Colonoscopy

     So I've taken all 20 of you this far on my journey it seems a little rude not to finish. Christy arrived at 5:45 am in the pouring rain yesterday and got me to the drop off location at 6:14, one minute shy of go time. Then I did one of the most regretful things I have ever done in my life. I peed in the waiting room bathroom. They called  me back (first! The waiting room was full) took my history and started the IV - apparently it was a blood bath but I didn't look so I didn't pass out. It took two people to clean it up and Christy worried post procedure that I might have a bleed - I assured her I didn't - it was still all over my chuck. 

    While the nurses were changing the sheets I was in the bathroom for the first or second time I cannot remember I had completely forgotten I had to, as a female under 55, take a pregnancy test and I was so dehydrated a full bag of saline failed to produce any urine. I thought about getting some water from the faucet at one point and trying to pass it off as pee. Christy asked if I ran the faucet to help unfortunately it was heat operated and I was too far away. Honestly the trying to pee part was worse than the colon prep. In between unsuccessful attempts when I alternately conjured images of waterfalls and privately railed against what Republican body made this rule what if I was? Pregnant? I've had an IUD for 15 years the likelihood is less that .01%. And were they worried about going up the wrong hole? Maybe the anesthesia would be bad. But at this point in my life, if I found out I was preggo, I would be none too happy and if something happened it would keep me from pursuing further action, so it would be a favor.

    At one point I lay in the bed and a cute nurse came in and said I have lots of pee if you need some and I really could have paid anyone in the facility lots of money for pee at that point. Another nurse who gave me her daughter's contact info - she's applying to med school and I said I'd love to give her a tour of my world - said we only need two or three drops. But I was a desert. I closed my eyes and watched the clock and heard at least a dozen other people get their IV's started and their history and they provided urine instantly (if they were female - curse the men that got to skip that step) and were wheeled back ahead of me. But I was here first, I thought. It's so unfair.

    I literally provided two drops (Eureka!) and it was so little the nurse with the short hair and pretty orange eye makeup Miranda was making fun of my cup and I said but I only need two drops! This, finally, an hour and a half after I arrived. I woke up at 7:40 today and looked at the clock and thought yesterday, at this time, I was trying so hard to pee. Thank god that's over. Someone came to inform me what I already knew, that I was not pregnant, and that was my golden ticket to be wheeled back to the procedure room. 

    When I woke up I thought I was in my house, but it was recovery. I was super loopy. I waved over a GI doc who used to round at Baptist - Hey Terence Angtuaco! I'm a pathologist at Baptist. He looked over confused and asked with Maria Porter? and Rob Shaver? I said yeah that's my group nice to see you! He politely chit chatted. Then I told the nurse I wanted to see my slides. I knew the path went somewhere else but I wanted to get them. He said there are pics on the report and I said yeah I know but I need to see the glass. Gotta see the glass. Christy was dying laughing. 

    She wheeled me away in her BMW and we watched the first episode and a half of Pose (highly recommend) and she asked me to volunteer with her at Lucie's Place (dying to). I liked it so much I asked S to watch it with me again last night after a hair appointment and a three hour nap and finally a full plate of nachos. Christy had a bunch of Delicious Temptations bite sqaded in the am but my appetite didn't hit me until 8pm. What a crazy two days. Hope not to have to do that for a while. Happy Friday! Much love, Elizabeth

Anticlimactic

     This has all been a bit so. For someone suffering from GI issues for over a year this day of no eating was actually a break. It's been kind of nice not being a walking wind instrument (Jack hated that analogy, but hey, he's 15 and I'm his mom). Christy had last minute dental plans and I missed hanging out with her but she will be here early in the morning and I had a nice long nap this afternoon.

    Been thinking a lot about patriarchy and attitudes toward women. Trying to support my friends this week and it angers me that their pain is ignored and blown off and their angst is written off as crazy. I've spent hours on the phone this week diffusing this bullshit, which isn't going away anytime soon. I guess I can be a little thankful that as a part of the medical process I can recognize the crazy and help friends who aren't in the inside loop. It still irks me.

    And WTF is up with cis white men and their bad decision making processes that they then take out on everyone around them. This is generic shit I know, but I cannot get into details online publicly. I railed however this morning to my financial advisor, who assured me that everything I told him was in complete confidence. He had some good advice. 

    My husband was wondering what was worse a colonoscopy prep or a work day I can confidently say for me it's a work day colon prep is no big deal I didn't need anything recommended but it was nice to have on hand if necessary. And I like work, but it's nice to have a break too. I told my finance guy today I want to work well into my 70's but part time would be nice if it's an option. With C's finance package for college (She chose Fayetteville SOOO pumped) she will have over 90% of med school paid for hell that's way more than me I took out loans I was proud to pay off 10 years into private practice. 

    My partner's wife told me once at a Christmas party her biggest regret was encouraging her kid to go to Boston for college she lost her. Well C has always wanted to get out of Arkansas but she's more frugal than her dad (if that is even possible) and her visit to Gainesville luckily fell flat. My OB Cindy told me her favorite part of Anna going to U of A was getting Airbnb's and inviting all her daughter's friends to dinner that sounds so lovely I can't wait to emulate. C is struggling a little with working so damn hard and not getting into Ivy League schools. I say fuck that. Have you watched the documentary on the college admission scandal? Highly recommend. Ivy league is a terrible racket. Happy Wednesday. Much love, Elizabeth

EGD/Colonoscopy Prep Eve

     I'm kinda glad to be getting this out of the way. I dry heaved so loud in the bathroom today while in a stall I set off the motion sensor paper towel machine and was temporarily freaked. This is just all so ridiculous I need to move forward so I can get closure. Christy gave me a lot of great tips for tomorrow - I had to call the nurse and have the prep instructions faxed bc I lost them - luckily I could buy all the prep stuff at the Baptist gift shop. Christy swears by Boudreaux's Butt Paste and baby wipes. I was alarmed, as I talked about my colonoscopy all day, at how much it cost people that do and don't have insurance. Brian at Boulevard told me it took him two years to pay it off Michelle in late transcription said the bills kept coming and coming. If only I could stand politics, I would upend the health care system. Maybe not imminently, but in due time.

    I had a case of the decade or lifetime today Melody was a big help. It was a guy in his mid-thirties who suddenly developed leg weakness and bladder issues (think spinal cord here) and sure enough he had a big mass on his spinal cord. Rad suspected myxopapillary ependymoma but it looked just like a shwannoma. Antoni A areas, Antoni B areas, pseudorosettes it had the works. Melody agreed. I've had one myxopapillary ependymoma in my career it's classic on touch prep I diagnosed it while the patient was still in the OR. It has lots of mucin, and papillary structures. This didn't. 

    Turns out there is a rare variant of ependymoma Melody found in her book she and I have never heard of called the fibrillar tanycytic variant that looks exactly like guess what. A schwannoma. I've got to look up the root language analysis of the word tanycytic it sounds fascinating. When  the GFAP lit up like a Christmas tree and the S-100 was predictably weak and patchy I went into Melody's office and cheered. It was the highlight of a hard day. Hope your Tuesday was better than mine. Much love, Elizabeth

Ugh It's a Monday

     For some reason cases came out early last week - most of our stuff trickling out at 9 and 10, biopsies in the box when I arrived. It felt heavenly. Today, not so much. I was glad I had a dentist appointment  because we STILL did not have cases when I got back I strode alarmingly into Melody's office and accused her presence of being the problem (she was off last week). We commiserated.

    I hadn't been to the dentist since the pandemic, well once but I left bc I was having a terrible day and I was panicking about it. Seems like having a cough drop in your mouth and having to clean your teeth are not compatible. Well, I proved otherwise. During the beginning X-ray part I dry heaved so bad I almost threw up and told her I've never had this problem before but I worried about it I cannot go on. The patient angel talked me through it and Christi told me I need a crown. But she wants to wait a month after my EGD and colonoscopy to get those results. And if they are negative she will refer me to a doc that does oral care, which sounds good bc I told her this is an oral issue, I don't get nauseated, I just feel like my mucosa is caked in clay. No blankets in a pandemic. So I froze and listened to the 1980's top 40 hit music they always play and vowed to bring a coat the next time. In July.

    I read about the Oscar winners and watched Colette over lunch it didn't make me cry but it was very moving. I was glad, because the cases started raining down upon me and Melody's sister Rhonda, an oncologist, texted with a molecular issue that took me over an hour to bird dog. Do you ever get up in arms and grab the secretaries to help you try to right a wrong and it turns out part of the wrong can be traced back to YOU?!! Lol. Melody and I learned a lot about ckit mutations (it's done differently since we trained) and I talked to a GenPath rep in Hackensack NJ - told him that part of the mistake was ours and please make sure to not charge the patient for the extra test.

    Luckily I had tons of benign breast. More B9 breast in one day then I think I've ever had. No residual tumor in a re-excision of a core. Marked acute inflammation, consistent with abscess. Marked lymphohistiocytic inflammation with surrounding fibrosis. Fibroadenoma. Dilated ducts with periductal fibrosis and chronic inflammation. The list goes on. Those patients are going to be so happy with the results of their formerly owned tissue and it made for an easy afternoon I saved two breast cancers for the morning.

    When I went to my follow up toe appointment a few weeks ago I worried, it is still super swollen. I hadn't called but he reassured me that I was healing properly and everything was normal. It's just the baby toes, he said, they take the longest to heal, sometimes three months. The stay swollen up like little pink/purple sausages. LOL that's exactly what mine still looks like. He said don't worry it will heal and look just like the other one. Whew.

    Even though it's a Monday it's my Thursday I'm not looking forward to procedures but Christy will make it fun. She's already taking care of me she worried about the 1:00 hair appointment I made after the procedure on Thursday. So much so that I left a message for Deidre that she could try to fill it but if not, and I flaked, I would pay for it anyway. Christy said it's illegal to drive I said I was planning to Uber and I've got crazy roots but it's nothing I cannot live with. Half the people I talk to go out to lunch and half the people sleep 10 hours that's a gamble for a hair appointment I don't want my friend to have to take. Happy Monday. Much love, Elizabeth

Lab Week Drama

     We've had some run ins with a certain Baptist faction that have been, to be polite, contentious. Back when the vaccine came out I went to the secretary, per instructions in huddle, to tell her I wanted it and she informed me that I was PLA, not Baptist, and we couldn't get it. I was incredulous and flabbergasted and replied, "Well I'm active medical staff, and all active medical staff get the vaccine." She had no retort to that, but continued to deny it to our 50 employees. I problem solved with those who were upset - they didn't really ask for anything just a badge - why don't we scope out the situation and go down when they aren't there. But it still grated and 4 days later 4 of us pathologists received a text from a PA in the NLR gross room - they all had the vaccine no problem - that we need to advocate for our employees in LR. Our chief texted admin and they were like what is the problem of course you all can get the vaccine. 

    Fast forward to last Thursday. This is Lab Week. I know, kind of nerdy, but a huge deal in the pathology world you should see some of the cookies my friends in PMG are baking that's not me but it's impressive. I was showing my PA's last week lots of oohs and aahs. Drug companies bring breakfast and lunch and even though it isn't as festive as it has been in the past (I'm talking talent shows with med techs and dessert competitions us pathologists judged) it's still a big deal and a week of happiness and camaraderie. We were told by the secretary that tried to deny us the vaccine that we weren't invited to lab week this year we could only come to the Thursday lunch that we traditionally provide since the beginning of PLA time. 

    This is so mean girl to a next level I could not even. We were all in disbelief. I traditionally haven't wandered into Classroom 4 to get Whole Hog for lunch - that would wreck my entire afternoon - but it's the principle and a lot of our employees love it. I was so mad at huddle on Friday I told everyone in micro if you don't see PLA at lab week it's because we were uninvited yesterday. Amy was incredulous and said Biomerieux was being a lot more stringent about numbers in the pandemic and tried to exclude the rest of the lab but she said no. Well I guess we are the red-headed stepchildren because no one stood up for us.

    So we planned our own lab week and I think it's even better than theirs. And it's kind of fun being snarky about their balloon decorations that were everywhere except for in our departments they looked pretty sad by the end of the day - helium leaks - and it's only Monday. This morning the secretaries planned breakfast and we had Cinnabon and Morningstar Bagels and fresh fruit and lots of Boulevard pastries (thanks Kimberly:) there was so much we can do it again tomorrow and I ordered a Mickey's cake Sunday to pick up tomorrow that says Happy Lab Week PLA. I can't wait to see it. There's also a pizza day and bring your own dip day we will remember this week, I told Tina my head transcriptionist, until the end of time. And I've planned a surprise involving plush organs I discovered in an MD FB group last week. 

    Other exciting news KC of MiM emailed me Sunday and wants to revamp the blog. Someone told her it was their only female connection in a male driven residency and saved their life. So I'm excited told her I'm writing again she's planning a motherboard with quarterly meetings and invited me to be on it!!!! I told her I thought that was a good idea bc blogs used to be self driven before the advent of social media but now we should have more admin direction to solve problems and issues. 

    Good movies - Lars and the Real Girl, and Palmer. And I read about Sasquatch on the Guardian today it launches on Hulu tomorrow looks amazing. Happy Monday, much love, Elizabeth

Dr. Askhole

     I decided that was what I was going to call him today (he often asks for us to come up for frozens), because he had five cases in Conway and makes us sit there and often doesn't even use us. I looked at two uteri with EIN (endometrial intraepithelial neoplasia) that was diagnosed on biopsy and one looked normal but one looked ugly cancerous it makes a difference what he does in the operation and CARTI loves him. He came and looked himself Jessica could have opened without me because his assessment was as good as mine but I made sure to charge for a gross only. I'd never met him even though he's been there for a few years - he primarily works in Fayetteville I think (googled him a long time ago) but comes down to operate so he can check in on aging parents. And he was so nice and grateful I doubted my moniker. I'll shift the anger to the people who decided to build that hospital that still seems like a ghost town and doesn't have enough business for us to place someone full time there. One of the ovaries was enlarged on the grossly cancerous uterus. I warned him to stand back while J pierced it with her scalpel. Sure enough a bunch of serous fluid popped out into the sink looked benign, we both agreed.

    But I've never been up there with Jessica while I was waiting for the 10:00 courier we had so much fun talking and listening to music I told her we need to make this happen more often. We got on the subject of horses - my Barrington country club equestrian cousins and aunt and uncle used to try to get me to like them when I visited I wanted  nothing to do with it and they sensed my terror and tried to help me overcome it. To this day I remember sitting atop some giant horse (of course the biggest one was the calmest) at age 7 or 8 - his name was Gentle Ben I think? Or Ben? and using all my concentration not to pee in my pants I was so terrified. 

    Then she told me a horse story that has had me dying laughing every time I think about it all day. Her friend had a Shetland pony - size of a large dog she said - and they would saddle up and ride it at age nine. One time the saddle started listing to the side - she demonstrated this by leaning over, and suddenly they found themselves on the underbelly of the horse. Although their heads were probably only two inches from the ground they had no idea what to do so they were holding on for dear life (the pony was standing still) until an adult happened upon them and said, "Dear God what are you girls doing? Just drop on the ground!" They were so relieved.

    I told her my aunt used to try to teach me how to feed the horses with apples and carrots she said hold your hand flat so they don't accidentally bite a finger off. I was mortified, even as a small child. That's not really a risk I want to take in life. Jess agreed. Horses are too scary. We were both scarred as young children. I told her about the horse at the dude ranch that dropped to the ground and rolled - I narrowly missed breaking my leg - I had to scramble. I'm sure there are horse whisperers out there but I'm not one of them. 

    So happy it's almost Friday this week has stretched on forever. Highly recommend the turkey burger at Baptist Conway it's incredible. And Flight Attendant. I think we have one episode left. One more full week of no call work next week and then a two day work week with colonoscopy (fun!) then long weekend in Eureka. Happy Thursday, Much love, Elizabeth

LIbra Rising

     Lucy told me this was a lot more important than my sun sign. So after an hour and a half I marinated it. She is new at charting, it must be in her genes - she picked up on it in four months I told her I watched the Leo King for years and never understood it. She could honestly be an internet celebrity she identifies as LGBTQ she's amazing. She told me she was so jealous of my chart and thought I was only 30 when I told her I was 47 she about blew a gasket. Courtney Love is a Libra rising I learned on the internet I love that.

    I was at Boulevard today and bumped into my hospitalist neighbor Q he invited me to his poker night tonight. I went to just be charitable - he told me he doesn't socialize with other work docs these were outside friends. I met a guy named Jose, he is from Puerto Rico he has a girlfriend who is a physical therapist a ACH guess what her name is. Elizabeth. He tried to get her to come to Q's house it was mostly a guy poker night. I told him to bring her next time I'd love to meet her. He just signed on to Baptist to be a physiatrist (FIZZY!) I told him Baptist Rehab is one of the best in the nation they really helped my Dad. We talked shop and docs looking forward to seeing him around the hospital. 

    Lots of GI issues still but I'm getting stronger I walked another 4 miles tonight after work I did the same route on Saturday. Watched Promising Young Woman Carey Mulligan hosted SNL on Saturday she is getting a lot of Oscar nods. It was triggering, I cried a few times, but I loved it. Want to watch it again. 

    Made for Love is also wonderful it's on HBO. So artsy and wacky. Short blog. I'm tired. I was up from 1:30 to 5:00 am. Day went well but there's much change in the near future it's overwhelming. I'm going to wind down to music and TV. Much love, Elizabeth.

Not Call Weekend

     I want to write but there's nothing much to say? I've already gotten enough sleep for a whole night but hoping to get more in a few. 

    Mallory, a new hire in the pharmacy, is adorable. She has glasses and dresses cute kinda librarian/pharmacy assistant with a millennial flair. She blends in, but stands out. She's pretty quiet and I don't need drugs much but Jack and Cecelia and myself had some things filled this week so I found myself talking to her more than usual. Turns out her birthday is Monday she turns 21. She said can you believe I turn 21 in a pandemic. I was like yeah that sucks no bar hopping I guess? She told me that she and her friends were planning a picnic after work. I said so you are an Aries girl? I've read a lot about Aries guys my ex was one but not much about Aries girls what's that like? She laughed and said we are really chaotic. Funny, bc she looks like the picture of calm in a storm. I laughed and said that sounds like my ex, told her we get along a lot better now that we aren't married. I think I'm going to buy her a festive drink for her picnic this weekend - maybe a bottle of champagne or Prosecco. 

    Something else happened since prom is canceled one of the mom's at Central is planning a masked event for those comfortable attending April 24. It's at Windsong in Maumelle - my partner Michelle and her husband Darius said it's a nice venue. So C wants 23 of her friends, she sent me the invite list, to come to our backyard for pics and dinner from 6-7:30 before it starts. We discussed catering something easy like Chic Fil A or Taziki's - I told her pizza might be dangerous to fancy dresses. I know parents will want to be there, so I started a group text with 8 moms I knew and told them the low key plan and told them to invite other parents I didn't know. Said it will be a masked event - I've held small gatherings with vaccinated people indoors since CDC approved and lots of people are vaccinated but this could be upwards of 50-60 people. 

    But eating and drinking are maskless activities and so I told them I'd have seating available for small groups so people could gather at their comfort level. Hosting during a pandemic is so challenging. I told the mom's I'd have some appetizers and wine but if each of them brought something to drink and an appetizer that should cover the adults with little cost and effort. Then I started freaking out and calling Kricia yesterday while signing out cytology bc that's a lot of people and do I have enough seating and chairs? I told her I want to use the dog run to serve, especially since we have no dogs or dog shit there, and she thought that was a great idea. She said PartyTimeRentals is cheap right across from Sauced go there and get two long tables and maybe get a couple of simple floral arrangements bc your view is the main attraction you don't need much else. I like the idea of leaving the pool area clear for photos. And Cecelia agreed an hour and a half is perfect - the shorter the better - less likely for kids (ack adults) to smuggle alcohol.

    C asked me for one thing for her bday - a mom and daughter shopping trip. She was texting me at work last week pics of new spring floral prints from Lulu. She works at All Aboard all day tomorrow, but she is off Sunday so we plan to do at least Lulu and Belle and Blush they texted me a coupon Friday I can't wait to use. So happy for a beautiful weekend off, hope to get some sun in tomorrow afternoon. Hope you have a wonderful weekend. Much love, Elizabeth

Astrology Chart

     I was hunting for my birth certificate a few years back because I have always wanted this done and couldn't find it. Deidre's friend does these; it's not in Lisa's wheelhouse. You need your time of birth and while your date is easily accessible (for most) this is hard to access without the permanent record. I called my dad and he no longer had my birth certificate on file so I gave up. Fast forward to needing passport to go to Costa Rica and I dug it out of a box under the stairs I've probably been lugging around for over 20 years after two hours of looking. Made sure to file it in my locked cabinet at work with the kid's. 

    So when I learned that Kimberly's replacement at Boulevard (since I poached her everyone loves her as much as I do and she's been a wonderful add to our work family) did astrology charts I was ecstatic. Wrote down that I was born at 9:53 am on August 20, 1973 and planned to get her to do one for me. Her name is Lucy, and as she was getting trained and up to speed I learned that she won even Brian over with her projections. Shelby was raving and Sean said she was very good. I asked her to do mine and asked her how much she charged. She said she never thought of charging, maybe 10 or 15 bucks?

    LOL that's crazy even Lisa charges a lot more than that and she's half of Yousef. I gave her a 20 Friday afternoon  and told her I'm in no rush, I have studied the cycles at BV for years I knew she had to break down for the week and transport still viable baked goods and food to the locations that were open on the weekends. She said give me your cell and I watched her write it in permanent black marker on the inside of her arm. 

    This made me think of two things. First, Eddie Vedder's MTV unplugged performance where he wrote pro choice or something like that on the inside of his arm atop a barstool and then fell over (I watched that so many times it's ridiculous). I'll bet Lucy's way too young to remember that but some of you out there might. Second, of a local doc who committed suicide a few years back - my chair knew about the note that became incoherent as the stuff kicked in and how he wrote NO AUTOPSY on his arm. Well, guess what. You don't get to decide that when you are gone. Rules are rules.

    So Lucy told me today that she would do my chart on her day off tomorrow and we could meet about it Saturday. She asked if I was familiar with Zoom. It took all my strength not to laugh out loud I just said Zoom, yes I know Zoom, that's fine. I mean who doesn't know Zoom??? She would probably laugh with me but I don't know her well enough yet to know that so I erred on the side of caution. In the meantime I texted Deidre and asked her how much her friend charged for charting so I could get a feel for what it costs and let Lucy know - she seemed incredulous at the idea of charging. I may actually be her first paying customer.

    Nice to have the kids back over here Jack did virtual yesterday and even though I had a gagillion needles it was fun to have him around talking about parallelograms and Hosseini's A Thousand Splendid Suns (of course you've read it Mother, no spoiler alerts please). He talks as fast as I dictate so when he was plotting to use me as an excuse not to go to a basketball game things got screwy. He said I'm going to tell my friends you can't drive me because you've got dinner plans but mask so I thought he said implants and we both got a good laugh about that. I told him he could use me as an excuse anytime but make sure that his excuse is escape proof bc any friend could say I or mom or dad could be happy to pick you up and then you are in another pickle. He laughs at my old timey expressions. 

    And OMG he's a fantastic shopper we tackled Kroger yesterday together and got it all done in a half hour it was amazing - this kid who has so much crap on his floor you can't see it and doesn't know how to find the dishwasher thank god there's hope. Planning a double batch of meatballs tomorrow. He's so excited. 

    On the way out today Tony cytotech brought me a case full of fungus. My friend Jason Holder did the bronch lavage yesterday. They were worried about an atypical infection bc it was multiple cavitary lung lesions in a 78 yo on Methotrexate (immunosuppressant). I noticed her crypto ag was pos and her crypto titers were high mycology was gone for the day but I showed it to Hal and he agreed we need to order a mucicarmine for tomorrow. Cryptococcus has this encapsulated mucoid shell and a mucin stain will light up the polysaccharide cell wall. I called Jason and he was working with the infectious disease doc they are on the side of belief and are doing a CSF tomorrow the stain there is India Ink they do that in the mycology lab. I'll touch base with Tommy in mycology first thing in the morning to brief him and give him a heads up. This is kinda rare. If the pics are good, I'll share. LOL cringe. Happy Tuesday. Hope you are having a good week. Much love, Elizabeth