Wednesday, July 7, 2021

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

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