SPEPs and Sex Toys

     I walked into micro huddle and asked if I missed the pizza party - I had slept in on Thursday. Amy said no, it will be next week. We had 944 tests yesterday, 176 were positive. We are at 99, 672. Good, I said, don't do it without me. I read at lunch the CDC said that the delta variant was as contagious as chicken pox (which I contracted as a child - still have the forehead scars to prove it). We are at an all time high, I believe - over 200 positive in the hospital system. Ninety-one are at Baptist Little Rock, according to her data. That's almost half. Past time to mask up.

    Melody told me that she was really frustrated last week with the serum protein electrophoresis training - there is a new method. I've been cc'd on the emails even though I haven't done them since I abandoned CP years ago. I told Pam King when she stopped me in the hall last week to take me off. Melody said there was a series of seven to ten videos to watch and they were sophomoric. Such a waste of time. They met last week around lunch with the rep and she wasted thirty minutes getting the software to work. Then she did an hour long presentation of guess what? Something the videos already covered. Boring repetitive power point. Toward the end Melody got so frustrated she said, "Can we please skip to the software tutorial? We've already seen all of this." I laughed and said she was turning into me - I was such an introverted go along get along until a few years ago when I snapped. I told her there was hope for her yet, as a troublemaker. 

    Melody asked me to cover for her for another inservice at noon on Thursday - I told her I couldn't bc I had a follow up appointment with the orthopedic doc. Apparently Pam King had told the rep how frustrated the docs were - she apologized up front and said that's what the company had instructed her to do. Pam said please have faith that if you send a half decent training video, or ten, to doctors, they will understand it in spades and will need no rehash. 

    I told Melody that good news is my rotator cuff, according to the MRI, is only 50% torn. Over 50% needs surgery. Under 50% gets physical therapy, which I can do at Baptist rehab. The scheduler called me today and I forgot to call her back but I will on Monday. Two-3 times a week with scheduled ibuprofen. I was jubilant. Two of the micro techs warned me that PT is hell I said don't burst my bubble. No surgery was the best news.

    I told Melody your plight reminds me of my one and only sex toy party a few years back. Kind of like a tupperware party for sex toys and lingerie. There was one in residency that Melissa and Laura Lamps attended a year before I started. It was hosted by the wife of a resident. Melissa told me so many funny stories I felt I had to be a part of it. One of the histotechs in Conway I'm friends with held it for her friend at her house in Maumelle. It was a total train wreck. She was obviously new - despite the festive mood and the drinks and appetizers we were held hostage on the couch for almost two hours hearing the party line, read painfully by the new representative. Go figure there is a party line for sex toys. Granted this was not her real job, she was in transit this was just a way to make money and she was super sweet. But I was so ready to get outta there I took her number and told her I would purchase a few items later I had to get home. Who knew a sex toy party could be so cumbersome and awkward.

    So excited I'm off all weekend. Christy turns half a century today - she's the one who threw my bachelorette party - and we've got fun stuff planned for tomorrow. Lucy loved the shopping trip and Christy last night - we have a date for her to do our makeup Sunday night. Saw Sean and Avery at Boulevard tonight they are such a breath of fresh air. Can't complain about anything despite some kinks in the week. Happy Friday, much love, Elizabeth

TB

     Yesterday's test tally was over 700. Total 97,100 plus. Pizza party coming soon.

    I bumped into Tommy in the hallway today. We've got a doozy. Sputum was 3+ he said. Mtb probe was positive. That's only the second one this year. We are overshadowed by Covid, but there are other bugs. I took note of the patient name, and looked it up in the chart. The TSpot is negative, I called and told him. They are doubting your PCR test. We are right, he said, the TSpot depends on a healthy immune system, and it isn't always right. False negative. The Mtb Riff is much more sensitive.

    They are depending on the cultures, according to the notes. But wait. There's a new note today. The ID doc contacted the health department and they said they had a bunch of false negative TSpots. Tommy and I commiserated. The TSpot was developed in part by Bill Gates to help developing countries diagnose TB cheaply, and more efficiently, but it isn't foolproof.The health department recommended we start her on RIPE therapy and discharge her for outpatient follow up. 

    Two late Conway Zoom meetings sucks when I'm not on call, post call. Covid is flooding the system. People seem glib. It will be interesting to see what the next few weeks portend. There seems to be a tentative plan for alternate care in place but I worry it's too little too late.

    MRI in am at 6:00 to figure out this right deltoid issue - I tried to find a time that wouldn't inconvenience my partners. A little worried - got beta blockers at the ready - but I was reasoning  myself on the way home that if I could cave an MRI shouldn't be too bad. Happy Tuesday, much love, Elizabeth.

Pizza Party

     When I walked into the micro lab this morning to go to huddle Amy was tallying some numbers - she wearily asked me if it was huddle time already, staying concentrated on her task. I asked her what she was doing and she told me she was tallying up the number of Covid tests we did over the weekend. Over 500 Friday, Saturday and Sunday. She showed me a big number - over 96,600. She perked up. See that? When we get to 100,000 Paula promised us a pizza party. We thought we wouldn't make it, but with this new Delta variant I think we are going to get there. In a few days, by the looks of it, I thought.

    A rather morbid benchmark, I communicated. She said, hey, we will take what we can get. We earned this. Not denying that, I said - if Paula reneges on her promise I'll buy everyone pizza. Reminded me of residency, when the VA gave a pizza party to the medicine team that got the most consents for autopsy every month. Autopsies are fine once or twice a year but when you are on the rotation in residency five or six a week (seven or eight if you are super unlucky) will have you cursing the pizza party promise. 

    Clean up today was busy - I went to get a redeye after lunch to get me through the afternoon. I bumped into Zach, who is a super sweet nurse who took care of my dad in the CVICU and always asks after him and the rest of my family. I asked him how many of the ECMO patients have Covid. All of them. We are full to capacity. This isn't what we were seeing in January. I've got a 20 year old college football player. A forty year old who was at the pinnacle of health. So, I wondered, how many of these patients get off ECMO and make it? I know the odds are grim. My dad, who was on ECMO then weaned off then placed on it again, is nothing short of a miracle. The 15 years younger doctor who was placed on ECMO at the same time he was did not make it. Dad was the first survivor in the history of Baptist to make it off of the external right ventricular assist device - Bhama brought it from Ohio - and that was freaking ECMO step down. Zach said even if they make it off of ECMO a lot of them die of pneumonia or sepsis. 

    Kathy Parnell - I've talked about her before - bubbly platinum blonde hospitalist with a wonderful personality called me about a liver core I got over the weekend. I told her what Zach told me. She said yeah, that 20 year old is my patient. I got back from vacation July 10, and I have admitted many Covid patients, most of whom are unvaccinated. A few are partially vaccinated. The vaccinated do fine. I have successfully treated and discharged one unvaccinated patient. The rest are critical or dying or dead. But this guy, he is Covid free! What do you think about the liver? I was kicking myself today wondering if I should have consulted Sosnoff over the weekend to scope him and save time, but it just doesn't seem like colon cancer. You are absolutely right, I told her, not colon at all three of us have looked at it number one differential is well diff hepatocellular. Which it was, and she called Melody's sister Rhonda when I texted her to get an oncologist on the case. 

    Speaking of Melody, poor thing is recovering from a nasty sore throat and cough (we swabbed her and threw it on the turnaround 1 hour Panther last week and when she came into my office with a negative result we both almost wept in relief). I told her the ECMO story, and she said so that's what that ECMO class is about in the hall. I recalled seeing an ECMO class sign on a door and lots of employees heading in. Of course. Staff is stretched to the limit they need to train more people to help out. 

    I watched another inservice today while triaging morning cases - new information on Delta from Novack and Dillaha and Keller and someone else I'm blanking on it was over an hour. It felt like Groundhog Day. Someone who is closer to Mandee than me told me she took June off to recover from the pandemic. Now here we are again at square negative one. But life goes on. Happy Monday, much love, Elizabeth

Variants

     So much happened today I don't know if there is a beginning or an end there were just endless cases. I worked my fing ass off. BHEC committee was underwhelming, I was ten minutes late; forgot it had moved from down by the Doctor's lounge to the Admin suite. I was talking with Ali afterwards - he was asking about my KT tape on my arm and I told him about my MRI fears and he said, don't worry - I fell asleep, it's not bad. GTK bc it's set up for next Wednesday at 6am. Lucy worked the kitchen at Baptist Boulevard today - hadn't seen her in too long - and we hugged and planned a girl's shopping trip next Thursday so excited. But that's an aside.

    As Ali and I were walking up the stairs after BHEC meeting we bumped into Wayne Lyle. He's an ED doc - I told Ali we went to med school together and we were blood draw lab partners. Told them I drew his blood fine but when he drew mine I passed out cold. Ali laughed and Wayne did too - said he didn't remember that until just now. Ali checked in on Wayne. How are y'all doing in the ED. With the delta variant. 

    Wayne said I've still got lots of compassion for my patients - that's my job, but I'm losing my compassion for the employees who won't vaccinate. I'm so angry and I try not to be but I am. I told him not all of our employees are vaccinated and some still don't believe that the unvaxxed are the root of the new variants - it angers me. Especially when so much of that movement, if you call it that, wants to blame the Hispanics, which Wayne and Melody assured my instincts today that the Hispanic population are not in the ED with Covid and are overwhelmingly vaccinated compared to our population. I learned that only 48% of our hospital employees are vaccinated, and it almost brought me to my knees. Physician vax rate is 95-98%, which makes the others even lower percentage wise. The floating reason for not requiring the vax is that we are so short of nursing staff that if we require it they bail and we are crippled. I kinda get that - there is talk of a coordinated effort to all require vax at the same time so there is no "safe hospital" for the unvaxxed but at the same time I just want to call bullshit like Emmanuel Macron.

    Went to huddle and was glad I did Amy did an amazing inservice on sequencing. There's not just Covid and a delta variant; we were looking at graphs and sequences of the entire evolution of the virus, which mutates daily, over the past year. I was supposed to be at the Zoom meeting Wednesday but call duties prevailed. The doctor in charge in Arkansas admits we are the 48th in the country for sequencing Covid cases (just like the vaccine, I joked with Olivia). When there was a geri psych outbreak last year at the beginning of Covid - I researched the contacts for admin - the sequences of the virus were all the same. B.1.1 maybe? I had Amy send me the Power Point but it's a little late to delve into that I've got to work tomorrow. Anyway, all the current infections - kids and adults - are overwhelmingly Delta. The bad news makes the news. If it bleeds, it leads. 

    Kids are going out of town next week - C to Mexico and Jack to camp. Already texting friends for plans - there are no triple surgicals or even pluses on the schedule next week (thank god) so hopefully work will be manageable. Happy Friday. Much love, Elizabeth

    

Breast Care

     I walked into Staggs' office Monday morning to chat, whatever, I can't remember, it was before the onslaught of needles. We were catching up. Tara from histology brought some slides into his office. There was a red stamp on top of a requisition about a centimeter high in bold. It said breast care. I looked at Staggs incredulously. Do you mean breast case? I asked Tara, and she said yes as she receded down the hall. 

    WTH? I asked Staggs. Dunno, he said, I've never seen that before. I wondered aloud if it meant for us to do a self exam. Not that you really need to, I told him, but guys can get breast cancer too. Later I told the story to Melody, and she said that Tina had ordered a stamp last week from the business office announcing breast cases (these are time sensitive to some of our clinicians) and they had f'ed it up. LOL. 

    A day later I was getting cases announcing breast case (in capital red bold letters), so I guess they finally got it right. Yesterday Tina got a white sac package from the business office. "I'm scared of this," she said. I wandered into transcription. "Why? Open it." 

    It was another stamp that announced breast cases. But we've already got it right, she beleaguered. Why are they sending us another one? I guess I could stamp it on my breasts, she said, might be kinda sexy. I told her that breast care stamped across the chest would be even more sexy. Less clinical, I was thinking, and more of an invitation. She laughed. I headed to CT. Keep up. Happy Thursday. Much love, E.

Preaching to the Choir

     Monday after I read an EBUS for Cydney Tony and I were talking about Covid. Wondering why people don't get vaccinated. Today he rejoiced that one of his cousins got vaccinated when he signed up for a cruise and they told him if he didn't, he would be quarantined in his room all week. No dinners. No community. No excursions. It was a win win, but God the lengths we are going through to get people to get the shot in this strange climate is mind boggling. 

    I walked into the Dr. Lounge to get a water after I read the slides - it is right next to the pulmonology lab. I ran into Bob Searcy - a seasoned and highly opinionated pulmonologist. He used to intimidate the hell outta me but when I told him who my dad was a year ago he took a shine to me and always asks me about how my dad is doing. He told me that one of the SICU workers (he is in critical care pulmonology) who refused to get the vaccine was on a large outing last weekend and a bunch of them, including her, got Covid. He was livid and ranting. I don't want anyone unvaccinated taking care of my patients, they are already critical, and Covid would be a death sentence for most of them.

    I told him I heard a hospital in NW AR was requiring the vaccine for health care workers. These are murky waters - it's not yet FDA approved, but I agree, we need to mandate it, and so does he. This new variant is so much more virulent and Melody and I wondered this afternoon about the ethicality of even having a sore throat and coming to work without a test. As vaccinated asymptomatic or mildly symptomatic carriers we can wreak havoc to those who aren't protected. Yes, I'm frustrated but not entirely hostile to the community who disagrees with my point of view. But the children. They are succumbing much more rapidly to the delta variant, and haven't yet been approved for the vaccine. If that isn't argument enough to mask up, I don't know what is.

    Laurie and I got called to a late brain frozen in NLR today and I was explaining my angle - who wouldn't want to protect the children? She is cynical in a good way, often more so than me. "Well hell you know who it is. They don't want to do anything to help the children when they are outside of the womb." But that's a control issue, I said, entirely separate. But not really, I sheepishly admitted. It's such a shit show. Luckily it was an easy frozen and we were back at work to finish up and be home by the decent hour of 7pm.

    Shay is one of the workers in the Doctor's Lounge - we have gotten friendly since she started working there about a year ago. When Breezes opened back up Geisha had to go back and Shay was her replacement. A spunky lady in her late 50's or early 60's not sure but her colored hair and smooth skin belie her age. She has 34 grandchildren! She lost a great friend to Covid last week, was showing me pictures on Facebook as the automatic Starbucks coffee machine was brewing my morning mojo. The funeral is this weekend. I told her I've had close people contract the disease and suffer greatly but had not yet had a close casualty. I sympathized.

    But it's bound to happen soon. I read the lambda variant popped up in Texas the other day and what even is that? We are like a Petri dish; all of our misinformation brewing opportunists. And our blissfully unaware (or so they claim to be - machination vs. ignorance is tough to snuff out these days) legislators are touting the vaccine (finally, some of them at least) but it's too damn late for that. Melody sent the numbers tonight in our hospital system - they are rising as predicted. On July 14 it was 163 hospitalized 47 in ICU. Today it is 185 hospitalized 61 in ICU. According to Mandee, we are at the tip of a disaster.

    In micro huddle we plot and plan to decide which machines to use on which patients - vaccinated vs. unvaccinated, asymptomatic vs. symptomatic, exposed vs. unexposed. Trying to get the information to the clinicians in the most efficient and expedient way possible - some are batched, some are not, some add other PCR viral tests that may be of use to rule in or out Covid. I'm noticing when I look in the charts that a lot of Covid inpatients are overdue for their second vaccination. The hospitalists I bump into in the Dr. Lounge are more frazzled than they were in the winter. I hear our patient count is over the maximum bed capacity - we are at 614 (max 600) and we are now converting private Covid rooms to shared ones for patients with mild symptoms to accommodate everyone. 

    I escape from it all by looking at science articles on The Guardian over lunch - they first talked about pyrocumulonimbus clouds last week and now the NY Times has jumped on board. Dangerous but fascinating. Family dinner over meatballs tonight also helped. I find that if I just reason that everything, no matter how awful or contrary to what I wish, is happening (oh god I resist to say for a reason that is so fing cliche) but if it just is, and I just go with the flow, me and mine will be ok. Maybe fairy fantasy stuff, but if it helps you sleep at night, use it. Happy Wednesday. Keep up. Much love, Elizabeth.

Interventional Radiology

      I walked into radiology for the sixth time this afternoon. Which was an unexpected nuisance - the new guys don't call us much anymore so we are used to maybe one a day from them. But I'd had a bunch of thyroids and Ken was on, he always still uses us and it's to his credit - he gets good material and we get good radiographic correlation for working up the case the next morning. I signed out over 50 cases today - a record I hadn't reached in years. That's what made it such a distraction. It was a Monday on a Tuesday. 

    There were only three rad assistants - none of whom I recognized other than earlier today. Tony, my cytotech, was staining the slides. I looked at the specimen name. Left groind node. I knew it was a typo, but I was having a day - already bitched about some changes I didn't agree with that were made in cytology when I was off last week. Back when I started, when the rad room wasn't a rotating bumbling cast of characters, I would have had my secretaries fix it the next day. But I was in the mood to ruffle feathers.

    Um, what is this specimen source? I asked the blond with braids. I'm pretty sure the groind is something I never learned about in medical school. Is that a new anatomy term? She giggled. The male assistant apologized, appeared embarrassed, and said he would fix it right away in the computer and get me a new rec and sticker for the patient. I sat down to read the dif quik. It was cellular, and looked like metastatic malignancy.

    So what's the history, I asked. The male assistant said, oh, I'm not sure, let me look in Epic (they used to always have the history pulled up back in the day - I sound ancient and crotchety lol) and said the thyroid was removed at one point? Maybe he had thyroid carcinoma? Tony and I, who are in a separate sort of antechamber looked at each other and rolled our eyes. I'm pretty sure no thyroid cancer ever has leaped to a groin node, I muttered under my breath, and he laughed. The brunette, who had also pulled up Epic, said there are liver masses! Over twenty they say. Too many to count, but then they say over twenty. Oh, and something about a lung mass? I muttered, "How many rad assistants does it take to get a patient history right?" Tony laughed again and I said louder, so they could hear me, "Who did this needle anyway?" Apparently Ken was out of the room working on another case.

    I don't fault the staff here - it's frustrating as hell but it's like this everywhere. No more consistency - and the blame should start at the top not the bottom. This constant staff shuffle has got to be one of those cost saving measures that makes the system infinitely less efficient and more prone to error. To her credit, the brunette asked me as I was leaving what was the purpose of Cytorich Red and did it have something to do with cell counts in the lab. Bless her heart she was trying to learn and wrap her head around the media and what our role was - she has a long way to go - but today was not the day for me to find the patience to explain it to her so I pointed to Tony to answer her questions and walked back to my office. 

    Watching Lisey's story and jeez it's a little much at times but good so far. I started a book by an Arkansas author - Michael Ray Taylor - called Southern Caves on the way back from Vail. Unfortunately managed to lose it somehow halfway through so ordered a new one on Amazon today it is fascinating. The chapter on the evolution of a new way of thinking about cave development with the assistance of heretofore undiscovered bacteria, some of the likes of which mimic the ones they are seeing on other planets, just about blew me away. It's not just chemicals, which was heresy to say 20 years ago, but now that myth is being debunked. Caves would not exist without the assistance of biolife. 

    Michael wore teflon suits to go into caves with scientists to study the bacteria that hides in invisible spiderweb form on the ground but if it touches skin the acid it (emits? Can't remember) will burn badly. And this guy, I researched him last night, is a freaking communications/theater professor at Henderson. Go figure. Genius springs forth from unlikely places. 

    Hoping that my surprise call week post vacay slows down (but with Rex retired and us being short staffed in summer months not keeping my fingers crossed on that one). I actually have triple surgical load on Friday. Yikes a first if I remember correctly. Oh well I'm taking it in stride I scheduled a chiropracter appointment tomorrow to address the mound of concrete that my upper back and neck have reverted to in the past 24 hours and luckily going to orthopod to address the right arm issues on Thursday afternoon. In good news on that front, my ambidextrous origins have come in handy over the past two weeks, especially with my ADL's. Aging is such a joy. Happy Tuesday. Much love, Elizabeth

Angel Wings

    It's weird being in another state vacationing while your home state is making national headlines because of a new delta variant wave. Sunday I texted Annie because her hospital system, Missouri Cox, was on the cover of the New York Times and today I read quotes by Jennifer Dilaha, of Arkansas Department of Health and recent physician Covid inservice fame, in The Guardian. NBC even did a piece on us, according to the Arkansas Times. And we have been banned from Chicago, along with Missouri, unless we produce a negative Covid test 72 hours before arrival or something like that. Eye roll. I've been second guessing my decision not to bring my vaccination card to prove I'm vaccinated even though they aren't yet required for travel. But I take solace knowing I could tell Melody where it is in my office - she could take a picture and text it to me if necessary. I asked her to send out the Baptist numbers again - it's been awhile - since we are a new hotspot. Systemwide there are 163 inpatients with 47 in the ICU. That's a lot.

    Other than hiking and shopping and reading and eating fabulous food not much going on here. We had a spa day yesterday and my masseuse was fascinating - I watched her walk in with her cowboy boots and cutoffs and half shaved head covered with tattoos and thought I hope that badass is the Sara that is supposed to give me a 105 minute treatment after my hour scrub/hydration with Krista. I got lucky. She had changed into appropriate professional scrubs but I complimented her on her previous outfit to get us off on the right foot. Sometimes I'm chatty, sometimes I'm silent. We did not stop talking the entire time.

    Turns out Sara, despite being in her early 30's, has traveled the world. She entertained me with stories of Cambodia, Australia, Germany, Egypt, and the Philippines, the latter of which is one of her favorite places to go - friendly people, amazing cheap food. She often works in hostels or volunteers for non-profits in order to pay for her room and board. She told me the best place to stay in Egypt that is right across from the pyramids - it is a family owned hotel for generations and she got to meet the patriarch before he passed. You can sit on the roof and watch the sunset, she told me. It is incredible. Of course I forgot the name, sphinx was a part of it, but we became Instagram friends after the session (I entertained her with some Dr. stories too) so when I plan a trip to Egypt I can message her. She told me most of her IMs are travel questions but she doesn't mind. I told her I get a lot of medical questions but I don't mind either - it's fun to share your area of expertise. 

    She plans to move to Costa Rica soon but has never been there - I told her I've been three times and we bonded politically over how much better women led countries are run -Jacinda Ardern! Etc, etc, - New Zealand is one place she's never been to but has heard a lot about Kiwis. I told her about Judy Melenik and how I'm waiting for Dawn to migrate us over to wordpress to write that article. We preached to our own choirs about the shifting climate from patriarchy to matriarchy, and how it's a frustrating but amazing time to be alive. 

    I also met a guy named Jack in the fossil shop in Lionshead - it is one of the most amazing fossil shops I've ever been to I've already been twice. I had a few half off smaller items shipped - I found these stunning blue quartz candle holders that were listed for almost $300 apiece in Vail Village on Sunday (ack too much) and they were half off in Lionshead Village at $70. I prided myself in getting out of there without a huge purchase - my last big one was in Aspen buying matching trilobite fossils about six years ago. Then I saw the quartz angel wings. Jack appropriately ascertained my emotional pull and described the artist and looked at the ticket and offered me 2K off of the list price. He said they had already sold out in Utah. I talked it over with S and his advice was to sleep on it - good advice for big purchases.

    I told Jack I'd be there until Saturday but he said he was leaving Thursday for the Ukraine to meet a friend - they are planning to hike the Carpathian Mountains. I told him quartz was big where I was from in Arkansas and he said come look at this piece from Arkansas. It was surrounded by Columbian quartz but it was twice as beautiful because it was spotted with gold. He also showed me an amazing museum quality dinosaur skeleton embedded in stone worth over a million dollars. When I went back today to seal the deal (turns out I dreamt about the angel wings - Sara agreed there are things that pull you and it is meant to be) I made sure Jack would get the commission since I spent yesterday at the hotel. The worker, surprised that I knew Jack was going to the Ukraine, assured me he would, and verified the price he gave me with her boss on the phone. 

    Dinner tonight is at Montauk in Lionshead the menu looks amazing - hoping it's as good as the Veal Chophouse the other night. Lionshead is a little more charming than Vail Village; I'm sure there are a lot of good restaurants there but it's closer and has plenty. We arranged a float trip for tomorrow - nothing too scary since I have been ignoring (like a doctor, I joked with Sara) a pulled muscle in my right deltoid for two weeks (paddle boarding incident) and it has not gotten better. It's either a badly pulled muscle or a hairline fracture of the humerus, mid-shaft. The orthopedic clinic in Vail, world renowned, was booked this week so I'll got to OrthoArkansas to get it x-rayed next week. I almost started crying in yoga last week and it wakes me up at night. Advil and Ace wrapping aren't helping. I'll take this though over the vastly improving GI issues that plagued me over the last year any day. I'm finally feeling normal again. Practically cough drop free, unless I want one. No longer dependent. Wine is good again. Happy Friday Eve, much love, Elizabeth

Gross Room

     I still don't know what the hell that arm thing was. I told Jessica to give it to me for today, but Bob reassigned it yesterday evening. Not his fault, their job is to make the block count even however they so choose, but by the time I realized that I wasn't getting it and figured out who was they were already gone for the day. Oh well, I'm off for a week so I'll figure it out when I get back. 

    I was on afternoon frozens this week and the first two days were quiet but then it ramped up. Yesterday I got called to a brain frozen mid afternoon. This neurosurgeon has worked there for years, but he's pretty stoic - I can pick him out in the hallway but I've never met him. Bob said the radiology looked like a 4 cm GBM but I was hard pressed to call anything besides normal brain on the sliver of tissue he sent to freeze. I called Staggs for a consult, he agreed. 

    I called back the surgeon on the bat phone and told him he did not have diagnostic tissue. He loudly asked in front of all the OR staff how long it would take to do the next frozen. Confusedly, I asked what? He said I'm sitting here waiting for your result with the patient on the table not being able to make a next move can you tell me how long next time? I channelled my inner Michelle Obama. When they go low, we go high. I told him the average frozen takes 15-20 minutes (this is not an arbitrary number these are the CAP standards) and that if it is difficult we sometimes, like I did on his, get a consult and it takes a little longer. I apologized for his wait. 

    After I hung up the phone I walked back into the gross room and told Jessica what a dickhead! I haven't been treated like that since training - what an ego. She told me way before 15 minutes his staff was calling the gross room wondering when they would get a result. She was seething. If you call, she wanted to say but held her tongue, I have to stop doing the frozen and answer your call so you are chopping off your own leg here. 

    I went back to Stagg's office to vent. He told me yeah, that's the guy who idolizes John Wilson. John is a neuropath expert over at nephropath at Arkana - we send him rare difficult brain cases. I met John and his wife at Martha's Friday night sip and sit yoga a few years ago - he is an amazing individual who trained all over the country and he's humble as hell. He also goes to great lenghths not to step on our toes, which is different from a lot of consultants (Jesse McKenney is good about this too). A lot of consultant's mission is to steal our business with a lot of fear mongering over, basically, bullshit. 95% of what we see in our practice on brains is cookie cutter - either metastatic lung or GBM. Not rocket science, but if it's hard, we send it to John.

    Staggs told me about five years ago he had a frozen from this guy about like mine, non-diagnostic and the surgeon got so angry he didn't get an answer he asked Staggs to take it to John. At the time Arkana was behind the Heart Hospital. I called him on his bluff, Staggs said, and told him it would be an hour turnaround. Luckily John said the same thing - non-diagnostic. This surgeon is a young soul, I decided. The next two frozens he sent were similar. Luckily he got the tumor on permanents today. I bumped into him in the hallway today and introduced myself. Told him he got the diagnosis on the perms. He looked like a deer in headlights, and I wondered where his headspace was. So it will be out Monday? He asked. But I just told the patient I didn't get a diagnosis. I gave up on frozens. No, I said, it will be out today. I got a second, it's a done deal. Necrosis, prominent vasculature, nuclear pleomorphism, atypical mitoses, it's a shoe in for GBM. He startled, thanked me, and walked away.

    Bob had the best retort. Next time, he said, you should tell him you are waiting and twiddling your thumbs for the next frozen bc he isn't getting good tissue he needs to speed up his turnaround too. LOLOL. I would never. I get it - they are working in the brain looking through loops it's gotta be tough. But no excuse to shit all over your help. This afternoon Sims sent nine frozens. It was all good, mostly negative margins on a glossectomy, and the positive one that he had to send a supplemental margin on was negative. Promise to follow up on the arm mass sometime this week. So excited to leave for Vail in the early afternoon - time to wake and pack and clean the fridge. Happy Friday - much love, Elizabeth

Denial

     I got a call at 6:45am Tuesday from Jessica. She said you are on the schedule to go to Conway tomorrow for frozens, but the surgeon moved the surgery to today. So you need to go to Conway. Oh, I said, thanks for the heads up. She told me he was starting at 8:00. He's usually a slow starter, so I figured I had time to eat breakfast and head to Baptist to get my early biopsies and diagnostics before I hit the road. I asked her to call the histology lab and tell them and to please notify the business office I needed  to have the courier, John, bring me a run at 10. Emily in histology assured me I would have most, if not all of my 120 blocks by then. 

    I texted Misty on the way up I would be there if she needed me to sign anything. I didn't hear back but bumped in to her when I was looking for a water at 9:45 - the surgeon was having a time finding the offending parathyroid (adenomas and hyperplasia can cause hypercalcemia, it's an easy frozen) and we weren't released to go back to Little Rock until early afternoon. Bob lives in Conway, one of our PA's, so he showed up to do the frozens. Thank goodness because the frozen machine broke and he had to perform miracles to get a section. Misty asked if I would like to have lunch, and I was excited. She's gluten free too. After the lab inspection we shared a philly cheese chicken sandwich, sans bread, over french fries. We talk process. Yesterday we did the same. She was upset. 

    We bumped into the CEO, Tim, he's so nice, getting food. He asked if she was on vacation last week because he didn't see her. No, I was in Little Rock, she said. He asked about our holiday weekend, and she replied that she was in Conway Baptist every day catching up. Oh god I offended him, she worried over lunch. I'm usually not that blunt. But I would never just take a week off? Without telling him? WTH? Turns out Covid is ramping back up with the re-opening, I'm sure you've read all about it in the news. Delta, Delta plus, Delta schmus. Luckily it's not so dangerous for vaccinated people, but so many are unvaccinated. 

    Misty started dishing on the real reason she is frustrated. She told me she was instructed by a doc to bring up the antigen test again, Sofia, for employee testing. But that's a bad test, I said. If there is a false positive, we have to quarantine them for two weeks and it is a waste of resources. Inefficient. If it's a false negative, we are exposing the other employees for 7 days, the amount of time recommended in the doctor generated algorithm before we do a PCR test. She crafted an intelligent, non-emotional e-mail to the doc and showed me it and his response over lunch. Did he even read your e-mail? I asked. It doesn't look like it from his response. She wanted them to do the PCR test day one and day 7, and do the antigen test in between.

    I was texting her today worried - Amy and Olivia in micro (two seniors) are off this week so I couldn't run it by them. She told me that it would probably be ok. We take care of our employees, she said. If there is an exposure or a symptomatic employee, we usually bypass protocol and do the PCR test. Whew. What a relief. Hopefully they do that in LR too, I know Mandee Novack does not trust the antigen test either. The gift shop worker at Conway - we have chatted about divorce and kids in the past - said her unvaccinated nurse kiddo was calling her worried. There was another exposed nurse that worked half a day exposing everyone before he tested positive for Covid. Gift shop manager said I'm vaccinated, but my adult kids are opposed.

    I get it, I told her, I'm not judgmental. It's not FDA approved, it's still under EUA. We cannot really mandate it yet. But from everything I read the side effects are less than .1%. That is dwarfed by the side effects of getting Covid. It's a gamble I am willing to take. Despite the relaxations in public, we are all still masking at the hospital. 

    While I was waiting on another frozen around 1 yesterday a surgical tech walked a specimen into the gross room. Y'all gotta see this, she said. Just hold your nose. It's an arm mass. I held my nose and looked in the white bucket. It was a 15 x 5 cm cylindrical shaped mass that was flaky and grey-green and gangrenous with an ulcer on the top. Gosh, I said. I've never seen anything like that let me see the name so I can look it up in Epic. The doc had taken a pic in situ and I asked Bob, where is that? On the shoulder? He said no it is protruding from her arm right above the elbow, according to the surgical tech.  In the H&P she said it had been there two months and was the result of a minor scrape.

    I went into the gross room in LR today and was telling them about it - Michelle said we just got it and accessioned it I told her and the rest of the crew the story and showed them the pics and told them to give it to me for tomorrow. Jessica asked do you think it's a squame? I said like none I've ever seen but I'll lyk tomorrow. If it's weird I'll send it out. I had heard there were a lot of frozens over the holiday weekend - more than usual. Jessica said one was a young woman diagnosed with a 3cm cervical tumor at UAMS last year and she went to a natural healing place in another state for a year to get treated. She presented with total ureteral obstruction - the mass had grown to 10 cm and there were implants all over the pelvis. Ugh, I said, poor thing. I get denial too, I've been there. But modern medicine has a lot to offer, despite its downfalls. Do the natural thing, I'm all about that, but in conjunction with us. Surgery, immunotherapy, radiation, there is a lot out there to combat cancer these days. We don't have all the answers, but we have a lot of good science driven tools in our toolbox. 

    On the home front, things are looking up. I haven't expelled any demons in two weeks. I started drinking and enjoying hot coffee for the first time in a year on vacation last week. TMI, but lower GI tract is normalizing as well, giving me the energy to walk and exercise. I went to my first gym yoga class in over a year tonight. It was Monique, who is amazing, nice and slow. Cecelia and Joelle went with me, which was ecstasy. I saw Shelly, an old supper club friend from Foxcroft, and we crazily hugged. My body temp is normalizing back to the colder side of things. I'm cautiously optimistic. 

    Misty told me that Covid numbers in our hospital system are rising. We were down in the 40's in June. She said last week we jumped to 60's and this week we are in the 80's. Makes sense, as C would say. Probably over half of our state is unvaccinated. Hopefully we can get control, but I'm not holding my breath. Or planning any European vacations in the next year. Got CARTI tumor board in am looking forward to seeing that crew it's been a bit. Happy Wednesday. Much love, Elizabeth

Respite

     Florida was unrecognizable for June/July. It made me feel guilty, all the lush green surroundings, as I thought about California and Arizona - made me wish I could lend them some rain. There were daily frequent pop-up storms; it felt like we were on a Caribbean Island. And the color of the ocean on the bay was new to me. Ink black ocean turned amber as it was approaching the shore and the crashing waves were the color of honey. My brother and I first noticed it on our arrival evening walk, and I marveled at it all week. The only time it turned sea green and clear were on two sunny mornings. The resulting weather from all the rain was pleasant for excursions and walks and sunning and reading on the third floor roof balcony. Once Cecelia and I had a long walk interrupted by a downpour - it was cold but I'll never forget the sight of the raindrops pelting the ocean while hanging out with one of my favorite people on the planet.

    It was fun to get to know their friends - both new fast ones. Noah looks like an Abercrombie and Fitch model (if that store still exists) so it is surprising to look into his dark eyes - they are like a doe's - and see introversion and even insecurity. He, at the young age of sixteen, has sworn off alcohol and drugs and tobacco for the same reason my partner Michelle did - early overexposure. His caretaker of two years, Ms. Candy, is a social worker for crime victims. She works for the state government. When I learned this on the phone a couple of weeks ago - she rightly wanted to talk to me before she sent Noah with me for a week - I told her she was a Saint. My brief background in psychology left me raw and wounded, I told her, and she assured me it took her a bit of time to build her own boundaries. 

    As Cecelia and I walked in the rain we assessed Noah glowingly. She told me that all his other friends are mean - I mentioned a couple who I knew had a tendency to tear others down. Not pathologically, but probably insecurely. She said all the Episcopal boys trash talked each other. In stark contrast Noah was very kind to Jack. Jack is also a kind, sensitive soul so they meshed well. They were always checking in on each other and making sure if there was a plan, everyone was ok with it. In the middle of the week we were on our way for lunch and shopping and we went in to get the boys a one week gym membership at Port St. Joe - they work out together in Little Rock and were missing that. As we walked back to the car  Noah grabbed a door so I walked to the other side of the car and looked up at him confused when I realized I was on his side. "I was holding the door for you," he said, and I was floored. Cecelia called out from the back seat "Gallantry is not dead!" and I told the girls expect nothing less from anyone you date. He worries that he is not as book smart as his older brother and sister; I assured him kindness is more important and he already has that in spades. 

    And Joelle (Yousef's daughter!) was wonderful to hang out with. She is heading to Hendrix in the fall to major in poli sci and to minor in French. She, like Cecelia and Jack, comes from a blended family - she told me on the plane on the way back she was about the same age as C when the divorce happened. She speaks highly of both her mother and her father - makes me think they did it right like we did. I'm not glamorizing divorce.  I know the kids have their frustrations especially having to pack up every week and move to a new house; but the benefits I see are great, especially if the marriage wasn't working. Four adult heads to bounce things off of. Seeing more than one way to do family and picking your favorite parts for your future self. Joelle seemed very wise and grounded. An old soul. I'm glad C has her as a friend. I told C the other night I had friends from Fayetteville come stay at Hendrix for the weekend; I'm sure it won't be hard for them to keep in touch over the next four years.

    Being sans a husband - he's saving his much less vacation for Vail next week and already visited my parents last New Year's - I had a lot of time to read. I finished Melody's thriller Mother-in-Law on the plane and resumed one I started a few months ago called Vesper Flights. I had read the author's first NYT bestseller H is for Hawk when it came out - a lovely book about grieving her beloved father's premature death by becoming a falconer. This is a book of essays on animals and political and climate commentary. Turns out I have a saturation point for that, even though they are wonderful think pieces. I took a break and turned to the doc mom book club pick - Amanda Ferrell's turn.

    Hollywood Park is one of my favorite memoirs I've ever read. He's my age, we grew up listening to the same music. The book starts with his mother running away from a cult with about 7 year old him and his older brother. I won't ruin it in case you want to read it - I finished it in under 24 hours (was up until 2am reading and woke up at 6am to finish). There was prison and addiction and poverty and love and happiness and family despite all the hardship. It grabbed my by the shoulders and didn't spit me out until I was done. Mikel Jollett was in a band I've never heard of.  They must have achieved brief fame during my med school and residency, in other words, The Cultural Dearth. I look forward to looking up and listening to Airborne Toxic Event.

    I'm still working my way through an anthology that was recommended by a Native American activist I follow on Instagram. Love After the End. It's a mash up of Native American culture and sci-fi and LGBTQ culture. I never thought I would like it when I saw the sci-fi part in the intro but these stories are blowing me away and a couple have brought me to tears at the end. Looking forward to getting through the second half. Just had ten days off and looking toward a short week before the next adventure. Can't wait to see my work family tomorrow I miss them. Was joking with Rex on group path text that I haven't missed him yet since I've been on vacation but I will start building his shrine on Tuesday. Happy Monday, much love, Elizabeth