Wednesday, December 22, 2021

The Mythical Elizabeth

     S started his job in February before the pandemic. As you know, Christmas parties were cancelled last year, but we had one last night in the party room at Samantha's Tap Room. There weren't over 20 people, it felt safe. We cancelled the PLA Christmas party this year bc with over 50 employees, it didn't feel safe. So I had never met the principals Tim and David or the draftsmen Dick and Riley or their lovely wives. Last night we all remedied that over food and drinks and it was a blast. I was surprised that they all thought I was a myth, since they hadn't met me before. I got super quizzed over Covid and that was a softball. 

    Another strange thing happened last week I didn't tell you about. I got a gross only report on a penile discharge/penile foreign object. I'm not even a guy, but I cringed. What the holy hell. We get a lot of rectal foreign objects but never penile? Was this person sane I wondered? I looked at the age. Four. I wandered into the gross room and asked about it. Savanna, our mouse in the house sex toy expert, said it looked like an apple stem. I LOL'd. I guess if something can come out of it something might go in. Savanna said he probably hoped he could shoot it out. Hahaha. Like I gun, I said. The stem was a bullet. Those little men start early with their dreams of projectiles. 

    My intake is so much less than my output lately I'm amazed that I'm not stick skinny. But I love the curves and that's the way of the world lately right? Moving into a curvy future. Tipton and Hurst at Baptist went the way of many stores during the pandemic but they are putting in a new scrub store and it's exciting watching it go up. The inventory is all there it looks like it will open soon and none too late. I'm through with trying to fit into my small tall scrubs it's not in the stars I decided. Certainly the tops will never fit no much how exercise I do. Time to explore medium, maybe large even. I'm pretty tall. 

    I had to go to the family doc this week (it's been three years!) bc when I was in the ED a few weeks ago they picked up incidental hypertension. It's returned. Sigh. Back on daily beta blockers and I bought a new sphygmomanometer at Walgreen's to chart my blood pressure, which was 167 over 115 on Monday after a restful non-eventful day (it was 206 over 120 after the traffic arm fell on me). That's pretty crazy high. This does not run in my family not sure where it came from. My family doc Kent Covert (he's highly recommended Melody uses him too) LOL'd when I told him the story of the ED trip. He said he always worried about it falling on his car but never imagined it falling on a head. I told him Staggs was so alarmed it happened to me twice he wondered aloud that I should not tell anyone that it's kind of embarrassing. Much? 

    Having a relaxing week I got a massage today and had lunch with Christy. Trio's requires vaccine cards I fing love that. I heard from Maddy when I got my hair done yesterday that 42 and the Rep require them too. I need to get out more. Monday shopping with Jack and Rennie was fun at Belle and Blush but scary as fuck in Gearhead Outfitters and Big Orange there were way too many people and no one is masking what are they thinking? Batshit crazy. Who knows what the next possible mutation will bring. Ebola nastiness? I wanted to scream get your Vax. But the world is crazy, so response to the pandemic is not surprising.

    Best ever show Bo Burnham Inside on Netflix. I died laughing at White Women Instagram and Sexting and empathized to the point of tears when he was talking panic attacks. I have about one a decade since my twenties - to the point of physical terror - and it happened last Thursday out of the blue. Shaking, perioral numbness, phalangeal numbness, you name it. 0 to 100 in a second it scared the holy shit outta me prompting a visit to Yousef yesterday for the first time in nine months. Turns out one a decade isn't really that bad. I'm gonna be ok. Interstate travel might be dicey for a little bit but it's a small sacrifice for sanity.

    Got a big grocery trip planned for the am our Christmas Eve potluck looms. S is cooking the beef chili and Jack wrestled the turkey chili from me so after I shop I'm home free just hosting. C gave me a list so long I think I'm going to be shopping for her whole spring semester so I'm hoping I can limit it all to one cart. Sunday we are leaving for Nashville to see Rainbow Kitten Surprise. LOL I'm on call Monday and am covering frozens I realized and turfed that to Shaver last Friday. I'll get up early and play catch up in the afternoon. Merry Christmas! Much love, Elizabeth

Friday, December 17, 2021

Hand Presentation

     I had two interesting placenta's this week, which is saying a lot, because I rarely get one a year. They are junk surgicals. Back in residency I cut my hand on a placenta. Unfortunately the histo director Marty saw me and made me initiate the reporting of it to workman's comp and HR. About thirty minutes into that process I could tell it was going to take a long time so I was like fuck this and went back to gross. Took a deep dive into the charts and Mom didn't seem high risk. When I was planning my first pregnancy I told my OB Cindy to check for all the things, AIDS, whatnot. I can handle putting myself in harm's way but not a kid. It was all negative, thank goodness.

    Anyway, the first one had chorioamnionitis. This is the most common placental problem but the requisition was what piqued my interest. It said hand presentation. I normally don't open Epic for a placenta but I did. Mom was of the young age that the prerequisite effort for her current predicament was possibly criminal and not recreational. She had no idea she was pregnant and called 911 bc there was a hand protruding from her vagina. I think I would have had a coronary before I was able to call 911. But she did, and delivered a viable 25 week old female infant in the ED. What a way to enter the world, I marveled. Maybe this chick will be president someday.

    The second one was today. We document the amount of placental villous infarct - it is estimated grossly - and they are usually under 5% which is normal. This one was 85% infarcted, which I've never seen. Mom had asymptomatic Covid, she was in town from a small town bc hubs was on ECMO with Covid. A closer examination of the req showed the baby was IUFD - intrauterine fetal demise. 33 weeks. I learned there are case reports out there that show that having Covid can cause massive fetal malperfusion and placental infarct. So it can bypass Mom and be terminal to fetus. Melody and I marveled - I printed out a case report for us to read.

    Mandee Novack did a Covid update for us last night and I watched the video today. The Omicron variant, which is plaguing South Africa and Europe, is just hitting the US and Mandee thinks it will cause massive problems in January (after my Christmas Eve party thank goodness). It's more transmissible than Delta and OG Covid but less virulent. Meaning vax boosted people will probably be ok. She showed lots of charts and graphs and where the other two VOC - variants of concern - were like a steady climb Omicron is like a straight up peak. 

    We had a plateau in April but there was no plateau after Delta there was just a nadir and we are on the rise again. Omicron is definitely here, if not yet detected. She got all sciency and nerdy in a good way but the gist is that Omicron has never before been seen molecular variants on it's spike protein. It has S dropout, and we have Thermofisher which is the only machine in the state to record S dropout so she's been charting it since Thanksgiving. No big spikes it that yet, but it's coming. BioFire and Thermofisher have the ability to identify the Omicron variant in the pipeline - it's coming soon. 

    Mandee predicts that while it may not be as virulent or cause as much problems as Delta it will be a crisis, if a more abbreviated one. It will wreak havoc on staffing - those L&D nurses who throw baby showers and have breakfast after a night shift could catch it and wipe out 40% of a department for 10 days. Whereas Delta and OG have a transmission rate of one it has a transmission rate of 5 so that might cause, and already is in Europe, exponential disaster. If one person infects 5 and they go onto infect five more it's a real problem.

    There will be testing issues and shortages. At the peak of Delta we were testing 500 a day in the drive through and this is worse. We have shortages on monoclonal antibodies and that's bad too. Our ICU's have remained full through Delta's waning and if there are asymptomatic people transmitting it to already sick patients they won't do well. Child care will be a big issue - Omicron doesn't care if you are vaccinated, although you will probably be ok you will still be a problem and there will be lots of shut downs of day care units. She illustrated the transmissibility with an article about a person from South Africa staying on the same floor as a person from Canada. Camera footage showed they never even passed in the hallway but the person from Canada got it anyway. So it can go through walls and HVAC units. Delta and OG could not do that.

    Cecelia came home today - I got two tubs of pimento to celebrate and she is happily diving into one with Ruffles. Jack excitedly texted that he got all A's this semester - I'm proud of his hard work. I've had a rough week physically but I'm excited to be off for a whole week. Got lots of boring doc appointments and OT but that's ok. Boring is better than exciting sometimes. Hope you are well, much love, Elizabeth

Thursday, December 9, 2021

Snake Oil

     Well Jack is better. He's over at his dad and stepmom's this week so I haven't heard from him but no news is good news. He was prescribed a new antiviral for the flu - Effluvox I think? That cost about 200 bucks insurance did not cover. It was interesting watching the cyclic nature of the virus. One minute he was eating and wanting to watch Merlin, a couple of hours later he had a blinding headache and was breaking out in new hives. He texted me at 2am Friday morning saying he wouldn't wish this on his worst enemy. So we filled the script Friday morning, and two hours later after a hard sleep he was right as rain. Worth every penny. He got the first dose Baptist gave this year.

    This week has been my week to suffer - I had such horrible dry heaves Monday and puked a bunch. Kimberly had to drive me home at noon. Tuesday was a little better but similar. Luckily the week has been slowing down a bit and my GI system has been somewhat normalizing. I was super pissed to see a flyer in my box Wednesday morning from a molecular rep asking me to go to Arthur's and view a lecture. I did a double take - the name was the same as the one who invited us to an Afirma dinner about four or five years ago. 

    Pam and I went - she is the head of cytology. It was in a private back room and the food and wine was abundant and lovely. The lecturer was from Dallas - she looked like she belonged to an affluent country club. ENT surgeon specializing in thyroids. About three fourths of the way through the lecture she showed pics of her pathology thyroid team and marketed our work out. I side-eyed Pam. WTF. At this stage in my career I would have stood up and called her out and left but I was still trying to be polite.

    Dr. Kirsch was there from Conway. A very vocal ENT, I met him first at Laura Lamps' house when I was a resident helping her host an international famous GI crew. He is tough to get off of a conversation with, I learned, and have continued to on the phone over the years. But he's sweet. He defended us. We like our pathology, we don't need to farm it out. As we were walking out, he was dissing her. Why do you need to be a thyroid expert if you are an ENT anyone can do that? I said, yeah, most of our general surgeons do the thyroids. She's moving backwards, and pretending that she is moving forwards. They aren't tough, surgically or pathologically. Most of them, 98%, are benign colloid nodules. It's not rocket science, it's job security. She's a slave to who she's crawled in bed with.

    A couple of weeks later Pam and I were doing a bronch for Cidney and she was there marketing lung technology. Passing out fliers for another dinner at Arthur's. She apologized to us for her guest speaker. I didn't know she was going to do that, I'm so sorry. She walked away. Sorry not sorry, I said to Pam, screw her and her dinners. Cidney said that lung molecular is like snake oil right now I wouldn't go if she paid me. He threw the flier in the trash. I laughed. I did the same thing this week. Tossed that bullshit.

    I started Heart of a Dog last night and am about 3/4 of the way through it is so good. Amanda is going to drive me to book club Saturday night I told her my night driving was sketchy right now. I was laughing so hard today when the dog was morphing into a human I had to put the book down to breathe and dry my eyes. Can't wait to see Natalya's home. Other than that it's just finishing unboxing and putting up and starting to wrap for Christmas. Can't wait for a weekend - I'm not on call again until New Year's week.

    Cecelia is doing good - she nailed an interview with a doc to work in a lab called TEMPT and she is so excited. Also got some travel abroad honor award. I was worried about her bc she called in agony on Monday in the midst of my physical distress. Sometimes a girl's gotta cry to her momma and it makes everything better. S is excited there is some retired hedge fund guy who researched water for 10 years and is building a plant in Hot Springs. Also restoring a dilapidated barn as a visitor center for lectures and museum. He wants to enter it in magazines and make a splash and win awards. He loves S's design. 

    We have some exciting things brewing in our company that are too early to talk about but I'm vibrating with possibility. Pathology is moving into some amazing new technology and we are trying to be proactive so we don't become obsolete. I think we are on the forefront. Rex and Dianne both heard about it at the party and said they are glad they are retired but I'm happy to be a part of it. Hope you are having a good week. Much love, Elizabeth

Thursday, December 2, 2021

The Flu and the Feud

     This call week has been so crazy. Monday started off slow, but Tuesday I got bad dry heaves during Conway QRC Zoom meeting I kept checking the monitor to make sure my sound was off. I ended up expelling demons in the Dr. parking lot on the way to my car and had to catch a ride home from my head transcriptionist Tina. That was a prelude to the craziest two days at work I've had in a while. I did more frozens in the past two days - at least 20, and ordered more immunos on hard cases than I usually do in a month. Collision tumors, rare parapharyngeal masses I didn't remember existed (1% of all salivary gland tumors and in the minor glands - that's even more rare). And I had a breast core that has a low grade ductal cancer and a lobular cancer and high grade DCIS? What are the odds.

    Jack woke up yesterday morning with fever and chills and I took him an Icee and some Benadryl to knock him out before I headed to work. He slept some, but called me throughout the day with new confusing sx. Hives. Terrible headaches. He's not a complainer, so when he complains, we take notice. Mike called him in a Zpac and I stopped on the way home to get him some topical steroid cream. DayQuil. The hives calmed down then returned in the evening I was calling Eric Bravo and texted Ahmad Brown some pics of his skin. Ahmad is in Vegas now. Hope to see him when Christy and I go. He confirmed urticaria. Said it could be viral exanthem. I started Jack on a steroid dose pack I abandoned a few years ago. 

    This morning he called me again to say he was having the worst headache of his life. No more armchair doctoring, I said, make an appointment at the Children's clinic. He did for 1:30 and I met him. In the meantime Cecelia called and said that all of her friends in Fayetteville were deathly ill with the flu. She had her vaccine so hers only lasted three days but Woody was so sick he was in bed all day on his birthday and her un flu vaccinated friends were laid out. We are all worrying about Covid, but flu is really bad this year. Sure enough, Jack tested positive. But he's already on the mend (got vaxxed three weeks ago at well child visit). It's a breakthrough strain, I told him. They don't always get it right. But the vaccine will still protect you some, like Covid. He wanted to go back to school tomorrow but I told him wait until Monday. You might still be contagious. So, moral is, get you and your loved ones flu vaxxed. 

    Monday when I visited the gross room Jessica told me a funny story. We just got this new 17K fridge for the OR to put specimens in. It's totally glass - transparent to the OR. An anesthesiologist wandered in to complain. Did not even introduce himself. You have to cover up the legs. Maybe build a cardboard thing. This is insulting to so many of the OR staff. The legs are in a big bucket on the bottom shelf.

    But they are already covered, I said. We put them in red biohazard bags. Isn't that enough? These people went into medicine how can they be offended by bagged amputated legs. She said fifteen minutes ago, someone put that blue OR blanket over the legs. LOLOL. So it's a feud, I said, like the Hatfield's and the McCoy's (her maiden name happens to be McCoy). I think it was Brian Jansen, she said. I think he is offended and using his staff as an excuse.

    I rushed to his defense. Brian is one of the number one if not best anesthesiologists in the group. Mike hand picked him to do my anesthesia when I broke my jaw and my dad's when he had his heart surgery. He's quirky, I acknowledged, but in a savant like way. He saved my dad's life. On the year anniversary of my dad's almost fatal surgery, I bought the entire department (70 some it was over a grand) Taziki's and wrote a letter of thanks. They wanted me to stay and read it but I was too choked up so I asked Mike to. I credited Jansen and Morelle, the PA, in the letter. He was nice to me after that - asks about my dad, but half the time I say hi to him in the hallway he doesn't acknowledge me he is often in another world, I think. OK I'll cut him some slack, she said. Won't move the blanket. But still.

    I was checking the OR for late frozens and bumped into McCall Hogan, another anesthesiologist, last night. I joked about the feud and he laughed and said he knew about it. It's a full on war between y'all and the gross room, I said. We are gonna win.

    In other news, I got my first tattoo on Friday! C has been planning it for over a year she designed it off of pics on the internet. They are matching we did it together. Howard from Lucky Bella said I did amazing - I told him it was a lot easier than getting hammered on the head by a traffic gate arm or breaking your jaw in three places. C got a little woozy in the beginning but I told her to take her socks and shoes off and touch toes to tile and Howard got her a bottle of water and she revived. It's a moon design. She wanted to do it based on a song I always sang when she was little - you know it - I love you in the morning, and in the afternoon, I love you in the evening, and underneath the moon.

    I always thought my first tattoo would be a dragonfly. During my first Reiki session with Lisa years ago she told me I had dragonfly wings. Turns out that dragonflies are a traditional sign of resilience. Well based on what I have gone through this year I'm hella resilient LOL. I'm a little addicted. I think I'll start planning that one next year.

    Excited about Rex's party I'm throwing Saturday I've got Boulevard catering and Christmas decorations going up (except the tree - always a live tree) and a couple of people can't come but Dianne is really excited. Need to start reading Heart of the Dog for book club the next weekend. My attention span has been like a squirrel's lately maybe this will jump start me back into books. S and I have been revisiting old movies. Resurrection and Say Anything aged a lot better than Lost Boys and Silver Bullet but it's fun watching horror turn to comedy. Happy Friday Eve, much love, Elizabeth