Rules

     It was Baptist's 100th anniversary on Tuesday, and big festivities were planned. Every employee was to receive a gift, and there were a lot of food trucks out in the parking lot.

In the gift shop on Monday the sales girls were blowing up big 1-0-0 balloons. Amy read the news in huddle on Monday and transcription  was all abuzz. 

    When Amber and Janet came up with their gift box and showed us the stainless steel water bottle and umbrella and pen and journal set we got so excited to get our own - I grabbed Tina and Kimberly and Jan and we walked down to the cafeteria. There were rules. You had to get a number at the front and go get your badge swiped then go to the correctly numbered table. There were six tables with pyramids of gift boxes and more and more pyramids of gift boxes behind to re-load the tables. I haven't seen that many people in the cafeteria since they gave out free food during snow week. 

    When we walked up to the ladies giving out numbers - admin, I recognized them - they gave me a number and turned my secretaries away. Told them contract workers do not get a gift box. We all recoiled, and I told Tina I would give her mine - she has worked for Baptist for over 20 years only recently became PLA. Tina turned away in disgust and Jan followed her. The ever positive Kimberly, who Rex loudly wondered if she was running for governor last week (we all had a good laugh) decided to stay with me and see if she could find a back door. I was angrily telling her this smacks of lab week WTH. If they are going to offer gifts and turn people away they should warn them in advance so they don't get hurt.

    Sure enough the crowds were thick and the lines were long but they happily swiped her badge - she excitedly called Tina and told her and Jan to return and told them exactly what to do. I got my gift at table number one and smiled at the CEO Troy Wells in the receiving line and Mayor Scott was there as well. I got a little sweaty in the crowds and was unsure of the outcome and lost Kimberly so I texted Tina that I was going back upstairs. 

    We were all triumphant when the girls returned with gift boxes and everyone was praising Kimberly's genius. I told Melody and Quinn and Shaver about it - they didn't know. Melody missed the cafeteria, but when she was finishing up an apheresis consult today she walked into admin suite and asked Laura for a box - Laura gave her one from under her table. At about noon Quinn came in my office with a story.

    He told me a little later in the evening on Tuesday - they were giving boxes out until 8:00 - he went down to get one. He stood in line and showed his badge to someone from human resources - there were about 10 people scanning badges. She asked about his u number, like me he said I don't have a u number I have a p number I'm with PLA. She gave him this long rigamarole about how contract workers cannot get a gift box and kept persisting - he said people were looking at him it was really embarrassing. His badge said Dr. Quinn. We are on medical staff that makes us Baptist. He told it in a funny way that had me laughing so hard all day today thinking about it - some random chic following a blanket rule that should not be black and white (or even exist). I told him about Melody's success and told him he should go to admin suite he said I don't know. I still have a lot of PTSD from that incident. LOLOL.

    Arbitrary ignorant rules inferiorate me. The dress code at Episcopal comes to mind. The first thing Jack's teacher told him on the first day of school in first grade was that his shirt was on inside out there was a bathroom across the hall go change it. I hadn't even noticed. No praise for putting it on by himself? No hug welcome to my classroom? We grew to love her, but that institution had some of its priorities backwards. Give my daughter detention for not following the exact dress code? When she decided to go to Central, she was so nervous about what to shop for and wear. I told her let's buy a few basics you like, and when you see what everyone else is wearing we can branch out. She quickly caught on, created her own look, and eclipsed mine.

    I called in sick Monday for the second time in fifteen years - first was when I broke my jaw. I woke up at 3am with alternate chills and fever feeling so bad I wondered if I needed to be carted off to a death hut. This was last year's experience times one hundred. I told S I wouldn't shower but he would need to dress me in a t-shirt dress and get me to work somehow - I was imaging him putting me on a dolly like that movie years ago with Ryan what's his name and the mannequin. Probably a little delirious? In retrospect that would have been poor patient care. He called in too and took good care of me. 

    I was telling Rex about it this morning and he said he's called in once in 31 years in hypertensive crisis. Competitive much? You beat my track record, I said. I told him last night's ejection was so epic it was no longer just retching I think I'm expelling demons. Sure sounds like it. He said maybe you should get on with the Conjuring? He hadn't seen any of them but I love every one but the last was not very memorable. I said they would love to record my voice for expelling the demon possession parts it hurt my ears but by now I'm used to it so I just try to enjoy it - it only lasts a minute or two. Then I can dry my tears and blow my nose and enjoy a drink. I stopped on the way home to get him a bottle of wine - tomorrow is his last day and I've got a good wall around it but I'll break down at some point when it's safe. S is safe in Austin after a long drive. Visiting dad and stepmom. I'm flying out Saturday with the kids. Kallie may come spend a few days with us so excited. Alone in the house for the first time in a long time - kids are at dad and stepmoms grilling cheeseburgers. Think I'm going to tuck into a book Melody lent me that I read half of the other night. Intellectual brain candy thriller. Happy Friday Eve, much love, Elizabeth

New BFF

     I don't think I've told you about Jeff. He's the security guard who works at the front desk at Med Towers 2. I've been friendly with him for years. A couple of weeks ago at Boulevard he alluded to an incident in the ER that was hairy - some psych patient he had to help subdue. So I started thinking, if I go to his desk and share stories with him he will share some with me and I'll get some juicy gossip.

    Well I did just that and we started talking about psych and I mentioned my experience at the child and adolescent ward at Turning Point back in the day when I was taking pre-med classes at UALR and he exclaimed I knew you were familiar! I know you from somewhere. When were you there? I told him I was there in 1994 and he said he was security at ACH at that time. It blew me away I recognize his voice but not his face. We reminisced about Joe and Penny and Randy and all the nurses and techs it was a wonderful trip down memory lane. We shared gossip from back in the day. He told me that one of ours, we both cannot remember the name, he was from Africa (amazing accent) and he was well respected by the patients. He was killed by a patient. Head slammed into a desk. I kind of started crying I really respected him. 

    I asked if he knew about the teen gunshot wound in the flank he did not but he knew about another teen gunshot wound last week in the leg. He was so mad because he told the mom to get a police report and not to allow any family members to show up because of Covid. Well guess what an hour later the ER entrance was gummed up with cars of family members coming to see him. Tommy in mycology told me that at UAMS (his son works there) they put the whole hospital on lockdown if there is a gang shooting in fear of retaliation. I was wondering why, as I have left the hospital the past few days, there were so many cars in the ER. 

    Jeff and I were talking about the resurgence in gangs - it was heavy back in 1994 (there was an HBO special). He said that the Latino gangs are more organized - they move drugs and make money - but the gangs behind the hospital just do drugs and shoot guns it's a mess. I told him about the young teen patient back then that was proudly a queen in the gang because she was pregnant as a result of being sexed in (gang raped). It really woke me up to what a privileged life I have. 

    He lost a daughter at 29 - he showed me pictures yesterday - to lupus. I had a former nanny with that disease it can be brutal. She was a gymnast - he and his wife took her all over the country to competitions. She once danced with Paula Abdul. Losing a child. I cannot imagine.  I shared about the funeral I attended of my friend Carmen from Sunday school. I saw a meme recently, about grief, that I shared with him. Grief doesn't shrink over time. We grow around it. 

    He's a fisherman, and I hope to benefit from that in the near future. He gave a cousin and a friend a bounty of catfish for a fish fry last weekend. The friend recipient was from Chicago and was so grateful he gave Jeff a bass boat. Jeff and I were problem solving how to get it from Chicago to Little Rock yesterday. Hire someone, I said, and he agreed. Happy Saturday, much love, Elizabeth

Gross Room

     I'd just settled down to my lunch today - Kimberley has been bringing in Boulevard's Kale salad for the girls in transcription and I was formerly addicted but hadn't had it in years was dying to try it again. So many pine nuts. Kimberly adds chopped up boiled egg whites; I excitedly got two boiled eggs from the Dr lounge this morning in anticipation. Then I got paged for frozens.

    Two different frozens on two different patients, Jessica told me, and the first one was a Scott Stern. We were reading the history on Epic. Jessica said Wow! He's had a sore throat for 1014 days. I looked and sure enough that was in the H&P. That's pretty specific, I said, do you think it's a typo? She said maybe not, that's a little over three years. We all belly laughed so hard and I wondered why it took so long for him to address it. I told her I needed the laugh after a funeral, my second one in a month. Jay Clark did a wonderful service. I texted him this evening, and he thanked me for my kind words.

    The patient had a history of squamous cell carcinoma, it was a tongue lesion, and I was relieved when I looked in the scope that it was normal lymphoid tissue. Waldeyer's ring, I gathered. When I called the OR to tell him he was so flabbergasted - I guess he thought it was recurrent cancer - that I physically recoiled in paranoia. Was there a specimen mix-up? Did someone give me the wrong slide? But no, it all checked out. Meanwhile Laurie announced from her grossing table that she's had a bad attitude for 48,579 days. We all laughed. Then she said I think there is a blues song in this sore throat thing, and started singing about a guy with a sore throat for 1014 days. We all joined in, except Savannah, who was on break watching boxing matches on her phone. But she was smiling.

    The other one was a 20 something year old with endometrial cancer - luckily it was superficial so she will probably do ok. I learned from an ob on the way home that she had a BMI of 88. If you are storing that much estrogen in your fat you will inevitably grow an endometrial cancer. So she's a victim of the food industry, I said. We were problem solving another case of a 30 something year old with mucinous carcinoma of the ovary. His wife is an oncologist and wants to know how to treat - this was all over the abdomen. I assured him I was confident of my diagnosis, but since there is a clinical question that will make a difference I will pull everything tomorrow and re-evaluate and stain and give him feedback ASAP.

    I had another gyn/onc Bandy frozen later in the afternoon. Gross only. I cringed calling the OR. I told Melody earlier in the day can we just replace that OR tech that answers the phone? He is often in some robotic equipment so he depends on her to take the frozen diagnosis. I told her very superficial cancer on the frozen at the most inner one half of the myometrium. This helps him make a decision to take pelvic lymph nodes or not. She said let me write it down, speaking slowly and asking me to repeat every word. She said in or one half? I said no inner one half. She said inner or one half? I said no, there is no or, only inner. Melody said she asked her to wait on hold so she could relay the information to Bandy in case he had any questions. I said hell no, she's done that to me before, I learned to hang up the phone as soon as I get her to write it down. If there are questions they know how to find me. Luckily the tech in the late afternoon was a competent guy he said thanks and I was done. 

    Jessica said she had entertained Joe with the story about the guy with the sore throat - he works in cytology in the mornings and in the gross room in the afternoons. Apparently after I left she and Laurie made a parody of it to Red House. She couldn't remember all the lyrics, but relayed a few, and it was genius.

    In the Guardian over lunch I read the title to some review of the Friends reunion and their stint on James Cordon's Car Karaoke - neither of which I have seen - and knew it was Stuart Heritage. Another good laugh, and good replacement for any latent desire to watch either. Happy Friday Eve. Much love, Elizabeth

In Extremis

     Ugh. I am so mad about white patriarchal construct and belief system right now I could puke. Wait, I already did. Yesterday and today. Zofran helping, but I'm still yakking my guts up. But that's depressing. 

    I was looking at a teen's stomach and omentum today and these kids are getting gastric bypasses earlier and earlier but I wondered why the omentum too? I feel like every case deserves a delve into the charts. Turns out he came in last night with a gunshot to the gastric flank. One of our general surgeons - he's really good - worked like hell to save him. The chart came in saying he was "in extremis" - a medical term that was new for me I had to google it. On the verge of death, apparently. Luckily he came through the surgery fine and is doing OK so far. We don't get those very often, but Christy said there was a rash of crime the other night after an anti crime rally in LR; two stabbings and two shootings. 

    Got plane tickets today to go visit mom and dad with the kids and their friends I'm super excited but they cost an arm and a leg. With my track record lately for needing Uber for prevention of panic attacks it was a necessary cost. We leave the 26 and get back July 3rd. So in need of a vacay. S and I are going to Vail for a conference two weeks later we are staying at the Grand Hyatt. It looks incredible. I was hoping after a healthy weekend to start to hike and kayak but it's a little iffy after the last two days. Hopefully it won't be like Chicago where I slept most of the trip in the hotel but if so, it is what it is.

    I'm not sure who Stuart Heritage is but he cracked me up so hard over lunch with his article in the Guardian called The Celebrity Dating Game; haven't we suffered enough already - it made me want to google him and read other stuff. I was laughing so hard my eyes welled up. That's what we need more, to get through the day. Laughter and song. So addicted to Nightbirde's performance on AGT. She's like an angel. Way more wisdom than any of her audience. 

    Another funeral on Thursday morning for Sunday school member Carmen. She's another beautiful soul. We had a good gathering on Sunday to start to heal and plan to do something for her kids. Two cancer funerals in a month - this is a little ridiculous. My chief said we are getting of the age, but I disagree. We are not of the age. Cancer is getting us at a younger age. 

    Shaking righteous anger when I was on call last - I was not shy - is finally leading to process change that is making our group more efficient. The head of cytology is crediting me I told her it wasn't intentional it was natural and a long time coming. Everyone is happier so far I'm cautiously optimistic. We were marveling at the results this afternoon and she wants to have more events outside of work, like the girl's night outs I have had, to make us even more familial. Excited on that front. Happy Tuesday. Much love, Elizabeth

Winding Down

     Luckily I have no call for four or five weeks. I can't stop watching Nightbirde on America's Got Talent. It's kind of ridiculous. She's like an angel. The cats are afoot. We rehomed the piano to a woman in Maumelle who teaches underprivileged kids. Rex and my parents approved. Rex said I don't like the idea of kids learning on a junky piano. I shared pics of mine he said it's worth 2-3K and it's one of his top five fave brands, a Kawai.

    My friend Deidre is stopping doing hair. This is significant - she's done my hair for over 18 years. She and Jerry are starting a top secret business - she relayed the difficulty of getting federal loans when I saw her on Thursday. I broke down a little bit in the middle of the session recalling the past - her opening her salon, etc. But I'm happy for her - she needs a new chapter. The freak storms that occurred caused me to get an Uber home - I don't like driving in that shit - and I met a new friend, a retired nurse. She recommended Zofran, for my dry heaving, which seems to be working so far. 9 months of hell and multiple doctors consulted and a freaking Uber driver saves the day. 

    Single mom Sunday school is starting up again and I recently learned one of ours, Carmen, had breast cancer and was fighting mets she died a couple of nights ago. Kind of fell apart at lunch the other day. She has an 11 year old and a 14 year old we are all, as a group, going to figure out how to do something to support them. The Sunday school group is coming over tomorrow for brunch I invited kids can't wait to see them swimming in the pool. It's a potluck. I shopped at Fresh Market yesterday got lots of Prosecco and Rose and cake and sparkling water and orange juice and lemonade and croissants and fresh fruit can't wait to entertain. Happy Sunday. Much love, Elizabeth

ENT Tumor Board

     Who knew how hard it is to get rid of a piano? We've been trying to get rid of our upright - donate to a charity - for two weeks. Our House, who has picked up stuff from our old house before - is not answering the phone. Habitat said they didn't take pianos. I wandered into the gross room this afternoon complaining. Joe said he had a piano, no one else wanted it. Jessica said that she watches enough HGTV to know people walk into a house and see a piano and say UGH. She said a lot of people buy them and don't use them. I told her my Mom and Dad gave me this one it's really nice and she said yeah, they got rid of it to you. I laughed touch in point. I want a baby grand in this house. Rex said there are some really nice ones that are a fancy version of a player piano. Technology has elevated it so much you can just plug in a playlist at a dinner party and it sounds like you have a personal pianist. I also want to take lessons again. I was really good as a kid, but it is not intuitive for me. S's partner David is getting in touch with a friend from Knights of Columbus who knows a piano teacher that works with underprivileged kids and only works in studios with donated pianos. Hopefully that will pan out. 

    Luckily the open lung was a softball - early DAD pattern (diffuse alveolar damage) but I had Staggs look at it Monday to agree with me and he did. Nothing here to treat, I told Muesse on Sunday. I got a pleural fluid from the patient today - he's still on the vent - and looked in the chart. New theory, according to Cidney, is that it's vaping related. I went to read a ROSE for Cidney today in the bronch lab and he told me it happens, he's read papers. I had no idea. I read about vapes blowing up in people's mouth and causing major trauma but not this. It's not common. I asked Cidney what happens to these patients. He said they usually recover and do well with support. Good news. 

    ENT tumor board this morning was good - I presented three cases. Was so exhausted from call weekend I forgot to edit and migrate my pics from my phone to a jump. Discovered when I woke at 1:40 am I had left my jump at the last tumor board and panicked. Luckily S plugged in and found a new jump and helped. One of the cases was a rare one - adenoid cystic carcinoma. It has a tendency for nerves - likes to travel down them and spread. 

    After I presented it I told them I had another interesting case this week that is probably adenoid cystic of the breast. I've only seen it twice in my career in the breast - super rare. Strange thing is she had a history of multiple cylindromas. I had to google that it's rare too - there is a syndrome I forgot the name but they happen mostly on the temple this lady had them on her temple and her torso. It's a benign tumor, very different from adenoid cystic but the weird thing is that morphologically they look the same and are each other's number one differential. Rex and I were working on that case together. It's gotta be related, he said. But I'd send it out anyway. So I did. Happy Tuesday - much love, Elizabeth

Open Lung

     I walked into the Dr. Lounge this morning to stock up on bottled water and greeted one of the long time servers Tammish - told her about the funeral I was going to for my son's friend's mother at 10am. Way too young to pass. Funny you should mention that, she said, I am going to a wake tonight for a 24 year old who died from cancer. I shook my head in despair and told her I've been doing this for 12 plus years and they are getting younger and younger. We are doing it to ourselves somehow. She agreed. 

    At the funeral I didn't allow myself the space to grieve - I was there to support Jack and I knew I would be returning to a lot of cases that demanded my full attention. The space was beautiful and the service was very similar to a Catholic mass I grew up attending. The Apostles' Creed felt like rote soothing memory on my tongue. I remember being at one of my parent's friends funeral as a child and hearing On Eagle's Wings for the first time - such a beautiful send off. Jay Clark did the service and his wife Karen sang a song I'd never heard before - You Say by Daigle - she sounded like an angel. 

    Debbie's dad, who was going through chemotherapy and needed assistance to get to the altar, gave a beautiful eulogy. A retired undercover police investigator. He was born on January 27, 1947 and his daughter was born on January 27, 1974. He admitted he was a little long-winded, but I didn't mind it was only about 15 minutes. He shared about himself being diagnosed while she was fighting cancer and their same symptoms from the poisonous treatment. Brain fog. Fatigue. Body aches and pains. He'd lost two brothers to cancer, had four daughters himself, and he discussed the devastating event of a parent losing a child. 

    Jack looked very handsome - I'd encouraged him to go to his dad and stepmom's to get a suit when he asked and assured him I'd get there early and save him a space. It wasn't that crowded. Jacob has been his friend since he first arrived at Episcopal. He hasn't been the easiest kid, but his friend group has always supported him. He used to wake up in the middle of the night during sleepovers spectacularly wanting to go home and I finally gave Debbie my house door code so he could call her to get him so he didn't have to wake me. He's matured quite a bit, thanks to Debbie's unwavering support. He looks like an Adonis, as a teenager. I was proud of Jack - despite his self proclaimed fever (I gave him some clean tissues from my purse to wipe his sweaty forehead and told him to call in for work today) he was the first kid to walk up to Jacob when the family was receiving guests on the steps of the church. I watched them exchange private words and felt proud I raised a son that will inevitably continue to support his friend. The grandmother has been a huge support to Debbie, who was a single mom since I met her, and Jacob. She bear hugged Jack. 

    This morning I finished huddle and was discussing a challenging mycology case with Tommy, the mycology tech, when Jason Muesse called. We've had a lot of hard cases over the past year or so since he came here as a thoracic surgeon but he's never called. I excused myself from Tommy to answer the phone. A nurse's spouse, only 30, got sick on May 29 and is tanking fast with no diagnosis or cure. He's going to do an open lung wedge biopsy in the morning and wanted to know if it could be processed over the weekend. I'm on call, I said, of course, if it's too big we might not be able to short cycle it but I can look at it Sunday the latest. I'll keep you updated. The head of histology is coming in to help decide the best way to handle the tissue. Muesse texted this afternoon I know these are hard, and have to be sent out sometimes. I said yes, only half of us look at them, I'm one of them, and hopefully I can see something treatable right away but if not I'll send it out first thing Monday. Happy Friday. Much love, Elizabeth

Volcanic Eruptions

     It was a Tuesday on a Monday yesterday, and those are honestly worse because everyone is trying to cram a 5 day week into a 4 day one and not sure what the deal is lately but we've had record block counts for the last two weeks we are all frazzled. Hopefully everyone will go on vacay and it will all calm down. SO. MANY. PLACENTAS. Forget the beginning of Covid 3 months in was when everyone started going stir crazy it is evident by the overflowing pile of placentas on the placenta cart.

    I felt like a bi-mouthed volcano yesterday last week I started erupting at work and I'm really hoping yesterday was the peak because I lost count at a dozen. Luckily everything hit an appropriate receptacle and I was able to do all my work. Last week my head secretary brought me water in alarm until I assured her yes, it sucks, I'm shaking, but it's been happening for almost a year. You want to keep stuff at home private though, so the work family leak has been a little distressing. Yesterday I had to get Melody to cover a frozen because I was actively emitting into my trash can. It is what it is, but it's exhausting. 

    Today, though, what a relief! I went into Melody's office and told her I'd only dry heaved twice and she laughed. Sad that you have such a low bar for happiness, but I'm happy for you. We shared a lot of consults throughout the day and problem solved some disorienting issues with Whipple's. At one point I was reading a gross on a BKA - I've had a lot of them lately - and LOL'd. I remember back when I started that I was surprised at the amount of detail our PA's put into the gross on BKA's. When I was a resident four to five sentences sufficed - they do like three paragraphs. 

    I wandered into Melody's office to share. I said have you ever noticed how overboard the BKA grosses are? I never studied a gangrenous leg that closely in residency. She said yes they are particularly in tune to the vessels and they know all their names and like to describe where they are we never did that. I had to call Jessica earlier to fix a typo in the gross because I couldn't possibly tell what subcapture conference might mean it was calf circumference. There were also all these measurements and descriptures of lesions ranging from red pink to red brown to sloughing off grey green with exactly where they all were! Also thick and distorted nails and crusty tan white lesions it's like they were conjuring the actual leg onto my desktop and it was hilariously unsettling. I guess if God forbid my leg is ever BKA'd I'd enjoy reading them wax eloquently about it. Wonder who trained them to do that.

    The Zoom meeting Friday with KC and Terry was great I finally used my camera for the first time. I learned that the reason I hated how I looked and pretended my camera didn't work for the last year is that I was sitting way too close I looked like I was looking down on my iPhone and accidentally opened the camera in reverse. I studied them and learned how you really need to sit back and create a tableau. For next time. We got Dawn involved and she's tech savvy - wants to migrate us over to wordpress and Liz crafted a shout out for new authors when that happens. Exciting stuff. I want my interview with Judy to be the next blog - I've embarrassingly dropped that ball with all the Spring craziness but promised Jill and Judy it was the next thing on my horizon. Happy Wednesday. Much love, Elizabeth