Apocalyptic Melrose Place

     I just had lunch with Christie it was lovely. Guacamole and pumpkin soup and Kahlua cake I'm probably not spelling that right but too tired to look it up. It's been a hard couple of days. Sometimes when you have a lot of time to yourself you start processing shit that you had to stuff. In the past 48 hours I've been not drunk dialing way to many people to get me out of a bad headspace. Mary, Daniel's wife really helped yesterday. And I reconnected with Marcie and Conley - we are having dinner next week at The Terrace. Caught up with Deidre last night late - she was working in her new business space. Christy and I plan to throw a party there after the holidays.

    I've told Sean that Christie's apartment complex is like an apocalyptic Melrose Place, since the pandemic. The neighbors are all rich widows and divorcees and they take care of each other. Christie is a guardian for a 4 or 5 year old Monroe, and sees him every Wednesday with his mother, who is going through a tough divorce. Monroe is precious - I met him a year and a half ago and their bond has strengthened over time she is besotted. Last week they went to the fair and yesterday she staged a Halloween he will never forget. Christy texted all of her neighbors and she took him to every door where he was received warmly and treated. He dressed as a duck - his mom Haley made the costume it is so cute.

    I remember being about that age and my Dad taking me trick or treating. We lived on 3217 Shenandoah Valley Drive I was at the age your address was a mantra. I still think of it as a song. That space across from The Terrace that was a Blockbuster for years, not sure what it is now, used to be an office building. There were various businesses mostly insurance and maybe a dentist. Every year they had a big safe Halloween that was especially fun in the rain because there was an overhang you didn't get wet. Although there are plenty of times I remember my dad driving us around in the rain - Sara and I would jump out of the car with our baby umbrellas to trick or treat. I was super shy but the office workers dressed up and decorated their spaces and gave us candy and oohed and aahhed over our costumes. Monroe is going to remember last night forever, I told her.

    At her condo there is plenty of adult fun too (some to spicy to mention) - they all text and meet at the cabana for drinks. Some host Cajun nights. Christy is usually in her pj's by nine - the preferred witching hour of those around 50. She bragged over lunch - Monroe's Halloween was over by 5. I planned it. Isn't that perfect? Halloween should be over by 5. I agreed. Give the adults time to wind down and relax. She said she prescreened the gift baskets and made sure most of the offensive toys were sent back to bio dad. Remember those gooey things you throw around. Yes, I cringed. They got stuck on ceilings and made permanent spots on the paint. He got all the pixie sticks too, and I made sure Monroe knew how to open them. I laughed.

    My massage got canceled - I was going to go with a new girl named Courtney, but she had a death in the family. I told Christy over lunch she said she would go through with it if I really wanted and I texted back hell no I'm sending love take care of you. Can you imagine, said Christie (I'm not sure if it's y or ie can you tell?), a guilt massage? Hell no. She bent over backwards to reschedule for tomorrow. But I'm seeing Yousef for the first time in months in the morning and want to have time to pack in a relaxing fashion. Courtney said she was sorry to be the bearer of bad news on my anniversary. Well bad news is relative, right? I'm not dealing with death, just stress.

    Cecelia is good though so it's a good time to process supporting her. She is wanting to bring three friends to Colorado for the Grand Social Experiment and she's almost talked her dad into letting them rent the luxury apartment out back. It's not much extra and I want to meet Bailey and Harper and the other kid she is signing a lease with right now to live with next year. If we sign at lease this week, mom, we get a discount. That kid is so frugal but I love the organization. I'm not a helicopter parent, I wasn't helicopter parented, and I think they are better for it. Needing to figure out some podcast thing, it might not happen today bc it intimidates me as much as the breastpump machine many years ago but it's on the radar. Happy Thursday, much love, Elizabeth.

    

Monday Madness

     I only had four cases to finish this morning which should have taken me a half hour. I came in all sunny bringing the secretaries gifts from Walgreen's - nuts this time cause you gotta balance the candy out. Honey roasted pistachios, chili lime ones, smoked BBQ, and some corn nuts too. We chatted and I looked at my immunos - three of the cases were hard and I had to dole them out for consult. No worries - I visited Savanna and Joe and Laurie in the gross room and Shelby and Avery at BVD - noticed they were training a new guy. Shelby is coming to work for us November 8. She was sweating the application last Friday I told her no worries it's an ancient form. Give your two weeks and take a little time for yourself. She was taking her cat Eclipse to a vet in Hot Springs for a second opinion and it was good to hear he was gonna be ok.

    I went to release in CoPath and there was this funky mode - the secretaries couldn't figure it out but I did eventually on my own. Then I went to release cases and none were typed. Where are my cases? I asked. I dictated one almost an hour ago. One of them got on the other two and I waited impatiently cause it took her almost a half hour to do what I could have done in five minutes. Shaver came with the third consult as I was walking out the door. I'll be back I'm done here. Do you want me to do it for you? Suspicious is where I landed. That's where I was too. Please. I'm way to mad on my day off to wait around another half hour. This is ridiculous I have call days that take me less time.

    Wound down at Edward's - planning a meatball dinner for C's send off back to college. Just the four of us. I desperately need a pedicure but I've got all week there will be no more driving today. Got lunch planned with Christy on Thursday - long one at Trio's - then we both have 90 minute massages. That day is S and I's five year anniversary! We are headed to Eureka for a long weekend on Friday and I'm so excited got the Amelia Earhart room again that one has the best back patio it's really excluded perfect for wine and music. I might take a nap this afternoon. Took one yesterday and it was lovely. Never to late to become a napper. 

    Looking forward to domestic activity as well. I had to get some dishwasher pods at Edwards bc I  accidentally bought clothes washing pods for the dishwasher. All these damn pods look the same these days. And it's easy to screw up at the grocery bc masks and no glasses - it's hard to read the fine print. A couple of glasses of wine and a long overdue chat with Christy has me in a better mood. Happy Monday - hope yours is less stressful. Much love, Elizabeth

BHEC quarterly meeting 7am Friday

     I took over going to Baptist Health Extended Care quarterly meeting years ago, when Shaver became chief. We get paid 150 bucks per meeting so I try to attend. Gail McCracken used to run it, but Bob Searcy took over a couple of years ago. It used to be at BHEC, then it was where the vaccines are given out now near the Dr. Lounge. Now it's in a new place every time, and this time it was quite cryptic. Behind the glass door. In the small conference room. I found it, in the admin suite, and made it on time. Greg is the admin - he used to run the lab before Cody took over. 

    Ken Robbins is always there, and Greg Zawada. Ali usually comes, but he was absent. There is a pharmacist - she is constant, but the three nurses, all of whom I respect, were new to me. Damn travelers, said Bandy last week, when he sent for frozens but it was not communicated to the gross room and so they didn't get done. The entire hospital is made up of travelers. Radiology is a complete mess - it's a wonder we actually get specimens.

    The meetings have a routine - first the pharm approves new meds and we motion to approve and second the changes. Bob wandered in late because he got lost. One of the nurses presented a routine they were doing to measure the room cleanliness. She was talking about ATP and call buttons and phones and we were all lost. Bob stopped her. You mean Adenosine triphosphate? And what phones? Telephones, I told him and he incredulously wondered if there were telephones in the patient rooms. Yes, said the head nurse. Who uses these phones? Zawada googled ATP measurements and sure enough it was a thing. Bob said no disrespect, but we need more information here. The nurse said none taken, I'll bring more information to the next meeting.

    So then the infection control nurse presents the CLAUDIs and the CLABSIs and she mentioned there was a C.Diff. Admin Greg said we get a 2% ding from Medicare for that. Bob wondered for just that patient? Or the whole year? The whole year, Greg confirmed and we all gasped. Bob said who is making this stupid rule? Tony Fauci? Clearly no one that knows anything about medicine. It's like we are living in Infinite Jest.

    That played out again when Greg said our Case Mix Index is going down  and that is bad for reimbursement. What is CMI? We all wondered, and Greg said patient acuity. There's been a lot of young patients with COVID being admitted and they don't have as many comorbidities. Value based care! I announced. Didn't we have a mandatory meeting about that last night? I have yet to watch it, but I have two weeks.

    Greg explained that they needed more critical patients to get better reimbursement. Bob said well I could probably diagnose everyone in this room with sepsis. Anxiety. Depression. I see you Greg, I'm not asking you to cheat the system (we all laughed) but we need smart people to help us game the system. They've got all the Ivy Leagues, none of whom know medicine, so we've got to get those too. It's a new game, it's terrible, but we've got to play it.

    The meeting adjourned and I asked Bob if he'd ever watched the movie about David Foster Wallace. He remembered yes! The reporter who goes to interview him. They talked about tennis. I tried to start Infinite Jest but decided to save it for retirement. It's like Finnegan's Wake. Same here, I told him. Couldn't get past the first chapter. But that Kenyon College graduation speech? I read it in residency it's one of my favorite pieces on the planet, I told him. Yes I read that too. 

    Having an amazing weekend. Pool is heated and family gatherings are aplenty. So happy to be off next week. I've got three cling on cases to finish up Monday but going in when you are not actually on is a pleasure. Happy Sunday, much love, Elizabeth

Put the Petal to the Mettle

     The first three days of this week were nonstop batshit crazy. Needles, double the cases, you name it. So it was nice to have a slower day - a day to walk outside on breaks and read the news. Take a decent lunch break. No needles today - so hoping tomorrow will be the same. I take over chief duties in January, gives me time to finish out the year and party plan. Ease on in. 

      I hadn't been to general CARTI tumor board in a while - mostly covering ENT, so it was good to see Diane and Tom Sneed it's been awhile. And Joe Beck - he's a card. There was a case Tom presented - some guy that had a painful nasal mass. Two biopsies have been attempted but the first was read as a Schneiderian papilloma and the second was inconclusive for cancer according to Tom and he was trying to decide what to do. This isn't growing like a benign thing, but we cannot get a cancer diagnosis. Both read by our group, but not me.

    Joe Beck likened it to sticking a needle in raisin bread. Sometimes you get the juicy bit, but sometimes you get just fluff. Eww I hate raisins but it was nice not to be blamed. He's right though. Some nuts are harder to crack. They decided to treat it like it was malignant and try to shrink it with their fancy named drugs before they operated, which at this point would require extensive forehead flaps and more pain. Sometimes you have to treat the lesion, and not the diagnosis.

    Jessica finally got badge required restricted access to the gross room. They are all over the moon. I was in there yesterday and someone was trying to get in and they were giggling. They opened the door and accepted the specimens but told the messengers that in the future, they needed to use their badge to access the OR and deliver it though the window. Weeding out the interruptions slowly. I was in there even though I was covering needles bc Kimberly got some rye bread from BVD and was trying to get rid of it. The secretaries weren't biting, so I told her let me see if Jess wants it she loves rye. 

    She was so excited Joe Shaver made fun of her. How can you be over the moon about week old rye? It's the German in me, she said. I could do lots with that bread. Reubens, homemade croutons, it would be great with a fried egg in the morning. She texted me a pic last night of her dinner with rye bread and soup. I showed Kimberly this morning and she was gleeful. I'll never forget that - can't wait to treat Jess in the future. 

    Kimberly treats everyone. She's had a hard life, and she loves working for us. She's so positive and giving and hardworking. She's a lesson in how to be a person. She often texts me pics of what she's meditating over early in the morning - long before work. She's transformed transcription into a place of joy. She waits on the transcriptionists hand and foot - bringing them ice and doing a lot of the dirty work with pleasure. What others would consider dirty work, anyway. She offered to take my trash today and I said sorry girl I beat you to it. She tells me about Jacinda and another new cook at Boulevard - they are harder to get to know with the language barrier - and how amazing they are. So I gift them too. 

    I talked to Mom and Dad just now their house is really coming together. I'm on call New Year's week so cannot go this year but am planning a solo long weekend in February. I'm working a lot harder than I ever have, but it's kind of worth it. Got the biggest bonus in history this month and planning lots of house projects. Need to get in touch with my financial officer next week - I often give but I'd like to do some planned tithing so I can be organized about it. 

    Speaking of I got a weird fax earlier in the week. Kimberly brought it. It was to Elizabeth Nestrud. It was from a law firm that said I had a relative in Canada - another Dr. Nestrud, who was in a car crash 9 years ago and no one had claimed the money from this ancient stone dealer (that made me giggle). 11.9 million dollars. That is so fake, I told her,  but I have to check it out? I got a similar letter from a law firm in California a few years back but I knew Uncle Lorne and it was 5K so it made more sense and they sent lots of paperwork to claim it.

    I couldn't not check it out. Kimberly's brother Kyle is a PI so she gave me his contact info to look into it - I did not have the time. Another red flag was that I only had 30 days to claim it. I texted Kyle a pic of the fax and said I am 99.9% sure this is a hoax. But the point 000001 chance had me in a bit of a daydream for a half hour. The first thing I'd do, I decided, was buy Kimberly a car her van crapped out on her and she's been struggling. Then I'd contact my financial advisor and figure out how to give. I told Kimberly, at least the fax moved my bowels. She laughed and said if that's the only benefit it's worth it.

    Sure enough Kyle texted and told me it was a scam. I wasn't surprised. I told him my family moved from Norway to Canada - that's where the fax was from/unknown deceased relative resided. I said it had just enough truth to keep me mildly intrigued. He said it was an old scam. Surprised it was still in use. You would be amazed, he texted, how much info you can get on someone for just 12 bucks. I tried to pay him but he waived the fee. Thanks a bunch, I said. 

    Happy almost Friday. I'm booking lots of relaxing appointments for next week, looking forward to it. Cecelia is coming in town this weekend (YAY!) and she's got quite an agenda but it involves staying here Friday night and grocery shopping with her Saturday morning and spending a few hours as a blended family at the fair in the afternoon. Rach will host brunch on Sunday. Big social experiment in the works - we decided to book a luxury home in Crested Butte together for Spring Break. I promised Rach first dibs on a room - there is more than one King. It's actually the same place I went with Katie and Becky and the kids when I first got divorced - when they first learned to ski. I remember staring at the snowy hills at night marveling at the snowplows and enjoying reading by the fire with the snow raging outside. It's a beautiful home. Much love, Elizabeth

Toilet Talk

     When I went to Orlando to a conference with my friend Trish pre-pandemic we were walking and talking and wondering why the hell it took so long for guys to use the bathroom. When you have to go, you go. Once my Chief Shaver incredulously posited who wouldn't take their phone to the bathroom. Who would? I wondered. S says that most of the time is spent on the phone. But wouldn't that time be better spent in your office on the phone? Or on the couch? 

    My ex told me that when he is in a group stall they are all wondering and talking. How's it going? That seemed so cringy to me. The bathroom across the hall, the one that doesn't have the security lock to protect the public from the heinous of it all, has been my go to. Occasionally you enter and there is a girl in the stall or a guy in the urinal and you are like WTF? But most of the time it's ok. 1990's, not 1960's with no cleaning crew. 

    S is the opposite he still likes to take his time but he's OCD as hell and cannot stand public bathrooms. I empathize. He waits until he gets home and it takes some time but I like alone time so I'm  not complaining. 

    When Jack was in elementary school he would leave the table at the end of a meal out, like 75% of the time. I guess the GI tract was still developing. He got a load, and he had to get rid of it. Sometimes he wouldn't tell us. We would be looking for the check and he was nowhere in sight and we would all just roll our eyes. Gonna be another half hour at least. Forget the check order another glass of wine. Get dessert. 

    It was a horrendously crazy day. But hell, I'm getting the best bonus days of my career and still leaving at a decent time. So there's that. Happy Thursday Eve. Much love, Elizabeth

Harvest Moon

     I'm not sure if it's tonight or last night but it sure felt like a full moon today. Things got a little crazy from about 11-3. Jack had to leave school because he was seeing spots and getting dizzy and hypertensive. I had scheduled the job interview for Shelby at 1pm and learned yesterday I had to run a micro QA from 1-2. And I was covering needles. I couldn't clone myself, and I was worried about Jack. I told Marti and Amy I'd be late to the QA and to start without me. I went outside before I picked up Shelby at Boulevard at 5 to one and walked. Paced, stared at the trees to calm down. Micro QA used to be just lab but lately they've added all the ID docs and it's stressful. There was a strange guy, and old man in a black tracksuit with a black and fluorescent yellow backpack that was pacing erratically. I wondered if he was a geri psych patient. He unnerved me, so I went to the gift shop to peruse the merch.

    I walked over to BV to get a water and wait for Shelby. I walked right past the CEO, waiting on his coffee, and decompressed talking to Avery. You are a sight for sore eyes, she said, and we commiserated about our day. Then we talked about the fair. She hasn't been in a while, me neither, and we talked about wanting to go this weekend. She never liked scary rides, and I've had to step back from them as I have aged from vertigo. But the other stuff. The corn dogs. The funnel cakes. Both don't fit into my gluten free diet right now but to smell them would be enough. The turkey legs, she said. The livestock shows, I thought. We were going to heat the pool this weekend, but it looks cloudy so maybe I will go to the fair if I can talk S into it. 

    I got Shelby settled in to meet Jessica and Keith was late, so I called him. Oh! I forgot. I've got to do this thing and I'll be there ASAP. He showed up about 1:10 and said he did something he has never had to do in his career. A patient, coming from Hope, did not want to drive an extra two blocks to deliver a bill so Keith had to meet him at the hospital with a receipt to receive the payment. Was he wearing a black tracksuit? I wondered. That's the guy, Keith said. He had those things women use to put their hair up on his pockets. Bobby pins? Jessica and Shelby and I finally guessed and he said yes. The man said if you ever were pickpocketed in Chicago you would do the same it works. He painstakingly removed one and gave Keith cash - he showed us the proof in his front pocket. He then went for the 77 cent change owed in the other pocket and Keith said no worries, we will eat that. 

    Then I got called to rad for a thyroid. Sarah told me earlier when I went to the first one that there would be three. So we get to bond. Bond we did. I tried unsuccessfully to join the Microbiology Google meet and decided it was fate. I needed to chill and ponytail and breathe. Marti came later with the minutes to review and sign and we talked about what I had missed, which was nothing bc I attend huddle every day. I learned this morning Greg Crain finally approved the WASP. I saw a presentation on that like 7 years ago I said. Change does move at a glacial pace but this is HUGE. I googled it this morning geeking out before cases came and I cannot remember what the acronym stands for but it is super amazing. Revolutionizing specimen processing. It's a Biomerieux product. 

    Jack made us watch the first two episodes of Maid with him last night and it was super intense. So much so that my left eye kept leaking and I was filled with emotion. I told Kimberly this morning I always felt guilty if I felt sorry for myself as a single mom bc I had the financial means to secure aid. But it was hard, and that show brought it back. Working. Supporting. Attending all of the school functions - getting covered. My neighbor at the time, Birdie, told me I needed to get friends. I have friends, I said, but I'm too exhausted for friends. Work and kids and books and wine were all I had time for. An opportunity for growth, Kimberly said, and I agreed.

    I'm off next week - a staycation - and I texted Yousef and Lisa today to set up appointments it's been months. Need to plug in with chiropractor too my upper back is killing me. I did the best ever in OT today I think all that Marco Polo and racing underwater with Rennie over the weekend really loosened things up and helped me heal. Whitney and Steph were also watching Maid - Steph is a single mom to a 3 and 14 year old - and even though Whitney has no kids and has never been a single mom she said she was bawling. She told me that the daughter in the show is Andie McDowell's daughter IRL and it makes me even more excited to watch it. If Jack hadn't told me it had a happy ending I'd have to quit. 

    I assume Chief duties in January. I volunteered my house for Christmas Eve this week for all the Nestrud's and Dickinson's in town - I'm off. I also planned a retirement party for docs on December 4 for Rex. Crawling out of the pandemic, slowly but surely. Jeff from security - he's becoming fishing friends with Tina's husband Reggie - asked me what I was going to do next week. It's my fifth anniversary, I said, and we are headed to Eureka for a long weekend Friday. He has never been, so I launched into a diatribe about its attributes. 

    There's this restaurant called the Grotto built in the side of a cave. They have this appetizer, quail poppers, that is one of my favorite foods on the planet. Jeff grinned. I love quail! My college roommate and I hunted it all the time. It used to be easy to find, but now it is scarce. We baked it we grilled it you name it we enjoyed it so much. I hear they have good quail in Brinkley, if you are interested. I love the memories of my dad taking us to the Passion Play too, and staying in the Crescent and getting those cheesy old time photos were you dress up like you lived in the 1800's. Good times. 

    Planning to wind down and grill maybe when S is back from his bike ride. Just watched a Merlin with J. Went on an Epic shopping trip yesterday to feed these hungry boys - I won't let them touch the pantry or the fridge that is my territory to keep organized even though they offer. They have strengths in other areas that I depend on. I want to be one of them in my next life - the endless energy, the bottomless pits for food. Happy almost hump day. Much love, Elizabeth

Hail to the Chief

     I wandered into the gross room around 3:45 after I had checked the board for late frozens. Jessica and Savanna were the only ones left - they were hunched over a catalogue. Jessica said we just grossed in two large dead bowels and are taking a break. Looking for stuff to buy. This catalogue is amazing! Tell me about it, I said. It's called Uline if I recall? Endless office supplies. Oh look! We need this. They were swooning. Zip ties!

    Jessica told me there was a woman that tried to sell them a 10,000 dollar piece of equipment a couple of weeks ago. It fit under the cassette labeler, and spit out something that attached a zip tie to all the cassettes to keep them in order while they were waiting in the queue and to keep them organized when they spit out cassettes for the PA's. She was like hell! Great idea. But I can get zip ties for 2 bucks at Home Depot and do that myself. We all laughed and I congratulated them on their ingenuity. They were also looking at cookie sheets. Something to use at the grossing station to gross on that will catch the blood and contain it and keep it from making such a mess. Genius, I told them. Go for it.

    Lindsey walked in from NLR - she is on call with me. I told her it looked like we were clear for late frozens and bonus! We are limping toward the weekend finally. Limping is about right, she said. She was looking at the schedule for tomorrow and exclaimed hell yes! Hagans and Fant are both off tomorrow. I didn't know about Hagans but Fant called me earlier in the day to fix a typo on a case and told me she was on her way out of town for a long weekend. We scored, I told Lindsey. Knock on wood for a good call weekend. Jessica said she cannot remember when both of the breast surgeons were off at the same time.

    Poor me, said Savanna, I am on call next week. You will be drowning in boobs, I told her, and Jessica guffawed. Savanna deadpanned, yes but not the good ones. LOLOL. They told me that once, about ten years ago, some visiting student walked into the lab when they were grossing in a dead bowel and said Wow! It smells like moist cherries in here. That is their running joke for dead bowel. What the heck is a moist cherry, I asked. Reminds me of the restaurant Juicy Seafood. S and I ate there once years ago and it was decent but we haven't returned. The name is off putting. They were looking for potent air fresheners for dead bowel. I told them the plants they have are supposed to help - they have three NASA air clearing plants - Jess is a green thumb she inspires me. Jess said we would need at least one for every grossing station. Savanna said no, we'd need a forest to combat that smell. 

    Another busy day but I joked to the girls that 130 blocks used to be a crazy hell day but now I'm like yay! Only 130! At least it's not 170 or 200, which is becoming a new norm. Savanna marveled when I told her we used to have 70 block days once a week, twice if we were lucky. No more. It's a grind. In other small news, I will be the next chief. I'm kind of secretly beating my chest and getting drunk on the possibility of power. I'll be the first female chief in PLA history. The staff doesn't even know it yet.

    To be fair, I'm kind of chief by default. Shaver has been doing it for years - he's going through a divorce, poor guy, and we commiserate about that. He's done. Hal, who is vice, doesn't want it. All the other guys who have been working ten years or more than me aren't interested. Melody, as head of clin lab in LR, is too busy for the extra meetings. There has been no fanfare. When I got elected chief resident many years ago it was much more of a big deal. Then they tried to take it away from me, because I was going to be gone on maternity leave for the first month. Such a toxic, misogynist environ. I pleaded my case (I got the most votes!) and suggested that the runner up co-chief with me to make it more palatable to them. They reluctantly agreed. 

    So I get to be in the room where it happens. A room, Shaver assured me, would become quite boring and too much. But I'm excited to be with all the other chiefs and the admins. Change might not happen with me, but I've got opportunity. My grandpa Jack on my mom's side, he was in the Navy, was nicknamed Chief. My brother Matt carries that nickname too. Move over, make some room, there is a new Chief in town. Happy Friday Eve, much love, Elizabeth

    

What is in the Water?

     I had OT at 10:00 today. It's like my Calgon Take Me Away moment, especially on a busy call week. Maria traded me an hour of morning frozens for an hour of afternoon frozens. I met a new girl, Susan - she is the Director of the Covid Unit at Baptist. WOW. She was fun and salty as hell. She injured her left hand on a car wreck and was getting therapy. She unapologetically had a take out container with French toast and bacon then set up her laptop and phone to work while she was getting therapy. She talked about Covid burnout and her history of working that belied her youthful appearance - she was director of a hospice in Dallas but worried she wasn't doing enough to help in the pandemic. She also helped process sexual assault victims at UAMS before she took this position. She managed to command the audience of OT with stories and work and entertain at the same time.

    Me, not so much. I told Stephanie I needed a light session like Friday. Recovery is not a straight line, mentally or physically, and I'm moving backwards. I got nerve impingement moving my mouse this morning, which never happened before. I told her I was picking up a brain from a bottom shelf in the corner to show a potential employee yesterday and someone must have poured more formalin on it, because was heavy as shit and it hurt my rotator cuff like hell and I had to get Savanna's help. 

    Shelby loved touching the brain, though, as a lot of people do. I though it would be softer, she said, and I told her it is when it's fresh this is some research brain that has been sitting on the shelf for at least a decade. Abby Normal, it says on the bucket. So the real brain owner is a mystery. She put on the gloves I gave her and caressed the cerebellum and corpus callosum in awe. She's going to be a great addition to the team. Sharp as a freaking tack, and helped me a lot with IT issues when I was trying to show her cases on my new computer over lunch. I marveled, and handed her the mouse to take over. I've been putting computers together and learning code since preschool. An untapped gold mine, this girl. We meet on Thursday to assess the needs of our group and my input is we need to hire her ASAP.

    Especially since IT is still a freaking mess - Jessica actually exploded yesterday in the gross room dealing with issues. She's kind of back together. I was supposed to meet them at Local Lime for drinks during happy hour this evening but it's been a day. Not just work. Jack texted the family gressage at 12:30 and told us there was a school shooting at Central and they were on school shooting protocol and lockdown. My blood pressure went into outer orbit and I was not able to concentrate until we had ascertained that 1) it came from outside the school - two bullets had hit a portable school unit and 2) the picture of the dead body with head pooling blood on social media was a fake. I had to take a beta blocker for the first time in a while. Nancy assured us on a school robocall message that they were working with the police and school security to find the shooter and find the person who made the fake picture. She actually sighed on the recording. This is the hardest day of my career. I'll say.

    Stephanie asked if I was up for adjustment even though I was historically too guarded and I was game. She kept telling me to relax. She's got one cold hand on my inner shoulder while I am lying supine and one holding my hand sticking it in her underarm and moving it around holding it between her ample cleavage. Who can relax?? With this state? I was thinking I was glad I wasn't a guy I'd need to cover my pelvis with a pillow. Jessica tried to come talk to me and she said no, she's in time out she needs to relax. I closed my eyes and thought of a dream I had last night, one that I desperately tried to hold on to at 5:30 am when I woke up but sleep was done with me. Five minutes later she was like wow. You've never relaxed that much before. Great job. You ready for some rowing? Remember, bring it to the girls. Then you get rest and ice and electrodes. Good thing, I felt much better and it prepared me for stress to come.

    Then as I was finishing up some hard cases Kimmie, Christy's other BFF, told me she was bringing her son Tristan to the ED - he'd had a work injury and fractured the tip of his finger so the clinic said he had to go to the ED. So I plugged in there and talked to all my docs and met the APN he was assigned to and made sure he was taken care of in a well and timely fashion. Our poor sons, I told Kim. Is this craziness ever going to end. I can't even. After I released my cases I told the secretaries I've got lots more work, but this day is done with me. I have to go home. Call week and it seems like Friday on a Tuesday. Enjoyed the last episode of Squid Games last night. Need to find and new show. Happy day, thank God none of the students got hurt. Much love, Elizabeth

Friday

     I walked into the Dr. Lounge yesterday morning. Bit of a kerfluffle. Geisha - I haven't mentioned her I think - is leaving in a huff. Top secret where she is going. She's a little worried and paranoid. Shay and Tammish aren't talking either - about that anyway. I ducked behind the counter earlier in the week and talked to her. We aren't them. They don't care about us either. We commiserated. She's super cute and spunky. A few months ago I wandered into the dr. lounge and she was ranting to Tam, then me. Then she stopped, and left. I laughed at Tam. She does that? Just goes off and then leaves? It's her signature, said Tammy, and we both LOL'd. Tammy lives in England. She's got a daughter about my age. She isn't going anywhere, thank goodness. When the Dr. lounge moved with the new admin a few years ago everyone fought for her. They tried to replace her. She's irreplaceable. 

    Then I went to get a water or two and John Sims was the only doc eating. How are you? I said. I haven't seen you this week. I've been at an ENT conference in LA, he said. I'm making up for it in the OR today. I'd better warn Shaver, I told him. He's on call. John is the freezer, if you remember. No, tell him it's ok, I only have one case with frozens and I won't go past four. Shaver said I hope he holds up to his promise.

    I had five consults before 8, it sucked. Hard cases. Sometimes I don't have five consults in a week. I felt like the gross room earmarked me for bone and soft tissue, which is super rare and I abhor. C texted me at 9:16. Your therapist is calling me. I was super confused. I haven't used Yousef in months. She's from Baptist, C said. I grabbed a piece of paper with OT on it. Yeah, Stephanie was trying to call you. Wondering where you are. I was coming at 10? I got covered? Oh, we had you at 9 but that works she's free then. How in the holy hell she had C's number remains a hellacious mystery to me. 

    I had called Shaver at 9 to ask him to cover me for OT. He said sure, who are you having tea with? Good god me and the secretaries LOLOLd over that. I explained, and he said he thought I was really fancy going to have tea. But he was up to cover? What's next, I asked Tina and the gals. Massage? Hair did? Take the day off for fun? He opened a door that cannot be closed. 

    Stephanie said I was up for reassessment but I was so stressed and tight she decided to put it off. She took it easy on me. I brought pimento and cookies bc it was  Chris's last day (bawl). We made lists of our fave books for each other. It's gonna take me a year or so to get through his. I love that one of his faves is The Story of Edgar Sawtelle - I told him I loved that so much I read it twice. I didn't see him last week bc he was out due to migraines. He and his gf are headed to Kalahari next weekend on my rec I told him he has to tell me all about it. That buffet. The candied jalapenos. The smoked salmon. The capers. YUM. Planning to take Jack and a friend next summer. I think I'm going to invite Chris to the next book club. Gender be damned. He's a card.

    S is grouting and J is sleeping and I'm headed out to the pool. S heated it for the weekend and I cannot wait to read and relax. Recently started following Annika on Insta - she's a weight lifter like J. She spotted him two hundred this week. I graduated to three pounds LOL. I told Carrie to come over and see the house and catch up it's been way too long. Looking forward to that. Happy weekend, Much love E

    

Gold Star

     Jack's here this week, which is AH-mazing. We've watched two episodes of Merlin in the past two days. We laugh about the cheesiness of it and the ancient special effects. He's downstairs studying right now, but I asked him tonight how many times have you watched this? And what age did you start? I was 11, he said, and this is my third go around. I love that he's sharing something that comforted him at a younger age and ages well and not so well with time.

    Learning more about boobs from Christy. She said as long as your boobs aren't bigger than your stomach you can eat as much as you want. Love that, wouldn't work well with size small B but leaves me lots of room for eating at a DD. Another good tip I learned from Monday afternoon from her was a rule of thumb. If your nipples sag below your elbows you don't have enough support and need to seek more to gain higher ground. At my stature I gain that status without any support so I feel like I've achieved something. A gold star.

    Work was crazy as hell - I had 5 needles before noon prompting me to convert from kitten heels to flats for the rest of the day. Sarah is the PA who does thyroids. Her first was a bust - a subcentimeter nodule that yielded nothing but blood. She wasn't surprised. It's one of those patients, she said, that is moaning and screaming before you do anything. I'll get a little more for cell block and be done. When I was summoned to her second thyroid, she informed me that if it wasn't adequate she would take it personally. So she was pleasantly surprised when I told her she had plenty of cells and colloid. Is it B9? she asked. I told her I thought so but FLUS's can sneak up on us when we see the cell block and the paps so don't get too reassured.

    Pam, the head of cytology, is on needles this week and I told her I was a little enraged. I had a case that was paratracheal mass vs parathyroid vs thyroid. I thought it was thyroid, but the history was so confusing I showed it to Shaver. He pointed out that there was no requisition - we need a req to accept a specimen. He agreed is was a FLUS (follicular lesion of undetermined significance - these go out for Afirma testing - that's a molecular panel - to further guide treatment). Oh! I was so locked up in Epic trying to figure out the location I failed to notice that.

    I called Beth and told her to find the req. She called me back and said Tony sent it up with you. I was like hell no there is no req I'm putting it in the cytology box he needs to find it and send it up. I was telling this to Pam and as I finished the thyroid got called to bronch lab by Tony. It was slam dunk malignant and he sheepishly told me that he changed his dx and sent the req to the recycle bin, where he recovered it. I'm so sorry, he said. Tony is a gem. He sees people, and helps out when needed. I'd risk my life before throwing him under the bus. We all make mistakes, I said, no worries.

    Speaking of mistakes I threw a huge fit yesterday when Van sent a case to Hal in NLR that needed flow. Pay attention to the damn schedule we are short staffed and we need to not make mistakes that cost us almost a whole day and cost us time problem solving. Poor Melody was so confused - she was taking day call duty bc Maria was acting as an expert molecular pathologist in a court case. She was so stressed I asked Shaver for a ride home instead of her. Luckily she was able to order and find the flow and take care of the patient. Van owned up to the mistake - he's pretty amazing too.

    I'm so excited on Monday Shelby from BVD is going to shadow me - she reads Judy Melenik and other pathologists and is so jealous of Kimberly for inhabiting our world. I hope we find a space for her ASAP I've been promising her for months. I want her to meet all the dept heads we may have an opening soon. She had a ganglion cyst removed a few weeks ago and I took pics and sent them to her - her response was so animated you'd have thought I saved her from a fire. She's sunny and wonderful. Hope she joins us. 

    The new girl at BVD is named Anna and she studied geology at Colorado Springs. She's brown haired and introverted but once I learned she loved rocks I was totally hooked. I showed her my trilobite and my crinoid and my angel's wings and we had an animated discussion of rocks this week - she said I have them all over my windowsills. ME TOO. 

    Saw some good articles on up and coming horror movies this week so excited about The Maid (Thai) and The Lamb (or maybe just lamb?) and The Manor - love Barbara Hershey. Seems she got the wrong end of the stick twice in her life - first for breastfeeding at 25 on a talk show (in 1973 - the year I was born) and another time for getting lip injections for a role and becoming the butt of ridicule about plastic surgery around the nation. Effing patriarchy. Strengthens her, doesn't diminish her, in my mind. Happy almost Friday. I start a week of call Monday so this weekend will be sweet. Take care, much love, Elizabeth.

Testicles and Car Trouble

     Well my car didn't start this morning and it sucks anyway bc no music but I think it's just the battery. My friend Sean was T-boned last week - not his fault, and understandably the insurance companies are a pain in the ass to deal with. Kimberly recently got her van fixed after the brakes failed. Shaver told me that our business manager, Keith, fell out of his fishing boat over the weekend and has a huge hematoma on his thigh, so he has officially joined Hal and I's club. I was group texting Kimberly and Sean this morning asking what the hell is going on with the Universe. Sean posited that Arkansas was narrowly balancing over a fiery pit of Hell. Makes sense.

    Ugh there was some video I had to watch to meet my performance metrics for reimbursement due by Thursday called Value Based Care. I listened to about 20 minutes and then put it on mute. I'm scared to attest that I watched it without playing the whole thing because that's just the kind of money wasting Big Brother thing that might happen - them monitoring us in a lie. Like today when I was in OT and Jessica (Stephanie had way too many patients but Jess is sweet she teaches pilates or aerobics or something and gently guides my form to correct it while I'm exercising) told me she had a zit forming at the base of her nose. I was like hell no that's the worst the last time that happened to me was at a Lollapalooza I was with my friend Kallie and kept hitting the bathroom to pop it all day and it kept growing. It almost ruined the concert but I finally got relief by nightfall, and with a little beer on board. She said yeah it's so painful I've almost got referred pain to the top of my nose? Like it's involving a nerve. Ouch.

    Jessica mentioned that the paper masks she feels like dry her out and cause more acne. Why don't you use a cloth one, I said, and learned that a couple of weeks ago paper masks were mandated. What?? I told her I noticed everyone was wearing them in micro huddle and thought it was a little weird but had not realized the etiology of the new sameness. Sheep. I learned today when I glanced at a slide that ACO labels me as a proceduralist. That's almost, if not as insulting, as calling me a provider (which they did frequently in the video). I didn't go to school for 10 years after college to be called an effing provider. I'm a doctor.

    Luckily the cases weren't to bad until I got to the last tray - a bunch of placentas and amputated toes and gallbladders and easy things. Then I got to the testicle and sighed. By the time I had spent a half hour on it I took it into Shaver's office for a consult. I told him I went into Melody's office - she has the latest books - and asked her if she had a good testicle book - I thought I had a tumor fascicle but didn't. She gave me a male GU tome with a little bit of testicle at the end. After I played matching wallpaper (that's what Dr. Waldron called it may he RIP) and it matched three different tumors I decided I'd show it to him and send it out. I haven't had a testicle in 6 months! I lamented, and the last one I had I sent to Jesse. He said he got one today today too and hadn't had one in over a year. I went from no testicles to two testicles in one day. Haha he grew a pair too. We laughed. He wondered aloud that I might be looking at the wrong parts of the internet if I was having trouble finding testicles. I just want a book, I said. A testicle book.

    He came back and said I think it looks like a Sertoli-Leydig? Or a juvenile granulosa cell? Maybe stain it? I'm not smart enough for that tumor. I said that was the exact differential I'd landed on in Melody's book but there was a new entity maybe tumor related to adrenogenital syndrome and it looked like that too. I told him I was just going to get a block and send it - Jesse trained me not to stain testicles and if I do he would wonder aloud how I strayed so far from his wisdom at the scope. We commiserated. If it's not a straightforward seminoma or yolk sac/germinoma it's not in our wheelhouse. Melody agreed. Off it goes tomorrow with the block. 

    Well Kimberly and Sean and I decided if life's rough you just gotta hop on and enjoy the ride. She's calling I'd better run. Happy Tuesday! Much love, Elizabeth