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



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