Tuesday, May 11, 2021

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

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