Thankfully Back to the Grind

     Not that I had a bad holiday, but it was intense. I learned about two things that happened to Cecelia's friends, both that I know and love, that spun me into mental health instability and more GI craziness. One threw me into such PTSD it was all I could do to hang and shop and make lovely memories, which I did, but not without desperate phone calls and texts to Yousef and Paula and Kimberly. All wonderful grounding forces. It's one thing when you read about the ills of the world, which is important to do despite the unpleasantness, but another thing when it hits the young and the innocent. Ones you know.

    Your workspace is grounding as well - it's where you are in control, where you operate at the top of your game. After a day on the couch yesterday reading a novel and watching two movies (that Knives out redux was amazing and Breakfast at Tiffany's surprised me) I told S I was never more ready to return to work. It was busy, and I had a lot of BS CME Board reporting to do at the 11th hour but I managed to pull it off - almost, I still have a little more but not due until January 5 and that seems like a lot of time. To me. Melody is like Cecelia she has to get everything done in advance to stave off the anxiety. I'm like Jack - I work best under time pressure.

    I got a letter from the Patient Safety Officer tonight acknowledging my ED experience. And a text from Mike Perkins, the new Baptist LR CEO (I think? Admin titles elude me). That felt good. I assured Mike minutes ago that writing for me is processing, and based on all the wonderful experiences I have had at Baptist over the years that eclipsed that one I'm moving on. No need to sit down and talk, I told him. I said my piece. See you at the next med exec committee meeting. Enjoy the holidays and your family.

    The Shop Around the Corner was one of the most pleasant holiday surprises. While we were in Florida we were looking for a good holiday movie. Both that one and Bfast at T's had some terrible cultural appropriation but at the time? Probably misguided bc they didn't know any better. Mia, C's friend who spent her entire high school watching movies, recommended it. I will never forget Jack guffawing in my parent's living room. I shared it with S, and C and J shared it with Mike and Rachel. 

    Ugh I looked at my call calendar today and highlighted the rest of the fiscal year, through October. The reason I'm having such a gap is bc I have two weeks in a row three times in the Spring. Yikes! I've hardly ever done two weeks at once. It happens to Melody more often. But I'll buckle up and survive.

    Can't remember if I've mentioned this but we are planning a trip to Basque country in the Spring. My first ever two weeks off in a row. Barcelona, where I will see my high school friend Vicente, then Bordeaux then San Sebastian. I've ordered a ton of books on Basque history and culture, and C has amazing recs. I'm having a little panic over it. When I went to Germany to S's mom's hometown in Bad Herzfeld a few years ago there was no English speaking. It was beautiful, but I sometimes ordered a dish that was fish heads swimming in soup, accidentally. C assured me it was fine, and my brother told me that with all the advances in Google Translate I won't feel so isolated. You can take a picture of the chalkboard menu, and it will automatically translate it. Whew.

    So anyway. Happy Holidays. Looking forward to hosting C's friends this weekend and getting a little R&R the next weekend in Eureka then moving C into Hendrix on the 15th. She is so good. She's finishing her yoga instructor's degree and making all the fam look good with her thrifting at Goodwill. Jack has friends over tonight watching a movie. I'm hoping for a slow down after all of these patients meet their deductibles but who knows? I see new doctor names every day. It's a grind, but a good one. Much love, Elizabeth

    

    

Social Justice Crusade

     After I got back to work on Wednesday, which was Hell, I should have taken one more day off, my adrenaline from Monday crashed. But I got through it. I bought Dr. Flamik and Shelby and Katelynn, who blew my vein but she was nice, which goes a lot farther even if you are inexperienced, gift cards to Boulevard and some cookies for the employee lounge. By Thursday I still hadn't heard anything from Mackenzie, and I became worried when I talked to Jeff the security guard who said that happens more often than it should in the ED, with the nurses.

    I had a burning desire to be HEARD. I wrote an essay at 2:30 Thursday about my experience, one much more eloquent and less conversational than on the blog, and delivered it to Mackenzie and Mike Perkins and Pahls on Friday. Not in person, just in a work envelope. It felt a little like I was writing a victim's statement. Monday I had S's Christmas luncheon at his new building downtown, the Arkansas Pharmacy Association, so I had to cancel with Mackenzie but today her secretary rescheduled for 3:30.

    I've had a lot of good experiences at Baptist as a patient, and it feels comforting to see familiar faces. Chandra, head of phlebotomy, did my bloodwork. Jeff checked on me - he spends a lot of time trying to keep the ED, which can be chaotic, safe. My goal here is to educate, not litigate, I assured Mackenzie. Mike and I's goal is not to be victims here, but to try to right a wrong. Mike called me after I shared the essay for feedback Thursday night.

    I hope you aren't mad that I did something, he told me. I took a picture of you on the floor. Mad? Hell no. I felt validated. I shared it with Mackenzie. This nurse was insolent and aggressive and reading the room as wrong as hell, and refuting Mike's polite entreaties to get a stretcher. She asked if she could share my essay with the nurse manager, and I said absolutely. I told her after the weekend my urgency on the matter fell from 90% to 10%, but I didn't want to be swept under the rug.

    She agreed, and I told her I talked to my sister about it this past weekend. She is a P.A. at Scottish Rite (sp?) in Atlanta. She told me she has long been frustrated that physicians and P.A.'s get peer reviewed, but the nurses don't which allows for a lot of bad behavior. Not just insolence, but laziness. They get hired, they behave badly, they get fired. No peer review. I asked Mackenzie if nurses get peer reviewed at this hospital.

    I don't think so, she said. They get annual competencies, but not peer review. That's how we do it in my company, I told her, but we are much smaller and if there is bad behavior? Intentional or not? We root it out and address it immediately. We do not tolerate egos. Power trips. Laziness. She said I agree. I told her when you are vulnerable and someone is aggressive you doubt yourself. I did, I heard Mike doing it too. She said that is a good point. 

    So yesterday and Friday were awful. I became uncharacteristically terse with many employees on Monday and was glad to have a luncheon to go to. Shine, entertain. Get out of my own fing bad headspace. Enjoy the amazing view of the Capitol - there were obviously school carolers singing in abundance on the front lawn, I observed from the second floor which was created as an event space. The grand opening is tomorrow. 

    So if you've never seen carpal tetany I've got a pic. Of me, escaping incompetence on the ED floor. It's almost Wednesday, hump day, and I'm looking forward to a week off. Happy Tuesday, much love, Elizabeth

Carpal Tetany

     I was in a pretty bad headspace last weekend. Lots of plans, canceled. Went to bed at 5 Sunday night. Woke up at one. Twisting, writhing. Hot and cold. Surely I had a fever, but I'm a doctor, so nothing in the house to prove it, but I knew. I finally got out of bed at 4am for ice water. Sugar. Had lots of GI issues. But I rallied. Got up, showered, planned a low key outfit for Yaya's dinner. Had bfast with S and his dad, who was heading back to Austin. 

    Second guessed my plans to drive to work (dry heaving in my car), but drove on Cantrell, avoiding the interstate. Managed to get to work, and my head transcriptionist Tina automatically knew something was wrong. I was on her radar. I was dry heaving and shaking. I asked Melody to take my place at the dinner (they want us to represent) and she agreed.

    Finished off a tough breast cancer case and knocked out a few cytologies and decided I needed to rest with a blanket in Rex's old office - there is a nice recliner there. Dry heaving like a boss, and then puked water and half a bagel with peanut butter and cough drop juice and bile spectacularly in Rex's trash can. The secretaries came in, Jan and Tina, worried. This is nothing, I can handle this, but then something happened that I couldn't.

    I developed carpal tetany. This has happened to me twice before in my life. Once, as a teenager - I called my Dad from Allen TX after eating at Applebees. The second time, I had a puking episode all night after eating at a quinceanera at Nina's. Food poisoning, I wondered. Probably just a bad GI bug, in retrospect. I had to call in to my first day at the Crime Lab, one of the only times in residency. I had puked all night, and laid on the cold floor of the bathroom, my arms drawn up like I had cerebral palsy, burning and aching. 

    This time was much worse. I couldn't use my arms they were drawn up and rigid with pain. I told them I knew what it was, it was just an imbalance of electrolytes, and Melody ran to get a Powerade from the gift shop. But I was too far gone. Tina got a straw (I couldn't hold the bottle) and Jan called my ex with my instructions to get to our office ASAP. Before? It didn't hurt so bad. This time? I felt like my muscles and sinews and nerves were about to burst out of my skin. And it didn't let up, I was way beyond Gatorade. 

    I began screaming and moaning with pain. Sucks, being vulnerable at work. Mike said what I didn't want him too - you need to go to the ED. I couldn't stand up, so Quinn and Tina and Mike got me in a wheelchair and took me there. The last thing I wanted was to spend all day in the ED, but here we were. 

    I've got a pretty high pain tolerance. I didn't take any meds post kids (I was breastfeeding!) and the narcotics they gave me after I broke my jaw dulled me and did nothing good, so no pain seeking meds here. Here's where it went even more South. The intake nurse was on a power trip. Mike went back to secure a room with the docs and I thought she called my name.

    When she realized I came without me calling her name (I said Jackson!!! Not Seng!) I apologized but luckily Mike already had the ball rolling so she was forced to acknowledge me. She tried to take my blood pressure twice, and accused me of being uncooperative while assaulting my tetany painful arms. I was moaning and arching my back in the wheelchair while she was insisting on me telling her my name. My social security number. Mike aided me bc I was slurring in indescribable pain. 

    She was horribly rude, accusing me of malingering. Not my jam. Mike asked for a stretcher. She power tripped on him - saying she knew her job and I did not need a stretcher. He politely told her she's gonna be on the floor soon and then you will need one. I mean, he's a doctor? WTF? In all the craziness and confusion my body told me what I needed. A cold tile floor on my cheek, no care it was foul ED floor. Mike had tried to give me a bag earlier to stop me from hyperventilating but the pain was too bad. At this point, she accused me of jumping out of the wheelchair on purpose. 

    I have never felt so dehumanized and disrespected in my life, while I was in so much pain. Is this really the intake of our hospital, I wondered. My hospital. As the staff pulled me onto a stretcher, and my breathing eased and my hands returned to their normal state over the next half hour and my body returned to its normal self after potassium and magnesium infusions that took until 2:30 (I was correct in my dx) I became a little angry.

    My partners gave me the day off today. Melody told me Yaya's was so much fun she joked that she hoped I would be sick next year too. I called Mackenzie to tell her today. Before she responded, Christy came to bring food and gifts. She said she had the exact same experience. Harrison ED? Good. Baptist? I was treated like a criminal like I was lying to get admitted.

    My voice was shaking when Mackenzie called me back today. I'm not good at confrontation, I told her, and I would not be calling you unless Mike and Kimberly urged me too (Kimberly spent five hours of her birthday advocating for me in the ED, much needed). This cannot be our hospital's entryway, we have to do better. I'm more for re-education than punitive measures but this woman cannot be around people for a while, IMO. Mike was a bit more angry. She needs to be fired. 

    Ah the state of our system. Abandoning all that angst today, feeling much better, and wrapping Christmas presents - my partners gave me a much needed day off. I assured Mackenzie all the other docs and nurses in the ED were good to me - Katelynn, Shelby, Darren. Katelynn blew a vein in my wrist (ugh I could feel it happening) but was super polite about it and reclined me when I told her I had a history of passing out with blood draws. She was much more successful antecubital. One thing that angers me is that a question asked of both me and Mike was did they know she was a doctor? This shouldn't matter. GD. Everyone should be treated with respect. But hopefully I can use my stature to right a wrong. Happy Tuesday, feeling good enough to go back to work tomorrow. Much love, Elizabeth

Up in Arms

     Monday, after I belatedly realized that the med exec committee meeting at Yaya's was December 5th, Christy drove me home. We lol'd as we sang in the car. The anxiety dreams that had plagued me Sunday night continued. Here, I was going to do yoga (if only I had the energy ugh) in a strip mall and all the lights went out and I was a football field away from my car and had to run. There, I was in a public setting and something terrible happened and by the time I got to the scene the only thing I saw was a severed arm. 

    So I was very surprised on Tuesday when I got an arm as a specimen. Legs, toes, feet, transmetatarsal amputations are super common, but arms? Hands? Not a thing. My first arms were in residency at ACH - a young kid got electrocuted, I can't remember how, but I had to gross his arms. It was eerie - such a sensual receptor to lose. I dove into the charts and found out this arm belonged to a woman with multiple medical comorbidities (ESRD, DM2, etc.) who had axillary artery blockage that was not amenable to recanalization so they cut it off to try to alleviate the pain.

    It got me thinking about other arms, and hands. The fetal one under the microscope - I think I posted it here long ago bc I was scared it would trigger someone on Insta but the pic was amazing. The hand I signed out about a year ago from the woman on ECMO - hers had gone gangrenous and it moved me to tears and to text my entire family in gratitude.

    When you are on ECMO it's kind of tough for the machine to get circulation to your periphery - my Dad went into kidney failure briefly that luckily turned around and we had to be very vigilant about his hands and feet bc they were often blue and the CVICU nurses were amazing but no one cares for you like your family. So we scheduled around the clock care and my brother Matt took the night shift. He often had to ask for heat packs to keep the fingers and toes from losing circulation. 

    I went into the gross room Tuesday or Wednesday I lost track? The week after the holidays feels like a freaking year. There was a Sims frozen and it was a softball - Warthin's tumor. Such a beautiful thing with its oncocytes and lymphocytes and motor oil gross appearance. There is also a Warthin-like papillary thyroid carcinoma - very rare - I wowed Jesse McKenney by diagnosing it once in residency. Will probably never see it again.

    After I called the OR with the diagnosis I noticed something different at the bottom of the fridge - a large plastic bin. Jess? What is up with that? Oh, well, they are still complaining about the smell. From the legs. The head nurse came and talked and was really kind and not rude so we purchased this bin to satisfy them. Um why? I asked. There is no smell.

    Apparently, she said, some of the staff and patients see the legs in red biohazard bags and have an olfactory reaction based upon sight. It disturbs them. Well, I guess that makes sense, I said. We are a service industry. Jess said I finally got to retire this. She pointed to a porcelain metal bin with black rust marks under her grossing station.

    What the hell is that? Oh, it's been the leg holder for IDK, thirty years? Evans (a retired PA) probably got it off of the supply dock back in the 70's. Looks like it might have been used to bathe babies in the forties. I laughed. It certainly does, and when they were trying to get rid of it he repurposed it. 

    And what is up with the arm? And I also got an index finger this week. Poor thing had it crushed while welding and they could not save it. Jess said we had another arm this month, and I exclaimed in incredulity. What happened? Some guy punched through glass and severed his brachial plexus and they couldn't save it. Good god, I said. What a crazy month.

    But it's a new one, and I am not on call I discovered this week until January 16! Long strange wonderful hiatus. Heading to Port St. Joe on the 17th with C to visit mom and dad and I cannot wait. Long weekend solo re-reading old books I haven't visited in 8 years or so? Jack called to ask if he could invite friends over and I told him can we table that? I haven't had a weekend alone for as long as I can remember. Don't want to embarrass your friends with my singing. Happy Friday, much love, Elizabeth

3:09 AM

     That's what the digital clock read when I convinced myself this morning that I had GI lymphoma. It must have been a half dream, but the circular fans were cycling overhead and I felt like it was real. Far from dismay, I started to plan. Ugh I'm going to have to get an endoscopy for a diagnosis. Hopefully, and I was kind of sure of this, it was something low grade. Maybe follicular, or a MALT driven by H.pylori. This is doable, I decided, I just had to get my big girl panties on like when I had small kids and was in residency. The more you have on your plate the more efficient you become. I'll take Rituximab, if that is still the thing. I haven't done lymphomas in over five years, and things change. 

    I guess I still could have a GI lymphoma cooking, but what a relief to wake up and it be all a dream for now. I think it was probably work anxiety - Sunday's after a holiday are particularly stressful. Mine almost went South with my headspace after the family left but Jack saved me with a Merlin and a deep dive into Season 2 of White Lotus made it hard to stay in a funk.

   This morning was challenging. I told Michelle after I called her about a consult that I misjudged Friday, we all did. It was horrible. Lots of crazy cases, took me a couple of hours this morning to climb out from under them all. Michelle said, yeah, I always forget the Monday after Thanksgiving is the good day. The Friday isn't usually that bad, but the last one was a doozy. 

    I thought I was on call when I woke up, and I knew we had a med exec committee meeting at YaYa's from 6-8 tonight (what crazy person dreamed that up as a good idea the Monday after a holiday?) so I dressed to the nines and was so relieved when Tina told me no, Shaver is on call, not you. I was even more relieved when after consulting Shaver about a degenerative specimen that fell out of a lady's uterus in the ED over the weekend (he helped me with wiggle words - CYA type sign out) he told me to leave when I was done. Which was before 11. WHEW. Time for chill and nap before dinner.

    I am also having one of the worst GI days I've had in a while, will not bore you with details. It started off fine, I entered the dr. lounge and greeted Shirley who works there and asked how her holiday was (she worked the cafeteria on Thanksgiving). Then I noted Zach Roe was sitting down to a big breakfast as I was getting coffee. Hey Zach! I said. His sister shadowed me a couple of times a few years ago. I've not seen him much since.

    How is your sister? I asked. He said I was just texting her she's in her first year of medical school. Thanks for asking about Grace. Tell her I said hello please. I told him one of Cecelia's best friends is a scribe in the ER Anushka, we ate with her a few weeks ago at Three Fold. I told Zach that I had gone to high school with Lane England and to med school with Jon Palmer and Wayne Lyle so I feel like I know the whole ED. I told him I asked Anushka who is your favorite? She said Zach Roe.

    He smiled and said she is such a good scribe. Hendrix grad, trying for med school. They all are, I said, it's good experience, one of my recent shadows is in his first year after scribing for three years after college. His dad is a med tech in micro I've know for years. When people get as good as Anushka, Zach said (I could be spelling that wrong but it feels right over Zack) we silently and selfishly vote for them not to get into med school. Although we are always appropriately happy when they do. I've worked here long enough to see scribes finish residency, Zach said. I'm no spring chicken either, I quipped. It's fun to watch the new generation. Happy Monday! Much love, Elizabeth

Thanksgiving Week

     Ack I had the kind of a Monday that makes a five day weekend disappear. But oh well. 202 blocks, not a record but close. Lots of breast cancer. And I was brushing up on a case I signed out a couple of weeks ago to present at ENT tumor board tomorrow morning. Low grade mucoep in the parotid with a met good God - to the intraparotid lymph node. Not common, enough so you need to grab the books and show it around. 

    Seems Thanksgiving snuck up on everyone this year. It did Alyssa - she forgot she had planned a dinner Saturday night. We were going to go have a girl's night at her new lake house in Cherokee Village on Thunderbird Lake (there are seven lakes there!) but instead we did a day trip. It was fun - Hardy, which I've never been to, reminds me of a super tiny Eureka. Shopped in an apothecary, an antique store, and a record/boutique shop after having white Russians on her back porch all morning and eating lunch downtown in Hardy. 

    I said no worries about the plans. Things happen for a reason. So I got dinner reservations for S and I at a restaurant two blocks from our boutique - ALL DIGITAL SO WEIRD - hotel Saturday night. Whenever I make hotel and restaurant reservations S worries bc I accidentally sometimes delete important emails (Um, when you get forty a a day in this horrible climate it's easy to do). Friday while we were touring Alyssa's amazing pandemic renovated home, he made me forward him some emails. The key was digital at Intersect 311. You had to download an app to open the door. Gah! Too much work. Give me a freaking key. Interesting concept though. There was no ice, no reception, but a big fridge, and a fancy coffee shop in the basement.

    The Root was Saturday night and we were ordering after listening to the waiter talk about the Ecuador woman and her American husband (or vice versa?) and the gourmet fusion they created in this restaurant - it did not disappoint, although the drinks could have been stronger. Four honey infused Manhattans should have put me under the table but I was only slightly buzzed. A family wandered in and I was admiring the mom jeans on the teenager (only they can rock them) and I saw a familiar face.

    Jessica? Jessica? It's Elizabeth. Lots of big hugs and catching up ensued. Jay Thompson was in my med school class and he's sweet and goofy and we always wondered how he landed the classy as hell and gorgeous Jessica. He gave me a big hug, we talked about studying together long ago - Wayne Lyle and Jon Palmer? I still talk to Jon weekly, he said. You helped us. Kricia decorated my home, I told them. She just sent me an essay this past week she wants to post on KevinMD and I helped edit it and give advice. I see Wayne all the time. Please tell him I said hi, Jay said. Will do.

    The holiday snuck up on me too I thought I would have another weekend to decorate but no. So I did it a week early bc Mike and Effie are driving down from Chicago tomorrow and Cecelia will be home Tuesday. She called me ecstatic this morning with her finance package to Hendrix. She was in NYC the past few days for a psychology conference. God she's growing up. They leave the nest full of confidence and then realize how good they had it at home. I'm happy she will be closer. And it's my alma mater.

    So a week full of family and fun. Work too, unfortunately, but not call. Stopped at Edward's for staple food today and saw Susan McGeorge. Gunti? I asked her. That's what we called her back then. Holy hell. you have not changed. Um, Liz, it's been 15 years? She doesn't practice - stay at home mom. Yeah I haven't seen you since the last med school reunion. It's a theme week. Old friends. I told her about Lys and Jay and Jessica. 

    Mike and Rachel are hosting Thanksgiving for about 20ish people Annie and Dave and Adele and Will and Gretchen and Jason and us. I'm still peeved that our work has us come in the Friday after Thanksgiving but oh well. Baby steps. Iv'e got tons of food coming from Zingerman's - ordered a charcuterie board and pastry basket and cured meats. And the advent calendars are rolling in. Happy Monday, much love, Elizabeth

Friday Eve

     It's mine, so I should be excited, but it was a low energy bad GI kinda day. Last Friday was hell, I told Shaver when we went to the Dr. Lounge this morning and got coffee. I felt like someone had put a fire hose down my throat when I showed up for work and it did not stop. I'm not like Melody or Quinn, I cannot work through lunch I need a break. Thursday was great - I got to run errands, but Friday did not work for me.

    Ever since Bell retired we have been working harder. We have plus days, and we have double surgical days, but we don't often have triple surgical days. On top of cytology. That was my Friday. And on top of that, a new interventional pulmonologist had a two hour procedure that was a fruitless effort. I got called down three times to the bronch lab. Cidney has us spoiled. He is so good and fast. This guy is too, but after three passes of blood in a lymph node there is not much expectation for higher yield (this is scientifically proven. But who acknowledges science these days).  After thirty minutes of looking at slides of mostly blood I told Gary you screen them lmk if you need me to look at something. I cannot babysit on a day like this.

    The weekend was wonderful - Jack had Asher over Friday night and they did art. Noah came Saturday and after I worked I stocked up on chips and Little Debbie's to make a fun sleepover. Noah loves chips and ice cream. He's such a good friend to Jack, and vice versa. Call Saturday wasn't that hard so I didn't have a problem going to Fresh Market Sunday morning to get sausage for their bfast tortillas. Jack was so appreciative. I don't deserve him, he's so good (our kids teach as much to us as we do to them) but I love him, and love to guide him. One of his teachers asked him to let their almost high school kid shadow him at Central. He was so proud. 

    Rennie's turned nine this month and Mike and Rachel are having a celebration tomorrow night at their house. Hamburgers. I asked Rach what does she like? Anything a 20 year old would lol. So I wrapped Cecelia's advent calendar - 15 days of surprise makeup gifts I can buy her a new one. Jack got her a paperback gift box set of Harry Potter, so thoughtful. And Asher's bday is this week too I wrapped a fancy art set Jack ordered on Amazon. 

    Lys's bday is this Thursday. I used to visit her twice a year in Jonesboro. Since the pandemic, not so much. She bought a lake house in Cherokee village during the pandemic. It looks amazing online, I haven't seen it yet. We were going to spend the night there Saturday night for a girl night but she called me last night alarmed bc she forgot she had a work dinner Sat. I told her no worries? S and I will go out in Jonesboro instead. We have a swanky room in a luxury hotel less than a mile from her house. We can do girl's night another time.

    Nevertheless in my excitement I bought a birthday present for her and presents for her daughter Ainsley and her son Beckett and a group gift for her family. Enjoyed wrapping all the presents this weekend. Prior to that, I booked a massage Wednesday with Reiko and Paula Thursday morning and Christy is making shrimp and grits for us and Trey Thursday night. I told Christy I wanted to do an art project Thursday afternoon. Jack and Asher inspired me. Or I can be your sous chef, I told her. Whatever works. 

    C continues to heal and that makes me happy. Watched Everything Everywhere all at once yesterday and I laughed and ugly cried at the end. Such a powerful statement on the mother daughter bond, or lack thereof. Read all about the debonaire male protagonist at lunch. Also watching The English. Highly recommend. And speaking of C? She's pretty much a rock star too. On a different level. She teaches me so much. I'd hate for her to read this and compare herself to her sibling. They are both wonderful and unique in their own way.

    I talked to Susi Jeffus at UAMS last week - had sent her a case - and she was kvetching that she cobbled together a month rotation with SVI and Jonesboro. - private practice rotation. She's been texting us but we have no more multiheaded scopes and are way too busy to have a resident for a month. No one has taken me up on it, since I've created it. I told her I do a two hour tour and she is welcome to give my cell to the residents. I told her a couple of hours might be more palatable than a month. Are you sure? She asked me. Of course. I give college students my number. If they get weird, I can block them. And that has never happened.

    So a Rachel texted me last Monday and she is coming tomorrow. I have learned to give these kids explicit directions - hospital campuses are difficult to navigate. I'm excited to meet her. She reminded me of myself contacting Charlie Sullivan for a job so many years ago. I tailored my career to fit the needs of the group - Rachel seems to want to do the same thing. I hope it works out for us and her, but life and group needs are fluid so no promises just meeting and potential. Happy Friday Eve for me! Much love, Elizabeth

    

Subway

     About a few weeks ago I decided screw gluten free I'm eating it. Paula's work is making my GI system stronger and while it's not completely healthy it's better than it has been since before the pandemic. Cue Christmas Cookie ice cream, cue pizza, cue Subway. Talk about control/self-sabotage I've been doing it all wrong. My journey this week supported that decision.

    When I decided to start eating bread again I went to Subway, which I have been addicted to since my decision. Right about that time my good friend Amanda who works there disappeared. I was worried. Herman, the guy at Subway who looks twelve and had five kids back then, now six, came back after a two year hiatus. I missed him he was lovely. He courted me back then bragging about their guac, trying to lure me to them from Boulevard. Amanda told him she only comes when she need baked Lays. 

    Amanda is a single mom. She worked at Subway and as a janitor for UAMS. Once she complained about the rash she was getting from the mask, she has very sensitive skin like me, and I promptly went upstairs to my derm clinic and bought her my favorite barrier cream - it's fifty bucks, but it lasts a long time and it really helped her. She gave me a big bear hug that week. I will never forget it. 

    Herman refused to talk about Amanda. So did Donetta, the single mom who works the gift shop and Subway to make ends meet. I finally got the scoop from Scottish Brian. They were trying to make her move to a new location for three months. She needed to be in the same location to do her janitor work, and they weren't accommodating her needs. I was livid. 

    Corporate got nasty with her, and they were stonewalling their employees - telling them not to talk about it, I'm pretty sure. I told Herman and Donetta not to worry, I got the information from Brian, I just want to know if she is ok. When Herman realized I knew a half truth, he finally admitted that Corp was so bad with her that he didn't think she would ever work for them again. Fucking Aholes.

    I went to stand in line for Subway today. A radiologist employee, one I have know for years but I still don't know his name, was in front of me. We started talking about our departments, both being crucified by the system. I joked about his footlong sub, before I realized that I was wrong. He got a flatbread like me. He's super cute, so much so that all the girls in the gross room talk about him.

    About eight years ago I diagnosed his sister with lung cancer. I asked about her for two years every time I saw him. The last time I asked, maybe six years ago, she had passed. I extended my condolences. When I was talking about my six foot plus son and how much he could eat he told me about his 12 and 14 yo nieces and their appetites. The girl who actually ordered the footlong apologetically told me this was her lunch and dinner. No apologies needed, I told her. I only joke about men and never women's food intake.

    Cute rad dude was giving his veggie and sauce orders and I said Jasmine! Did you and April save any of the truffles I gave you yesterday (8 dollars worth, a pittance for me, but April and Jasmine screamed in appreciation I love surprising people) for Herman and Willie? Willie is also new, has beautiful sleeve tattoos, and has been giving me free Subway coupons and free cookies. You smile at me, he said. I love when people smile at me. Herman deadpanned no, Jasmine corrected him - we saved a few for the guys! Only if they deserve it, I said. You are in charge of the candy.

    I told rad guy that Jasmine teases me all the time for not getting meat on my sandwich, just cheese and veggies. He said you are probably in the right. I said no, I'm no saint, I eat meat, but it puts me to sleep and I need to be vigilant for the afternoon work. Rad guy was paying at this point and I heard Herman say $18 something which was a lot for a flatbread I thought, but whatever. I claimed my sandwich as he was walking out the door and tried to pay. He took care of your meal, Jasmine said. You can take it and go.

    I was so surprised I turned as he was leaving and said thank you! You made my day. He smiled and left. I cannot wait to see him again and asked about his nieces and make a better connection. S thinks he did it bc I helped with his sister. I think maybe I surprised him by being kind to restaurant workers (who are treated like shit in our society). Any which way, I'm very flattered.

    Christy was horribly depressed about the midterms but I'm kind of jazzed. Nope, we didn't win, and now we have Sarah fing Huckabee Sanders as our governor (Ack) but overall the red wave didn't happen and that's a good thing. Lucy told me change would take years and I think, Pollyanna me, that we are incrementally moving in the right direction.

    Jack has had a tough week - we watched Merlin tonight. I know you don't believe this, I told him, and you don't have too, but between the lunar eclipse and the full Moon this is a shitty electrical week. My journey taught me to weather it through creativity - writing and singing - two things I'm halfway decent at. So that's what I'm doing. Busy call week, lots of frozens, weird cases, what's new? I feel like a broken record. Glad to have Herman and April and Jasmine and Willie and my work family to support me through it. Happy Friday Eve, Love Elizabeth

    

Election Night

     Jeez fuck the news they got Trump so wrong I don't trust them anymore. I prefer to wind down on a Tuesday. Whatever happens will happen, I can't control it so I just go with the flow. I'll check tomorrow and react, hopefully things will go in my direction? But I've got no confidence anymore in this arena.

    Daylight savings time sucks ass. On top of that, I woke up at three thirty Sunday morning bathed in sweat. No prior history of this. I  pondered it for 45 minutes wondering WTF is up. It wasn't entirely uncomfortable at the beginning. We keep the bedroom at 67ish bc you truly sleep better when you are cold and I love snuggling in the covers. So light sweat, not affecting the covers, full body, cool air helping, but when the alarm went off I had an almost panic attack.

    I tried to get out of bed but dizzy as shit. Almost went to the ED but I know the limitations here so I acquiesced. Not flu shot related, I had it last week, so strike out there. Maybe a new viral strain? But I didn't feel bad other than sheen of sweat. Is this a new presentation of menopause that I haven't yet presented? I got panicky when the alarm went off. 

    I couldn't move. Got way too dizzy - was plotting Dr. office bc ED and Urgent Care I totally don't trust these days. But I was starting call Monday so I tried and tried to get to the shower with big fails. Sweating and dizzy this hasn't happened in two years. But aha, perioral numbing and distal fingertip numbing started happening and I was like. AHA. I'm hypoglycemic. I yelled to my spouse to get me ice cream ASAP.

    I have not had ice cream at home in a while, but Jack asked for mint chocolate chip and I saw the Christmas tree cookie and succumbed. It was amazing, I was up and showering in ten minutes, call Monday fail rescued. I think I've got crypto in a lung mass? Mucicarmine pending. There is just so much going on these days. But it's handleable. Happy what? Tuesday? Much love, Elizabeth.

The Penis Edition

     Man it's been a week. A better week. But a busy week. Today there were weird cancers crawling out of the woodwork. So much so that when I exploded around one my partner Melody said I'll do tumor board tomorrow (I was about to send a very inappropriate text to a very kind oncologist. Melody saved me. Again.) Let's trade, you do December 1st, I'll do tomorrow. OK. I acquiesced. It's so nice to be supported.

    Tommy in mycology has a son who is a first year in med school. He worked hard, tried for a few years, scribed in the ER after college, and now he's a freshman at UAMS. Tommy could not be prouder. I let his son shadow me a couple of months ago before he started. He's a gem. He wants to do family practice - the martyrs of medicine. He truly cares. Tommy followed me out of huddle the other day to talk. He said that his son was anxious but performing well - they were already being subjected to patient simulations.

    Gad, I said. They didn't start those until my junior year they are brand new students! It's a different world. My son is doing ok, he said, but something weird happened in cadaver lab. They asked the students to cut off the shaft of a penis. None of the boys raised their hand, but some of the girls did. I LOL'd. I'd totally volunteer for that. But we didn't do that in cadaver lab, or autopsy, or ever what is the new deal? I mean, I'm sure the corpus cavernosum and the corpus spongiosum would be satisfying to squeeze between scissors, so squishy (Lorena would know love her) but what is the point? More foot forward anatomical dissection? Gotta see the vessels and the urethra?

    When I was in cadaver lab there was no looking or dissecting of any GU or GYN parts. External ones anyway. Except this one lady, her head was appropriately covered, who had a clitoris the size of a small penis we all rotated around and looked at it in awe. Gender is truly fluid. No body is alike, and no anatomy is wrong.

    Our patient simulations started junior year, not Freshman. They were new and so fing stressful. I remember back then I had such a bad unilateral sweating problem I researched lots of crazy deodorants many with minerals and once my ex accidentally used mine and was in excruciating pain all day. It didn't hurt me, but it staved my public embarrassment. 

    We had to do a male GU exam on a fake patient actor and ask all the right questions while being recorded and do a penile exam. My silk tank was soaked through at the end, but I got a good grade thank god. One of my friends Melissa was almost crying at the end of hers - we all met at the end in the lobby to commiserate. She forgot to put gloves on, and did the penile exam without them. She's a SAHM mom now, but aimed to be peds. She thought she had ruined her career. It was honestly hilarious.

    I got a penis this week. This is a very rare specimen in pathology, and usually is involved by squamous cell carcinoma. This one wasn't. Poor guy was on end stage renal dialysis and had calcified atherosclerosis and distal necrosis. I struggled with the path - I can count on one hand the number of penises I've had in my career. Had to pull out the old Histology for pathologists and I was right on the mark. 

    Called Bob to ask him a question about it yesterday. He's at lunch, Laurie said. Well, tell him it's not urgent but I have to ask him about his penis specimen. So you want me to tell you to ask Bob to call you about his penis? LOL. Yes. Sorry, I couldn't resist, she said. Bob is one of the last men in the gross room, I'm cultivating a female atmosphere. He tells people that he works with a lot of beautiful women. That must be amazing, his friends say. Um, no. I'm daily subjected to some crazy ass smack. But I think he still loves us. Happy hump day. Much love, Elizabeth.

    

Control and Self-Sabotage

     The architecture convention was nice, my first. Good to be the spouse of a convention rather than an attendee. I holed myself up in the hotel room and read three books and got a massage and walked around a bit - the locale was a concrete jungle but the weather was beautiful. Cecelia and her friends Mia and Blakely came up Thursday night and we treated them at Local Lime. The girls were happy and the food was wonderful and the tres leche cake servings were enormous. 

    Daisy Darker I'd recommend - I gave it to Cecelia to share with Mia and her roommates. The plot twist surprised me and the characters were interesting. I also read Verity, by Colleen Hoover maybe? It was terrible I left it in the hotel room. So much boring sex scenes I felt like I was reading Fifty Shades of Grey, which I never read, but I did pick it up from a friend on a beach trip and read maybe three pages? How does this stuff get NYT bestseller status? Are there that many sex starved people in the country that this is titillating? I was telling Mia and Blakely about it and they had heard of her and the reputation. Bad soft porn, I said. I starting skipping the scenes to try to get to the plot, which had a lot of holes. But it made for a quick read.

    Love on the Brain was surprisingly wonderful brain candy. I had read her first book, and didn't love it, so I was hesitant to get into it but the characters were lovable and even though it was so predictable it still managed to have some surprises at the end. And cats. Lots of cat love. Intelligent brain candy, and full of humor. A good escape.

    I need escape. It's been a tough Fall. Cecelia is entertaining a transfer and I continue to support her on that. She is crawling out of a dangerous path of overachieving without self nourishment. She's doing great, but there are still bumps in the road. I tell her that the more she is trying to control, and be her old rocket ship self, she is self sabotaging. This morning I gave her an example.

    I've had a couple of rough anniversaries. Friday was one of them. About three years ago, I had another. We used to follow the traditional anniversary gifts, it was fun, but we abandoned it this year. That bad year was cotton. I bought a trivial t-shirt and a bundle of cotton - I was overworked and overstressed and didn't put the time in that it deserved. S did have time, it was about five months before he started his current job, and he put Heaven and Earth into it. Researched bedding and went all out.

    I was not pleased. A person's bed is their haven. When I divorced, I researched it a lot. Got a brand new bed, sheets with a crazy good thread count - isn't that a thing? I can't remember, maybe the higher the better, and I bought the best. Found an amazing Eileen Fisher silk bedspread that I use to this day and had some custom designed silk pillows to accent the ones that had the duvet covers. I felt, with the change, that my safety had been stripped from me. Was I able to articulate this? No. Did I try to cover it up to preserve the day? Yes. It did not work. We had a terrible tense day of hiking and lunch at Tropical Smoothie and my attempts to cover up and salvage my disappointment with effort and false cheer were not successful. I was not able to explain this accurately until the ride home yesterday. It was freeing.

    I try to teach this to my kids, especially C these days. You have to let go, it's hard, even for me, at almost 50. So you didn't have the picture perfect Halloween weekend. So you aren't achieving your goals as soon as you make them. So what? Lay on the couch, let go of FOMO, and stop freaking beating yourself up. Make plans with friends. Old trope but, fake it until you make it.

    I took a walk today, and the smell of the outside and the dirt post rain and the transition to Fall and the Halloween decor at other's homes was a balm. I've got another couple of full work weeks then a short one. Planning to have a girl's weekend with Lys at her lake cabin after her Nov. 17 birthday. C is volunteering again at Camp Aldersgate this weekend and will be here Thursday night to shadow at Hendrix the next day. Happy Sunday, much love, Elizabeth

Happy Friday Eve!

     I'm not sure I remember what I wrote last weekend, it was kind of stream of consciousness. Last week was one of the hardest weeks of my life. The Monday, not this week, but the one before, was tough. Tuesday I was a shell of myself, even Melody noticed. I was on cytology, and I had a testicular tumor that wasn't grossed right. After I called and asked some more senior levels to assist fixing the mistake, I realized I shouldn't even have gotten a testicular tumor in the first place and when Jessica asked me if she could give it to someone else, she apologized for the error, I burst into tears on the phone. 

    The guilt of handing it off eclipsed my state of hollowness. But she convinced me to give it to Shaver and I felt so bad when he asked me yesterday, rather guiltily, to cover for him for a couple of hours (three bronchs, one in the SICU, and I was covering call morning frozens) I was like why do you think this is a big ask? You do so much for me. Let me help you. He was grateful. As am I. We may be a little dysfunctional but we are a democratic work family and that supersedes an autocracy.

    Tonight at Three Fold at dinner with Jack and S we talked about Effie and Mike coming for Thanksgiving - Mike cleared it with his family that I was ok to come - Bill had a hard time but he's gone. And even though he couldn't be in the same room with me since I divorced Mike I'm still sad. Sometimes you work with people on their cylinders. Not everyone can work on all cylinders. And it's ok. It's their path in life, not mine, so I honored it. Especially bc it caused conflict with the family. I don't want to be a source of conflict, even though it's not my battle.

    I'm off Tuesday through the weekend next week. S's architecture convention is in Bentonville. We are staying at the Embassy Suites, and I'm excited to be close enough to Cecelia to be able to support her and spend time with her. Need to book a massage too. It's been too long. God this has been a hard Fall. Literally and figuratively. But Lisa taught me, and Paula reinforces, that we will not be handed anything we cannot handle. So my Pollyanna state is a little bit intact.

    Kewen texted me and Amanda today - she is off next week too and wants to have dinner. I stalled the re-opening of the book club bc C has been so fragile I feel like I am on call for her more than for any frozen section. We plan Ocean's next Monday night. K said she would pick me up - my night vision and driving is giving me near panic attacks. More guilt, but I supported her through her cancer and she is now supporting me through my troubles with my kiddo so tit for tat. It all works out. 

    Feeling a little more emotionally stable so that's good, especially since work is fucking crazy. I bumped into Whit Goodwin, rad and avid Trump supporter, in the dr lounge this week. We commiserated over our governing bodies and their lack of care for our well being. Giving us ridiculous things to do with our time to make money for them. I told him it's the same everywhere. Academics, oil companies, etc. We need to brace ourselves bc no party is serving the people the way they should. Mid terms, schmid terms. We can only do the best we can. Despite the fact that we are working twice as hard as we did ten years ago for the same compensation (we shared charts and documents to support it) we are still there for patient care.

    I've got BHEC committee in the morning at 7am. Skipped CARTI tumor board this morning bc they didn't give me anything to present and what's the point? Might change my mind in a few months but for now, grace and ease. That's what Paula preaches and I agree. Still. Mindfulness. Hoping C gets that memo, I've certainly preached it to her many times over the last two months. I'm so proud of her, she's rock climbing and mountain biking and transitioning into a better person. Transition is not always easy. Happy almost Friday on one of the second longest weeks of my life (last week was terrible). Much love, Elizabeth.

    

    

What a Week

     You know how you think you have hit a low then you hit a new low? Not fun. But it is what it is. When I'm stressed, I get manic. Retrospectoscope. This week I dived down two internet black holes. The first was a post in Bad Mom Docs - someone asked for good fall finds to wear on Amazon. 364 comments later I had an arsenal of fall wear to order. And it was prime week, so the finds were mostly under 20 bucks. 

    Fast forward to last night I was trying on many outfits and 85% looked ok. It's hard to shop with my size. Medium is 8-10 Large is 12-14 so I'm 10-12 it puts me into an arbitrary category. Normally best to size up. Especially for fall clothes. I have been guilty of toxically putting my large self into the 6-8 category my whole life. Abandoning that this year. Gave away all those sizes. And also my shoe size? Not a nine. They hurt. Gave them all to C. I'm a 10. It's freeing.

    Also been going down an advent calendar hole. There are so many good ones. Above and beyond the gift store Baptist chocolate ones. So far I've ordered a chili one for J, bath and body ones for me, Sara, and my mom, and planning sex toy ones for Christy and a wine one for S. A makeup one for C. You can spend thousands on advent calendars. But I'm not. Only a little around a hundred. 

    We all hate our bodies right? When there is nothing really to hate. S and I joke that we become like our cats. Well I've got a Katybell waddle. Which is ok for me to say, but if anyone else does? Including S? Instant decapitation. He's right about one thing. Me and Katy can sneeze with the best. Champion level sneezing. That's worth a few calories. More than I've been logging in lately. I'm a marshmallow, but I'm proud. 

    When I listen to Pearl Jam radio it becomes abundantly clear that one of my fave songs yellow ledbetter I know none of the lyrics. I listen to the sound, on the recorded album, and sing the sounds. Not the words. Let's face it, Eddie can mumble the shit out of a song. But that's another thing I'm letting go. Screw the words. Happy Saturday. Planning maybe fair tomorrow if I can get outta bed. R&R weekend. Hope you are resting too. Much love, Elizabeth

Cloud Nine

     Cecelia just called while I was getting a pedicure and I braced myself to ground her but she was the happiest I had heard her in two months. She had just been to a Spanish fair and saw her teacher and was given a high compliment. She was brainstorming about future jobs and all the possibilities in life. You are interested in global health? I'll bet there's a dr mom group for that on FB I can try to find possibility. And I think Paige Raborn is studying something like that at Georgetown do you feel comfortable calling her? Phoebe and Laura are still on my shit list from over a year ago but that's a rant I probably shouldn't take online. Yeah mom we've actually talked since all that happened that's a good idea.

    After a reeling Monday - she called 10 times and my GI was at it's peak Judas - well, not as bad as last Monday when the lab team took me home after dinner to the hotel and one of them got me ammodium to take for the lab inspection. I had to leave four times at dinner to head to the bathroom and to ground C. It's like I have cholera, I told them. When you are vulnerable, people open up to you. On the way back home Wednesday I sat next to Pam, head of cytology and uber ocd amazing inspector. She told me her daughter Liv had some of the same problems in college and she was in NOLA every weekend keeping her from going off the rails. Now at 26 they are much closer and Liv is flying. 

    So we got a VRBO in Fville this weekend. It's really different from last year - when I moved her in she was already changing. Last year she wanted me to plan dinners for her friends and take them shopping and I was never alone with her. Now she just wants to hang out with family and BiteSquad and shop. Even if it's just Target or grocery. I told her if plans pop up we can entertain ourselves but she only has one plan late Saturday night she wants to be with us otherwise. So that's good.

    It's funny S and I have a totally different philosophy of food. He adheres to expiration dates I'm like if it's not molding visually it's ok. Once when my power went out for a few hours when the kids were little on South Lookout I started to throw everything away after it came back on. My nanny, who didn't speak English, conveyed to me that this was a bad idea. It's fine, she said, yogurt and all, through hand gestures. Other cultures have a much better handle on this than we do.

    Since Monday GI stuff is a little better. I had a great session with Paula on Tuesday - I missed last week due to the lab inspection and two weeks was way too long. She gave me lots of tips. I feel like psychology/psychiatry is a construct. A useful one, but one that was developed in a patriarchal system to cure the ills of what it inflicts on women and minorities, and men too. So many people I have talked to said their kids struggled in their teens and early 20's bc of it. 

    Work has slowly been getting better and I need to go pack so I can leave as early as possible to get to Fville for dinner. Gotta check the weather if it's gonna be cold here it's gonna be colder up there. Maybe need to do some laundry too. Things are moving in the right direction. Hard, maybe, but that's what happens when you change. Gotta learn to feel discomfort and get a little comfortable with it. Happy Friday Eve, much love, Elizabeth

    

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

Support

     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

    

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

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

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

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

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.