Sunday, October 2, 2022

Seismic Shifts

     There are things that happen in your life that shake you to your core. Crack you open, leave you bleeding, help you see the world in a whole new way, but the getting there is so fucking hard. I'm thinking of a few things. Riding a bike, diving into a pool, having your first freaking kid (Did ToysRUs really look like this before?). And then your adult kids are struggling, and you dive underwater again. Come up for breath, hesitantly. Because the world is different now.

    Lab inspection was fun but they are always hard. Chief of path was a tall drink of water, about 15 years older than  me and elegant as hell. They are always on the defense at first, because I've been on the wrong end of a lab inspection I know what hell that can be. But we aren't that. We are collegiate. When I asked her about her kids, about a half hour in, she seemed shocked. I was reading your resume over breakfast, I told her. I have two kids too. Any grands yet?

    Yes, she said, a couple, and we just learned last week we will be having twins. Still recovering from that news. My youngest is in Panama City this week and I worry about them getting back. The hurricane, I said, and told her about my family's experience. Panama City will be fine, I assured her. My parents have been tracking it. It'll go way South of your kids. They will be safe. 

    She was kind of like a buttoned up Melody. Melody is a little easier and friendlier but I was the team leader so she was probably not being her real self. Super organized though - I've never gotten through a checklist quicker in my life. At the summation, I complimented her. But I did have to call her before, because something happened that has never happened to me at a lab inspection (I've done tons).

    Kayla, a young mom from Ward AR who supervises NLR was doing Heme/Coag. Her supervisor wasn't super helpful, kind of antagonistic, but towards the end of the day she snapped. Started yelling at Kayla making no sense. Mary went over to support Kayla while Angel and I were reeling. My adrenaline was pumping and I wondered is she going to get violent? What do we do here? 

    We do nothing. We support our own. I called the doctor to report it and told her that I would not bring it up at summation but someone needed to maybe check in with her. Her home life. I told the team if that was a member of our family I would address it more fully but ultimately that is their mess to deal with. Their own backyard. They were a very well functioning lab and they served their patients well and the CEO and CMO were happy so I've got nothing bad to bring to our governing agency.

    I'm not on call until mid-October so planning trips to Fayetteville to support C. She's good, she always was, she always will be, but she's in transformation. We all are, I told her. I've been struggling with GI issues for three years - can't be the badass hiker and yoga person I've always attached to myself. So the fuck what. Embrace the unknown. Because if you don't, you will get locked into horrible control patterns that won't serve you at all. Happy Sunday, much love, Elizabeth

Saturday, September 24, 2022


     For an essay title that's pretty bad but if there was a theme this week, that would be it. I've been continuing to provide daily support for C and she is moving in the right direction. She and Christy and her new beau are all at the Format Festival this weekend. Christy called this morning - she said it was hilarious bc there was no cell service, it was in the middle of nowhere, and it was like a comedy of an entire (very professionally done, she told me, good, I said, Woodstock 99 docs have given me PTSD) fan base, security, food vendors trying to get cell service the whole time. I just told Cecelia she and her friends should bring lighters tonight, that's what we did back in the day.

    Monday was kinda crazy - Jan in transcription's daughter was upstairs delivering her first girl and Tina was at jury duty and Kimberly's brother Kyle came to ED for second day in a row. C'mon let me help you get some info. I grabbed my white coat and walked into the Dr. pod. I introduced myself to a Dr. Melton, they only one in there. I saw Wayne, who I went to med school with, and Lane, who I went to high school with, but I don't know you. I'm Elizabeth. I'm Shane, we all rhyme he said with a deadpan burnout voice but then found Kyle in the queue, told me to talk to the head nurse Michael over there to find out the wait, and honestly tried to talk us out of waiting for the sx he was having.

    I went into the overcrowded waiting room that immediately made me hot and dizzy and grabbed Kyle out of the throng of sick people to explain what he could and could not expect out of the ED when our name was called. As Shane walked in he said that was fast and I said I promise I did not pull any strings that's not my intent here but I appreciate it. Turns out Shane went to the same Methodist church in Bryant as Kimberly and Kyle's dad and stepmom and spent ten years doing house calls and supporting them through his multiple myeloma before he passed. So even though Kyle didn't get what he needed (they will not do an EGD in the ED for outpatient stomach pain unless you are coughing up blood and need to be admitted) I told Wayne when I brought two dozen Boulevard cookies for the break room the next day that I see all the posts in BMD. Insurance is squeezing out primary care who are leaving in droves bc they are so miserably overworked then you go to an urgent care bc you can't get in for three months and they tell you to go to ED with a 6 hour wait it's just such a fucked up system. You are under appreciated and overworked heroes. He smiled and said thanks, Liz, it's not a problem. He was always so laid back.

    Jan's granddaughter was delivered without problems and that was a high then we found out that Tina got picked for jury duty again and we were like what? Second murder case in a year she has been picked for jury duty. Like she's got a target on her back. We tried to entertain her a little through text until she got back on Friday. It was a nightmare, she said. Evidence was terrible. Forensic path was that new girl I had on the autopsy presentation I forget her name. Ended up being a hung jury. Lots of highs and lows, in transcription this week. 

    Poor Frankie in micro came out of retirement from being a med tech at ACH to help us during the pandemic. She is no nonsense, in her 70's, with short bristly grey hair and wonderful black blocky glasses, we talk books sometimes. Her hairdresser saw a suspicious lesion on her scalp, she showed me a pic, and wondered if I could help her get into derm bc she didn't want to wait three weeks. She just went through a large melanoma diagnosis and re-excision with her sister in Memphis - I helped interpret reports - so I texted Ahmad and he is going to pull some strings to get her in with Hayden Franks on Tuesday, Christy's derm. I texted you for Dan Smith - yes, Ahmad said, he is my first choice, but he's here vacationing with me. Oh! Tell him thanks - S's alopecia is gone.

    Thursday was our annual shareholder's meeting at LRCC and that's two weeks in a row I had to perform on a work night and that just is really hard for me these days. Last week Jack wanted me at this Clinton Library thing to support and watch Hillary and Chelsea's new show Gutsy, which was cute but smacked a little bit of we sophisticated people go back to LR to show you our hillbilly roots, and since Jack mostly hung with his student council friends and sat with them and wanted to talk with them afterwards I got an Uber bc I was ready to go. Thursday night I missed the dinner part supporting Cecelia and I was spinning I was so over it. Choked up a little in front of my partners but regrouped bc I wasn't about to hijack the evening with my issues. I sat there while they talked way past dinner on an empty stomach and three drinks and almost fell out after I tried two Ubers - one said 22 minutes one said 30 minutes as the bill was being paid but luckily Shaver offered to drive me home. 

    Thursday at four I was working on two hard cases - a metastatic urothelial cell carcinoma to the lung hilar nodes - Moeez (pronounced Mo-ez) Beg, a new interventional pulmonologist, had used me for a wet read the day before. And Gary brought a stat case for a 20 something female with HIV who came in with pneumonia. Pneumocystis all over the BAL. I don't know those NLR docs but this is stat and I googled her to call her - Zafirah Salman. She's stunning, and looked like maybe has ties to Pakistan and a small girl she was tweeting about it. I was worried for any possible family or friends she had over there bc it's drowning (yet we still let Trump and Musk and Putin dominate our news cycle eye roll). She thanked me for the phone call, I told her I knew she probably had been pre-emptive tx her with Bactrim but it was still a very impressive GMS stain. Pneumocystis jeroveckii everywhere.

    When Beg called me Friday morning about his case I found out they are brother and sister in law and I was the discussion at their dinner together Thursday night. I got so excited I grabbed the GMS from micro (I had presented the case in huddle and left it for them to see) and took pics and sent them on group text. WOW THAT's AMAZING (no all caps but they loved seeing it they were ebullient). Made me happy. 

    I'm having a calm girl's night Ms. Kandi Noah's caretaker and Becky Langley who I've know for years and first went to Crested Butte with - she started our single mom's Sunday school which has fallen apart oh well. There's a time for everything. Anyway they are coming over I said let's do a heavy app potluck and I'll have a key lime pie I just cut up the strawberries for it. I'll also do a cheese and cracker and fruit tray. Let's have dinner and swim (suits optional I emphasized - women need a safe space our bodies are so over scrutinized and under appreciated for what they can do) or just put your feet in the water and watch the sunset. Next M-W I'll be in Jefferson City, MO for a lab inspection - the last one ever for just NLR we finally got the two hospitals combined. Conway is a little too far away for that so the CAP inspections will continue there. So more business but for now, calm. Happy Saturday, much love, Elizabeth


Sunday, September 18, 2022

Way Off Kilter

     It's been a doozy of a call week, and while I've had hundreds of cases (no exaggeration) I'll tell you about one. Brian and Jamie Burton are a OB/GYN onc duo. I referred a BFF (deeds) to Brian a year or so ago - she'd been seeing midlevels for years (Ugh don't get me started midlevels suck go to a freaking dr.) and he's revolutionalized her life. I don't care if that's a word or not. I made it one.

    Anyway, he had a frozen mid-week. And he's not a normal freezer. But this chick came in with a boggy uterus and he sent a sample of her cervix. Malignant, I said. Maybe Squam? That would be common, but it's horribly discohesive on permanents and I showed Melody bc I was like WTF? Three rounds of immunos later I was texting Jesse on Thursday morning. I can't get anything to stick. Can you help? Are you on service? We do crazy (Cleveland Clinic), he texted back. I'm happy to help.

    Meanwhile Jamie is calling me on the way home from work Thursday telling me she will see this chick on Tuesday. I'm on the way home, she is on the way to a football game. I'm telling her nothing stained but blush synaptophysin which I do not trust as far as I can throw it. Can you call it malignant, so I can get a PET scan? Absolutely, I told her, I'll revise the report ASAP. The ins and outs of insurance are a nightmare I'm happy to accommodate. 

    So honestly that one is up in the air. Along with many other balls I'm juggling right now. My oldest is dealing with a bombshell that was predictable but still. It's eating at my every fraying nerve. As a parent, you want to fix. As an adult mom, you just support. And that can be really rewarding but really hard. Give me back my toddlers, ASAP.

    After call Saturday (creating ten more cases for me to tie up on Monday) I came home to lovely Jack in a crunch creating multiple meals for he and his non-binary friend Rory (I spilled the news to his Dad last week on the phone and Jack is grateful. We are testing patriarchy and I think he might be chameleon enough to jump on board) to got to Ozark for a music festival of cover bands I think? With C and her friend Leila they were camping I cannot wait to hear about it.

    Jack was making chicken fried rice and homemade banana bread muffins from scratch and trying to get out the door by one which changed to 2 bc he slept in. My contribution was cleaning the kitchen. I told S, can you imagine? Any teenager preparing this much for a small town music festival? If he did all this for me - I tasted the CFR it was mouth melting - I'd invite him to every freaking music festival for the rest of my life. 

    So Christy's French lover turned out a dud. Those French guys do have a tendency to be an ass. But, she found a new guy on social media. Her friend Hayley told her if she want so date she has to get on social media so she doesn't look like a serial killer. Good advice. She's now with a guy Trey, who is as emotionally supportive as he is fun in bed, which is really important. Much more so, IMO. He's also from Harrison, and the mom's know each other, which is cute as can be they talk about the relationship in the local grocery.

    We had them over last night. Grilled, I remember that, but I tapped out early and we still have a key lime pie in the fridge I feel guilty about bc I never presented it. Maybe eat some tonight. Happy Sunday. I was born on a Sunday. Much love, Elizabeth

Wednesday, September 7, 2022

The Wizard of Oz

     It's a good thing the weekend was so good or I might just throw in this GI crap towel. Last Friday the casework was insane - I'd forgotten to take my beta blocker that morning and was having chest tightness by noon. No need to check the old blood pressure I could feel it. I knew I probably had a refill left at the pharmacy so when I told Mike to call in some Paxlovid for Jack (he tested positiveThursday night) I decided to get some more Metoprolol too, so I could have a purse back up.

    Jack's second round - so our weekend of plans and S's dad coming and projects disappeared before our eyes. Quarantining for him. I told Jack everything happens for a reason, and we honestly needed the R&R. He got to cancel his last few shifts at the sno cone station and we didn't have to entertain (although S's Dad is pretty laid back and fun). I actually ate a few bites at each meal and didn't need cough drops. Read two novels. 

    Was still feeling good Tuesday morning - making plans for long neglected friendships and tackling cases, but by noon it was unraveling. I got fish and wild rice from the dr. lounge but started dry heaving after two bites and had to toss it in the bathroom trash across the hall. Went back down to get the vanilla soft serve yogurt - they recently fixed the machine and I'm so excited - it's more like milkshake, honestly, they need to turn the temp down, but I'll take it.

    At 3:30 I puked violently into my trash can at work. As I left for an appointment with Paula, I asked Dr. Quinn if he heard. He worried I needed a cold wet towel for my forehead. No, I'm fine, I'm used to it, it just normally doesn't happen at work. It's sooo loud. S can hear it from the pond and the garage. I'm thinking about putting out an advert to do a voice reel for exorcism horror movies. He smiled, but his eyes were sad.

    Paula was great and a lot came up. When I was little there was nothing I loved more than The Wizard of Oz. We had a tiny toy black poodle named Toto that was the joy of my life. Once, when my Aunt Sheeran learned from my mom of my obsession, she bought me the novel for Christmas, I was maybe six or seven? The Nestrud's had driven down from Chicago and Minnesota for their annual pilgrimage to Arkansas with their dog, aptly named Tinman - a Great Dane maybe? Huge to me. I was so excited to open the book I accidentally tore the cover with the movie picture on it, one of the biggest tragedies of my thus young life. In retrospect, the red cover with gold lettering and the author's name on it - L Frank Baum, was infinitely cooler than the movie cover.

    So all this is coming up - you don't just go into other dimensions you relive memories, and I told Paula it was so ironic that those were coming up bc there was a double rainbow Monday night and all I could think of is that I was Dorothy, and there was my Oz. Not too far away. Just gotta be patient. In order to process all this I set up a meeting with Yousef tomorrow - it's been a while. I'm off until Monday, and after being up all night with the runs and puking again in my trash can spectacularly at 11am I need it. I finished up my cases by one and my partners volunteered to cover the OR from 1-4 so I could go home. It is so fucking hard for me to ask for help when I need it. But they all looked at me like I was a trooper for even trying to show up to work at all.

    I've been seeing a lot of good results online from Paxlovid, and Kewen Jauss called me about a case Friday and said her entire family was ravaged a week ago and it really helped to mitigate the symptoms. Jack had a rough first day but by Saturday morning with the meds on board he was upstairs in his velvet Harry Potter cloak and his N95 mask baking lemon pound cake and stirring wild blueberry jam into the batter. Genius! I told him. This will be one of the best memories of my life. It tasted so amazing with the brandied strawberries that had been soaking for 48 hours. 

    Well I'm going to chill and maybe go to bed at an ungodly early hour because I have no obligations until one. Still need to work on my mom's 75th bday project - I got the whole family to pick wishes and I need to sign each wishers name on the back of their wooden token wish and wrap and Fedex but I've got Thursday and Friday. Headed to a VRBO on Lake Hamilton for the weekend - Laurie has done it twice this summer and I admired and booked. Happy MY Friday:), much love, Elizabeth

Wednesday, August 31, 2022

Volcanic Explosion

     Well we are finally on the right end of hump day and it feels like a long time coming. I've done two tumor boards in the last week. The first one was CARTI general last Thursday, and it's the first time I've been back since they granted the contract to SVI. On Wednesday Tina handed me a request to present a case. Diane Wilder has retired from running tumor board (I suspect the SVI battle had something to do with it) and Grace Raja is now in charge. She's sweet as can be but the fax request to review and photo a 50 slide case less than 24 hours before TB rubbed me the wrong way. We have boundaries. We ask for 48-72 hours. This shit takes time.

    I was shaking a little, angry about being disrespected and honestly still reeling from the big decision. I crafted a text and smartly showed it to Melody before I sent it to Grace. It was a little snarky and cold, I knew it, and she helped me craft a better one. She doesn't know, Elizabeth. We can teach her. You are right, I said, you catch more flies with honey than vinegar. But you catch the most flies with bullshit, she said, I LOL'd bc I'd never heard that and we both kvetched over someone we know that does just that. We initially wanted to stop doing these bc we were so crushed, but we decided to pull a Michelle Obama - when they go low we go high - bc contracts get dropped and we might have a shot in 2-5 years who knows?

    So I asked Grace to remind the docs that 48 hours is ideal but I am happy to do this last minute for her. She said OMG you don't have to I'll add it next week. No, I told her, its a rhabdomyosarcoma of the uterus and I haven't seen one of those since residency I'm excited to look at it. I told her Quinn was Diane's point person for last minute cases and I'm happy to be hers - Quinn is looking to go part time in the next year or so and I'm far away from that. Just text me, I said. If I'm on vacay I can still figure out who is going. Guess what? Sneed sent his case of hairy cell leukemia for Quinn on Friday of last week. So she is good, Melody was right. She's already communicated it to everyone.

    I showed up early and sat front and center (SVI dude creeped in late and sat in a back corner and didn't present - that's snarky I know but I'm still pissed about it all). My case was first, thank god, there were 31 and I did not want a repeat of med exec committee. I told everyone how rare it was and how I trained with David Parham, the international guru, at ACH. He was also bipolar, I said (no secret the lithium was on his desk and his Jekyll and Hyde personality spoke for itself), and so I looked at all the rhabdo's - alveolar, embryonal, etc. We looked at them together every day for two hours in the afternoon and this is the first one I've seen since (wonder if the guys were subjected to that? It wasn't horribly painful he only made me cry once. He retired during my training. Hope he's still alive. He had a band called The Specimens - they played at an event I cannot recall what it was for. Kind of wedding band-ish). 

    Grace's question, which she worried was silly, was why isn't it a MMMT, - these are much more common in older women. Rhabdo is a peds thing. It was easy for me to answer - there are no carcinoma elements and look at this stunning rhabdomyoblast - but I assured her on text no question is silly you know way more than me in your world. These oncs are incredible. Diane once told a story of fighting with an insurance company (DEVILS INCARNATED) on the phone to get a puking patient a med so she didn't have to be admitting. The patient was puking in her office trash can. She was holding her and comforting her while she was on the phone.

    ENT went well Tuesday but honestly Friday and Monday were so freaking busy - I signed out more cases than ever in one day - that I had chest pain. Luckily the workload has eased so I can breathe. Excited for a long weekend not on call. Paula and I had a great session yesterday - energy is moving and my gut is going nuts but I think it's a good thing. Paula said Pele showed up for her (I have a completely different experience and we share after) and I was delighted. Pele was my divorce goddess when I discovered her and walked on her volcano where she resides. It felt like full circle.

    So I researched her today and it turns out she shows up as a young woman, and old crone (who bums cigs and disappears in the roads around her volcano lol) and a white dog. I learned what she likes to receive, loose tobacco and gin and flowers and coins. She is creative and loves unity but also has a jealous streak and can obv be fiery. Her volcano, Kilauea, is one of the most active ones on Earth and the name means spreading. Like strawberries! If you soak strawberries in brandy and eat them it pays homage to her - the sweet and the fire. So I'm about to do that. Got some good recs from my liquor store guy after work. Happy almost holiday weekend, much love, Elizabeth

Tuesday, August 23, 2022

Med Exec Committee

     They canceled in June and I had to go home early sick in July. I notice there is a pattern - this GI stuff can be really bad on Mondays. So when I hit a new low yesterday, I won't even go into the embarrassing details, I went into Melody's office at 9am and cried. She made me sit down and hugged me and made me laugh and I picked up and moved on. I told her today you are pretty special. I didn't even cry during my divorce. 

    I had written a statement about autopsies last month that I planned to present last night since I had to skip July. But I was super stressed bc it was a bad GI day and I had to correct a false belief that many doctors and admin had disseminated over the years that would literally be in the room. I was dry heaving up a storm and Melody and Shaver gave me the bright idea to Zoom. So I explained to Sherry, the secretary to a big admin (there are lots of them - bean counters all but I can appreciate some intelligence and care as I get to know them but STILL.) She took Jessica's carefully made autopsy info handouts and supported my decision.

    And let's face it, I can turn very red. Rosacea, hot flashes, you name it, but me dry heaving loudly in front of a room of doctors and admin and having to present in person? After a really bad day? Nope. Jessica met me in my office at 5:00 to Zoom and I made sure not only was there a blue post it over the camera but that it was off. I was dead last, and the meeting went over. We were finally on at 6:30, when I was at the end of my rope, but it went well.

    In a nutshell, admin and docs have this perception that we don't do enough autopsies. But we are right in line with the rest of the private practices across the country. They have been complaining to Shaver and Palmer for years, but there has been no clear communication, so my goal was to remedy that. I explained that we have done autopsies pro bono for years, which may have made sense back in the day, but now it is like a bomb going off in your already busy day.

    And the facilities are so outdated - Blake Phillips was on a bit of a tirade right before me about the slow renovation of the 1971 ORs and I capitalized on this. He's doing surgery late (generating money for the hospital) and we do 5-8 autopsies a year. It's a no brainer not to renovate and send to UAMS, which we did last fall in the contract renewal. Which was a huge relief.

    I told them I knew that it was assumed in our medical community that we turf too many autopsies. We turf everything that is not within the scope of our practice. Anything medicolegal, anything that requires tools we don't have - that's for forensics. Anything family requested gets sent to two local pathologists who do private ones, and it costs money! It's the way I was trained, and a recent Facebook poll of over a grand of pathologists on PMG agree it hasn't changed. We only do physician led autopsies with specific questions. 

    I talked to Susi Jeffus in preparation for July and she told me UAMS only did 57 autopsies last year - a far cry from the 100 I was required to do for my training. She said a new young doc at the crime lab - Ted Brown I think, has taken over the autopsy directorship there and their long term goal is to move them all to the crime lab. They take a few family requested ones, and that's only bc they are a teaching institution and need the numbers. They DO NOT WANT our family ones - inquires there should be directed to Frank Peretti and Jennifer Forsyth - I provided the phone numbers. 

    I was trying to convey that we, in this current climate where getting out patient reports is priority to next step and efficiency, is much more important than playing arts and crafts with a dead body all day in an outdated morgue for no money. I wasn't that crass, but it's really what it is. I have helped get clinicians off the hook over the years (no, you didn't botch that aortic dissection surgery, your sutures are intact), and answered important questions and it's fun! But not practical, and 90 plus percent of the time it's redundant. My one AHA moment in residency was when I discovered a giant esophageal cancer in a woman who had been in the hospital for three months with no CT. Let's not even get into her race, or talk about marginalized women. She'd done snuff her whole life.

    Speaking truth is hard. One of the reasons this got so out of control (Quinn was attacked in trauma committee in early summer which prompted me to get together this talk) is we just listened and agreed and didn't change our correct practice. One of the only guys who had questions, chief of staff Shenker, was incredulous at our numbers and was up in arms that someone was pressing us to do autopsies. He's OB, so probably has never requested one. The irony that most of the people in the room were perpetuating their frustrations over a false belief was not lost on me. They didn't speak up. I replied to Shenker that I wasn't on a witch hunt, I was just trying to clarify our policy and help clinicians get what they needed.

    Death is scary and stressful and I'm not the one dealing with the aftermath. I get it. You lose boundaries, and want to please people (these days for patient satisfaction surveys but that's a whole other rant). So when we draw boundaries docs play with them and we have to play the heavy. Docs get pissed. But hopefully now they understand. There's funny stuff too but I'll save that for later I'm so tired. GREAT session with Paula (who I also called for help after I cried to Melody). She's a godsend. Happy Tuesday, much love, Elizabeth

Tuesday, August 16, 2022

Friday Eve

     Metaphorically, of course. It's mine, anyway. Thank goodness I need a break. This GI shit ramped up again Friday and Monday and honestly it's so exhausting. I think it's because Paula did a cord cleansing on me last Wednesday - we decided to meet every two weeks on Wednesday. She's a rock star in Reiki, something a lot of people think is silly and on the fringe. Working with her, just twice, has been earth shattering. I've never vibrated before, or dropped into different dimensions, or met teachers (three so far) and NONE of this has any drug enhancement just after work before yoga (I'm trying to go back but it's soooo hard). She recommended a Reiki book I've yet to read - Hands of Light maybe? It was published in 1978 and was recommended by Elisabeth Kubler-Ross who I worshipped in college when I learned about her so that's promising. One book instead of twenty. Cecelia is not the only one who tends to bite off more than she can chew.

    I'm talking to my sister again! Which makes me happy, and seems like her too, so we will see how that goes. Cord cleansing was a big help. - my first. Baby steps with Sara. Mom turns 75 next month so we are planning a low key surprise gift and all the sibs and spouses are involved, and Gkids. Dad's in Atlanta with Mike and Sara getting new cardiology consults. He has had a rough road lately and I pray the tides are turning for a bit of longevity. It's certainly in the Nestrud lineage - I have Great Aunts and Uncles that lived until their late 90's and I think my Polish Mother will probably outlive me.

    Lots of new exciting developments at work lately that are too soon to share. Change is afoot. Not much more to say here - booked dinners and massages for Eureka so planning a lazy fun weekend after getting Cecelia settled. It's getting more and more necessary to do that ahead of time - I guess it's growing. I'm used to procrastinating until the ride up; that doesn't work anymore since the pandemic. Got massages at the Basin for the first time in a long while. Staying in Zelda's room at Cliff Cottages - also a first - it seems a bit more private so I'm excited to check it out and let loose. I assume it's named after F. Scott Fitzgerald's wife - I guess I will find out when I get there can't be too many Zelda's in the world. Maybe she was an author too - haven't read her. Another woman squashed in time by a successful husband. Maybe. I know their lives ended pretty poorly. Who knows. Happy Tuesday, much love, Elizabeth.

Saturday, August 13, 2022

Nude Photos

     This call week has been hell, culminating into today, which just created more work for Monday. I have never had a stack so high on a Saturday. Thankfully, it was doable. Now it's pool time and I can finally relax but it was a long time coming.

    This is so funny. I was looking up a heart transplant rejection patient this week, I'm on call, we get those on AP call, it can be exhausting, they do the biopsies to rule out cellular and vascular rejection. Most are none or mild - super easy, but occasionally once a year you get a tanking patient and it's a doozy. Anyway this was not hard, very routine, but I always like to look up the patient to make sure they are ok, ya know, clinical correlation. Ejection fraction, whatnot.

    I was alarmed reading about one guy who was complaining about peeing all night long (dude needs a TURP) and asking the interventional cardiologist for a refill of his Cialis (card said ask your PCP for that please) and then the next paragraph? LOLOL Wife told doc that someone in the community had alerted her to the fact that he was sending nude pics to women and after two therapy sessions that seemed to have abated. For now. No more vast sums of money or social security numbers given to random women. 

    I took a screen shot without identifiers and sent to partners and gross room. WTAF? Is IV card getting into psych? This man got a new heart did he get a new lease on life with this? I have never gotten this much information researching a heart bx for rejection. This goes down in your permanent record. Don't get so distressed. Did I happen to tell you I'm a mess. Sorry. Sidebar.

My birthday is coming up! Christy is throwing a huge brunch party on the 28th since we will be in Eureka on the 20th. I shared 15 contacts with her - mostly women but Jack and S are invited too. It's gonna be at Yaya's, I've heard their brunch is amazing and I've never done it so I'm super excited. C scheduled Sullivan's next Wednesday at 6:30 since she can't be there for the brunch. Their cocktail menu looks incredible I'm dying to try some of the drinks. Happy Saturday, Much love, Elizabeth

Tuesday, August 9, 2022

Queen Bee

     It's already a Friday on a Tuesday good lord. Two twelve hour days in a row - I'm not used to that on call. I realize that I've been getting lucky - I've pounded out the Jan-June Q/A and started working on July today - and I see all the late frozens that mostly Shaver and Nelson are getting stuck with and thinking in the back of my head that I must have a call angel on my shoulder but no. Karma came around last night with a late brain frozen, probably metastatic breast cancer but we won't find out until tomorrow bc it was too late to process.

    Today I walked into the gross room assessing the afternoon - I had dinner plans with Noah's caretaker Ms. Candy - we have been planning this for two years and she had to postpone last week bc they all got Covid. When I told her that Notorious Freezer Sims was supposed to start at one but he didn't until four and he wanted frozens on both cases could we postpone again until next Tuesday? She said sure the case I just walked in to probably needs more attention so it works out good for me too. Maybe I told you, she's a social worker for the government she does sexual assault intake (holy hell of a job) and is a single mom of two and takes care of Noah. I'm dying to get to know her.

    Between five and seven Sims sent six frozens and it was doable. You always think and reflect and overthink - like last night on the way home from the brain - could that have been an epitheliod meningioma in disguise? Sims' last case today was a 3 cm neck mass in an older lady - number one two and three dx is squamous cell carcinoma of the head and neck of occult etiology but I was underwhelmed. I favored a branchial cleft cyst, but I don't see them very often so I was consulting Melody's frozen section book as he was googling lymphoepithelial cysts on his phone. I showed him the gross, it also did not fit for metastatic cancer at all - a cystic mass with motor oil colored goo all over the cutting board. See? I said? If this was met SCC it would be hard, defined, scirrhous. Stellate. You know what I mean? He agreed. Think I'm going to stop now and close, he said. That's safest for now, I replied.

    Luckily my children are still cooking away - they plan homemade sushi for tomorrow (that was a helluva long stressful grocery trip on Sunday morning) but I've frozen a few perishables bc they got invited to see Pine Grove in NO with C's friend Ainsley - they play tonight. They also saw them at the Rev Room last Saturday. They should be back tomorrow but I don't want to hold them to it. Last night C had made homemade tomato soup. Jack was underwhelmed and wanted me to add chicken bouillon on the sly. I said absolutely not she wants me to taste it as she made it. As I was eating it she described roasting the tomatoes and pureeing them. Very garlic forward, I told her. Yes! I used garlic and onions. Jack said he could not taste them. I lowered my voice. Maybe Jack is frying his taste buds with all these spicy foods. If any vampires come around tonight, I'm well protected. She smiled, pleased.

    Jack was kvetching over the four almost rotten bananas he just bought a couple of days ago. What are you going to do with rotten bananas? Well you know what I used to do, I said, make banana bread. Chocolate chip. Of course he remembered, especially when I accidentally burned it on South Lookout and they covered it with bandaids. C had eaten all the chocolate chips but he decided to make banana muffins for the New Orleans trip and he added some nutmeg and they were fabulous.

    Remember the bathroom series from a year or so ago? Well, I've been using the one they remodeled and left open bc it was fit for public consumption in contrast to the lab one. I correctly surmised that they added an overflow ED across from the lab and so we have traffic. The one of two stalls I've been using is OUT OF ORDER so this morning I used the other one, forgetting why I abandoned it in the first place.

    The flushing. My goodness. I did a courtesy one, even though I was the only one in the room (courtesy to me) and it went on and on and on. Way longer than before. And the water was hot and viciously flushing - it wasn't really a bidet? But felt like a steam bidet. After lunch I decided to time it it was so ridiculous. One minute, thirty six and .07 seconds. Isn't that crazy? I told Kimberly. I mean, what all is that contributing to our climate issues? She LOL'd. You are adorable Dr. Seng. Not sure about that, but we shared the story with Tina and I showed her my phone timer and she laughed too.

    Many years ago I became addicted to NYT Spelling Bee. Before the crossword, which I used to do religiously but I just am not finding the time or inclination these days. I introduced my dad and husband to it, and they play too. It changed a few years ago - and got a lot harder with weird words. Before that I used to think the highest honor was genius, and reveled in getting it pretty easily every day. Then my dad taught me about Queen Bee, and looks at the hints every day, and gets it. Even S got it once a few months ago. Frustrating me to no end, bc I have never gotten Queen Bee.

Last night waiting on brain frozens I FINALLY GOT QUEEN BEE!!!! I was so excited it eclipsed my exhaustion - I had a nice weekend but maybe slept too much? Very low energy yesterday. Luckily it was better today. I'm four words short of Queen Bee today but I'm ok with that. I tried to cheat last night with Scrabble scramble stuff online but that didn't work I had to intuit the last word. So it was a true all me queen bee. I told the kids last night they had to call me Chief Queen Bee. LOL. Happy Tuesday, much love, Elizabeth

Monday, August 1, 2022


     Last week Cecelia decided in characteristic OCD Type A oldest child fashion that she had to start packing for college right away bc she's seeing it happen on social media. I got a couple of days off - August 18 and 19 - to move her in. That's almost a month away. Jack and I were laughing as we were helping her wrap all the goodies I gifted her in her mountains of clothes into suitcases. Both Jack and I would be doing this the night before. Or a week or two into school when we realized how little we had pre-planned. But, she's a pre-planner. So we indulged her.

    It was super satisfying. I got rid of miscellaneous glasses and coffee cups and baking items and wine glasses. A pumpkin cake mold I've never used and didn't even know I had. Are you sure momma? She asked incredulously and I assured her that I was not a baker but if I happened to get a wild hair I'd order something online or just go to the baking isle at Kroger. She squealed when I gifted her a never used juicer I won at an auction to benefit the Shakespeare program at UCA a decade ago. To support a college friend. I could see the wheels turning in her head - imagining future juicing sessions after class. Mia is going to love this mom, thanks a bunch.

    I saw on social media a couple of weeks ago that an acquaintance does Reiki sessions and her space looked so inviting I called her up and talked to her. Had an in person session last week. It's hard, Lisa and I have worked sporadically since the beginning of the pandemic, to gain anything from a phone conversation and I've been so stuck lately. This was such an incredible session - I had a major breakthrough. I'm looking forward to working with Paula more, and offered to take her to dinner Wednesday night to talk about her journey. Lisa clearly inherited all her talents, but Paula has had to work for them. And she seems like one of the most disciplined people on the planet. 

    All of this because I'm still trying to figure out my journey. I heavily researched Andrew Weil's Integrative Medicine Fellowship a couple of years ago and Yousef urged me to wait - he said it was the beginning of the pandemic and I'm just too busy. Despite the fact that I'm a procrastinator I can easily bite off more than I can chew, much like Cecelia. He was right. It's so intensive and we are so understaffed and overworked and as a pathologist what the hell am I going to do with all that patient related stuff. I could apply it to myself, but I can just read a book and do that without having to take classes and follow a schedule, none of which I have time to do.

    I was telling Paula all about my GI issues and lack of energy and how I was hoping to eclipse all this. As I was describing my awful dry heaves she said maybe a spiritual purging? I smiled. Intuitively, I think I know this is what is going on. But still I seek modern medicine out because I'm at my wit's end. It's been three years. It's getting better, but still. My physical health throws my mental health sideways and it's just not good. 

    Tonight I came home and decided it might help to clean out my closet. Get rid of all those size 6's and 8's and anything with a waist size under 30. Those aspirations are toxic, and in my past I think. I'd like to get back into yoga and get back on the treadmill slowly and strengthen my core but never again with the goal of being as small as I can possibly be. Kimberly lives near a halfway house for women and children recovering from addiction (and I'm sure abuse and neglect and all the other things women are subjected to in this world as third class citizens). I've got five large bags of half of the clothes in my life to donate. Another satisfying purge.

    Well it's been a halfway decent Monday for a change. Had time to start working on April Q/A and do the annoying monthly time sheet that came into vogue a few years ago. I swear, if every overworked person had to write down everything they did all day long to benefit the hospital and not our company - with numbered codes and time increments - we would all explode. But we do it, because they task us to. And luckily I'm still intact.

    Oh funny story I told micro huddle and Mike Perkins, the new Greg Crain in the game of hospital admin bingo and Mackenzie last week - with her I was searching for help. I told Eddie Phillips in line for lunch on Friday (he's the OB who delivered Cecelia and turned admin - how do I turn admin? Looks like a path of least resistance) and he chastised me for almost ruining is lunch. Former OB, I laughed, acting squeamish. LOL, I teased him.

    We had our gross room fridge replaced last October. Brand spanking new, transparent glass doors. It's been circling the drain for about two months and finally went kaput two weeks ago. We put in a work order to Darrell, the refrigerator guy for all of Baptist, and despite his earnest efforts there have been manufacturing supply issues. Weekends are not too busy - we put in a mini fridge in the gross room for the gallbladders and appendixes, which go on formalin, until we can get to them on Monday. Sunday is the only day we don't have anyone staffed.

    Legs are the only things too big for buckets of formalin - we gross them straight from the fridge where they have been placed in their red biohazard bags. And they also won't fit in the mini-fridge. So for the past two weekends all the legs amputated on Saturday afternoon, evening, and Sunday are going into a dead fridge. And who knew how many legs are amputated on the weekend? A LOT. So nurses have been paging and calling and complaining and making our lives a literal hell for the past two weeks. Jessica has been getting the brunt of it, but I got paged last Sunday after Shaver was paged the Sunday before and what do you expect us to do? Wave a magic wand and make a large fridge? This is a Baptist issue.

    The nurses, who have been a little hysterical about the legs in the past (NOW we can see them with this new fridge! We hate to see them it's so offensive). Um, they are wrapped in bags, and you are OR nurses surely you see a lot worse. I actually hear all the stink was started by a male DR. LOL. Hysteria is contagious. Our Sunday calls have been because the stink of rotting flesh coming from the unrefridgerated legs is soooo bad that they don't even want to wheel patients back to the OR to get their mostly emergent surgery. I get it, but what are you going to do?

    Mackenzie found no short term solution but just being able to tell the nurses we had admin involved took loads of pressure off of PLA gross room and weekend on call path. I got a text today that Darrell made a new connection and someone would be here Wednesday, with the proper part this time (they screwed it up last week). I was kvetching with Mackenzie about new appliances and their problems and she agreed. Nothing is made to last like it used to be. Happy Monday, much love, Elizabeth



Saturday, July 23, 2022

The Terrible Horrible No Good Very Bad Week

     Monday was ok. I managed to get caught up on January and February QC reports and started on March. When I walked in Tuesday morning I noticed an impending flood. Staggs' overhead tiles near his office were heavy and dripping. I notified Jan and she put in a notice for construction, whoever the heck you call. They came and looked and said they would be back. Seven hours later after another phone call and two more requests for help online we had sprung two new leaks and there were three trash cans strategically placed in the hall and on top of the mailboxes. The secretaries were worrying about leaving for the evening.

    I ran to the C suite and found Mackenzie. I had told her at our lunch that we flooded every two years, but this was another possible after only two weeks. She got on the phone and within five minutes the head guys were  problem solving. It helps to have friends in the right places. Some sort of air conditioning condensation issue - it certainly wasn't rain this time haha we all joked. She texted me the next day after I thanked her for nipping the issue in the bud that she would try to make sure we were evaluated comprehensively so a long term solution could be found.

    Then on Wednesday, cases raining down, not coming out in a fast or efficient manner (this is a chronic issue) I got a huge dump at noon. Chose to work through lunch (and Thursday and Friday) and a supervisor came into my office to problem solve something rather trivial on my computer. You can guess the race and gender. I said no, I'm busy right now, now is not the time. We need to do it right now, he said. No, I just got all my cases, it's not the right time. Scroll down, he said, I'll have this fixed in an instant.

    I started shaking I was so mad. I turned around and looked him in the eye and said what part of what I'm telling you is not clear? Let me say it again. No, I don't want to work on that right now, I'm too busy, I want you to leave my office. Zero boundaries, zero respect was going through the back of my head. He patronizingly told me in his honey sweet voice that we need to resolve this right now. Resolve what? I was wondering. Your feelings? My time was being wasted. My no's were being ignored in a mind fucking way. I stood up and pointed my arm/finger at the door and yelled at the top of my lungs (after two more no's) GET OUT OF MY OFFICE RIGHT NOW!. He ran, I called business office/HR and complained. Second run in, last one was last Summer. The holy shit you deal with as a woman is really frustrating. I like this guy. He's really nice, he's helpful, this is a systemic issue with our world. But still. 

    Thursday I just melted. The work was excruciating and for the first time since I've been there I closed my door until 1pm. Wondering, what is my place in this company? Am I viable? Should I job hunt? I haven't been that insecure since my dad was sick in the hospital. It didn't help that the gross room (my territory) was being criticized and I was trying to help them course correct - none of us are perfect and we all slide toward entropy at times. But when you are in a bad headspace, everything gets taken way too personally.

    Friday, what can I say? Christie's surgery was rescheduled for 2 so I was working my ass off so I could see her post op and talk to her dr. and make sure the post op nurse had the contact information for her driver. I was surprised, I told Kay Chandler, that she could be d/c'd from post op s/p hyst? I thought it was magical thinking on CB's part. I know, Kay said, this has just happened in the last two years. I was incredulous too, but they do fine. She just needs to void and she can go home. So when I went to visit C twice Friday late afternoon I told her you have two jobs. Stay calm and pee. Sure enough, she was home mid evening. When I visited her today she was sleepy but good.

    Kids are doing a grand world tour of Arkansas today - we uncharacteristically had breakfast this morning together. They went to get Rennie and Will and Adele (Annie's kids) from Winnamocka and took them to Fayetteville to visit their grandparents. I stocked up for breakfast today at Trader Joe's after work bc they intend to come back tonight with Rennie spending the night and I wanted them to have bfast options.

    A little nervous about presenting at med exec committee Monday - I asked Mackenzie to put autopsy on the agenda and she complied. Quinn came to me and told me that everyone was kvetching in surgery/trauma meeting a couple of weeks ago that we don't ever do autopsies. I told him Shaver has told me admin asks us to do more autopsies. See, here is the deal. You get a bad rep in the community if you don't communicate. So I told Quinn I would present our policy at the next med exec meeting. 

    Our policy is right in line with private practices all over the country. We only do physician requests, we refer family request to others. We did autopsies pro bono which made sense 30 years ago when 70 block days were high but now 150 is the norm so getting one is like a bomb going off in your day. And the morgue is so 1960. And anything medicolegal is not what we are trained to do.

    I called Susi Jeffus at UAMS to get some back up for the presentation. She said yes, if the family presses the doc we do them but we are a teaching institution and we need it for the residents. We only did 57 last year (I was required 100 to be boarded, now it's down to 50 I hear). 90% are unnecessary, Susi said. There is a new guy at the crime lab who is head of our autopsy service and we hope to move all of them over there eventually. She gave me another private autopsy contact, Jennifer Forsyth, which was nice I thought the only one in town was Peretti.

    When I queried my Pathology Moms FB group they were like why? Do they want more autopsies? I said they don't understand. We need to explain it to them. I told one commenter that now that they are paying for them to be done at UAMS, I'm thinking they will finally come around LOL.

    So clear communication beats fear based silence. Not Earth shattering, but so not intuitive to so many people I am daily surprised. Wish me luck on Monday early evening - I hate to present and am bringing Jessica for back up to explain the transition of autopsy to UAMS, something SVI did a decade ago. Happy Saturday. Much love. Elizabeth.

Monday, July 18, 2022

Post Vacay Call Monday

     Today I had vacation brain. Luckily workload was light for a Monday, which is unusual. Got a lot of backed up admin work done. And Cecelia came over yesterday for a long afternoon by the pool which was a balm. As I've said before, if your kids aren't happy, you aren't. She still needs to spend a few days off of her feet so the wound can approximate - she's got lots of gauze and ointments to assist that. Hopefully by next week she will be able to walk again.

    I saw something on social media today that reminded me of a guy I went out on one date with (the monthly forced dates I tortured myself with on years ago). It talked about how scared women can be to even reject a guy making advances. I usually limited my first dates to mid-morning coffee at Starbucks or a public park that was well populated but occasionally I relented and agreed to a dinner. Twice, actually. Neither went well.

    Every time I go to the Chenal Promenade I remember this one bad date. He was a little short, I know petty, but had a decent knowledge of music and dressed well. I had a couple of glasses of wine, so violated my strict rule not to pass out personal information - cell, email, etc. - on a first date. I was leaving to spend a week in Florida with my parents and sister and our young children. About halfway into the week he emailed me.

    He was in California and waxed eloquent about some museum that was amazing and every picture reminded him of the possibility of us. Um, hello, we had just met. And then he went on to say how I was the best person he had ever met on match and he couldn't wait for us to have a future together. Slow down pony, I was thinking. He described a Coldplay concert he was going to and how they had these cool armbands that lit up and vibrated with the music and how transcendent the experience was (ewww, that was an essential dealbreaker). That, and the fact that at the dinner he complained that his ex-wife was responsible for the divorce, he did nothing wrong. This is a huge red flag, I heard it from doctors to insurance salesman, which he was (the latter).

    It was so unsettling I was trying to figure out how to get out of the Tuesday proposed date when I got back and fate shined upon me - but not my parent's dog. The poor thing had bad cancer and I had to get the slides to diagnose it. All very true, but I realized at the time it sounded like a very lame excuse to cancel but who cares? I'd already written the guy off with creepy vibes. So I didn't feel the need to protect his feelings. 

    The drama that ensued was horrific. He left multiple messages on my phone alternating between Dr. Jekyll and Mr. Hyde. I was an angel, I was a devil. Again, met this guy once. I finally got so fed up I uncharacteristically texted him that if I didn't stop harassing me I would report him to the police - lots of support from friends to get me to that point. That shut him up.

    It's no wonder women are so fed up with the patriarchy. It's not conducive to peace, or respect, or really anything productive besides assault and making lots of money for the assholes in the world. I read the news and it's upsetting but I think it's important to stay informed. So I just persist, and keep doing my day job, and hope that things will course correct in the next few years. It's been a long time coming. Happy Monday, much love, Elizabeth.

Thursday, July 14, 2022

Operation Extrication

     All the C's in my life are having a rough time. Christy is better, but when her hyst was canceled the morning of she about blew a gasket. That's under control and rescheduled, but Cecelia has been in a bad way for the last few days, requiring unusual frequent face time calls. I'll explain.

    About three weeks ago she went out with a bunch of locals who were walking on coals on numerous bonfires. She, who no doubt had a little lubricant on board, decided to do the same. Not surprisingly, the results were not good. She called Jack as she walked the 45 minutes home to tell him how bad it hurt. He supported her. She checked in with all of us on the family Snapchat the next day. The pics were gruesome, but it was mostly superficial blisters I saw the top of the feet only at this point.

    Luckily, she was flying to Seville to see Annie and Dave, both physicians. She also saw a local Dr. She plugged in a lot and things seemed Ok bc she had her Tefla gauze and her wraps and her abx and she went to Florence a week later with friends. 

    Then it got infected, so much so that her dad and the local Dr. recommended bedrest if not in school. This is where my ENFJ slowly over the last week came unglued. Come home, I told her when she FaceTimed me at work last Friday for an hour. About 6 hours of FaceTime later up until yesterday with lots of tears and support she finally agreed. I have seen the bottom of her foot. It looks like a crater. It will heal, but it will take time and I'd rather her be here than unmoored for her last few weeks in Spain. We problem solved - they have those knee scooter thingies but not, apparently, in Spain. And her daily 15 minute commute to school was taking an hour on crutches and she was developing underarm blisters. 

    I called a local travel agency we have used in the past - Poe; and after about a half hour of back and forth we got her a ticket out Friday morning to return to Little Rock Friday night. She first told me that she could not get her out of San Sebastian until next Tuesday. C had told me tearfully she needed to be back by the weekend to finish her course on Zoom next week, so I asked her about ground transportation.

    Ground transportation? I don't know about that. I am the air agent. I patiently told her that C was asleep now but I know she had secured ground transportation to Madrid about a month ago and couldn't we get a flight from there sooner? All the time wondering when did travel agents sub-specialize? Doesn't travel mean land, sea, and air? She knew this was an emergency, why did I have to figure this out with my limited knowledge of international travel? 

    I guess medicine has sub-specialized over the past couple of decades, and while somewhat functional I see it hurt the integration of the patient. There is a lot of unfortunate miscommunication, and you need a family member, preferably one with medical knowledge, to navigate the murky waters. But STILL. She offered me a 11:15 flight today from Madrid, yesterday afternoon. Um, she's asleep? She has to get ground transportation? That makes no sense. What about Friday. I can get the same flight on Friday. OK, great thank you so much.

    The promised flight confirmation to three different emails never came (and we were busy cooking a double batch of meatballs which Noah and Jack have destroyed) so when she FTmed me at 4 and 6 am trying to secure ground transportation I had no idea of the flight number, which was required to secure the GT. Luckily S googled Friday and Madrid and Delta and 11:15 and was able to get it - the heavily Spanish accented guy speaking English in the background said he could not wait for Arkansas to wake up she would lose her spot. When he said he had all he needed and C looked happy announcing she would start packing I breathed a sigh of relief and slept until 10 am. 

    Life lessons can be hard. I promise you can go to Copenhagen to see your friend another time, C, I told her. She worried about blowing all her scholarship money and having to leave a month early. Um, you worked your ass off to pay for your college, cell phone, living expenses, travel - your dad and I laugh about how we cannot commiserate with all the doc in the lounge who complain about the expenses. So stop beating yourself up and get your ass home so we can hug you and take care of you before your sophomore year. If you ever need money for travel we have saved a ton that we have not yet spent - as long as it's education involved it's all legit.

    I'm already doing that stupid thing where I remember leaving for vacation and wish I could move back in time. The McDonald's stop with Jack and Noah - Jack was a snob about it but went back for seconds he loved it so much. The time with Matt, before he had to go back to Atlanta. but there is more fun to have with family and more wine to drink and food to eat so I'm going to try to live in the present, like I preach to Cecelia (easier said than done). Happy Thursday, much love, Elizabeth

Thursday, July 7, 2022

Friday Eve

     I am so freaking exhausted. All those specimens that were piled up on the countertop at the end of last week hit us like a hammer on Tuesday and Wednesday - short week my ass. I can be very efficient if necessary, so I am still getting home on time, but at what cost to my neck and my psyche I cannot describe. No breathing room at work lately. Florida will be a balm. I uncharacteristically texted my dad today and said please, get me a 90 minute massage down there next week ASAP. I feel like there is a knife lodged in the back of my C spine.

    It flooded again in our department Sunday. This has happened like 10 times, every couple of years, since I've been here. Usually after a long rain, once when the sink was dislodged due to presumed hanky panky, and now what? Luckily my office has never been hit but Hal's and Brian's have been center stage to much damage. And it's ALWAYS on a Sunday. So we have had industrial fans in the office all week. It hit the hallway this time - blew out some ceiling tiles and was so forceful it practically soaked everything in all the open mailboxes. Lots of slides and paperwork affected. 

    Tina got a phone call on Sunday - she didn't go in - the techs were just alerting her. Maintenance was called. I don't understand? I told the secretaries on Tuesday morning. The smell was gnarly, and persisted Wednesday until a night cleaning crew came - today was a little better. Is it air conditioning condensation? Where did it come from this time? What are we, Noah's Ark? Do we have to put up with this for 40 years (don't blame me if I have my biblical references off I'm not a scholar in that arena.)?

    On a good front Christy, who has had a few beaus since she was divorced but none worthy of introduction, has found a French lover Sebastian. I met him a couple of weeks ago when he took our pics before we went to the musical. When she stopped by on her way home from a family weekend in Harrison on Monday afternoon with gifts from Courseys S and I tipsily agreed to host them for dinner Wednesday night since she is NPO tonight for a hyst tomorrow and we are going out of town for a week.

    Finding the energy to host on a work night is not something I enjoy doing but it's Christy! I texted S Tuesday do you remember agreeing to this (what the hell were we thinking)? They showed up a little before 6pm and he has passing English and a heavy French accent. Works at Dessault Falcon most of the year and lives in Bordeaux the rest of the time. It was a lot of fun. He is heavily into musicals, so I showed him the puzzle we were working on and he excitedly told me every one he had been to and where and I did the same. One of his faves is Rent, which I haven't seen, but remembered C telling me that he has a great singing voice and belted out the lyrics while he introduced it to her on TV.

    The twilight post dinner swim was invigorating - I vow to do it again, with or without company, especially with this awful weather. And it was so wonderful to see my friend with new confidence and happiness. A little emotional attention and great sex will do that for anyone. She, like I did once, has vowed to never marry again but I love that she is enjoying a little stability. He is clearly enamored. We joked about how she is robbing the cradle - he is only 41. Good for her. And his intelligent take on politics reassured me that he wasn't an idiot. She also knows when to make an exit. Her Uber call timing is uncanny. Right before sunset, so I could wind down.

    Christy was giving me hell about not watching something she shared a couple of days ago on YouTube and I told her I tried for three minutes which is really impressive. I don't watch things. Or listen. It makes me angry and bored. It's too slow. I read things. But not very well lately. Even Stranger Things is making me roll my eyes these days. I'm the only one not running up that hill. Trying to watch Pieces of You, which I remember reading, but it's a farce, just a way to pass the time. 

    When I had lunch with Mackenzie yesterday, who strikes my as a highly intelligent and focused woman just on the verge of coming into her own, I asked her about books or tv, what she likes to do in her free time. She said obviously both, but the pandemic has taken it away from me. She said the amount of Covid information and hospital response has ruined her appreciation for the arts, at least for now. I told her I totally agree, it's attention span rather than appreciation for me.  As we sat there surrounded by twenty men (mostly old and white) and one woman at various tables in the Dr Lounge I entertained her with path stories. She's gonna help me out at the end of the month explaining the new autopsy policies to med exec committee - Jess is coming too.

    I asked her if she had any inkling when the mask hospital mandate would be lifted. I told her that I heard in micro huddle last week the numbers were climbing - 16 in house, 6 in the ICU, one or two on ECMO. She said today it is 20. Ugh, I said, as I replaced my mask before I walked her back to the C suite and returned to my own cozy but stinky lab office. As long as the numbers go up, makes sense to mask up. At least in the hospital. Happy Thursday, much love, Elizabeth


Monday, July 4, 2022

Placenta Crew

    The gross room was deluged this week. We at PLA are experiencing bomb shells daily and our company same same. I got a little sideways with Jessica in the middle of the week but she plugged in and they were working their asses off every time I stopped by Thursday and Friday. But it looked like they were treading water/running up a down escalator. The countertops in the gross room looked like someone really hungry had gone to Kroger for the first time in a month. THIS IS CONWAY. Jessica said when I stopped by Friday afternoon. THIS IS HEBER. It's never been like this, I said. Bob is off next week, so they let him go at 3:45, but there was still a massive amount of work. 

    Jessica said that Bob lamented why are we working so hard? But there is still so much work to do? Makes no sense. I told her we pathologists feel the same at PLA. Their income is fixed, ours is fluid based on bill collections, so we have been taking a hit ever since I was hired to protect them, our family. Saturday I texted Jessica and Savanna, who were frankly overwhelmed. When are you coming in. I will help you. 

    So we planned to meet at 8am to noon today and I was kind of excited really I haven't grossed since residency. There are things you turf when shit gets crazy. Placentas are one of them. Breast reductions too. So there were over 20 placentas they couldn't get to this week. I said no worries, family canceled at the last minute (thank God) I'll come in Monday morning and help.

    We wasted 20 minutes trying to get me in the system and I said let me just write down the weights and the measurement and the cord measurements on a piece of paper and y'all can dictate once I get the sections in the cassette. I worked Bob's station. His sink SUCKS. At one point I asked Jess for help - placentas are the bloodiest specimens on the planet and after you do a couple, much less 20, it looks like a murder scene.

    She ran the disposal which was frighteningly far away and LAWD. The shitbucket smell surfaced. Placentas may be bloody as hell, but at least they don't smell bad. She got the virus x spray and the industrial odor eater and about ten minutes later I was able to approach the sink without dry heaving. Jess said they probably need maintenance to change his p trap too. Then I cleaned and cleaned and cleaned. It was cathartic. Bob and Savanna's station have never looked so good. At one point I was scrubbing dribbled blood counterside and Jess was like Liz? You didn't do that. But it's fun to get it up. I miss this, I told her. Call me anytime you get behind on a weekend. 

    I was texting them poolside today. So appreciative they came to work on a holiday weekend. Feel like I got some street cred today, I told them. When you've got a sinking ship, you need all hands on deck. We are not exactly sinking, but we've got some serious things to address. Planning lunch with Mackenzie, our new admin, on Wednesday. We need to plug in to admin, however crazy it is right now. Dad is good counsel here. Leaving LR to see them next Saturday after a thankfully short week. Hopefully Noah and Jack won't stink up the car too bad. Happy 4th, much love, Elizabeth.

Wednesday, June 29, 2022

New Mascot: Shitbucket

     I realize, based on my work experience, that most decisions are based on politics and finances. And in hindsight, I can see this CARTI decision coming like a freight train, based on hospital politics. So while CARTI hurts like hell, we will still put our best foot forward, accommodate the tumor boards as much as we can without it getting too awkward, and continue to be the stellar group we always have been and strive to continue to be. Spite might feel good in the moment, but it doesn't really get you anywhere in the long run.

    I told a story in micro huddle today. Back when I did autopsies, we had a toilet bowl in the autopsy suites. A modified one really, it's a lot smaller but flushes hard enough to pack a punch. You never know when you are going to die, so no bowel prep is involved. You just might be, and often are quite literally full of shit. So you remove the colon, and hold your nose (sometimes Vick's Vapo rub is involved if it's really bad) and squeeze that shit out like an entire tube of toothpaste and flush it as fast as possible. Gloves, of course.

    I was too busy on Monday to visit the gross room, and when Jessica told me Tuesday what happened I was glad. I tossed my cookies at home Monday night (or the little bit of lettuce left from a meager lunch) after a late work meeting (bad GI days are rarer these days but I still have them) and if I had visited them I likely would have at work. Sims was in good form chasing negative margins on a tongue cancer Tuesdy and I visited the gross room four times. Oh, I also had a shadow - the boyfriend of Sophie Sanders. Laura asked me to indulge him, a rising Junior at Hendrix, and I was happy to oblige - fed her one of my UALR shadows Lawren's info since she wants to be a pediatrician so Laura can help her out.

    He was so polite and intelligent and respectful and grateful it was a joy to show him around. I like to try to visit my departments daily so I apologized for being AWOL on Monday as Savanna showed him the mastectomy she was working on and Jessica showed him a bulging gallbladder and some old interesting stones that had been collected in a jar over the years. And of course I pulled the brain out. It's pretty awing to touch a human brain.

    It's a good thing you weren't here, Jessica said, especially since you were feeling ill. We didn't need two messes to clean up. A guy came in through the ED and went to surgery without a bowel prep. The contents plugged up my sink and shitty water was backing up into Bob's - we had to call maintenance. Here, she showed my shadow Reece, is the offending colon (they have to fix overnight in formalin to get good sections). I explained to Reece and micro huddle that we most often get colons for colon cancer and diverticulosis/itis, but occasionally (volvulus, toxic megacolon) it's an emergency. Not enough time for a good bowel prep.

    Turns out Shaver fielded the plumber who was looking in the wrong place with a tiny plunger and took him over to the gross room. A tiny plunger, we LOL'd in a meeting today. It took a snake and cleaning out the p trap (sp?) to get all that shit out of the system. And when they opened the p trap, they put a bucket underneath that collected all of the shitty water. It smelled like, you know. And they left it there!! Luckily the solid blocking stuff got cleared by the snake but we had to dispose of the smelly offensive bucket. Jessica told Reece and I we have this colon to thank for our new gross room mascot. The shitbucket. I'm not sure who laughed harder me and Shaver or micro huddle.

    That's what the past few days, months, years have felt like. The shitbucket. I think everyone in the company would agree. Hell everyone in the world. But, we persevere. What else is there to do. Happy Wednesday, much love, E.


Saturday, June 25, 2022

Bad News Friday

     They say if you are going to deliver some terrible news, it makes sense to do it on a Friday so people have a weekend to recover. Not sure who said that, but makes sense. Yesterday everyone delivered all the bad news on Friday. First, it was RVW - expected, but a blow nonetheless while surfing the news on the toilet around 9 or 10 am. I think it was rather fitting that I was on the toilet when I read that shit. Hopefully we can unify and vote and right this wrong ASAP. Clarence Thomas, Brett Kavanaugh, sexual assaulters deciding the fate of victims of the male orgasm? I think not.

    Then I learned I didn't get a quarterly bonus. Whine, whine, I'm doing fine but I count on those they are always delivered but bc we changed the billing system this Spring (major overhaul) there was a stall in collections so they decided on the board the other day to either issue a small one next month or pool it in October. Was counting on that to pay off summer trips to family I put on the credit card. No big deal really, I've got plenty in my miserly savings but it's the principle.

    Then Melody texted us at 3:45. CARTI, who we have great relationships with the docs and we have been doing their tumor boards for years, decided to make all the local path groups bid for exclusivity since they are building a new surgery center. We split services with SVI and tried to get them to join us in a joint bid but that didn't work out for unknown reasons (at least to Melody and I) so we bid separately. CARTI was supposed to get to us in two weeks but it took two months (hung jury we were told) and Melody, who worked her ass off for this, got a freaking email (can't you pick up the damn phone and give us the respect we deserve) that we lost.

    So all that happened yesterday and I got home to discover that S, in true BMD (bad mom docs) hubs style had installed a pond air conditioner (for the fish!) over four hours and a cover that completely ruined the aesthetics of the pond, which we are currently building an arbor for. I had kept my Pollyanna on all day at work but that was the straw that broke the camel's back I nearly lost my shit. Went to the grocery for gluten free bread and collapsed on the steering wheel.

    On the way back up the hill I frantically called Christy and she didn't answer but thank God Alyssa did (talk me off of a ledge!) and she thankfully prevented my from holding my poor hub responsible for all the bad news I had received that day. She put kind words into my mouth to address the pond situation, which I needed bc I was about ready for a divorce I was so ridiculously projecting. When your anger goes there, it's tough to rein in. 

    Today the glaring white cover for the A/C (how bad was the A/C, I wondered, that the glaring white Container Store cover is a bonus?) is dressed in cute burlap, the compromise we made last night before I vented about my day. Tomorrow I got tix to Menopause the Musical at Murray's for me and Kim and Christy. Christy has plans to have us over at 10 before the 11 lunch pre-matinee to make homemade paper fans to match our t-shirt summer dress outfits (her idea, she has all the stuff, LOLOL in my crazy call week). We need paper fans for the menopause musical for our hot flashes! Indeed we do. Emory, the star, one of Laurie's BFF's from Atkins, told me she would come to our table and say hi so I'm already feeling super excited about it. Laurie and Savanna went they said it was hilarious.

Happy Saturday, Much love, E

Wednesday, June 22, 2022


     Well hopefully this isn't too much but Christy is with Haley and Monroe and S is on a bike ride and dad and mom just sat down to eat and J is at the snow cone stand working and that is about the extent of the people, besides C of course, that I will talk with on the phone so here goes. Lots of exciting things going on. Table 28 was amazing - I got the wine poached pear with blue cheese and pecans minus the arugula (I HATE arugula) and some chicken meatballs prepared Indian style maybe? The Manhattan was satisfyingly non-watered down. The company was fun. My last meal there was a few years ago on my birthday and it was a bust so looking forward to bringing family next time.

    Elise was just a fun talky breath of fresh air. Her resume is stellar - she grew up in a super small town near Lake Charles in Louisiana but has been trained well and published a ton. Venable is her last name - it sounds royal. We chatted so long at work Melody had to interrupt us to share her with the others. She was at LSU and New Orleans and they offered a year in Queensland. Then Mayo Clinic, now in New Mexico with internationally renowned Foucar where Melody trained. She's like top 40 under 40 with College of American Pathology. 

    My first question was about Australia. What was it like. How was your year, how in the heck did you get that opportunity. My first babysitter, Aileen Greer, was from Australia and had a very strong lovely accent. My parents met her when they were in med school - she lived next door on C street maybe? Or Elm. Before they made a lick of money. She still watched us every Saturday night up until we were like 10 or 11. She would let us stay up late to watch The Love Boat and Fantasy Island and we would go out on the porch at Shenandoah (money was coming in then) and watch the stars, which were multicolored and much more easy to see in the city. She always promised to take Sara and I to her homeland someday. Her husband was mentally disabled from the war. She cared for him. She died before we made it, so I'm determined to go there for Aileen.

    I didn't of course tell Elise all of this but I ate up her stories of her experiences abroad. We shared crappy flying stories - corporate greed, I agree, lamented Solomon Mogbo in the Dr. lounge this morning. Cecelia is getting tix to Seville and Florence for pennies compared to America. And nothing is getting canceled. But ack, Europe has their own problems to deal with. The world is so crazy.

    I am the opposite of you, I told Elise. Complete intellectual incest. I trained at the same hospital I was born at, and grew up in the hospital I work at doing term papers and watching the Olympics in my dad's office. But luckily we had some greats coming through Arkansas, most of whom have moved on, when I trained. Jesse McKenney. Laura Lamps. Both of whom are on the new copy of the pathology bible that was started by Juan Rosai. 

    Melody was her main contact and offered her the job last night. We lost three good prospects wavering on candidates a couple of years ago when Quinn was out for four months and our contract with Baptist was in limbo so we were determined not to make the same mistake twice. I told Elise at dinner - she brought her husband Brian who is a plumber  (I made them tell the story of how they met - she was BFF with his little sister he used to babysit them bc he was seven years older how cute is that)  that we really value her skill set, her resume is stellar, and if she ever needed anything or had any questions to call. And if she gets any other offer in the next year (she is starting a molecular fellowship so won't start until next July - this is standard I was directed by Baptist to do a fellowship they needed) please don't hesitate to call us and negotiate.

    She signed the offer at 10pm after peppering Melody with questions in the hotel lobby for two hours. We told her to take much more time if she wants to. Please don't hesitate to back out if you wake up and change your mind, Melody told me she said, but she is ready to chill out and stop padding her resume (I've rarely seen a more padded one) and she cannot imagine finding a group that feels so easy to fit in with. Everyone was elated today - on cloud 9 talking about the future - none of the angst with all the extra work we have had to absorb since Rex retired last year.

    I'm having tentative success as the bellwether. Tenacity and research are the keys. I'll feel much more comfortable relaying the details when the fear has passed. I was honestly ready to move to a new job at the thought of national corporate takeover but every day that goes by I think there is less of a chance of that happening. Fear-based decisions are never good. And there is so much corruption in medicine - again greed. One thing I love about our group is that we are very ethical, despite the fact that we could totally monetize and make a shitload more money. First, do no harm. Happy Wednesday, much love, E.


Monday, June 20, 2022

Post Vacay Call Monday/Summer Solstice Eve

     Wasn't too bad. Managed to get in my quarterly stupid ABP questions and buy a gift for my OT friend Jessica whose baby shower I will miss because I work on Saturday. Just finished transferring my tumor board pics (five cases to present at 7am) from Cecelia's old busted phone to my phone to my computer to my jump and renamed them to prevent game time confusion - usually I only present one or two cases so can keep up with the IMG numbers but not with five. One of them is acinic cell carcinoma of the parotid which is super rare and beautiful. Large cells with small nuclei and powdery blue cytoplasm - they look just like normal salivary gland but there are too many and there is no admixed ducts and adipose tissue. I got a great pic of it side by side with normal gland I can't wait to show it tomorrow. Rest is run of the mill squamous cell but I still try to make it entertaining. Get that perineural invasion shot. Here it is spilling out of a lymph node - extracapsular extension. Cancer sucks, but I try to make it fun. Much easier when you don't have a face to match to a microscopic image.

    Week off was much needed and I even found some energy to exercise a bit. Jack and Noah are really fun to hang out with. Ms. Candy and I joke about their bromance. They roughhoused a little too much into the hotel TV - I was so proud they confessed that I said let's just play this one by ear, not say anything, and not ruin our last day with worry about it. I once again marveled over their massive intake. The vents in the bathrooms were terrible - we had lots of fart and smelly shit jokes going around and I was glad I had brought a candle bc teenage boys can really smell up a suite.

    I did my first escape room - Noah's too - and we got out 10 minutes early it was so fun and everyone contributed to save the world from the next virus. It's the only picture I have - the venue took it - extreme fake background cheesiness and I sent it to all my family. Noah and I were lording it over Jack and S - they are 50-50 in their four escape room experiences and we are batting 100.

    A funny thing happened on the way back - we stopped at a Subway in Palestine for lunch. Jack was asking some question and filling out a Subway survey as he was eating - I was rolling my eyes asking why? Everyone wants you to rate everything I never do that it's a time sink. Turns out as he was leaving he went up to the server to show her his code the survey filling got him a free cookie. I put the two and two together as he was asking the server her opinion. I want an oatmeal one, he said, but how is the strawberry cheesecake? I've never had that one. What would you choose?

    He was so grateful when she offered him the two for free I thought he was going to pass out. Thank you so much! I was going to share with my friend but now I can share more. I can't believe you did that you are so kind. As we were walking out I suggested the bathroom and when he handed Noah the cookies we smiled and rolled our eyes at Jack as he headed to the men's. Noah has had a few girlfriends, so he's a little more experienced. I LOL'd as we climbed into the car. Noah, you and Jack are the kind of faces to the world that can just smile at a girl, no less be kind and value her opinion, and you will get all the cookies. He laughed, and when Jack climbed back in the car marveling at his good fortune Noah laughed and said its cause ur hot dude. Delivered that message with an arm punch.

    Jack was carrying around a poetry book all week Richard Siken maybe? The one I got for his bday. I was so impressed when he had me read one of them and gave me his take. For someone without a relationship he had an incredible interpretation of the events - his empathy never ceases to surprise me. He informed me that poetry is something you need to read one or two and digest over a few days, not like a novel. I'm way too impatient for that, I told him, but I love hearing your interpretation.

    Was supposed to go to Table 28 for dinner tonight with a candidate but her flight got canceled. Along with 19,000 since Thursday. Reinforced my decision to travel by car this summer - Noah and Jack are coming with us to see Mom and Dad in a couple of weeks. Even Pete what's his last name how do you pronounce it how do you spell it beats me but I like him Zoomed the heads of the airlines to complain. I read a day later his flight got canceled and he had to drive from DC to NY or vice versa. At least they didn't charter a bus, I thought as I read. That he had to puke in the driver's trash can on. At 3am. For the cost of a plane ticket to Paris (can you tell I'm still bitter?) If the secretary of transportation can't get favored we are all doomed. I think the candidate (her name is Elise) found another flight we meet her tomorrow and rescheduled the dinner for tomorrow night. Fingers crossed. Happy Monday, much love, E.


Saturday, June 11, 2022

I'm Off!

     I told Micro huddle I'm off next week - we are heading to Round Rock to meet our new nephew Braxton who was a couple of months premature. We are staying at that awesome resort we stayed at last year - Kalahari - and I got a two bedroom suite bc Jack and Noah are joining us. Jack decided and asked his friend last minute. There is an amazing 24 hour gym, I said. That sold them, but when I told Noah one night last week it had tons of restaurants and a spa and the largest indoor water park in the world and an outdoor water park he was hook, line and sinker.

    You are always off, said Amy director of micro, and yeah, I get a lot of vacation I know that but with all the call I do and the intense work I am so over feeling guilty about it. I worked my ass off to get here so might as well enjoy the perks. Please sign off on the new Trichomonas validation before you leave she texted Friday and I told her I had two hard cases to finish on Monday and we weren’t leaving until Wednesday so no rush.

    My dad told me something I will never forget when I had Jack, who was also a preemie by six weeks (you could never tell that now LOL). A lot of parents get really nervous taking care of preemies. But they shouldn't. These early kiddos are warriors - they don't have the creature comfort of the full term babies they have already fought hard and won. So when you bring them home don't stress too bad - think of all the kids with way worse means than you are here to provide that make it, even thrive, in this world. Some of the best advice I ever had, and I pass it on - to Mandy, to Sandy, to Natalya - whoever needs it.

    One of my friends from high school's dad passed a couple of weeks ago - I went to the Memorial today. Lorri. We get together with Marcie and Conley every year or so but I missed the last one bc of GI issues. It was good to see them and Amy and Michelle and Robyn and reconnect. Need to plan a high school reunion since we are turning 50, they all said, except you miss 16 year old grad. LOL. I'm 49 this summer, right behind you. 

    The service was lovely - he served in the Marines I think so they played taps and did some fancy thing with the flag (the younger serviceman kind of screwed up the folding and I was thinking they need to bring the women in on this - we can fold the hell out of anything even a fitted sheet except me lol, but he got it right eventually. When the older serviceman placed the properly folded flag on the widow's lap and spoke kind private words to her I teared up).

    Shaver told me this week he got his fourth shot and I said I am just short of 50 I'm nervous. They don't care, he told me, just go. So I went to Employee Health and got it. Told Melody and she did the same. Just in time for the new variants this Fall. We are also entertaining some major shifts involving digital pathology so we met Thursday afternoon with some people. After watching my dad's group unhappily sell out to a national company I'm nervous as hell, and the primary bellwether of the situation. But we've got time, I decided, I need to breathe and not indulge all my chest pain around our tentative future, which mirrors the stress of the world.

    So what happened Friday? Instead of arm pain. There was hip pain and shoulder pain and a super bad head space I was like WTF? Just remembered this morning I had the shot Thursday holy hell that explained a lot. The nurse was saying her fourth shot was the worst mine was too S and I were planning dinner but I struggled to just work on a puzzle and watch Hacks and go to bed. I've got those two hard cases to finish off (Large Cell Undifferentiated Ca of the lung met to brain? Maybe? If my stains pan out and a huge abdominal mass that I think is a carcinoid but Monday will tell). Also massage and hair and lunch with Christy and trip. Ready for a respite. 

    Jack asked for a bunch of cool things for his birthday but air fryer was our most exciting acquisition. I was a little scared of all the hype after the Instapot which was a hard as hell to use nightmare fad except to the good cooks in the world like Tuhina. We also got him a lot of vinyl and a poetry book and some multicolored disposable fountain pens. A mother's dream 17 yo boy bday list. Happy Saturday, Much love, E.