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