Monthly QA

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

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

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

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

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

    

Doc Book Club

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

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

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

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

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

Happy Friday

     Good god finally. What a long stressful week.

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

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

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

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

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

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

Let Me Tell You What I Learned About Malaria

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

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

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

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

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

Let Me Tell You What I Learned About Bees

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

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

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

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

Mondays are Here to Stay

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

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

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

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

Ascension Day

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

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

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

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

    

Chasing Rainbows

     Early morning ENT tumor board - St. Amour and Sims were there on time but Stern and Wilder and Hall showed up late, but not too much so to participate. I was there early enjoying my Starbucks drive through and chided Sims on his thirteen frozens he bowed and nodded his head and laughed I know I know y'all hate me. I told him we are happy to help but it was challenging as hell. Later when he was presenting the 30 year old with the glossectomy Stern said something interesting. Once you have a total glossectomy there is no barrier to your airway and you either sink or swim. Some people eat fine and some need a PEG tube. Sims said that this guy has good young lungs on his side that will be able to handle a little aspiration. Talking is also apparently an issue - dieticians and speech path also attend and chime in - but Melody assured me two weeks ago when she filled me in during A-M (have I mentioned that yet?) that they combed through his lifestyle and had a heated discussion and decided this was the best decision. At one point Sims mentioned the patchy nature of the CIS and I chimed in. Yeah, this was a different bad actor. Most of the time you see invasive cancer then carcinoma in situ then normal squamous mucosa but this guy's CIS was all over the map. You might as well have been chasing a rainbow. 

    Sims and Stern said something else valuable presenting another patient from small town Arkansas she had been complaining of ear pain and trismus for six months but had been repeatedly been treated with abx and felt blown off. I was glad Sims defined trismus I forgot that one. She had a giant nasopharyngeal mass we looked at rad and discussed what to do. Sims said clinical pearl - anytime someone complains of trismus you rule out mass nerve compression that is the number one cause. Stern said speaking of clinical pearls anytime ANYONE, especially an older patient, complains of unilateral pain (hers was only in one ear) it's tumor until proven otherwise. 

    Work was good in the morning but got crazy with frozens again in the afternoon - luckily softballs today not curveballs. During my last frozen I got a text from the Mom group that was formed yesterday to help non-intrusively assist and navigate a family that was losing their mom/daughter (second one during pandemic, same first name strangely). According to yesterday she was supposed to have weeks to months. The text said her mom said she passed this afternoon. I burst into tears. When I recovered I called Jack - wanted to talk to him before anyone else told him. He really cared about her and she him and he told me some amazing memories yesterday. He wanted to write to her about them - I told him you should still write to the mom. My job is supporting him in supporting his longtime, albeit not closest, friend. 

    Rough week. Headed to Conway tomorrow morning to sign some last minute lab work for Misty and the CEO Tim wants to meet me before the lab inspection next week. 9:00 am lol wish me luck I've never had a meeting with a CEO. I've seen him on Zoom meetings (why oh why do the Conway people turn their cameras on Little Rock never does thank god I've got a hot pink sticky note on my camera). I guess I should pick out an outfit. Happy Tuesday, much love, Elizabeth

Frozen Fest

     This day. Can we ban Mondays?

    It started off rather quiet but after a weekend of respite from my GI sx they returned with a vengeance mid morning. I was super depressed, but persisted. Sims had A-M frozens that started right before noon but Melody needed help so I abandoned my soup to chip in. Meanwhile, Jack texted me about a sensitive subject so I plugged in. Cancer sucks. 

    Then I needed Melody's help - she spent most of the afternoon supporting me. How do you try to get margins around patchy carcinoma in situ in a 30 year old getting a glossectomy? It's tough. Then there was another 30 year old, luckily B9, but something that normally is the work of an ENT took a turn for the unusual - a chest surgeon was searching for parathyroid in the mediastinum!! And sometimes it's hard to tell lymphoid tissue from parathyroid this was no exception. Got three consults on a frozen for the first time in years, and we couldn't be definitive.

    Women are amazing. It really does take a village. Texted and talked to stepmom on how to non-invasively support a long time school family. But we fall short, because we cannot cure the scourge. It angers and saddens me. Happy no longer almost Monday. Much love, Gizabeth.

Broken Glass

 Posted over at Mim! 

Happy Cinco de Mayo

     Next weeks Chicago trip is looming and Christy was lamenting that we were wait listed at Alinea so I started a group text with Mike and Effie this morning they are planning dinners (let the food scientists/chefs take control. Duh.) They raved about a Turkish spa but Christy wants to establish a profile at the Four Seasons so she booked massages and manis next Friday. I'm not complaining. She wanted to maybe do a walking food tour but I researched them and they are all at least three hours and full of gluten - deep dish pizzas and pastries things I normally would love but lately cause too much dysfunction. So I found a 5 star rated two hour gangsters and ghost tour and booked that for 1pm Saturday. Christy sent a video of the three ring binder filled with pertinent info to air travel, hotel, and activities (complete with those dividers I haven't bought since high school) and said she makes them for every trip I loved it.

    This was the lightest day of my call week so far thank God. I've got so much anxiety around my bodily betrayal lately I needed a break. Luckily frozens have been super light knock on wood but I worried when I was leaving Edward's with Jack after work - we planned to get 6 items and ended up with over 30 - teenage boys are bottomless pits. On the way out of the supermarket door my cytotech paged me. I think we've got a blasto. It's all over the BAL. Do you need to see it? I was like damn we have tons of freezer food and I've got to get it home it's rush hour tons of traffic but yes. That is a medical emergency - it cannot wait until morning. 

    I called and asked if he reviewed the chart. He said yes, it's pulmonary failure of unknown origin. Can you send me a pic, I wondered? That might be easier than going in. He said he was thinking the same and sent a pic and the patient info and all the docs. Last time I saw this much blasto, I told him, I called the docs in LR bc I saw in the chart they were putting him on ECMO (it can bypass lungs, too, not just the heart) and they said he died an hour earlier while they were trying to get him on the machine. 

    When I finally got home I saw the pic and sure enough they were big yeast and he had taken a classic board picture of broad based budding. The culture around calling fungus on morphology has changed a lot in my career. In residency I would have seen the big yeast and the buds and said Blastomycosis! Or the non-septate 45 degree angle branching hyphae and said Aspergillus! Or the ship mariner's wheel (so cool, only ever seen it in textbooks) and triumphantly screamed, Coccidiodes immitis! But we get it wrong, occasionally, on morphology, I told the pulmonologist when I paged him through the medical exchange. So these days we are just descriptive and defer to mycology. I promised I'd send him pics tomorrow and consult mycology first thing in the morning. They are the bottom line. But different fungi grow at different rates, you gotta be patient. Luckily most of our antifungals cover a wide range so, no harm no foul. Earlier they start treatment the better. Happy Wednesday. Much love, Elizabeth

I Cannot Think of Another Bad Monday Blog Title

     I have been up since 2:30 am. Which is ok, because I got a ton of sleep over the weekend - my ex says post anesthesia does that I was all murky on Saturday. My suitcase was overly ambitious - four books and lots of fancy going out dresses and hiking clothes I wore one t-shirt dress all weekend and a t-shirt and yoga pants on the way home, never leaving the cottage. But that's ok, your body knows what you need better than your head does most of the time. 

    Deidre made me keep the hair appointment - she's going full throttle since a lot of people are vaccinated and told me if I canceled on her it was no big deal, she couldn't get me in again until June. I was still a little under the influence of anesthesia and I do not regret this decision at all but when she told me she shut down her mask business I bought all dozen or so that were left. I didn't remember until today - cheered up Cecelia from a bad day with some retail therapy. I told her she could give the masks as grad presents she wants to keep them for herself. That's my girl. Put your own oxygen mask on first.

    Speaking of bad days my stomach pain and dry heaving which normally ramp up in the afternoon hit me first thing this morning at work. I stuffed it, because it was a busy Monday and I learned I was on call and not only that I'm on call three weeks this month. That sometimes happens bc we take so much vacation but it was a really depressing realization when I was highlighting my schedule before huddle. I've got so much going on this month - Conway inspection and call and all that entails I felt grateful for my weekend of leisure. And Christy and I are headed to Chicago in a couple of weeks on a four day weekend that will be fun. But I texted her this morning - she had texted me the Lucie's place volunteer schedule for May on Saturday - that she had better count me out until June.

    Finally around 12:15 after I attempted to eat some fruit I locked the door to my office and lied supine on a blanket and pillow and it took 45 minutes for my stomach pain, which left me writhing at some points to clear. I was so relieved I celebrated with a coffee - I needed it to finish afternoon work. Last two nights around five have been pretty intense on the emesis scene Jack heard and I'm glad I had a gold star on my insides from the GI doc so he didn't worry too much. Rib muscles are so painful to pull. I'll get through it though, I'm tough. Happy Monday is almost fing over. Much love, Elizabeth