Day Three

         That's the day when you really suffer the sequelae of an accident. I was planning to take Kimberly and Tina out to dinner tonight - we had to postpone last time bc Kimberly's car was on the blink. But at about 11am I started having searing pain in my neck and my rib worse than even after the fall. An extra dose of prescription Ibuprofen didn't touch it - it was nerve pain. It hurt to breathe - I was compensating with shallow breaths. Yawning, belching (thanks Cherry Coke Zero) were excruciating. I was called to the OR to read a GI needle for Ali at 2 and it was tough to walk down the hall. I had Pam check the schedule - I was in the clear - and left early to rest. I told Hal I was going and why - he commiserated. I'm in terrible back pain, but still feel lucky to be alive, he said. 

    When I was complaining about the computer stuff to S the other night he remarked that he never saw someone so frustrated at getting a new computer. I thought they just added a monitor. I was incredulous when the mouse arrow went from one monitor to the next seamlessly - I still don't know what I'm going to do with the extra monitor but S uses three in his job and today I was thinking it might not be a bad thing to have Epic open on one and CoPath on another. Possibilities. I once told a venting Lucy, who has a fresh start at The Pantry (I need to go) that she needs to hold her cards closer to her chest. So I didn't tell S I wasn't sure about the new computer - I didn't want to look like an idiot. The next morning I looked under my desk and sure enough S was right - the black rectangle thing (hard drive? processor?) was brand new and about a fifth the size of its Draconian predecessor. 

    So I've been noticing the change - in CoPath the words I type glide rather than jumping staccato-like on the page. And in Excel there is a cool added visual feature when I order my special stains. And everything is faster. Still, dictation went down twice today and we were crippled. Jessica said it has wreaked hell in the gross room all week. The only reason they coughed up the bills to upgrade was because our computers only supported Windows 7, and we needed Windows 10 to continue to generate the reports. You'd think with such a major change they would station IT folks to help with the transition. Nope.

    When you have such a visible accident you get a lot of stories. Before my black eye came through on Tuesday I got a couple of people wondering if I was waxing my brow and left the strip on. I didn't even know that was a thing or what it might look like, but I was certain it was worse than what actually happened. I'll take klutzy over dementia any day. Stephanie my OT - I brought a dozen Boulevard cookies to the department yesterday - looked at me and asked if I had to fight for the cookies. My story is not so sexy, I told her, it's rather embarrassing. Whitney, the OT student, told me about her friend who broke her ankle over the weekend in a volleyball scrimmage. Cydney told me about the time he got a stray shotgun pellet in the skin under his eye while hunting - it caused bilateral black eyes for weeks and prompted his high school friends to text - we always knew you would be shot in the face but we never thought it would be by accident. But these people were doing things - sports. I'm just accident prone. But I'll gladly join that club.

    Speaking of clubs I told my head transcriptionist Tina about the D situation and she laughed and said Welcome to the Club! Christy has been giving me a lot of advice too. Strapless is apparently out, but demi cups are a thing? Need to google that. I walked in one morning last week and Tina called me D. It was early, I was wondering why she didn't call me E. Then I got it and LOL'd. Steph said you are Dr. D. She was demonstrating an exercise with stretchy bands anchored at the top of a door with a belt and said do this. Bring them down so, just to your girls. I smiled. My girls are a lot different these days. I asked Amanda at book club, she's breast rad, for an explanation she said if your girth is the same I have no physiologic explanation. So it's a miracle LOL.

    So excited to be heading up to Fville to see C on Friday - I'm off. Planning hair with Maddy in the am then driving in pm. Never stayed at the Chancellor (Graduate?) hotel it looks nice. Got reservations at Theo's early Saturday and C wants to take us to her favorite brunch place Arsagas on Sunday. She's calling less, which is a good sign. Amassing a huge care package to bring. So it's my almost Friday. Happy long weekend to me. Much love, Elizabeth

    

I'm a Walking Disaster

     So much has happened over the weekend I'm not sure where to begin. I guess the obvious place is Saturday night. Tumor board - oops that's what I was preparing for just now for the am I mean book club was fun. Natalya is going to host the next one and she sent an email last night that had me over the moon. Heart of a Dog by Mikhail Bulgakov is one of her favorite Russian authors during Soviet times. There's also a movie adaptation (after the book of course) available on YouTube. She said it has it all - political satire, science fiction, and a great history overview of post-revolutionary Russia. I just ordered the book. 

    After book club wound down relatively early S and I decided on a night swim. The music was fun, the pool was heated, the hot tub was even cozier. At some point I got out and slipped and fell hard. I decided to get back in the hot tub real quick to try to assess and mitigate the damage and I think I must have passed out a little bc when I came to sitting up everything had a halo and it was suddenly raining? No, that was blood drops dripping down my face to my chest and in the pool from where? Got a little woozy. After S got me a bandage or two and got me back up safely to bed he smartly called Alyssa. 

    My best friend from med school is one of the most analytical, intelligent stable people I know. She recently bought a lake house that looks amazing reminds me of mine - a contemporary with lots of updates utilizing the space very well to showcase the view. She's the one I decided years ago to be in charge of my kids finances and emotional parenting in the unlikely event that Rachel, Mike, and I perished early when I was still single. Head wounds bleed a lot, so they can be scarier than they really are. Lys told Stephan it needs stitches keep it moist and call me in the am I've got some friends that owe me a favor in Little Rock or you can come here.

    When I woke up at 2am my left side had excruciating pain I must have damaged a rib or at least severely strained some intercostal muscles. I was able to breathe without too much pain except on deep inspiration and exhalation and if there was a pneumothorax I would have not been doing so well so I reassured myself. S was still awake worried about concussion so I sent him for Advil and told him I was fine he needed to sleep. I haven't slept that fitfully since I broke my jaw. I called Lys at 8am and told her I wanted to come to Jonesboro. S was so relieved for her offer of help and her reassurances the night before he happily drove me. 

    It was a little rough getting out of bed and the sight of the caked up blood and bandages on my face made me so woozy I had to avoid mirrors while getting ready and lay down a bit before I cooked breakfast. On the road I had so much adrenaline and fear of stitches I was happy to be going to see Alyssa for the first time since the pandemic, despite the circumstances. She met us at her building around 11 and escorted us to a room. The first part was the saturation of the wound with water and gauze to clean it and decide how close it was to the eyelid. Luckily, it was mostly on the brow. If you had gone to urgent care or the ER, she said, I would call this a 50/50. Half of the staff would have called an ophthalmologist and half would have sewed it on their own.

    I was starting to sweat a little so she got me a fan and a cold compress. We don't keep the A/C on as high on the weekend to save air. It was plenty cold, but the circumstances. When she started the numbing medicine I got pretty woozy and had to take breaks. At one point I woke up and surprisingly S was standing near and Alyssa was bustling around with supplies and I said I think maybe I passed out? Lys said yes you did. Twice. S said it was so weird you were just sitting there with your eyes open but you were gone.

    Once I was numb though I was all in and I became the entertainer while Lys was approximating the wound and deciding the best way to place the seven sutures. She was laughing but I was most impressed with her concentration and thinking how lucky I was to have a good smelling person working so close to my nose for so long if this was some old halitosis dude I would have had to bail. We went to tour her massive downtown house renovation and took her family to lunch at a Mexican Cantina. God that was so much easier and more pleasant than Urgent Care or ED. How can we move healthcare in this direction.

    Today was a total shit show Baptist IT predictably did not successfully complete the CoPath upgrade but we did get fancy new computers and a second monitor. Result was that our old system was put on the new computers and was incapacitated - I didn't get dictation until late morning and ability to order stains online until mid afternoon. Pam fixed my internet, which wasn't working I had to google phthisis bulbi on my phone. Rick was helpful too. It's good to have tech savvy people in our company. 

    Hal told me a story that had me LOLing all the way home. He's a deer hunter and he was off last week. He was on the deer stand and a cloud of red wasps emerged from nowhere. He jumped backwards on instinct and fell off of the 15 foot stand. He landed on the roof of his ATV on his ass, which had a metal rack with some give. It bounced him onto the ground prone. Aside from a few bruises he is good as gold. I of course wouldn't be laughing if he was hurt, but damn, I wish I had been a fly on the wall. 

    Tomorrow OT is going to start calling me Dr. Klutz. The first student Bailey noticed the big bruises on me after Alanis Morissette - I had to explain that I got up to pee in the middle of the night, thought I was back home, and navigated poorly. I just finished tending to a burn on my arm from the French fry sheet in the oven a month ago - that was nasty. And with the rotator cuff and now stitches and rib injury it's getting a little ridiculous. At least the GI thing is getting better or I might throw in the towel. Happy Monday, much love, Elizabeth

RANT

     I think I talked already about CAP trying to get me to do an inspection with a month's notice in freaking June. I staved them off, and they gave me a new assignment to a Memphis lab in October through the beginning of December, which I accepted. We worked hard to assemble a team from NLR and despite the fact that Polly, the head of the lab there, resigned early, we settled on the dates November 9 and 10th. In the pandemic world inspections are no longer a surprise. So I was on a group email with the director of the Memphis lab and CAP. 

    The director emailed me directly earlier this week - seems he has accepted another job and wondered if we could move the inspection to October. No, I said, not possible. How about the week after Thanksgiving? Hell to the no (but I was more polite). See, the way this works, we get a window, they give blackout dates, and we plan. It's tough to assemble a team with lab shortages in a freaking pandemic. Talk to CAP if you have a problem, I said. 

    So today CAP emailed me and wondered if I could do an inspection in October. NO. I already told him NO. Well we could help you, she said, if there are shortages. NO. I'm not available the entire month of October. Why don't you tell me your availability, she queried? (Are you fing serious?!!) We planned the inspection for November 9/10, he said he will be available by phone, I cannot reassemble a team on such short notice. 

    This is such a waste of my time. CAP knows we planned a team to go - she could have consulted with her office, but was bending over backwards to accommodate Memphis. As an aside, I also got an email from CAP this week asking me to go above and beyond to do more inspections. Which I promptly deleted without answer. I told her I cannot provide extra services at a lab's whim at last notice with low staffing. We will be there November 9/10 unless you tell me otherwise. Ok I'll investigate and let you know. UGH. I got so shaking mad after a lovely and productive morning I had to vent and spit anger to my chief and the gross room and go outside to try to chill.

    Even the water feature at Baptist is not designed to chill it looks like a giant ejaculating dick angering all of the water in the pool. Figures. I told Shaver we are working so much harder and it seems like admin and our accrediting institutions are pissing on us. There is no love, only productivity!!! Let's give them candy bars and Girl Scout cookies and keep them short staffed. I learned today that admin is groomed. Get your masters in health admin and you too can be a VP and make ten times more than the people that actually spent almost twenty years of their lives training for their role. I was so shaking mad. Let's not even get into the daily emails from ABP reminding me to do my monkey CME questions before they are due at the end of the quarter (September 30). Yeah, I'll get on that ASAP.

    CoPath is finally getting a 15 year overdue update this weekend our reporting will be incapacitated from Friday at 5 to Monday morning. Seems I'm supposed to move everything I don't want lost on my desktop to a J Drive (How the hell? Show me!). Shaver thinks they will save it all and restore but after losing a bunch of stuff on my desktop a few years ago (no warning back then) with an unplanned upgrade I'm not as trusting. Looks like I will be going in Sunday to make sure I can actually work on Monday. 

    Surgical Pavilion dumped like 50 specimens on the gross room this afternoon despite Jessica begging for more trips to keep us from getting bogged down. I'm so over it all. Admin (none of whom have any idea of what the hell we do or our needs but hey! Here's a Hershey bar!), our accrediting institutions - seems like we are in the same hell as everyone else. One of my lab directors was lamenting - we could be growing weed in the lab and no one would know or care - LOL - and I just commiserated. They have no idea what we do. The people in charge. The state of healthcare is mimicking the apocalyptic conditions of the world. Bad decisions are being made - ones that cost more money. No one asks me. If they did I'm sure my opinion would fall on deaf ears.

    On a good note Jack and I are watching a series together - he's already seen it twice and is loving sharing it with me. Merlin on Netflix. Planning to take C and Joelle to dinner in Conway tomorrow night. OT will be fun even though I have to get covered bc I'm surprise covering all day frozens. I hope we get a good turnout at book club Saturday night. Weather is amazing and I told them all I'd heat up the pool. Happy Thursday, much love, Elizabeth

OT

     I just love OT. I had my two month follow up with Dr. Gilliam today and I told him can I please have more OT. I want to be an OT in my next life. He seemed as amused as a stern graying white orthopedic surgeon could muster and wrote me a script for a few more weeks, along with some Ibuprofen. I know you don't need it for the pain, he said, but please consider taking it to reduce persisting inflammation. That might improve your OT sessions and your range of motion. Makes sense.

    This morning I had OT and Stephanie has astutely noticed the connection between me and Chris, I forgot his last name, the English prof at UALR, and has scheduled us together. I told him how much I liked The Boy Who Drew Auschwitz - I gave it to S's dad who is a big reader we love to talk books. I told him I'm hosting my second pandemic book club this Saturday and of course he read the memoir. I just finished scouring my bookshelves making a list for him - authors I know he's probably read to discuss and authors I think he hasn't to try to surprise him with. He told me he would make me a list for Friday too I'm over the moon. Our impressions of the two books I read on Trish's rec were spot on similar. He's a kindred spirit.

    As is Stephanie, I gave Gilliam glowing reviews. Was showing everyone in OT picks of the amazing resort I stayed at last week. Stephanie had been asked to a Zoo Wine night by her boyfriend when I last saw her and she was showing me pics of dresses asking my opinion. She gushed today about the event and showed me pics of them. Last week I was telling her and Whitney about my expansion. Stephanie has been a 34DD since puberty and was still wondering today if I had ever been measured before. Oh yes, I said, girl, I have been made fun of bc of my small size. But it's weird, doesn't make sense right? I guess I finally grew a pair. She LOL'd. You are so funny. And that dress is amazing! Going out of business Steinmart sale, I told her, RIP I loved that place. I told her I needed to find a strapless bra bc none of mine fit and this dress works well off the shoulder too. She warned me that it is very difficult, almost impossible, to find a good strapless bra in our size. Another challenge. I'm up for it. I graduated to the arm cycle today, I didn't know there was such a thing. I attacked it with gusto. Steph warned me to slow down - she prescribed me two minutes forward and two minutes backwards. 

    Did a thyroid frozen today for Sims and I was telling the girls all about the new drink C told me about called Celsius. It strenghthens your metabolism, is zero calories, and helps you burn fat. You are supposed to drink it before a workout, I said, I wonder if OT counts? That garnered a laugh. Laurie showed me a new drink called The Rowdy Mermaid she got at Whole Foods. The flavors looked incredible. There was another one called the Rowdy GI or something like that I told her if it calms a rowdy GI I'm all in but I've had a rowdy GI for over a year I'm just slowing so I'm not interested in a reawakening. I'm already woke.

    C is still having highs and lows adjusting and Heather in pharmacy and I were commiserating today. Her son Jake is a Freshman and she feels like a punching bag every time he calls. Isn't that funny, boys and girls with such different reactions to transition and homesickness, I said. C is depressed and anxious. She called me the other week in tears bc she GPS'd to a new class and got lost and showed up late and the teacher said she had to go change bc no shorts were allowed in lab. Total meltdown. Mom, it's going to take me 40 minutes turnaround time to get there! Heather said I know a girl mom describing the exact same story as you. But today was a happy day she made a new friend in a Freshman leadership group she has been attending weekly. We have a family gressage - Rachel named it a few weeks ago and I was like WTH? C explained group message mom. Duh. I told C today when she texted us that I love having a front row seat to her college transition and it takes time to make meaningful relationships so be patient. 

    Last year I was worried about J and now he's flying - won Sophomore Senator with the most votes by a landslide and is busy working out with friends. Last night he was meal prepping rice and chicken for lunches for the week. Where do these kids come from, I wonder. Now C is struggling but it's all a part of life and learning I think she will do ok. Work is still hella busy - it's raining uterine cancer this week - but it's doable. Happy Tuesday, much love, Elizabeth

    

Expansion

     I have always been a proud card-carrying member of what Rex would call The Itty Bitty Titty Club. And I've never been upset about it - I've been happy with my lot and a healthy fear of losing sensation in that area after surgical enhancement (it happens, I've queried tons of people) has kept me from going down that road, amid other reasons. 

    So imagine my surprise a few years ago to spontaneously go from a B to a C cup. I squashed into the same bras I've had for 20 years for a while and when it became unbearable I solicited Christy to come with me to get new ones at Dillard's - this was the February before the pandemic started. There was a huge sale, which was nice since good bras really cost between 50 and 80 bucks. Not chump change. We scored. I got a bunch of nice ones.

    Fast forward to a couple of months ago - my 36C's have been stretched to the limit and the underwire is currently being lifted off of my chest by my boobs - not the most comfortable way to manage your day. And last weekend a white bikini I bought before the pandemic that fit me fine in July looked horrible on my chest. I can see why adolescent girls getting boobs might get a fat complex because if you try to host them in a too small receptacle it just looks like you grew a bunch of arm fat. Not aesthetically pleasing. 

    I wandered into the lingerie section at Dillard's and a woman with a heavy Eastern European accent asked if she could help. She was smartly dressed in black and white pants with a white t and a black blazer. I told her my dilemma and said the only bra that I like is a 38C I bought two years ago. She said flatly there is no way you are a 38 you are smaller than that and I liked her so much in that moment I decided to blindly follow her advice. We measured and I was a 36 - I told her I measured as a 37 at Victoria's Secret with C within the last year. But I have been a 36 my whole life before that.

    As I was in the dressing room and she was handing me bras to try on - she had another client; a third woman walked in and said Luda?!! I want you to help me please. Many people have referred me to you they say you are the best in Little Rock. I smiled happily at the support of my gut instinct. Knowing I was in good hands. Not literally. But she has an amazing eye and a knowledge of the brands. 

    As I was trying more on I noticed the sizes were D and DD. I was confused, we had debated my girth but not my cup size. I decided it must be some UK size or Australia it didn't make sense. When she came back to look at a new one I said are these D cups? She said of course. You coulda knocked me over with a feather. But I have all C's, I told her. She shook her head and gave my chest a cold, calculated look. No. You are not a C. You are a D or a DD. LOLOL. I haven't been this big since I was nursing. Better get that mammogram I'm due for soon.

    So of course I had to shop for new bikinis and even though the bras were painfully full price the bathing suits were 65% off - that made me so happy. I texted Lucy and told her she was gonna get half a wardrobe tomorrow because there are things that have zipped up on me since the age of 16 that no longer zip and I would like nothing more for her to wear the clothes or sell them for money. She is trying to save up to move to Ventura CA (she's got a chosen family there) and model and she's 20 and plucky as hell. She has people that could bankroll her but she prefers to work multiple jobs I told her about when I held three or four at a time in my 20's trying to reach my life goals. She looks a lot like Amy Winehouse but taller and definitely unique. I told her someday when she makes it she will have to remember the doc from LR, AR who thought she was amazing before the world did. Happy Saturday, much love, Elizabeth

Gnats

     So I've had gnats in my office for a few months. So much so that I googled their meaning. In Native American culture they are all about transformation (what bug isn't?) but they didn't date back to Celtic times. The cool thing is that they feed off of dead things. They are the ultimate recyclers. I tried not to kill them but having a bug flying around you and your microscope is annoying. Staggs came in a couple of weeks ago to return a consult, and I was complaining, and he said he killed it. Five minutes later another one was plaguing me.

    I learned a couple of weeks ago it wasn't just me, they were bothering all the secretaries too and even Melody. My husband had some advice. He said an overturned glass of wine is the perfect receptacle to trap them. I bought a single serving cardboard box last week, intending for him to drink most of it and bringing the rest to work. He said it would not work unless it was a clear receptacle - they would find their way out of a cardboard vehicle looking for the light. So he packed me a glass of wine in a Coke Zero bottle.

    This morning I was looking for a Coke Zero and I saw a half drunk one in my fridge. Took a big swig and LOL'd. Wine at work! That's a new one in my fifteen years there. I told Melody and she said she bought a contraption that works well at her home to trap gnats. It looked like a tennis racquet with electric  capabilities. Weird thing is, as soon as she got it in the mail, the gnats went away. I told her I experienced the same thing with the bottle of Coke wine. Not needed. No more gnats. 

    Conway frozen was crazy. Probably malignant, but I didn't notice at first bc I was just counting neutrophils at high power. All of a sudden I hit an alien mitosis and was like WTH. Backed off to a lower power and realized that septic joint was the least of her problems. Bc it might be lymphoma we sent it to Staggs, who sent it off bc it was so weird. Maybe sarcoma. Maybe carcinoma. Time will tell.

    I'm off for a whole week so excited. S and I are planning to entertain again on Sunday - Lucy and Christy are coming and Sean and Avery and Alex are invited. Leaving for Austin on Tuesday to help prepare for his stepsister's wedding on Friday. We are staying at a fancy resort in Round Rock just a couple of miles from his dad and stepmom. Kalahari maybe? It has indoor bowling alley and amazing spa and 14 restaurants and indoor amusement and water parks. 

    So much breast cancer. Usually when I get seven cores half of them are B9 but not this week. All cancer. This morning I had bilateral masses - both cancer. A record for me. Happy getting to sleep in this weekend. Much love, Elizabeth

Conway Frozens

     Cases were coming out late today and I was kinda pissed and raising hell about it with Shaver bc I was due in Conway at one. He assured me he would do any of my late cases, which ultimately turned out not to be necessary, but it was a scramble to get the bulk of 140 slides between 10:30 and 11:00. Pounded all of them out but one. 

    Melody is under a lot of stress, more than usual. On Tuesday I made her teach me how to check the billing charges (Rex would freak knowing I was taking that on - I was a bit reckless a few years ago in objection to the whole process) so I could relieve her of that duty until she is not drowning. I told Melody that a couple of years ago I told Rex that he needs to watch out in 10 years our practice would wear Melody down (Christopher Robin remember) and she would start popping off just like me. He gasped, "No, never Melody. Not like you." At least I made her laugh.

    I drove to Conway for the frozen and arrived there just before one. Bob didn't show up until 1:30, which I learned was the intended surgery time (sigh no worries could have used that extra half hour in LR but foraged for snacks so no big loss). At about 10 til one a peppy surgery tech I had never seen entered our suite - gross room/sign out. 

    "I'm so glad y'all are here!" she squealed, and I suddenly felt like a newbie in kindergarten class. She had on green scrubs and her bleach blond hair was leaking out around her mask and her scrub hat. Bob and I looked at each other like, um bc you asked us? She said, "We just got the patient in a room and she has a suspected PE!!!!" Bob said she has a what and I said so she has a rule out pulmonary embolus so that means we aren't doing a frozen right? "EXACTLY! But y'all stick around as long as you want to! We are trying to reschedule the frozen for noon tomorrow after clinic!!" Does she think we have time for Cokes and a sleepover? When I called Shaver to tell him he groaned. Like we have so many pathologists to spare, right now. 

    I always try to spin things positively, at least out loud. I said, well, it wasn't your fault she has a possible PE. Let's just see what the workup shows and play it by ear. And hey! Thanks for telling us what was happening so promptly. A lot of y'all just leave us in the lurch waiting for something that is never going to happen. When she left Bob said, I don't wish bad things on people? But I don't want to come back tomorrow at noon? I LOL'd. Same same. Maybe we can wish she doesn't have a life threatening PE but maybe she gets something that keeps her from surgery until I am off next week. It was just a joint check for PJI. Something I have done less than five times but a quick google will tell you if there are over 5 neurtrophils in a 40X HPF it's diagnostic. Been the same criteria since 1976.

    When I finally got back to LR I was finishing up some big cancer cases and one of the higher maintenance docs was crawling around. I told my head secretary tell him I was busy doing frozens and we problem solved to try to catch some inconsistencies (that no other doctor has a problem with and is well within the two week CAP standard turnaround - our average is 1.6 days I calculate that for Q/A). I crafted a polite text addressing that I took action points to try to solve the issue on our end before the clinic caught it. You catch more flies with honey than venom. No response. I'll take that as a good thing, maybe I'm wrong - I'll find out tomorrow. 

    C is still struggling adjusting to college and it breaks my heart a little but struggle brings growth so I'll continue to plug in and support and not get sucked into codependency just like when I was dropping her off at preschool when she was little. She flew then, she'll eventually fly now. S and I cooked meatballs tonight and I'm sending them and BV pimento and a big care package with Mike and Rachel this weekend. 

    Sean recommended Gunpowder Milkshake and Brand New Cherry Flavor and I texted him over the weekend that he should charge for curating and recommending good content. Both were a lot better than the book I read but I did learn what mudlarking meant even though I was disinterested in the characters (but interested enough to skim to the end) halfway through. Happy Wednesday, much love, Elizabeth

A Monday on a Tuesday

     As I was driving into work this morning Shaver sent a group text to the group. Apparently Quinn had a minor procedure while he was off last week and it reactivated his Covid neuro sx. Amnesia, insomnia, etc.  The doctors today said they think the anesthesia sparked an encephalitis that activated long Covid. So he was supposed to be on call this week but Melody took it for the team. Quinn is in more pain by missing work than attending so it's hard to be frustrated - he's probably spent more hours at Baptist over the years than all of us combined. Shaver divvied up his work to us all and it wasn't horrendous, but Melody reiterated what a lot of us are thinking - we desperately need to hire. 

    Then Jack called while I was in huddle and said that he had a sore throat. I called him into school and told him to rest. Spent much of the day worrying and trying to find a Covid test to make sure he was negative but two Walgreen's later we were SOL. "They sell out as soon as we get them in." I wondered aloud how us parents were expected to send our kids to school safely after being symptomatic when you can't get ahold of a freaking test. He was fine tonight. Ate two family servings of frozen Korean food. So I'm just gonna hold my breath on that one.

    Shaver told me today that Conway needs a frozen at one pm tomorrow can you go? Of course, I said, I've got lots to sign in the lab and Misty and I keep missing each other. He's going to get my afternoon frozens in LR covered and take care of anything that arrives past noon. It's a skeleton crew these days. 

    I had gastric and omental biopsies today the clinicians were calling about - the biopsies were done at 7pm Friday evening. It's always like this on a long holiday weekend - everyone clamoring for their dx. I was problem solving with the gross room how to get these done quicker on three day weekends - maybe they could call us and assess the need for short cycle. Nevertheless I got it signed out this afternoon. Both metastatic ovarian cancer - in the stomach? That's another one for the books. Fungating mass I would have placed my bet on a new primary but the stains said otherwise and Hal agreed. I'm starting to think weird is not weird it's the new norm and I'm wrapping my head around trying to get used to it. Hell I never would have guessed that bounty hunters on women in Texas would be a part of the smashing of the patriarchy so who's to say what cancer is going to do in the next couple of years.

    Jack asked for help making posters for his campaign for sophomore council this evening - we spent three hours perfecting his block letters and cutting and pasting his slogan for tomorrow. I love his slogan - love that it is his. When he asked for pics he said he wanted some without C because he didn't want to appear to ride on her coattails. And he admits his slogan is goofy, but it's also wonderful - I can't help thinking that if a girl campaigning described herself as a snack it would be much more delicate than a cis white male. Role reversal. We need to upend things.

    And I told Jack, campaigning as your wonderful self is a lot better than trying to be slick or cocky as a front. This applies to more things in life than sophomore senator - it is true of anything you ever campaign for including your friends or your love interest. We laughed that we could have used the computer to be more efficient but I loved that he executed his idea and I was his sous chef and we bonded. Happy Tuesday, much love, Elizabeth

    

Cancer and OT and Porn

     Up until today this week has been so crazy case heavy - as Melody said - I've been having the kind of days where it's like trying to drink from a fire hydrant. And weird ones too - which makes high workloads even tougher. There was this one case of a guy in his mid 40's who presented to a breast surgeon with nipple discharge and redness and pain. The surgeon figured it was an abscess - he expressed white pus-like discharge from the nipple - and gave him some abx to calm it down before surgery. Nope. The most high grade multifocal cancer on the planet I've never seen anything that bad in a chic. It wasn't pus it was necrosis - they both look the same. I was mulling it over with Staggs and he winced in all the appropriate places when I was telling the history. He grabbed his own chest wall, and I said hell no nobody's getting 9x7x4cm off of you lol. How big is the guy? Staggs wondered and I said the surgeon didn't mention it in the H&P. But it's on the demographics on the left, he said, and we both raised our eyebrows - he was over 500 pounds. Ugh poor guy. I did some stains to make sure it was breast etiology because it was so weird - the cancers were TNTC I've never seen anything like it.

    Then there was another mid-40's guy from Conway who had a TURP for prostate hypertrophy (that's a new one on me they are usually at least in their 60's) and it was wall to wall high grade ugly prostate carcinoma - honestly the ugliest I've ever seen in my practice. Gleason 9. I never call that. Did some stains to rule out urothelial and when I was showing it to Melody she gasped in awe. 

    OT has been fun this week there is a new guy who I overlapped with on Tuesday and today who is the most stereotypical chatty batty English professor you have ever endearingly met - he's probably about 15 years older than me. We bonded over books on Tuesday - he read 99% of the ones I mentioned and recommended The Boy Who Drew Auschwitz, which I ordered and is coming tomorrow. His mania and chattiness were infectious and I matched it. He has traveled the world and seems so interesting.

    Today he revealed - Stephanie and I were talking about our kids - that he lost a son at 16 to a drunk driver who crossed the median and lived without a scratch. His birthday is three days from now so this is a particularly hard time of year for him. My eyes welled up with tears as I was lying on the therapy table. I asked if he had read Wave or The Year of Magical Thinking he said yes both, but they were very hard to get through. I was thinking maybe healing but I can see PTSD too I told him let's change the subject. He has the same injury as my mom - she had a commuted fracture of the wrist requiring external hardware and he did too. He said after this I'm going back to tennis (he fell playing and chose his left hand to protect his head) are you going back to paddleboarding? I said not in the ocean, maybe in the lake. He approved. I also showed him the other two novels my friend Trishie recommended and he had read both and told me which one he liked better. I'll start with that then, I said.

    Stephanie was a little concerned despite my progress I was still in a lot of pain when she manipulates me. She said that she prefers me to stretch with the solo exercises bc I guard too much with her manipulations. She grew up with horses. She's a single mom. I've entertained her with online dating stories. Her teen is obsessed with car detailing and her three year old is obsessed with horses. She told me she was going to have to give me a horse tranquilizer to manipulate me I was so tense. I'm glad I've got another couple of weeks with her, at least.

    She asked me today if I had seen my MRI embarrassingly I said no so she pulled it up on Epic. She said that I not only tore my supraspinatus (over 50%, not 50%) but I also tore my deltoid and possible another muscle - she was reading about bursae and footprints it was all a little confusing and I got hot and sweaty imagining my insides being torn. So no wonder you are still in pain, she said. That's a lot. I told her my resting pain is zero and I haven't used a biofreeze patch since Monday so we are making progress it's just slow. 

    Ugh I got so frustrated today I somehow followed a porn ig I thought it was body positivity and it kept popping up in my feed and I was too busy to figure out how to unfollow it. When I tried tonight the ig internet was out - then I checked my email and I had my first ever porn email ewww - I didn't click on it just unsubscribed. Then I unfollowed the porn and hopefully that is the end of that. Not judging, but I like to choose my porn and not have it pop up unbidden in my personal spaces. Happy almost long weekend with no freaking plans and lots of tv and books and pool time hopefully. Much love, Elizabeth