Janet couldn't make it bc a snow plow came through and created a drift in front of her driveway higher than her truck so Tina went solo yesterday in transcription. Padma has spent the night all week in histology on a cot despite the processors beeping all night I encouraged her to move to my office but she declined. Melody thankfully remembered it was Padma's birthday on the 17th so we shopped for gifts at the gift shop and got cookies for the department and slices of cake and pie for her to eat in her basement at night. That was fun to deliver. She gratefully texted as she opened and ate and said she was having fun it was like camping and our new hire Brandy, who is amazing, was with her so it was a camping sleepover. It's all in perspective. If you spin it right you win every time.

    I could sense Jessica's frustration around noon yesterday so when I heard her telling Tina she had to get out of the gross room for a bit and go to lunch I told her I was taking her to the Dr. lounge to treat her. She was so excited to see them serving turkey and stuffing and green beans she said (and others echoed later) that Baptist turkey is almost as good as the Thanksgiving she serves. I didn't do that (gluten) but got a mediterranean soup and introduced J to my dad's partner Bill Benton. Bob Searcy asked about my foot and I entertained him with stories of my too small shoe. Jessica and I talked about cases she grossed this week I gave her feedback on the thyroid and an epic prostate I need to finish today it is a Gleason score 10 (5 + 5) I've never had one of those. Jessica exclaimed that she didn't even know it went above 7 I said yeah 95% at least are score 6 or 7. This one is so poorly differentiated that I got some stains just to make sure it wasn't crawling up from the bladder mucosa (TCC).

    I'd better go stare at my view and get ready for the day. Road up here was clear and salted so no stress there. Excited for a long weekend of melting and returning to normal. Hope you have a good day. Much love, Elizabeth

Covid Update

     Well I'm probably blogging too much but I've been locked up in a hotel for days and there's really not much else to do besides watch trashy hotel TV with way too many commercials. Or read, which I haven't  found much attention span for this week. I cannot believe it's only Wednesday. 

The two hour Baptist metric Zoom lecture on Covid was super informative I watched while doing September Q/A. I learned that you should not go out try to determine immunity to your vaccine by seeing if you test positive on the antibody test. There are a lot out there on the market and they target two different antigens - the nucleocapsid and the spike protein. The spike protein is a surface antigen that can be positive with infection or vaccination but the nucleocapsid is a core antigen that will only test positive with infection. So people might think their vaccine didn't work but really it did. So this is a no no.

     They also talked about the post vaccine axillary lymphadenopathy we were talking about it the other week at breast conference. Trouble is that you might think an enlarged axillary node is a breast cancer met but it might just be a response to vaccination. So everyone agreed for the next few months or so vaccination history will be important to avoid unnecessary cores to look for tumor. But you don't want to miss tumor either. It's a dicey situation.

    One thing I learned that was comforting to me regarding my risk of transmission to my family was that there was a Pfizer study that showed that if you are on Day 0-10 of vaccine and test Covid positive your viral load is similar to someone with no vaccine that tests positive. But if you are on Day 11-28 of vaccination your viral load is significantly lower. So it seems that vaccination leads to less viral shedding even in asymptomatic carriers. A bit of a leap, jury is still out, but that study was really encouraging. 

    Ugh there are so many myths about the vaccine out there. One of the presenters delved into the psychology of myth perpetuation. She said the more it is presented as a fact or statement the more it spreads. So when patients come to docs and say "I heard the vaccine contains a microchip" you should answer by questioning. "So you are asking me if the vaccine contains a microchip? That's impossible. There is no way a microchip could fit through the hub of a needle." (Your phone, on the other hand - no they didn't get into that.)

    There's another myth that vaccines have fetal parts/cells in them. This is a little harder to address. The Johnson and Johnson vaccine was developed from an adenovirus that was created in fetal cell lines (this is nothing new - read Henrietta Lacks i.e. HeLa cell line). The doc suggested that you spin it as this fetus didn't make it but it now has a chance to save millions of lives by donating the cell line to vaccine production. Man I'm glad I'm a pathologist I'd want to hit them over the head with their stupidity.

    And I learned new myths Melody and I were laughing about it today some people believe the vaccines have to be activated by 5G? LOLOL. Presenter suggested to tell patients we are fortunate this is not the case or there would not be access to many people around the world, but there is.

    The UK strain is scary but the vaccine protects and I'm more scared of the South African strain after watching this update. BTW thanks to Amanda Novack and Ryan Dare and Jennifer Dillaha and the other guy I fast forwarded bc it was all clinical and not relevant to my practice they did an amazing job. South Africa just received a boatload of vaccines which have recently proven to not be effective against this new strain (new strains have a stickier spike protein which makes them more transmissive) what a holy hell of a public health nightmare. We should be more afraid of that.

    I only had two cases today one was a widely invasive (this refers to the capsule) follicular carcinoma of the thyroid it was also angioinvasive and since I diagnosed a met to the thoracic spine on Monday I knew it would be easy I just had to look at it all and plug in the information required by the cancer protocols. Never seen that go to the t-spine it was so shocking but immunos supported and when I showed a beleaguered Melody on Monday afternoon I was happy to make her smile in awe. 

    Hoping this weather all stops tonight as planned so I can get more done tomorrow and maybe go home. All in all it hasn't been too bad a week but I feel for Texas and donated to a couple of shelters for domestic violence victims and homeless this afternoon. They are getting the shit end of the stick. Happy Wednesday hope you stay safe much love, Elizabeth

Bath or Shower?

     This week is one for the books. Sunday night in the hotel I was fumbling around looking for the bathroom in the middle of the night and a wall sized mirror fell to the ground and shattered. That's bad luck right? They moved us across the hall Monday afternoon and it was interesting to watch all the tow trucks on Chenal. Monday was busy - I'm not the only one who made it to a planned surgery lots of breast cancer over 160 blocks. I probably should have taken off a couple of more days after surgery I went in early and went to huddle and took the stairs down to the dr lounge and had to sit down and eat eggs and drink two waters before I was able to function without dizziness. I was texting my friend Christy she said Liz you are not even 72 hours post surgery take the damn elevator. So I've been taking the elevator it sucks to wait but it's smart.

    Getting clean is a real struggle with a gimpy foot I took a bath (I don't take baths) on Saturday it would probably be hard for me to get out of a tub with two working feet -pandemic de-conditioning is real - but with one it seemed impossible I drained all of the water out of the tub and still struggled. The hotel tub has a handhold it is a little easier but shallow and Holiday Inn Express skirts the rules. The drawers are cheap and don't align the fridge has frozen all my drinks and there is no bathroom vent S says that is against code. The girls in my text group said shower don't bathe get good packing tape and rubber bands and double Kroger sack so I'm looking forward to trying that tomorrow I've got it all in my arsenal. 

    Tommy stopped me today after huddle about an interesting case that's been moved to UAMS. Guy witb history of Histo had neuro sx and he had a lot of fungal colonies in his CSF. When Tommy called the ID doc she said shit that's too many to ignore. Hopefully systemic anti-fungals will help but it's out of our hands. 

    Today was slow and expecting rest of week to be too getting caught up on Q/A. I've been doing this for 5 years and never got more than two months behind but today I did July and August last month I did May and June (of 2020!) that's kind of crazy. It's nice to have time to get caught up planning September and October tomorrow and there's a required Zoom recording to meet some Baptist reimbursement metrics hoping to have time to watch all 1:37 minutes. It's an update on Covid so maybe I'll learn something this virus is defying all the rules. When I texted Mandee a question the other week even she didn't know the answer. 

    When I was little I longed to have an injury that required crutches and attention lol now I just want my foot to be back to normal. Heather, the pharmacist at Baptist, who recently had a foot injury (intense mountain mike break that required many weeks in bed at home) marveled at the misjudgment of my shoe size. I told her I know it's way too small my toes hang off it's hard to walk and I cannot get ahold of anyone for a post-op follow up they are closed due to inclement weather. She said they gave her a too small boot as well. What's up with thinking women's feet are a size small I asked her I'm a freaking 9.5 that's at least a medium I will try to get it replaced when I get a post-op. But it was already there when I woke up in the PACU I had no say.

    Hoping the last leg of this three tiered weather front is kind and I can get back home Thursday or Friday. Looks like it's going to be in the mid-60's by the end of next week thank goodness. Doing well here enjoying all the snow pics on FB and Insta seems like I'm in Colorado. Stay safe. Much love. Elizabeth

Happy Galentine's Day

     Yeah that's a thing. My daughter celebrated last night at Purple Cow and my BFF Lys's daughter Ainsley planned a brunch and decorated the house and executed the meal (she's ninth grade I think?) but I just texted my girlfriends. Doing surprisingly well today, after surgery.

    I was way more nervous than I thought I would be going in. Big drawback was nothing past midnight including cough drops I dry heaved twice when I registered that and confirmed over the phone. But I did fine and today I didn't even think about cough drops until 2:30 so maybe it was a good thing. The whole getting IV started and EKG and blood draw was worse than the actual procedure. I woke up in the PACU and my friend Dana Abraham visited and I was feeling pretty good the guy to the right of me was getting reminded to breathe and the lady across from me was puking in an emesis bin and the lady to the left of me looked kinda rough but I was talking to the nurses about how excited I was to see Alanis this summer she was rescheduled for August and Christy already has a room within walking distance. Elton John rescheduled for January. Can't remember if I said that already - a lot has happened in last 48 hours. 

    But my doc told me I would have  a local block and anesthesia (Don Frost - I remember Mike talking about him long ago and we made the connection) assured me that Dr. Burks was generous with his blocks and I wouldn't feel anything until the next day (today). I don't think the block worked or it was a partial block bc I really hurt when I woke up but I wasn't pushy I was like it's a six? out of ten? and throbbing? I hate narcotics but can you fix this? They were generous and I had one Sierra Mist and two waters in the PACU and two packages of saltines (oops gluten) so I could take my oral Percocet and get the hell outta dodge.

    My last narcotic was at 4 pm yesterday I just don't get the thrill. I get heavy and dull and depressed I hate it. My friend Tracy in SGS told me she calls long lost friends and cleans the house and loves life oxy doesn't do this for me thank goodness I guess. Been on ibuprofen since last night and I'm totally pain free since this afternoon. This morning I got dizzy again - I now respect the dizzy feeling like it is a goddess - and laid down on the bathroom floor hoping the cold slate against my cheek would keep me from passing out. No dice. Woke up wondering where I was briefly and crab crawled back to the bed and hoisted myself up and slept until almost noon.

    Spent the afternoon finding out which shoes would level with my surgical shoe don't want to be walking all gimpy and I've got to plan there's more weather predicted so we've booked a hotel near Baptist for the week to make sure I get to work. Turns out not much even kitten heels too high but a couple of sneakers and one boot and some slippers work. I also got some new boots in today with retractable crampons and fur lining they are two weeks early good for outdoors but way too intense for hospital. But they are super cute and will help me in the parking lot.

    At the risk of sounding cliche - time is really a good predictor of character. Helps you weed out the ones that don't deserve your time and attention. Kids are good, family good, that's what is most important. Hope you are too. Stay safe, much love, Elizabeth

Covid Test

     Yikes I had to get my first Covid test today at ASH pre-surgery for Friday's bone spur deal and I was so nervous I took a beta blocker - have some leftover from before I broke my jaw. It really wasn't that big of a deal they just go up your nostril until they feel resistance for the antigen test not nearly as bad as the PCR nasopharyngeal swab I hear. I complimented her as the tear ran down my left cheek and she said I did much better than the last lady she gagged and gagged.

    Then I went to Christy's it's been way too damn long we talk on the phone all the time but I haven't seen her in person in awhile. She texted last week that Alanis rescheduled for a Saturday in August she's already booked a hotel within walking distance of Wal-Mart Pavilion and sent me and Kim a menu of spa services. Her logic is that we need a clean bathroom nearby and a place to not to have to drive to (good logic port a pottys at concerts suck). We had cheese dip and watched half of the Britney Spears doc and I filled out the million documents my GI appointment required of me as a new patient it was insane my appointment was at 3:45. Paul Svoboda I trained with him he's cool as hell he's who Ali and Melody and her sis Rhonda recommended. I was talking out loud about the questions as Christy was tuning in to CNN she hadn't watched it all day and she's addicted. 

    I said they are asking me my referring physician. She was like what? They are asking you your preferred position? You mean left or right? Are there other positions? Like doggy style? Do they list the positions? I LOL'd and said no my referring physician. I'm just going for a pre-screening appointment. She said when she had hers they insisted she roll over on her left she would have preferred 1) If she had an option and 2) If they had offered to position her (there were four of them and one of her).

    When I was filling out the medical history part it was truly random in places. Not having much experience being sick I cannot compare it to other medical history asks but on one they listed having a right mastectomy but not a left. I was telling Christy and laughing - so the right boob is pertinent to the freaking GI doc's medical history but not the left? What's wrong with the left? Red headed stepchild? We both looked down at our boobs and could not fathom the logic of that. They also asked if you had ever had a body piercing or tattoo and what the heck. Christy and I were trying to figure out how a body piercing might affect a colonoscopy. Who gets pierced in the anus? I wondered. She said maybe the perineum?

    So I guess everyone is worried about the weather I'm happy to not be since I'm not working but Laurie is staying at a hotel and one of my new amazing hires Savannah is sleeping in my office kudos to them from carrying the torch. In the middle of the Joan Didion doc it's really good. I'm gonna wind down this vacation week has been uber busy hoping the ice will prevent me from doing so much. Happy Wednesday, stay safe, much love, Elizabeth.

House of Cards

     I just finished The Witch of Kings Cross which I read about in The Guardian today and the interpretive dance parts were a little cringy but overall I'm glad I watched it.

    Nice to have the kids back. I was awoken this morning at 6:30 by Ali (Interventional GI) asking me what to do with a specimen from the esophagus he wants to rule out pemphigus vulgaris. Which I had to then google, bc that's like a board question. Oh yeah it's autoimmune I texted Shaver and appraised him of the situation he called Ali and told him to put it in RPMI (it needs to have fresh tissue frozen for immunofluorescent studies) formalin might ruin it.

    Then I helped Jack with his lunch - he joked tonight Mom if you call putting together a sandwich cooking (cooking? who said cooking?) but he was kidding. I text asked Amanda Ferrell after he got off to school if she had any luck getting that tibia rad imaging burned to a disc for Jesse she did not. Ugh. Luckily the orthopedic surgeon from UAMS Jeffery Stambough? New to me, called my cell and asked about the status. So I played middleman between him and Jesse for an hour or so and got rad pics and open surgery tibia pics (eww alive patients are so much bloodier than dead ones) and then was like here is his contact I'm on vacay not vacay lol.

    After cooking eggs for C and having bfast with her I took off for chiropractor and had a wreck!!! Was so focused on getting through the trash and recycling bin without incident I missed the giant horticultural van across the street. Luckily he was super cool and I didn't really make a scratch. I thought my turning light was damaged but S said no it was just a reflector. Whew. I have not had to share insurance info in over a dozen years.

    Sometimes you get sucked into bullshit. That happened to me recently. But it came from a place of love so I'm trying to quell my shame and anger. On the good side - exciting things. Like I tell C - our failures in life are a greater source of learning than our successes. And beautiful things come from darkness and failure and hard work. 

    So tomorrow Matt at 10 and Deidre at 1:30 I'm going Robin Wright House of Cards again screw this ponytail for now. And I scheduled a massage for 4:15 some new girl Leah. My brother-in-law is receiving IvIg in an ED in Atlanta for Guillain Barre who knows what virus incited that so send good vibes. Can't think of anything else right now. Much love, Elizabeth

Edited to add there's a great article today in The Guardian about Joan Didion. I thought it was an obituary at first and I cried. I need to order more of her works The Year of Magical Thinking was a huge thumbprint on my life. They included her essay Why I Write in the article I've read it before it was nice to re-read. I'm glad to believe in reincarnation bc when she does pass on it won't be so much of a loss. 

Phone a Friend

     You know how it is when your job is cookie cutter and you cruise along like a king bc you've been doing this for a dozen years. Yeah, that didn't happen this week. I was covering morning frozens for Michelle, who was on call but she's in NLR, and I was frustrated as hell bc I kept having to consult my partners. I can go for months without needing anyone but I was calling Staggs and Shaver and Bell like I was just out of training (they struggled too so it made me feel better about my neediness).  I mean weird polypoid squames in the larynx of non-smokers and spinal tumors and brain lesions craziness was crawling out of the woodwork.

    I had an amazing case yesterday. Freaking cystic hemangioblastoma in a patient with Von Hippel Lindau syndrome. I was ooing and ahhing over the plump pink cells and showed it to Rex for confirmation. He was like if she hadn't had 14 in the past I'd make you stain it to rule out a met from the kidney but let's just all go out on a limb and call it. It really is a once in a lifetime case. If that. We are lucky to get to see it. And the fact that the patient was cooking along long enough to have more of the same removed from the son of the neurosurgeon that originally removed the former tumors (David and Jonathan Reding are an amazing duo) makes me feel good about medicine.

    I got to be a part of something really cool this week. Becky has a friend who had breast cancer 10 years ago and she had a core this week, done by my friend Amanda Ferrell, for calcs. Becky wanted me to read the core ASAP and I promised her I would. Well I was on my way to Conway Thursday and she was on her way to Hot Springs and she saw her friend walking at dawn and thought, she probably didn't sleep all night. I'd had a heads up and had the cores directed to me but didn't get them on the first run so bird dogged it as soon as I got back to LR. Turns out Staggs and Shaver had grabbed cases out of my box to help me out and Staggs had read it out as B9 with a little ALH (SUCH GOOD NEWS). I had talked to Amanda in the AM she was at UAMS she was totally cool with Becky calling the news to her friend. I reviewed the case and concurred and called Becky she was so excited I swear I could palpate the relief over the phone. She said so often I feel like the grim reaper it's nice to be able to deliver good news we don't get the opportunity to do that in our job it's just a report. I echoed that. 

    So happy to have the week off. I was an effing idiot and ate a bunch of gluten at date night at Bonefish Grill (bread and crab cakes and the batter on their fish and chips is like savory funnel cakes) and I really paid the price Friday afternoon I almost could not drive home my stomach was on fire. But GasX helped and I had a nice dinner party and I'm so happy to have the week off I'll keep in touch. So much to talk about. Much love, Elizabeth

Conway and Cocktail Classes

     So breast conference was a lot better this week. But I was texting Becky bc I don't really get to see what I am presenting (bad platform) and frustrated bc she said my pics were great but blurry when blown up. Despite my frustrations I'm a perfectionist and I want to get it right. She suggested, despite her self avowed tech issues, that I try to use my digital platform I use for ER, PR, and Her2. They use Aperio we have Coreo it's kind of ingenious. We can scan in the pertinent slides and show live images like they do. I asked her how does she drives the images when stupid Oncolens won't let her see she said she has two monitors. WOW. I told S to order me another monitor ASAP.

    Went to Conway today frozens were the least of my worries - a parathyroid effing cake. But I am also taking over CLIA responsibility for the clin lab in lieu of BDQ's recovery so I had to sign a bunch of shit and meet admin and meet the techs that was super fun. Misty, the lab manger, is like another Jessica she's cool as hell. We were texting our love for Cherry Coke Zero and Peanut Butter M&M's I'm going to now request to go there as much as possible. But the dictation was on the fritz and I couldn't order stains I had to over the phone it was painstaking I was back at LR by 2:00. And I had to sign my name so many times I have Carpal tunnel. Kidding not kidding.

    Learned of an incident that is kind of unprecedented with us someone messed with my head of transcription Tina and it's easier to cut when you've been cut. Learning a lot about workman's comp and unemployment these days in addition to Visas it is kind of a lot but we can handle it we are a family and we are strong. 

    Eh I could say more but I'm tired as hell. Maybe this weekend. Looking forward to having Cindy and her husband and the Sanders over tomorrow night and there's a Boulevard cocktail class Saturday I invited Laurie and her new pandemic friend excited to meet her. Lots of people over for the weekend more than I've done in a year. Gonna wind down now. Much love, Elizabeth

    

Surprises

     Ugh I got assigned to breast conference again tomorrow *sigh* but I'm there for all my surgeon pals and I texted Becky today cause I'm helping out with one of her friends and she will be there tomorrow too. I'm going to be there for everyone except breast rad running it I've done lots of dirt digging over the past two weeks and . . . surprise surprise . . . there's dirt. Sharing widely amongst my circles. But Oncolens still gives me panic attacks I will be there too early to make sure I can share the pics I took on Cecelia's old shattered phone today. Then AirDropped to mine. Now I need to try to remember how I got them to my computer because I know that my work gmail won't take large files (or small files, or hardly any files). 

    Been talking with an orthopod over at UAMS this week who thought he was doing a knee repair and uncovered a surprise ugly as hell tumor. Part of our QA is that we call surprising findings and I could tell by reading his op note it would be a surprise. He marveled and said there's no history I told him today that every stain I threw at it was negative doesn't look like carcinoma I'm going to rule out melanoma overnight but I'm worried it's a sarcoma got the block to send to Jesse tomorrow up at Cleveland Clinic if I can't figure it out. I talked to Jesse last week. He cracked me up. He said that if someone told him when he decided to have kids what all he was in for he would not have believed them. He said that they have started putting Prozac in the house tap water - facetious or not, I'm not sure, but no judgement here. I spent two hours dealing with kid issues today and it kind of threw me off my game but I think I supported them well. Seems like kids cook along fine for a while and then they need the shit out of you and when both do in one day it's emotionally taxing. 

    When I was little I had a rich imagination. I certainly never dreamed I'd be a pathologist but I'm not sorry I ended up here it's mentally rewarding and certainly pays the bills. I don't think this is my be all end all though. I might stick around part time forever, but I was studying Andrew Weil's integrative medicine fellowship a few months back (I almost signed up in October that would have been batshit crazy with all I've got going on) at Arizona you can do it all online and it looks amazing. When I was unboxing books a few weeks back (it's a never ending process) I uncovered a prototype of his tome Spontaneous Healing I have yet to revisit. I read the other month about an OB up near Bentonville who did the fellowship about a year ago she's starting a huge integrative medicine practice with doc services and yoga and lots of other things to address the whole person, not just their parts.

    I'm not sure what a non-clinical doc has to offer in this arena if anything but I'm excited, maybe over the next year or so, to try to find out. Happy Tuesday. Wish me luck at blasted breast conference tomorrow. Then I go to Conway on Thursday for a 7:30 frozen and it's just in the nick of time I've taken over that hospital clin lab directorship from BDQ and Misty keeps emailing me I've got lots of stuff to sign. BDQ is recovering at home and we are making him listen to his doctors and not his ego. Lindsay turned down the job - back to square one there. I'm a firm believer in fate and destiny and non-attachment so open to the next chapter despite having to buckle down on the work. Starting up Doc Mom Book Club again Kricia and Natalya and Becky are joining so excited. Hope your week is going well. Much love, Elizabeth