Gross Room

     I was watching a taped version of Mandee Novack's talk on CLABSIs, you know central line associated blood stream infections, this morning around 10 am while waiting for slides. They have these physician metrics that you have to meet every year and they tie it to reimbursement somehow and it's always really boring for us pathologists because nothing is very pertinent it's all for clinical docs not lab docs. But all my partners have been talking about how great it was. This is her second one, and I just texted her and said girl you gotta stop knocking it out of the ballpark or they will make you do every one. She is seriously engaging and entertaining and has the ability to summarize massive amounts of data into useful information that's super rare in my experience. She said aww thanks I was glad to get that one over with the subject of CLABSIs is about as boring as watching paint dry. Not if you tell interesting stories to make it meaningful and have lots of gut churning pics (for a pathologist anyway - give me parts and dead bodies over live patients any day) as examples of bad insertion site maintenance. 

    I paused it when I got paged to go to the gross room for frozens. It was Muesse, a pleural rind, and I couldn't find anything malignant. I looked real hard because last time he was so incredulous there was no malignancy I looked again and found a tiny focus of probably cancer and called the OR back. The next day I was sweating bullets bc it got cut away on permanents but luckily he sent more pleura for parts B and C and it finally showed up in C. I showed it to Hal and he was like wow! You got so lucky! I cannot believe you called that flat out on frozen but you are right it's there so subtle. 

    While I was waiting on Jessica to stain - he sent two frozens so I decided to hang out and chat in between, I noticed Laurie grossing in a large leg. It looked kinda good so I wondered aloud why they cut it off. They had done multiple revisions of an ankle fracture and she was still in pain. I said that's a lot of leg for ankle. Laurie cursed when she could not get around a metal rod and Jessica from the stain line wondered if a bone saw might help.  I wandered over to Jessica and she said there was a blue light special on legs this week, everyone is doing legs. I looked in the glass front fridge and saw a big pile of legs - they put them in red plastic bags and tape them up. Lotsa legs.

    Jessica told me one guy came into the ED and had a history of a remote motorcycle accident with lots of surgeries on his tibia; his whole foot was red and swollen they took it off. She said oh my gosh most of his tibia was eaten up and hollowed out like a tree trunk someone had sawed into and I'm surprised he was still upright I would have thought he would have keeled over. Here I got a pic I've never seen anything like it. I looked and think cross section of a leg but not very clean there's ragged skin and lots of bloody meat and in the center the tibia looked like 4/5ths necrotic dark brown goo I have no idea how it was bearing the weight of a human without snapping like a twig. She said another guy must have been sitting home alone for a year the leg was so rotten. Anything else? I wondered.

    Oh we got an apple from the anus! I was like what???!! I laughed incredulously and said I sure hope it was a crabapple! She said no it was not and she eyeballed it grossly for measurements and description she did not touch it or look for a grocery store sticker but her guess was a large Mt. Fuji. I commiserated, not sure I'd want to touch that even with a glove. People are sure interesting. Happy Wednesday. Much love, Elizabeth

Edited to add I picked Pele today. The awakening. Very cool meditation sequence it reminds me of my last one with Lisa in Colorado a bit. I'll have to try it.

Call Monday

     Ugh it was a doozy. When I came in this morning Tina handed me a stack of cases to take pictures for for ENT tumor board tomorrow. I said I think it's Staggs' turn? Unless that changed last week? Sure enough he took off last minute. I just finished editing necrotizing granulomatous tonsillitis pics with Histo on the GMS and diffuse large B cell lymphoma of the thyroid. I told Trip Mishra last week on text I would help him get to CARTI tumor board this week too, even though I'm not assigned - he was texting early Thursday morning that he was lost. Two extra tumor boards. Oh well. 

    Then since cases were coming out slow and I thankfully had no frozens I set out to do my quarterly ABP test, which takes about an hour or so, and is a complete waste of my time. So much so I have frequently considered just guessing and not googling and trying to find the answers but I'm too competitive for that. We have cumulative stats and as of today I'm nine percent above my peer average, at 89%. And I'm not sure how I went up a percentage point today because I missed a lot of questions, including the first three of 25 which gave me chest pain. Luckily the next two were softballs and many easily googleable but I missed a lot. I'm pretty sure I've never picked peds path in my assessment design but I had three pedi path questions including one on congenital epulis of the newborn give me a freaking break! And one question asked about what an ED doc would do with these labs and another what category does this oncologist ethical question fall in and they were intuitive but left me thinking what kind of crazy lab rat am I for whose freaking study on my work time. One question near the end was a repeat of one I missed and I was like how stupid do you think I am. They are measuring repetitive learning in questions completely irrelevant to my practice. Give me a lit review of something pertinent to read and ask me questions about it any day - this is pure hell. It's due Wednesday. They overly frequently remind you to do it early in the quarter but I always procrastinate.

    Then I'm on this e-mail thread with a CAP inspection officer and NLR lab director and our hire to travel and assure lab compliance Mary and two docs in DeSoto Mississippi whose inspection was due last August (we were supposed to inspect them) but then Covid. In March CAP officer said let's pick a date and I said I'm the new CLIA director for Conway and our inspection window is May 10-August 9 so after August we could do it I need to be here we've already sent blackout dates. The docs in DeSoto said we have CLIA coming in August and it's our first CAP inspection and we need it done before August. Dilemma. CAP said (today!!) OK Dr. Seng can you plan it for April. I almost blew a gasket. I emailed back to the group that I have done many inspections, and had always had a six month window to plan and expected no less during a pandemic. I sent a respectful but assertive email, but honestly you'd think she was asking me to perform magic or something. I said it takes a month even to assemble a team and we have med tech shortages in NLR and med techs on medical leave and a pathologist shortage and call and work schedule to work around so not a possibility. We are donating our time here. Required work comes first. CAP officer sent me a sweet private email requesting a phone call at my convenience to discuss possibilities and I said sure ASAP on a day much less busy than today I'd let her know when it works for me. 

    I won't even touch on my friend I'm helping in a lawsuit or my daughter's college issues today it's too much I'm ready to wind down. I got home from work and I'm not sure if it's a physical issue (EGD and colonoscopy should resolve that at the end of April fun vacay plans) or a psychological one (Yousef thinks so it always happens at the end of a hard day at work) or ascension sickness (that's my own theory I googled it a few months back) but I puked my guts up right before this blog. For the first time in a while. Turns out, corn lasts the longest from a lunch of chicken tortilla soup the rest was just bits and pieces of what I like to imagine, as I'm hurling my guts up uncontrollably in the kitchen sink, is ancient soil. Hope your Monday went better than mine. You have to laugh, though. Much love, Elizabeth

Seller's Market

     Did I mention I sold my house? And we signed a full price back up offer this week if the first full price offer falls through. So different from last year. I have read that it's a seller's market but we really experienced it when we put our house on the market and had 7 showings the next day. So grateful for good renters who have been taking care of it and are dealing with all of this so we don't have too.

    I think I'm finally acclimating to the altitude on the day before we leave lol. My body sure told me, in more ways than one, that this is not an active vacation for me I've been on the couch reading. I've had Angels & Insects on my bookshelf for years and finally started it I'm a little ways into the first novella and it is fascinating. The story and the protagonist, anyway, when the guys start pontificating about religion I get a little glassy. The protagonist is a naturalist, and I just love that. He gets lost in beautiful descriptions of ants and butterflies. Looking forward to reading more on the 12 hour drive to OK City tomorrow.

    The girls and I have a spa afternoon planned so excited. We booked massages and have the use of all the spa amenities throughout the afternoon. I've been to Elevation Spa before and can't remember their exact amenities but I'm sure it's luxurious. It's Mary Margaret's first massage so excited for her. C hasn't had many either. Planning in town Ryce for dinner it's one of our faves. My third venture out of the condo this week lol.

    Susi Jeffus texted me this morning and was wondering if we were still looking for a pathologist (yes dying for one) her chair interviewed a guy and made an offer his wife is finishing fellowships hemepath and cytopath trained (!! As Kelsey Forcum would say Yay say Yay) and would we tackle Visa issues? I told her to pass the info along we are definitely looking and would love to interview her. I texted my partners and everyone is cautiously optimistic. Susi said as soon as her chair and the guy they made the offer to come to a decision she will share her CV. 

    So despite the fact that every aspect of my physical body seems to be betraying me things are looking up. About to pick a card from The Goddess Oracle deck and book set Lisa recommended I bought it a few months ago but stalled out after I picked Kali. She recommends daily which I vow to do - yesterday I chose an Irish goddess Maeve. All about grounding and responsibility and authenticity which I need to gravitate toward right now. The meditations are a little too intense but it's fun reading about the goddesses. 

    Lisa taught me a grounding meditation yesterday about pretending your feet are roots connecting to Mother Earth. Well my roots shot directly to the molten lava core of the planet and despite the fact I hadn't plan to journey - was only getting Reiki - I traveled to the Underworld on a pterodactyl's back to prehistoric Earth. We flew over bubbling volcanoes and lush Amazonian jungles it was amazing. Who needs acid when you've got Lisa. Hope you have a wonderful weekend. Much love, Elizabeth

Edited to add I picked Bast. Love her.

Altitude Sickness

     Snuck up on me and kicked my ass today. I'd never experienced it before so I didn't know it was a thing and kids and S were skiing so didn't know my plight. I was sweaty and lethargic and in and out of consciousness so much it reminded me of when my best friend from med school Alyssa shared the story of how she was so sick in Africa they put her in a death hut and rats were nibbling at her. Luckily I was in an ArBnB not a death hut but I was in anguish. Thankfully my body knew what I needed even though I was thinking food poisoning I yelled at C for water late afternoon and finally started to heal and gain strength. Not enough to even bathe but enough to go to the couch and watch the college admissions scandal doc on Netflix (I was so addicted) and start Behind Her Eyes which was a C recommendation that we are now glued to - watched the first two episodes. A friend told me that as you age altitude adaption is more of an issue, well I'm aging for sure. He takes disposable oxygen tanks good to know for the future but lots of water righted me again.

    So hopefully now vacation can start I've burned two days sleeping and feeling way too sick but the Borg's came over last night and I freaking love Laura she's a ton of fun. Cute, quirky, Bernie fan. We got along really well. Tomorrow planning to cook for family so they can hit the slopes then walk to the grocery for a few items and shop in town in the afternoon. Need to book a spa for me and the girls Thursday afternoon. Planned to do that today but holy hell. Hope you are having a good week. Much love, Elizabeth

I'm So Excited!!!

     

    All packed up - books and candles and all - just need to pack an overnight bag in the am. Daniel and Mary invited us to stay at their house in Amarillo on the way there and way back they built a mansion since I've seen them last cannot wait to see it. And my niece and nephews, been missing seeing them grow up. Lucy and David and Henry. They are so grown up on social media. 

    The ides of March happened this week it made me think of Tommy. More good memories and he passed in 2008 but I will never forget him. He was poised to be a superstar he looked like a movie star and flamed out way too soon. Addiction and mental health issues are just like cancer. Unfortunately our society deems them flawed and their parents flawed for their struggles it's not ok. Kudos to all the good mommas and dads that are trying to help and support them it's not easy. 

    I had a weird breast cancer case that looked lobular and stained that way but there was a 2mm focus of clearly ductal it looked like a different cancer. Melody helped me with it and the dictation was lost but Janet found it and I managed to get it released before 5:00. The pathologist tasked with reading out the hormone receptors and the Ki-67 and the Her2 ISH when I am off next week will be super confused but hopefully my long comment helps. 

    S and J are picking up Aiden at the airport and I'm waiting on Taj Mahal BiteSquad. C is working at All Aboard. We won't leave for CB until around 8 so I'm hoping everyone will be comfortably packed by then. Jack had his three new friends over today and they had a Brazilian cheese bread competition - he and one of the girls - and he was frustrated that she won. Mom, he said, she used tapioca flour not yucca and her base was more watery and she put it in muffin tins but I thought mine was better. I didn't taste hers (apparently C is hoarding it) but I told him his Brazilian cheese bread wins for me every time. S saw them watching Harry Potter on the couch and told me they seemed like really good friends to J. He needs those. Hell, we all do.

    Such a wonderful lunch with Valerie in the Dr. lounge she was awed and I was embarrassed (drs do not deserve free food I told her. Kind of like swag bags for celebrities. Fing ridiculous). Introduced her to the server Shay is her name and she had her 34th grandkid yesterday. I did a double take "Did you say your third or fourth?" Nope. 34th. That's kind of amazing. She showed off the Facebook pics of her newest grandkid. Valerie was incredulous and I was happy she was so sweet to Shay, she's my new favorite person. Besides Kimberly.

    RIP Tommy. He's out there watching over me I just know it. Stay safe, much love, Elizabeth

The Hand

     So I had a POC today with a hand, the second one I've ever seen. So cool I shared with multiple text groups and I was hesitant to share on social media because POCs are so political these days. We require a permit to process fetal tissue under 12 weeks, which this was, bc of the legislature. And then there's the sensitive issue of miscarriage, I don't want to trigger anyone. I reminded my alarmed daughter that nature takes it's course - if there is a miscarriage it is usually because it wasn't meant to be viable. All my path friends were geeking out. It invokes awe. To anyone who doesn't believe in higher powers, I think it flies in their face. 

    Today was emotionally challenging in more ways than one. Cases hit non-stop starting mid morning and there wasn't much room for air. I was excited when my daughter texted that she had a dr. appointment, I got to see her, but got stressed when she became anxious. What is it about teenagers? They can be cool most of the time but then their world is ending and you have to be careful not to get dragged down support is your job but holy hell. Parenting is a job. 

    Christy and I are planning the mid May Chicago trip I'm so excited I can barely stand it. We got first class plane tickets this morning for a steal and she shared a bunch of hotels yesterday we chose EMC2 it looks eclectic and sciency and artsy so cool! Right on Michigan Ave. 

    Another tumor board this morning, CARTI general, and Diane presented a bunch. I chatted with Matt Steliga at it's conclusion he told me he helped Muesse with the flap, on the exposed heart, last night they used the latissimus dorsi. Praying for a good outcome. I discussed a crazy rare case I had last week Bandy took out a boggy uterus he thought was a molar preggo but it was all in the lymphatic system. Invasive hydatitform mole. I'm not sure I even learned about that in training but it was unmistakable Shaver agreed so I signed it out she needs chemo maybe 20-40% metastasize OMG. 

    Tomorrow is my last day for a week I'm taking a micro tech Valerie out for lunch so excited. Then driving trip to CB with multiple teenagers someone shoot me JK. Looking forward to lots of time in the condo (it has a fireplace in the center with glass enclosure in the living room) maybe write that Melnik article finally and get some reading done while the fam and friends are skiing. Hopefully snowshoe. Definitely partake in the good food options. Hope you are having a good week. Much love, Elizabeth

Post Call Tuesday

     ENT tumor board was this morning and was continuing to wow people with exposed heart video Hays and Sims were awed and I showed it to the guy sitting next to me I saw he had signed in as Phelan DDS. I asked if he was Tom's dad (he looked younger) he said no that's my brother do you know Tom? I said I know Kristi I graduated high school with her at PA back in 1990 where there were only 40 in the class. We don't keep up much except for reunions but she's in Dallas right? And your brother did my brother's braces and Tom did both my kids. He smiled and said he often gets mistaken for Tom's dad and thanked me for making the connection.

    Jason is texting right now he's going to flap tomorrow he wants to present it at tumor board and I told him to lmk when he does I'm assigned this Thursday but we rotate general CARTI and I will show up even if I'm not assigned to discuss the path. Speaking of, I promised him pics and I finally took them today with C's old glass shattered phone and I was really frustrated bc I tried to AirDrop for 30 minutes and couldn't wondered is it WiFi (lab basement office often sucks) or am I missing something? After I consulted tech savvy Melody and she verified I was doing everything right it happened to go through. Doing nothing different than I had done for the past thirty minutes. Technology ARGH.

    And it was that kind of an afternoon after a pretty smooth morning I got really frustrated trying to reup my CAP membership (their crappy website link was on the blink). Then I just got tired. DST catching up I guess I'd been up since 4am. Christy and I planned a tentative trip to Chicago in May that was fun. I can't wait to check in with my bro and sis-in-law - who relocated during the pandemic - and make restaurant reservations. 

    Toe is still giving me hell I'm problem solving by trying to hide flip flops with long outfits and giving it air I think I need to do intensive treatment for dry skin tonight. I like Burt's Bees foot cream Christy recommended olive oil and almond oil but Burt's Bees soaks in overnight there's no clean up job required in the am. I think I still have some even though I haven't used it in years. That's about all I've got, none very exciting but oh well. Here's to the almost middle of the week. Leaving for CB Saturday so that's exciting as Hell. Looking forward to snowshoeing and spa-ing and shopping and eating. Happy Tuesday, much love, Elizabeth

White Russians

     I was addicted to White Russians and Buttery Nipples in my 20's so when I learned from my Super Girl's Survival group that CutWater made a White Russian I was so excited. Before I even bought some Christy fed me two the morning after our sleepover and since BiteSquad didn't deliver until noon it was on an empty stomach. At 14% alcohol they knocked me on my ass and I napped for two hours. The guy at the liquor store said CutWater also makes a Mai Tai that is 12% alcohol and I've never had one of those to my knowledge but I'll have to try it.

    Jason texted me last night about the exposed heart - asked me if I would sign it out Monday so he could take her back to the OR and flap her. That case has been the talk of the week in the Dr Lounge, OR, etc. I got it yesterday and despite numerous docs pontificating recurrent cancer in the charts it was like I suspected - ulceration and gangrenous necrosis with stromal radiation atypia. Did some stains to prove my point and look for weird bugs but there were none it was all bacteria. 

    The cancer doc who admitted her upon presentation to his clinic (with a 4-5cm hole in her chest! To her exposed beating heart!) was an oldie and goodie Supercoop. That's what we called him in med school, David Kuperman, he was crazy smart at the top of the class. Then he got his first B of his life on rotations I remember he was so mad but turns out book smarts don't always translate to emotional smarts but I've talked to him, he recently relocated from St. Louis to CARTI, he seems to have mellowed since then. Married a nurse. Has two young girls. When he calls, he keeps me on my toes he's one of two docs on campus (Khan is the other) who understands immunostains and will challenge me with my thought process. Makes work more fun.

    Ok I'm halfway thorough a White Russian so I'm going to go chill and take a call Saturday nap. Got lots of random art from Rennie - she slept over last night - in my office, which is a WIP I'll share pics when it's done. I made three organized art drawers just for her and she obviously put them to use this morning as I was sleeping in after being up in the night. Happy Saturday. Much love, Elizabeth

Epic video

     My hours are super awkward right now. I was up at 4:30 am yesterday cleaning the fridge. I hope to wind down with this and get back to sleep for a couple of hours before work, but I have to share one thing at least. It feels wrong to post, but I will save it forever in my phone. Jason Muesse, we have been new text friends over the past couple of months, has amazing cases. There was one of a young guy that had a giant hemorrhagic lung mass that even Cleveland Clinic couldn't figure out. I asked him how the guy was doing last week at tumor board and he said ok. But two other docs were trying to talk to him he seemed distracted.

    He texted me yesterday a video of a case he was doing I was talking to Staggs about C's bday - he had agreed to cover if there were late frozens (which happens a lot more lately with the advent of Sims) so I didn't look right away but when I did I almost fell out of my chair. This woman had a remote mastectomy and she had a hole in her chest wall - it was rimmed in greenish soft material. I could see the EKG lead on her - looked like she was in pre-op. It had eaten through her pericardium and her heart was beating in the background. He texted, "that's her heart beating back there." It was haunting, and chilling. He asked me to take the case and I said absolutely I'm on call and head of the gross room I can call Jessica and direct it to me give me her identifiers. Differential diagnosis - radiation necrosis vs. recurrent CA. 

    I ran to the gross room to see the specimen and show the girls the video they were equally awed and Jessica told me that since it had bone (rib) attached she would have to fix it o/n it won't be out until Friday I said that's fine. I can make it a go for Saturday since I'm reading out then. I shared with Jason. Michelle, one of my new hires, said I've never seen anything like that it's like TV. I said, no, it's better than TV. A window to the heart. We all wondered how she was walking around like that. Seems like you might get a deadly infection.

    Later, after I picked up my daughter's cake and petit fours for the secretaries, I wandered around and showed my partners. They all were equally wowed and intrigued. I told Jason on text and he sent me more videos and pics from the OR of the WIP. We're gonna have to flap that, he said. See the gray area? That's exposed left ventricle. Please ignore the Strawberry Wine song in the background. Well I only heard static that's the state of my music these days freaking Satellite Radio is not working and NPR is not a good back up I don't want to listen to randomized controlled trials on the way to work or stories about euthanasia I just want music and Little Rock radio sucks horribly. Need to problem solve this weekend but in the meantime I'll probably listen to Spotify on my phone, which I have repeatedly tried to sync to my car, having been successful in the Forerunner in the past (I'm not a complete dumbass) to no avail. Even Jack failed. But I diverge. 

    90's country is a genre (he said that was the OR theme) I cannot relate to so I just haha'd I've nothing to say about that. But those videos. Exposed heart beating. Patient living through that. I promised to reciprocate with micro pics no matter how boring or bland. By the look of it I'm betting radiation it did not have a cancer look. I texted Fraley today about his parotid Melody showed me. I guessed on gross it was a Warthin and I told him that I was happy to be right but there were a lot of epitheliod granulomas that was bizarre and GMS highlighted possible histo so I told him to get serologies. That's not a COW that's a COY both are. Cases of the year.

    Medicine is endlessly thrilling. Had a nice blended family dinner celebration. Even my ex was wowed by Jason's video. Quinn was texting me about it after work - it really leaves an impression - and I shared him some of the new intraoperative pics Jason sent. Looking forward to reading it out at the end of the week. Hope you are having a good week - it's fing long as hell but I'm starting to see the light at the end of the tunnel. Much love, Elizabeth

Frankentoe

     I finally took a shower today for the first time in almost a month! It was nice. Bathing, while awkward, was more enjoyable than I thought it would be. And I got to use all the bath salts I have collected over the years intending, then failing, to bathe. I loved the idea of wandering around the house lighting candles and getting caffeine while "drawing a bath." And I'll do it again, every once in a while. My friend Becky, the teacher one, has this fancy wooden contraption that spans her tub rims horizontally that has a drink holder and soap holder and loofah holder and even book holder those are crazy bath goals.

    Nurse Jekyll and Hyde told me not to wear real shoes for a week and bandage tightly to prevent swelling but I've been testing the waters and either she's overly conservative or my toe is a prodigy or she's full of it. It still looks like hell - surgical scars and all. Strangely, my entire foot molted like Spotty Dangerous' skin when I took the bandage off. Skin sloughage in abundance. I wondered, moisture build up from sweating under bandages? Who knows. The baby toe is still quite scaly despite generous lotion and that is more of a correct reason than swelling at this point to keep it bandaged. Today I braved my socks and boots and thank goodness it was OK. It was a day. Worse than Monday.

    I headed to Conway for early frozens for a Fraley case that was supposed to start at 8:30. It started at 9:40ish - his nurse poked her head in to tell us he would bring the specimen soon. Funny, I've met and talked to Kirsch and Marrero multiple times over the years but couldn't have picked Fraley out of a lineup until I saw him on the Conway Q/C? Q/A? I lose track and I'm a new CLIA director but he (not me! my camera is covered with a hot pink post-it) was on video and must be the CMO or something bc he was a big part of it. So I know what he looks like, but I've never talked to him, so when his nurse vouched for his goodness I tried not to get too mad when he sent a fresh parotid specimen for lymphoma work up at 11:00. I was not needed, after all. A PA could handle that. There was no frozen.

    And it was a 185 block day, just like yesterday, and I was texting Shaver and he was helping me with cases bc John brought up NADA on the 10:00 run. But Misty had so many questions and things for me to sign it was moot. I was busy. There is much room for change and reform there and I'm excited to do it. Lots of paperwork and education, for me and the techs.

    I jetted back to LR by 11:30 and skipped lunch (lines too long, accidentally got Italian Wedding soup from dr lounge but gave it away bc it is one of my faves but very gluten heavy I couldn't handle that today). Worked straight through and was caught up by 2:30 it surprised me so much I checked in with Shaver and texted Fraley - we are new today text acquaintances - that I was no longer in the weeds (he called me while I was in the middle of emergently dictating a Hagan's case at noon - that's a story for another time). We were chatting amiably about intraoperative parathyroid hormone turnaround time and how to make it better. 

    But that Marotti case still hadn't hit my desk and I went to all my partners they didn't have it either so I checked in with Jessica and she bird dogged it. She found, at 3:30, ten trays including diagnostic GI's and lungs and livers and transplant heart biopsies and Marotti's case in a Conway box I didn't even know existed. I'm not a yeller, but I called the head of histology and told him what happened and demanded accountability and course correction. The shit was hitting the fan and everyone heard and Shaver and Melody and Staggs jumped in to help, while I was working up cases that I should have had on the first Conway run, some of them rush.

    Let me put this a little bit into perspective. We are so fast with our turnaround that we spoil our clinicians. Most of this, while certainly important, is not life or death. An extra day won't hurt. But we operate a tight ship and when a part fails it's kind of a big deal. Tara assured me she would shore up the new histotech on distribution (she's amazing) and that we are getting a night shift next month, which will be a huge relief for us all. But holy hell what a roller coaster of a day. And it's only Tuesday. Here's hoping tomorrow will be easier. It's my daughter's 18 BDAY!!!!! I've got back up coverage plans we have a blended family dinner at Ocean's at Arthurs and back at my house for cake and presents. So excited. I've spawned an adult. Hope you had a good day. Much love, Elizabeth

    

Call Monday

     I got a call from Dr. Marotti's nurse this morning - he's a general surgeon. She wanted me to bird dog a gallbladder he just finished on a 41 yo male. Scott is a gregarious guy - I remember meeting his wife long ago in training she is a neonatologist at UAMS and we bonded, bc, my dad. I bumped into Scott last Friday and he said, Whoa, is it wear your pajamas to work day? Not that that's bad? I was a little taken aback but I smiled back and said Well it is casual Friday right?

    I was looking at myself in the mirror later after using the bathroom and well I was wearing a headband and had a plaid shirt dress on and flip flops bc toe bandage but I was really going for more of a 90's grunge look, not pajamas. And hell he was wearing scrubs aren't they the quintessential work pajamas? He's so nice though I didn't take offense but when the stunning Amazon nurse in the bronch lab later told me how amazing I looked and how I always had such a great sense of style and I thanked her I was honestly a little relieved.

    Anyway the nurse said the omentum was really weird he sent me pics can I send them to you? Of course, I gave her my cell, told her I was on call would have the gross room assign the case to me and text her tomorrow when I got it. Jessica called me over to look at the gross specimen. It was very underwhelming. I showed her the OR pics they were a little confusing not scary omental caking like in ovarian tumors but definitely at least hypervascular. I need to find Scott tomorrow to ask him about it.

    185 blocks today that's a lot even for a Monday. And of course the big dump happened at 12:30. At 11:00 I was called to the gross room for a frozen for OMG frozen king Sims. Just one? I was relieved. Lingual nerve margin it was negative but he promised the whole specimen would be forthcoming. As long as it is after 12 I'm good. Jinx.

    I got called to the gross room at 11:50 by Jessica she had a frozen from Jason Muesse he's a super nice thoracic surgeon we have texted about complex cases in the past. It was a pleural rind and I was looking at it and talking to my friend Laurie who was on lunch. I called the OR speaker and told him it was just chronic inflammation and fibrosis and he was so surprised "I thought it was cancer!" that I took a second look. GD. I found a tiny 2mm focus of apparently malignant cells. I called him back and said based on your surprise I took a second look and I think it's enough but we are going to have to do stains to work out meso vs. carcino and etiology. Then I went onto the shitload of Sims frozens (b through J I think that is a record for me for one case at Baptist) thankfully they were all neg.

    Eating lunch (roasted red pepper with gouda) Jason was texting me gratitude for taking a second look at the frozen and I sent laughing and despair emojis lol I should have gotten it right the first time. He said pleura is hard and he's right, it is. I abandoned a dentist appointment in near panic attack this afternoon. SO. MANY. CASES.

    Quinn came back today and I was so happy the morning mood was super festive at PLA. He gave us partners all gifts of stationary and pens, all personalized, very thoughtful (probably Ginger influenced) and wrote a heartfelt thank you to circulate among the partners. He looks great, same as always. Sounds good too. I had a bit too much of a stressful afternoon to chaperone his exit but I'm sure someone else took care of that. Happy TG Monday is almost over. Much love, Elizabeth

    

Bronch Lab

     I went to my second bronch today and the first was Cidney he's a frequent flier but this one was Nutan Bhaskar he hasn't done one in months at Baptist. He's very kind and soft spoken I bumped into him at the Racquet Club a few years ago we talked about kids. He said there was a thyroid mass and I asked him to repeat himself (mask) to make sure I understood thyroids are in CT not bronch. So I'm looking at the smears and the picture was so confusing clumps of epitheliod cells. Maybe thyroid? The patient was already sitting up the procedure was over I'm trying to take the stairs now so I'm a little late to the game bc still slow. I looked at the second one as was like maybe? Colloid on the edge? Watery though no coarse chunks. I asked my tech Tony what he thought.

    He course corrected me this is 10L lymph node not thyroid we all had a big laugh and I told Nutan he probably had a met to a lymph node epitheliod cells, no matter how bland, don't belong there but I wasn't seeing background node so I hedged. I was writing my diagnosis on the requisition and Tony was chatting about a new obsession with ROMER Italian wood carvings I said I'll have to look those up. He sent me pics of a bunch of men I asked if there were any women, they are interesting. He sent me a link to some women, not as many as men, he said, but there is a woman doctor one I am interested in purchasing. They are funky in a way that reminds me of the wooden Santa S's mom got us for Christmas with the incense pipe.

    I have a friend whose daughter has a roommate at FVille. The daughter discovered her roommate aspirating this morning in apparent OD. She had the wherewithal to turn her on her side and sweep her mouth and get her to the ED. She probably saved her life, I told her in text. I have told my kids to get an adult immediately if there is any unconscious kid at a party but haven't told them what to do if someone is aspirating vomit need to remedy that. Apparently both her kids saw the episode of Breaking Bad where someone died after aspirating and it left an impression. She's heading there to support her daughter, who is understandably shaken as shit. I'm so proud of her for plugging in and her daughter for doing the right thing. Sometimes the things that rock us to our core grow us and send us in our life direction.

    I accidentally sent a group email to the larger book club last night that said our meeting was on Friday, not Saturday, and when I checked my email at 7am I got lots of confusion and declined invitations. I apologized profusely and corrected my error there are at least three that said they could now come so I'm excited. Forgetting bdays, sending out wrong dates, teenager issues - this pandemic is brutal. Can't wait to see those who can make it tomorrow night and catch up.

    So happy it's Friday it's been a week. I start a week of call on Monday and as far as I know BDQ is supposed to return on Monday, albeit abbreviated in responsibility, and if that happens we are going to throw a big lunch pizza party for PLA. Kimberly is diving into her new job with fervor and asked me about another position for her daughter that Rick from histo was mentioning I said we love and absolutely hire family I will review her resume and get with Rick and Shaver on Monday. I am loyal to anyone who appreciates a good opportunity. We are a somewhat small business we have 50 employees but we are like family and when we get a good person they stick and they rise we love to offer help for further education and salary advancement for anyone motivated we will not be sore if we can place them in a better job in the community as long as they serve with dedication. Passion is a plus. Kimberly has a ton of passion I love welcoming her into our family. Happy Friday. Much love, E

    

    

I'm Pinless

     Nurse Ratched turned back into Nurse Empathy today I was relieved because I was having a little bit of leftover gluten issues requiring afternoon GasX and was also having pin removal anxiety. I assured her I had a high pain tolerance but the idea was so disconcerting. She agreed it was disconcerting to many and reassured me. Burkes had told me earlier 99 out of 100 patients are pain free but occasionally one required a block. That involves a needle so I vowed to be part of the majority. So I reclined on my elbow and she grabbed the hemostat and I looked away and sweated and it didn't hurt but it was a really weird feeling. I gasped near the end and she slowed down and asked if I was ok before the finish. I said yes. You know that feeling you get right before the champagne is uncorked or right before the biscuit cylinder pops after applying pressure with the spoon handle? Imagine that but with a pin being pulled out of your bone. I was imagining marrow and all the anatomy. Then pop it was done. Whew. Now I can get it wet and pedis are allowed in a week. My biggest regret is that I didn't get to show off all my laminated card stock. 

    I'm hosting doc mom book club this Saturday so excited. We are reading I'm Still Here etc. etc. by Austin Channing Brown it's really good I'm halfway through it's kind of like a serious version of Gabrielle Union's We Are Going to Need More Wine but with new lessons. I invited three new docs Kricia and Becky Steward and Natalya so hoping we get a decent turnout. It's weird - hosting during a pandemic although I'm sure we are all vaccinated - the weather is a little chilly so will have to have food indoors but do we wear masks or not? I guess I'll leave it up to my guests. 

    Today was slow thank God that portends well for tomorrow but I won't count my chickens before they hatch. I was up at the ridiculous hour of 4am and left the house at 6 and got donuts for PLA and the Clin Lab. Tumor board went well. As I was headed to lunch - have I told you about all the amazing new soups down there in the Dr. Lounge? Chicken enchilada and chicken tortilla and roasted red pepper with Gouda and cheesy broccoli it goes on and on. Anyway I brought some leftover PLA doughnuts to clin lab break room and bumped into Linda and another tech. I was lamenting my glutenless status.

    Linda, from hematology, told me her pandemic angst was manifesting as high blood pressure. Her grandmother passed December 26, and she was charged with getting rid of all her things, which were plenty! She had to rent a dumpster and put it all in. The other tech, I don't know her name, said her great grandmother died on Christmas Eve and they still have two packed storage units to go through so daunting. She said I kid you not I opened an ice cream tub the other day and it was full of rocks. Probably some rocks some grandkid collected in a creek and gave to her as a present but Lord this is so stressful.

    I laughed and reminisced about my Aunt Genevieve's passing a few years ago. Uncle Chuck had to get rid of so much stuff she was a pack rat. That generation was, I said, because of the war. It made me wonder later as I was waiting on the elevator what strange things are our grandchildren and great grandchildren are going to have to sift through as a result of this pandemic. Masks, certainly. Lots of toilet paper hoarding. 

    Linda said one of the things she threw away was a tub of buttons! So many buttons. I laughed and said that reminds me of a game my Grandma Loretta used to play on Christmas Eve when we were kids and we all gathered at her house, then condo. She had five kids, I told them, my dad was in the middle there were so many grandkids. We always played hide the thimble, she was the hider lol. What a way to occupy a bunch of grandkids so you can enjoy your evening. We were serious as shit about finding that thimble alliances and enemies were made over the course of the holiday evening waiting for Midnight Mass. Linda said I'll bet she had a whole tub of thimbles. I smiled. Guaranteed. Happy Friday Eve much love, Elizabeth

New Hires and Good Friends

         So when I got home last Friday S told me his mom wanted to do dinner Tuesday night. Alternately, he wanted to take her out to dinner. I was like OK, for what. He said for my birthday. Facepalm. I'm not a forgetter of birthdays, but I forgot, and was thankful he told me before the weekend because I had a lot of planning to do. That obviously could not involve Amazon,  bc I was too late. I said of course I will take you out to dinner, and kids joined. He's a textbook introvert, but loved celebrating with just us and kids and his mom. 

    The sleepover was a blast, I want to do it again, but without gluten. I did another glutenfest - hush puppies and naan and fried catfish and onion rings - Christy has her finger on the pulse of bitesquad. Not blaming her I asked for it but Monday night was hell on the couch my daughter had her friends over for Foco/goco (friend homecoming goodwill theme) and I couldn't even interact I was in such pain. 

    Christy had obviously put a lot of thought into the surgical shoe decorating. She shunned glitter, unless it was laminated (she has a laminator- she taught me how to use it) bc she was worried it might seep into my open pin wound. Instead we spent the morning cutting and laminating card stock to fit the shoe - she attached velcro. Liz, she said, you need to adjust the decor to your wardrobe. All the while feeding me this new canned White Russian. 14% alcohol OMG. I loved White Russians in my early 20's it was my signature drink - besides Buttery Nipples - so I didn't refuse. 

    When I first got over there MaryGrace was still hanging out after delivering her GS cookies and they both were kind when a recently purchased bottle of Rock Town bourbon tumbled out of my purse and landed on the floor in a million pieces. It's always nice to be a klutz, MG said, and not a drunk klutz, then when you get tipsy people attribute it to your personality and not your inebriated state. Yeah I'm totally sober and that was a waste of 50 bucks, I replied. Christy pulled out the bread. We wondered why.

    Christy said I cannot believe I am teaching the two smartest people I know something new. Bread is a great picker upper of broken glass, mostly small pieces. Here are two loaves. MG replied that she was so poor and preggo in college she would never have wasted good bread on cleaning up broken glass but once we got the big pieces up it was a true miracle. 

    Work has been crazy intense this week I'm glad it's almost Friday Eve. Lots of needles I've had to call in for backup twice I cannot be in two places at once. Especially with this shoe. Taking the elevator sucks but I'm getting used to it I still miss one at least once a day. They are five they span a bunch of territory if I push a button and one comes up on the other side too soon I cannot get there fast enough. But I've finally learned the direction to go once I get off - helpful for bronch lab and trips to the dr lounge for coffee and snacks. 

    I thought I had a dr appt. today to lose the pin but when I got there it was locked and I was banging on the door I was only five minutes late. In retrospect, it's probably tomorrow I wrote it down wrong on my calendar. Took two of my dept heads Tina and Jessica to dinner tonight for singlehandedly manning their depts over the snowstorm for many days and we had a blast. Need to do that more often. They are so much fun and frankly the backbone of our company.

    In other awesome news I poached a cook from Blvd Kimberly Ogden and she started Monday and she's doing amazing. She texts me inspirational quotes every morning at 6am and she's already winning over the hearts of everyone in transcription Tina is her boss. I attended her job interview a couple of weeks ago to support her it was honestly Oscar worthy forget the Golden Globes. Real people are much more of an inspiration. 

    Happy late Wednesday. Hope your week is going well. Got CARTI tumor board in am so crashing soon. Much love, Elizabeth