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