Friday, July 9, 2021

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

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