Monday, August 30, 2021

Post Call Monday

     I've got three meetings tomorrow - starting with ENT conference at 7am. Luckily the three cases are either out at Cleveland Clinic or weren't done in time to take pics so I can just go and be present and not present. I'm tired. Call wasn't that busy but it's still call and we are down a pathologist which sucks. The other meetings are top secret but I'm taking Tina and Kimberly to dinner tomorrow night and that is the most fun thing on my schedule. 

    Everyone was getting the booster today - Staggs was recommending it but I'm gonna wait until Friday based on my experience with Amanda and S's mom - it kicked her ass too. Hal and Melody both got it I told them they would be my guinea pigs. I took a poll in the Dr. Lounge this morning. Eric is not due yet - since he had OG Covid he didn't get his vax until March, but nephrologist whose name I'm blanking on had a lymph node swell to the size of a baseball for four days. Planning to have lots of Advil on tap and a long weekend to recover. 

    When I went into the gross room to check out last Friday there were frozens and the circulating nurse - don't know her name either but she has short bleach blonde hair and ice blue eyes and always has my back. She was trying to give frozens to Jess and the window wasn't working. Can't you get it up? Asked J over and over we were cracking up. The circulator said she was checking on a room a week ago and asked if they were done - they said yes we are pulling out now. We all died laughing. Not the right words for surgery, but hell, it's an apocalyptic pandemic, we will take what comes. 

    Avery and hell me too were a little wrecked this morning despite going to bed rather early. But the get together was a blast. She recommended Broad City - S and I are thoroughly enjoying it. A nice wind down after a hard day. Happy Monday, much love, Elizabeth

Sunday, August 29, 2021

Rooster Booster

     So Doc Book Club got canceled. Amanda got the booster shot and it kicked her ass. I'm going to wait to get mine until next Friday when I'm not on call so I can recover if it does the same to me. Plus the community transmission rates are high, 20% someone said, so not so safe for gathering. I offered my backyard as backup to try to gather in September or October and the reception was good. 

    When I went to Shipley's to get donuts for the lab this morning the line was out the door and no one was wearing a mask. Felt like a septic tank as I observed from my car so I went to Edward's and got bfast food there. Luckily call Saturday was light - I finished up before 10 am and ran errands. Picked up some shoes from the cobbler. Went by Boulevard in the Heights. Avery was working - she said she was so happy to see me. I told her I was going to get coffee but that line looks daunting - she said I'll make you whatever you want. I said what are you making? Iced chai. I want that.

    She said her new fave is iced matcha tea with lavender I told her I'd order that next week at BVD Baptist. I told her book club was canceled and why she LOL'd. I wondered why. Was it the fact that I mentioned breast rad? We throw breasts around in medicine so casually I imagine no one else mentions them as much except in the porn industry and even there they have to bring them up heavy with mood. We get to be cold and clinical. But no, Avery thought I said Amanda got a rooster that kicked her ass LOL. Masks create silly chaos. Especially with me - I cannot hear worth shit and depend on lip reading so this whole pandemic thing has been challenging.

    The smaller doc book club text group was lamenting over delta Covid. Apparently a lot of clinicians, vaccinated ones, have been getting breakthrough Covid and while they are staying out of the hospital it is creating hell for scheduling since they have to convalesce at home. Jauss told us that she had an unvaccinated patient die last week who was retired and building his dream home. Such a waste. I told them about my unvaccinated work family that was decimating our departments. Such a societal ill.

    C called today with great news - she found some friends finally on Bumble friends - I didn't even know that was a thing. Normally it's a dating app mom, but you can find friends there. She found a girl named Trinity from Dallas with pink hair who is anti Greek and a yoga meditation friend  - they ended up being in the same house. They had coffee in the am and shopping plans and are probably out right now at a bar C told me about that ignores fake ID's. I told her to be safe. I trust that she will. I'm so happy that she is happier than she has been in two weeks. When your kids are sad, it eats you up. 

    Avery worried that she invited her BF to dinner tomorrow I was like no - I want him to come girl I was gonna ask you to bring him. It will be a celebration and a send off for the both of you. When you get to Fayetteville you gotta take care of C. I also talked to Shannon from book club today - she's rad and has two kids pre-med at Fayetteville. Shared C's contact with her. Building a network of support is so important. Happy Sunday I guess? Much love, Elizabeth

Thursday, August 26, 2021

Friday Eve

     Walked into the Dr.'s lounge for coffee after huddle this morning - nothing new there, except warnings about Ransomware and not opening fishy e-mails and IT sending out pseudofishy emails to determine what employees will open them and which ones will click on the link. I guess they are collecting data and looking for doorway entries to squash the danger. Amy told me some hospital in Europe was shut down bc of Ransomware. I had no idea it was such an issue. 

    Bob Searcy was in the Dr. Lounge, and after I greeted Shay and Tammish and Geisha he walked over to me while I was making coffee for me and Kimberly (her car is on the blink and she's bummed so I'm trying to lift her up a bit). She loved my adding Cinnamon to the coffee - I told her it tastes good and I think it's healthy too. Anyway, Bob was in a rant, which he often is - I used to be intimidated by him but now I find his fiery personality endearing. And he always asks about my dad, which makes me happy. He's a pulmonologist in the SICU and said he's taking care of a pregnant patient with Covid who has a 21 week old baby. She's prone and on the vent. He learned he has to keep her alive for three more weeks to give the baby a chance - her's are not good. 

    You don't have to tell me that, I said. 23 and 1/2 weeks to 24 are the edge of viability. When my dad first started practicing years ago, it was 27 weeks but the advent of surfactant and advanced vent technology changed all of that in his career. Can you keep her alive for that long? Not likely, but he's going to try. He's got another patient who is about my age who survived breast cancer. Husband, who he clearly has contempt for, is all "Don't tread on me" and wouldn't let her get the vaccine. She will die today or tomorrow from Covid. I told him about my department's issue with the unvaccinated. I said I have to reframe it all as a societal ill in my head (my gut wants to judge and be angry) and it helps. And I've got patient's loved ones asking me to use Ivermectin he raged. SMH.

    OT was lovely I gifted them chocolate and Stephanie was so apologetic and worried about the last session. I told her no worries it was only painful for 15 minutes I'm still progressing. I graduated to a pound today. I was so happy with my pain free performance of all the exercises - still no zero gravity video games though - but I told Steph, who was mealy mouthed behind her mask enjoying the truffles, that she could go to the break room and I would write myself up about how well I was doing, LOL.

    It's been so weird with frozens I've walked into the gross room to check on my crew right at 4 every day this week and it's like I anticipated them. Yesterday Sims was doing a rhinectomy for squamous cell carcinoma - wear your damned sunscreen - and he was chasing positive margins. Must have been pretty deep bc there was a lot of cartilage. Today Bandy was doing a case - he had opened the uterus - and it looked like a giant infarcted polyp or fibroid (circulator warning as she passed it through our gross room drive through window - watch out it stinks!). Jess and I were trying to reconstruct it and realized it was probably protruding from the cervix (no wonder it was bloody and dead at the tip). Luckily B9. 

    Planning a grilled dinner as we speak with Sean and Avery and Avery's BF Alex and Christie for Sunday night. So excited I've been trying to nail Sean and Avery down for dinner for months. Avery and Alex are moving to Fayetteville and I'm all over plugging them into the support system I'm creating for C. S got a new grill he's dying to use and impress. I'm so happy it's almost Friday. Cydney and Ali almost killed me yesterday four bronchs and four ERCP's I was regretting my choice of kitten heels. But it's all good. Lots of cancer. What's new. Happy Thursday, much love, Elizabeth


Tuesday, August 24, 2021

Field Trip

 OT was at 8:00 today and Bailey the student took me downstairs for a change of pace - Stephanie was working with someone there. The room where I get OT is lackluster and industrial but the space downstairs for PT and OT is mind blowing. I remember touring there when I was looking at BRI for my dad - there are faux marketplaces and partial cars and all sorts of fancy props to guide the downtrodden back into normal society.

    Steph was working with a teenager - he was in some contraption that Bailey described as "zero gravity" and "guided by video games" that made me honestly jealous. I was sweating from the heat pad Bailey put on my shoulder on the way down and as Stephanie was engaged with the teen she instructed Bailey to put me on the pulley system against the wall. Only it wasn't against the wall, it was against a door, which was abruptly and surprisingly opened; stretching the holy shit out of my shoulder.

    When Steph finally got around to me (on the bench, no video games or zero gravity or even simulated grocery stores) the manipulations hurt like hell. I reported an 8 outta 10 when I normally report maybe a 3 or 4 at most. She inquired if I wanted her to do an incident report (Was it the heat? Or the door opening? Or both?) I said hell no, I won't obstruct you if you want to but please don't make a fuss. By the end of the session I was bench pressing and curling one pound weights. She was over the moon. You are progressing!!! But I just want to do what that teenager is doing? How do I get to that level? She laughed, but didn't explain. I want an explanation.

    Book club is this Saturday and I'm sooo excited it's at Amanda's house and her SAHD is an amazing cook he did paella once. We were instructed to bring dessert (not my strong suit - give me cheese and I'll fly but since I'm on call Fresh Market will do). It's that Mike Jollet book I read a month or two ago but it was so good I still remember. It used to be a doc mom book club, then I invited Natalya and she is faithful and not a mom so just Doc girl book club? Ali Khan expressed an interest in joining a year ago and I was a little too rigid at the time - he is a guy but the nicest guy in the world. About a month ago when I was in Conway I asked the core group if I could invite him and they said yes (so now Doc book club) and I'm really hoping he can attend he's on call like me.

    I bumped into Kahn yesterday in the OR when I was checking on Sims, God love him, he's restricted his frozens to 8-4 this week knock on wood. Khan told me he was listening to the book on audiobooks - he said the author was reading it which enhanced the experience. I effing hate audiobooks. Same as med school lectures. The audio version of anything is way too slow my mind wanders and I cannot concentrate. I didn't tell him that, just relayed that I heard wonderful things about Michelle Obama's audiobook on her own autobiography. Which I have not visited. Because I have PTSD from attempting it in the past. Enough people sing its praises I maybe should try again but maybe not. I'm almost 50, and stuck in my ways. 

    Speaking of painful listening, we had some BHPP required lecture that I listened to regarding coding - I say I listened but I maybe 10% gave it my attention while I worked. It was so painful - the insurance companies require all this ridiculous documentation for reimbursement. Such a useless battle, I told Melody, and she agreed. Floods, wildfires, pandemics, too much to even process so you just jump through the effing hoops and move on. I'm getting a little cheeky with my feedback lately. When they asked what I thought of the required hour I said nothing pertains to pathology. But it makes me glad I'm a pathologist. What a fucking headache. They were talking about using certain pronouns and conjunctions to increase reimbursement for higher risk assessment. Big WTF. My friend Laura Sanders says her peds hub is up documenting until midnight. No wonder physician suicide is at an all time high.

    I had a late in the day Covid patient have tons of budding variably sized yeast on the GMS stain I called Kathy Parnell and she gave my cell to new ID doc in Pine Bluff Jesse Frazier. I told her the new guard (i.e. Melody's training) was to not try to speciate on morphology but the old guard (me now LOL) suggested a specific bug if we could bc growth takes time and critically ill patients don't have that. I think she is fresh out of training and lamented the fact that she couldn't get fungal PCR right away like she could at UAMS. I'm doing a mucin stain to rule out Crypto overnight, I said, and I will compare with mycology in am. Honestly I am all over the map here. Could be Candida! That would be a big change in treatment. I think it might be a mixed bag. It's a wash, not a BAL, so more risk for contamination (but it looked real). 

    I told Jesse that they can't support the blanket testing in a private system that they do in a government supported who cares if you go in the hole system. We are more judicious, because we get charged and have to bite the bullet. It sucks, but I also think it's more prudent overall. The mass testing that ignores the financial consequences is not allowed. I've had oncologists, I told her, that want me to order all the molecular markers on all the tumors. Not cool. What if the patient is DNR? What if the parameters of the test don't apply to them ( because they move and shift monthly, the parameters, not the patients). So we watch, and care, and try to be the best stewards of medicine we can be. What else are you going to do. Happy Tuesday, Much love, Elizabeth



Monday, August 23, 2021

Call Monday

     It kinda sucked. I was up in the middle of the night and overslept. Needed to be in Conway for frozens, which was ok, I made it there by 8:30 and the frozen didn't come until after 10:00. Made it back to Baptist LR by 11:00.

    I love my daughter so much. She's been struggling with health issues - unusual for her - and the last week was hell. Couple homesickness with not going Greek - something I'm so proud of - almost did her in. She started classes today and met up with a mentee - she signed up to be a mentor for a sophomore with Down's Syndrome. His name is Jack, she's enamored. I'm not judging the Greek life but it's so all pervasive at Fayetteville; it's ridiculous. The balloons alone must have cost an arm and a leg. Mike and I totally supported her decision, whichever way it went. She's got a full ride complete with a huge living stipend, cell phone paid for, 10K a year for travel abroad. She's an fing badass. I told her I would be happy to help pay for a Greek life. Her response: "Mom, I didn't leave for college to be tied to a new institution giving me new rules." Kudos. Apple doesn't fall far from the tree.

    She's an ENFJ and I'm an INFJ. I told her that she would have a much harder transition since she was an extrovert (sitting in the dorm alone with a book for a week would have been my dream). I hooked her up with a single mom from Sunday school who moved to Fayetteville a couple of years ago. She volunteers for a nonprofit (Pathway maybe) that rescues girls and women who are victims of sex traffic. Locally. C texted her. I'm glad they made the connection.

    Work is kind of screwy Shaver called in sick today, luckily he didn't test positive for Covid, but he did test positive for RSV and will be out again tomorrow. More sucking up work. I was supposed to be on morning frozens for call but now will be on EV. Staggs is covering. 

    Hal recently changed our pap smear review to only EV. For the past what, 15 years, it has rotated on the AP surgicals. Now I get paps daily on EV. It's terrible, and I'm confused, bc Hal hates change, but I think we are here for the long haul. So I was complaining, we can't call it EV anymore, bc it's no longer extravaginal, it's all up in the vagina. I'm getting maybe two trays of paps a day - more than I've ever done since I joined the group. Unless you look at it differently. EXTRA vaginal. So you get lots of vagina. Go figure. 

    Had a fun time tonight cooking with J. He's a master chef talking about flavor profiles it cracks me up. Got OT tomorrow in the am and switching to EV since Shaver is taking time off to combat RSV. Sending lots of love. Elizabeth

Tuesday, August 17, 2021

Happy Friday!!

     Yesterday was a shit show. Not work wise, only 100 blocks yesterday and today which used to be a decent load of work but now is a walk in the park. When I walked in I learned one of the unvaxxed secretaries tested positive for Covid Thursday night and one of the girls in the gross room tested positive for Covid on Saturday. Turns out, if someone tests positive for Covid, all the unvaxxed close contacts need to go home for a few days (maybe 7-10?) and not return to work until they have a negative test.

    Which decimated transcription and the gross room. We lost 75% in both departments and although we were able to call in reserves in the gross room (retired folk) Tina and Kimberly have been going it alone for the past two days. I was frantically arranging pizza lunch and brought in a bunch of chocolate today - I told Tina she and Kim deserved Bonefish meal from me when this is all over like when she went it alone during the snow storm. Looking forward to that.

    I know that we can't really mandate the vaccine at this point - it's still under EUA. Until it's FDA approved (Fauci says maybe September) or Baptist mandates it we won't in our business. This has become such a polar issue - as or more sensitive than abortion - that we don't bring it up but I can't help being annoyed. When one of the girls in the gross room said "Why didn't we have a plan for this" in despair Monday morning I had to bite my tongue not so say in front of the unvaxxed that we did have a plan. Fauci had a plan. And now we are ignoring the plan and becoming human petri dishes for mutants, here in the South. 

    I get it, there are reasons to choose not to vax. Most of which are wrongly political but some of which are legit (my bro in law got Guillain Barre from Covid so according to sis vaccine is contraindicated). Haven't researched this, but it makes sense that you wouldn't want to reintroduce any antigens that stimulated a war on your nervous system by your own autoimmune system. I had to discipline an employee a couple of weeks ago for shaming a non-vaxxed employee to tears. It's not ok. Baptist's reason for holding off on requirement is that they will lose already low staff numbers to other local hospitals that don't require the vax. Makes sense - we lost four micro techs last month to local hospitals recruiting heavily with fancy packages. Seatbelts are the law. Vaccines are not yet, to Covid anyway. SMH why you wouldn't take it but it's not my business (HIPPAA violation) to know and grill everyone who doesn't. 

    So even though it's my Friday (yippee!) I'm going in to finish off a case tomorrow and Thursday to go to OT. OT is cracking me up. We are in the same room as PT, and there are about 10 patients every hour. A therapist gets assigned two patients so it's often a struggle and they use a student to fill in. I finally had the same therapist my fourth visit (The first guy was a floater and Molly was filling in too). Stephanie is good but you can tell she's juggling a lot and so Bailey the student was assigned to me for the first 45 minutes. She said she was told to continue the same exercises and I was like, but no one has ever used the same exercises I'm so confused. She read my chart and ascertained the same thing. I bench pressed a half pound walking stick (the metal kind with the rubber stopper) for almost 45 minutes with brief adjustments and nice TENS unit at the end. Something is working. I'm getting better. 

    Watching the people doing PT across the room is fascinating. They work so much harder than me. Grizzly veteran looking guys and women that have clearly been through a lot. One guy was navigating cones with a walking stick - he looked good - another was trying to learn how to walk without a wheelchair. He looked like a marionette trying to turn into a real boy. I don't mean this in a derogative fashion, just descriptive. I admired everyone I saw and sent lots of love and support. Getting old isn't easy. Happy Friday on a Tuesday. Much love, Elizabeth

Tuesday, August 10, 2021

Friday Eve

     Thank God this is my Thursday or I might go insane. It is still Uber busy at the hospital. This afternoon I had so many people bugging me for random stuff - doctors and secretaries and techs - I had to shut and lock my door so I wouldn't inappropriately snap at anyone. I never lock the door for most of the afternoon. I felt like a ticking time bomb. I tried to book a massage when I am off next Wed. but my regular place was full so I got some calls into places in Bentonville on my birthday - waiting to hear back. Chiropractor and OT are helpful but I need a massage. 

    Had a late meeting in Google Meet with the medical staff last night, it's quarterly. Since I have taken over Conway lab I have all these new fun meetings, thankfully Google. QRC, ETC. Mandee was there along with 40 other docs including Melody and the Covid graphs Mandee presented are staggering. As of today there are 238 cases in the Baptist system inpatient - a new record. And we are more maskless than ever. Unlike last year, when we were Uber careful; the rate of mask wearing seems inversely proportional to the rate of Covid positive cases right now. Amy told me they sent 800 positives to UAMS to sequence the other day. 

    Cecelia has had a bad sore throat/malaise illness for a couple of weeks that has been refractory to OTC meds and antibiotics. She tested Covid negative three times last week at Mike and Rachel's (they are worried rightly about Rennie who is too young to be vaccinated) and our guess of strep was proved wrong by the lack of response to abx. She was texting me yesterday saying someone was recommending that she go to urgent care. I said no, urgent care is good for some cookie cutter things, but I've heard some nightmare stories. Your dad and I haven't figured this out. We are better than urgent care. You need to go to a real doctor. Let's make an appointment at your children's clinic today and I'll meet you over there.

    Brian Hirrel at Boulevard was having terrible stomach pain a couple of months back. He went to an urgent care clinic and they did not touch him and just did a few cardiac labs and tests and sent him home. He ended up in the ED with a burst appendix, and then back in the hospital twice in interventional radiology to drain intraperitoneal abscesses. I MEAN COME ON. Abdominal pain in a healthy person and no abdomen palpation? McBurney's point is one of the first damn things you learn in med school. I told him, especially as an uninsured restaurant worker, that the big bill belongs to the doofus that didn't lay a hand on him, as did many other of his healthcare worker friends from Baptist over the years. 

    I was talking with some techs in micro this morning and Savannah said she would never go to urgent care again after three misdiagnoses in her husband and her baby. I have actually never been to urgent care but based on what I've heard, about the only thing I'd trust them with is a Covid test. My hair stylist BFF has been battling a problem for years and I finally convinced her to go to a doc I recommended and she was properly diagnosed and is being treated. Doctors train a long time for a reason. It makes them experts, not mid level providers. I was bitching about this to Shaver on the phone and we both laughed and cringed. Preaching to the choir. 

    At the acute care clinic at 4:20 yesterday (tee hee) Cecelia and I got checked in and I was so happy to see Laura Sanders walk in I almost teared up. She wanted to test C for mono, agreed it wasn't Covid or probably strep, and assured us that there was something bad going around in the community and lasting a long time (Melody and Kimberly both had it). Strep Ag was negative and when Laura called me today to say EBV titers were not indicative of mono she posited it was an adenovirus. C is on a burst of steroids and doing much better today - not waking at 4 am in the morning feeling like she is swallowing knives. 

    Planning a big celebration off to college dinner for C Thursday night - I'm cooking a double batch of meatballs since I'm off. Rachel is bringing C's dessert request red velvet cake. Girl's weekend is on - we are a little hesitant to attend a concert but since we are staying at the Embassy Suites close by we can hang out and listen from a safe distance if we deem that necessary. Kim and Mary Grace and Christy and I are all safely vaccinated. Happy (my) Friday Eve, much love, Elizabeth

Friday, August 6, 2021

Gold Star

     I walked into huddle a couple of minutes late this morning. Amy was telling a story about two patients who tested negative on the BioFire, I'm guessing they were ill and looking like Covid I missed that part but they were retested on the Panther the same day and were POSITIVE. Dr. Novack is thinking this is some new subvariant of Delta that is evading the BioFire PCR targets. I looked at Amy incredulously and asked so what are we going to do? Stop using the BioFire? She shrugged. I shrugged back. She said the thinking right now is to divert the more important tests, like ED away from the BioFire. Olivia asked if the patients were re-tested on the Cepheid to see if it captured the virus. Amy said that's a smart question, we thought about that, but we decided to save the rest of the sample and send it directly for sequencing to see exactly what we are dealing with. That's smart too, get a definitive answer.

    I had to duck out a little early from huddle to go to my first OT appointment at BRI. I thought is was PT, but I was gently corrected by my therapist Francis. He was very nice, and explained the difference, but I still don't really understand it at all so I won't try to explain it here. When I told him I wasn't taking any pain meds bc they made my stomach hurt he looked surprised - he agreed that the shoulder ice packs my chiropractor recommended Thursday was a good idea. He was palpating my shoulder joint and was surprised at my lack of pain after he reviewed the MRI. I told him so was Dr. Gilliam, I could tell, is this unusual? He said usually patients with your injury have much more pain and less range of motion. He did massages, stretches, showed me some things to do at home (it was a pleasant hour) and I got electrodes and a cold towel at the end. He told me that normally he spends the first four to six sessions doing what we did but based on my functionality we would probably move to strength training next week. My inner child was glowing from the ego stroke. I told him I would happily move into the accelerated program. 

    God I'm glad this call week is winding down it's been holy hell. Yesterday about killed me - when you have employee issues on top of 160 blocks it's pretty unnerving. Jessica told me a funny story today when I went to check the OR. One of the nurses said that a patient went in for a laparoscopic procedure - she seemed a little off before anesthetized, and when they took a look they decided they had to convert to open. This nurse is cool as a cucumber she was Hugh Burnett's private nurse until he passed a few years ago. They discovered, I guess they were prepping and maybe placing a foley not sure, that she had left a clitoral ring in. You are supposed to take all that out before surgery. The OB asked the nurse to take the clitoral ring out. She said I'm sorry I have no idea how to do that (nor did she want to). He said ok I'll do it and expertly removed the ring. I'm guessing OB's encounter this stuff I've never thought of it before.

    When the patient woke up in the PACU she started wailing about getting her clitoral ring back in as soon as possible because the hole will close up in one hour. No idea if this is factual or not but she was certain in her own head. The surgical nurse handed the ring to the PACU nurse and said tell her if she wants it back in she can do it herself. We decided she probably worried the procedure would be over an hour so she decided to sneak in with it. People are so strange. 

    Jessica was throwing away a plastic trash can with a tear in the side of it - they are doing some late summer Spring cleaning in the gross room. Kimberly has been cleaning up and organizing the transcription area and Marta has made great strides on my office - it's infectious and somehow head clearing. She said it's funny, the story of this trash can. It came from Malvern. It carried an ovarian tumor about yea big (she held her arms out to mimic the size of three beach balls). They put it in this trash can, surrounded by a trash bag, in a biohazard container. I was trying to imagine it when she looked at the floor like it was that day and she looked me straight in the eye like I was the courier and said, No. We don't take stuff like this. 

    How did you get into the biohazard container? I wondered. Things that go into those and get sealed aren't meant to come out, it's in the design. We broke into it somehow, I cannot remember. Then I said I didn't even know they did those kinds of surgery in Malvern. That's the last one they ever did, Jessica said. We laughed. She's having a girl's gross room pool party at her house tomorrow afternoon I'm so excited to be included. They call it the tissue lab, but I was trained in residency to call it the gross room. Kinda fun to be old school.

    Troy Wells, the CEO of Baptist, sent me my first ever text late this afternoon - I read it to Jessica and Laurie and Bob. I said it looks like it went to me but it probably went to all the docs and admin I'm guessing? Who knows. Anyway, the take home message is that our plan to increase hospital bed capacity is going into effect as early as next week. We are adding 157 beds to Fort Smith and Van Buren and Little Rock. Probably 2 in Fort Smith and Van Buren, Jessica quipped, and the rest in Little Rock. Also, they are planning to recruit outside nursing staff kind of like New York did at the beginning of Covid. Once again we are heading into new waters. Wildfires, Covid variants, historic floods. I read a funny meme the other day that said we'd better be starring in the next version of the Bible. Happy Friday! Much love, Elizabeth

Wednesday, August 4, 2021


     I called Jessica yesterday and asked her, if we are holding these benign uteri, appropriately, we need to open them. We've been triaging specimens bc the surgical load is so overwhelming. I got about seven benign uteri (is that even a word? too lazy to google it, but she knew what I meant) yesterday and I couldn't tell what phase the glands were in because there was so much autolysis. The formalin was not penetrating the serosa. She agreed, and told me that she would pass it along. She told me a funny story.

    There's a cartoon on the wall, not sure if you have seen it, that addresses that. It is a fish in a plastic bag surrounded by water, but he's dying. It's about our frustration with gallbladders. I know! I told her. They surgical staff puts them in bags and then in formalin. What is the freaking point? Formalin cannot penetrate a plastic bag. I got so mad one time a few years ago I signed out a case as autolytic cannot read. Passive aggressive as hell, and I got in trouble for it from Shaver, who gave me a gentle correction not to do that anymore. I made an amendment to the case.

    Sean and I were dissecting White Lotus this afternoon and I told him I was off next Thursday and in town we could try a pool afternoon then. I've been inviting Sean and Avery and Lucy but weekends are not ideal for them bc they work. He told me that Shelby told him it was supposed to rain all next week. Shelby was standing right there and said yeah, but that was just a guess. I laughed and told Sean he might want to get a more reliable weather predictor. The internet maybe? 

    Today Melody and Jan and I went to Tina's mother's funeral. She was 91 when she passed, and none of us have met her, but we felt like we knew her and wanted to support Tina. Tina and her husband Reggie have been her primary caretakers for years - she lived next door to them. She was like a mother to Reggie too - his passed too soon. Tina texted me from the ED waiting room last Thursday and said please pray for my mom they are coding her. I ran to the ED and sure enough there was a team of 15 or 20 working on someone. Reggie was standing at the ED desk wondering if he could have done something to save her. I told him don't play that game you are amazing and he told me where Tina was. I hugged her and we both cried. She texted me later that the Lord had called her mom home.

    The funeral was downtown at a Baptist church on Gaines Street. We were the only white people there; it was a packed house. The finery was astounding - I resisted the urge to ask a couple of ladies where they shopped. The first few messages and songs had strange reverb - the music was too loud and something was amiss. Then Reggie got up to say a few words and sing. Something magical happened, it was amazing - I got goosebumps and teared up some. He has an incredible voice. I've seen him sing before at the Baptist MLK day service over the years and this was even more heartfelt. The rest of the service was pitch perfect. The choir did an almost acapella song that blew me away. I need to google some of this - there was a theme in the music I had never experienced. Lots of repetition at the end causing some of the congregation to stand and sway. 

    I could tell Tina was surprised to see us as she was exiting the church and we all hugged her and admired her beautiful pastel pink dress and blue hat. Losing a mother is a unique cut, one I haven't had to experience. Although her mom had a lot of health issues in the past few years it was still a shock to Tina's system - mom was living on her own and didn't have a long convalescence. Sometimes that's a blessing. It was a touching tribute to a long life, one that was sad but somehow easier to bear than the single mom funerals I went to last month. It was a celebration. I told Melody on the way out I might not have been an atheist so long if I grew up in a church like that. I'm not sure what she thought, but she did transcribe texts for me and gave me the non-interstate directions home so I don't think I offended her too bad. She is Baptist as well. 

    Finally reaching hump day. Light at the end of the tunnel. Lots of kid support the past few weeks. Marta came today and cleaned half of my office before she had to get her kids. She uses all natural products they smelled so good and she shared her vision of my future office it was genius. The bromeliad and other plant she brought really brighten the space. We talked kids and divorce and her strong desire to get better at English and get back in school. She has a hunger to learn. Cleaning, for her, is a financial means to an end. Looking forward to getting to know her better and support her in her vision for herself. No autolysis there. Happy Wednesday. Much love, Elizabeth

Tuesday, August 3, 2021

Moving Glass

     When I walked into work yesterday and saw Melody there at 7:30 I asked her why are you here so early? Apparently she came in on Sunday to clean her office and saw the record breaking (almost) block count of 240 and decided to start early. Happy call Monday. We broke another record - finally over 100,000 Covid tests over the weekend (there were 944 Sunday) so we get that pizza party this week. I will smell it but not eat it my stomach is still in knots. The Ibuprofen the doc recommended for my rotator cuff is tearing me up I took a break over the weekend and regretted my Monday morning dose for half the day. Talk about a handicap - screw that I decided I'd rather guard. 

    I told Melody I hired someone from my Sunday school class who cleans to clean my office twice a month I'm sick of the dust, and doing it myself for years, and not having much help from Baptist. She came to visit before Vail - Marta - she's from Brazil. She said once we get your office cleaned we are going to add plants to clean up toxins and essential oils to keep you calm. That sounded amazing. So much so that I couldn't wait and googled plants that are hard to kill and don't need light and clean toxins last week and ordered some online. Turns out there is a whole list of NASA approved air purifying plants - who knew. I got a five foot tall corn plant (Dracaena) and a three foot tall peace lily and a smaller Chinese evergreen for my office. Jack wondered aloud if the company I ordered them from was just making that up to sell them. I told him good marketing plan, but I'd seen it on more than one source, and it can't hurt. Finally a green thumb at 47? Jury is still out. 

    I probably moved over 300 slides yesterday when you count cling-ons from Friday and today was no lighter. I told my chiropractor I could skip a week but I was re-thinking that today. I've had two working lunches this week - more than I usually have in two years. I was talking with Michelle - she sent a consult - and she said Darius has commented that she is working later these past couple of months than she has in her career. Same same, I agreed. Can't complain about the last paycheck - also a record - I was gifting my money around last weekend like I had some to burn, but I'd rather have more wiggle room in my day. Melody and Michelle and I agree this is not sustainable, and as soon as we can breathe we need to meet for solutions. Everyone has different ideas - hire, don't hire, take less vacation, but we need to come to some agreement to relieve the stress.

    ENT tumor board this morning was fun - there is a new fancy schmancy conference room on the third floor. The note said it would be easy for me to find it, it was right off of the elevators - but it was not. Just as I was stressing a security guard showed up - he said it's off of the employee elevators not the patient elevators and you don't have access to that. He took me to the room - super high tech only monitors. I was early to make sure I figured out how to present my cases. The tech guru asked me to respond to him remotely to make sure the equipment worked for the two rad oncs who regularly chime in remotely. In turn I asked him to show me where to put my jump.

    He took me into a large closet off of the conference room and in front of a door sized black piece of equipment with a million lights and receptacles. I told him I felt like I was in the Wizard of Oz, and he laughed. He pointed to three USB receptacles in the middle and said any of these should work. When Hays showed up a couple of minutes later to test the radiology he was frustrated when it was too slow and abruptly wheeled his chair and his table and his fancy switchboard back a few feet toward the closet. Moving closer to the Motherboard? I wondered aloud. He muttered indecipherable synonyms in frustration, but it all went OK. 

    As I was leaving I took the employee elevators - having been assured that I didn't need badge access to exit. I noticed the old conference room was covered in construction and asked the temp taker what was up. Oh, that, he said, they are turning it into a patient intake area. I was trying to explain to Melody how to get up to the third floor room, which will probably house general CARTI tumor board now too, but I got so hopelessly lost on the way down I told her she would probably have to wait for someone to help her navigate the first week or so.

    I relearned Stern's lesson this morning. If it's unilateral, it's probably cancer. So when we started The White Lotus last night and a protagonist had a bilateral situation in his nether regions I confidently told S it was probably B9 and I was right. Good acting and music but super stressful. Physical and Schmigadoon are much more fun and relaxing, but also requiring wait times for the next episode. Covid update - 220 total inpatient in the Baptist system. Seventy in the ICU. 145 blocks tomorrow. Not 240, but not normal for a Wednesday. Happy Tuesday, Much love, E