Medical Executive Committee

     Was Monday evening, and there was a Zoom option, which about 2/3 of the docs chose. If I had been Chief for five years this might have been my preference but as a newbie I was really excited to be there in person. There were about 12 docs, half of whom I knew, and 2 admin. One of them was Anthony Bennett - he's been there a while and was a doc before transitioning to admin. He's kind of quiet, but we have been friendly over the years. I don't know him well, but see him almost daily in the Dr. Lounge. About six or seven years ago he invited me to med exec to share my Q/A report with all the docs. He was very impressed (Rex Bell said you knocked this one out of the ballpark Elizabeth when I first took on the role). I have shared it with him over the years occasionally so they can have an example. It's how we doctors check ourselves. Make sure that our reports match up with the institutions we send them out to (about 40-80 send outs a month). If not, pull and investigate - they aren't always right, but if they are, we make sure we amend our report with full disclosure. It's about patient care, not ego. That's one of many things I look at in the three page monthly report.

    Anyway, it was a new year, so there were a few new Chiefs, so Bennett went over the role (Rex gets so mad when I call him Tony IT'S ANTHONY lol I miss pissing off Rex) of the med exec committee - we sit right under the Board of Trustees so we are kind of a big deal. He was showing the charts and the flow of command and knowledge and most of the time he was making eye contact with me. Which was startling and endearing. I can't even get my business manager or the head of histology to make eye contact with me in a meeting. When you are a female in the room, you are often not the target of someone's pitch. Even though there were things that irked me during the hour, most of it was respectful and gave me a little hope even.

    Highlights of the meeting included a big press release Monday night (hospital press) of an increase in salary in bedside nursing. The clinicians were ecstatic. What can we do. Admin said be patient as we have new people coming on board. Try not to yell over the phone. Hopefully this is our version of build back better. We need a new start. They are also taking over half of the anesthesia lounge to expand OR 15 - thank god not the gross room I texted to my partners. For now. I saw McCall Hogan in the dr. lounge and he said they are already moving out couches. There are 70 of us. I know. I bought them all Taziki's on the year anniversary of my dad's surgery for saving his life. It cost a lot, but was worth every penny. Hell, I might do it again just for kicks. 

    The funniest thing was about the medical exchange. The Pulaski County medical exchange has been around for decades - I used to use it to page my dad when I was in elementary school. A couple of weekends ago, unceremoniously and with no communication they retired and sold out to a national company over the weekend. We were getting emails with multiple phone numbers and codes to log in (to what? A phone company?) and it has been a shit show. Blake Phillips said the national company sent him some crazy email with 10 patient attestations to promote themselves that appeared to violate every aspect of HIPPA. David Shenker, the new Chief of Staff, who very badassedly missed the big chunk of the middle of the meeting bc he had to do a C-section, said his colleague Jennings was receiving patient calls to her cell phone all weekend and when she ascertained it was the national company and called to complain they said you are wrong and hung up on her. I'm glad I'm a pathologist, I said. The Chief of OB/GYN, Julia Goodwin, looked over at me and said I've often wished I was a pathologist. 

    Melody, who as a CP still has to do apheresis, said she tried one of like 17 numbers on Martin Luther King Day and there was a message saying the medical exchange was closed for the holiday. We both LOL'd. Is that even a thing? You cannot close the medical exchange - it's a way for doctors to communicate important shit to other doctors. And for patients to get access is really weird - they are supposed to ask for name and identifiers to make sure you are a doc. Apparently there is a big lawsuit between the national company and the local one, so admin was rolling their eyes. Hopefully they pull out of our state eventually.

    I'm so ecstatic for Cecelia she had 70 people show up for her sex talk last night. She was on Cloud 9 (she, unlike me, loves the attention). She's gonna be the next Dr. Ruth. The short speech, which she sent us all in the family gressage, was so political and intellectual with the perfect dose of funny. She told me everyone laughed in the right places and I think she has found her passion. At one point she compared sex without mutual communication to ordering a steak without telling your waitress how you wanted it cooked. And she joked with the guys that they knew that the girl should have an orgasm too? And it was their responsibility to try to make that happen. Some conservative college watchdog group is hounding them today and I told her controversy is the best advertisement for your cause. Yeah mom, we plan to give them a statement and if they twist it we will slam them on social media. 

    Headed to Eureka this weekend and off until next Thursday I'm excited. This week has seemed like a month. Going to see Mom and Dad's new house in about two weeks. Ready to shed Winter. S told me last week that he hadn't heard me dry heave in a couple of weeks. LOL. The bar is low, but it's not death. My health is improving so I have more energy than in a couple of years. Good things. Happy Thursday. Much love, Elizabeth

    

Pancytokeratin and Purple Balloons

     The supply chain is compromised, and you never know what's going to be in short supply. You know if you've been to the grocery store - it's not pretty. Random things are depleted. Rick from histology called me in the middle of the week. We are having trouble getting pancytokeratin. What do you want me to do. Pancytokeratin? That's a staple in my world. We have never been out of that. Just run a low molecular weight Ck and a high molecular weight ck. They did, and it worked, and luckily the next day we had our supplies replenished. 

    Laurie's birthday is this week, and she reserved the private room at Sauced tomorrow night and invited a select few. I'm excited. Laurie had a rough year a few years back, and she is finally becoming herself again. She said no gifts on the Evite, but she didn't know who she was dealing with. Melody wanted us all to go in on a gift. Jessica told her she was longing for a classy understated string of pearls. Melody found one, and we all chipped in. I got a bunch of charms from Rad Girl Creations - I was introduced to them last week in Pathology Mom's Group on FB. The stickers and charms are edgy and pathology related and super cool. Emptied them onto my floor this week, shut the door, and invited Jessica over to help me pick out some for Shelby and Savannah and Laurie and Bob and Joe. 

    Laurie's favorite color is purple, I've known this since even before my time at PLA. Jessica and I ordered some purple decorations off of Amazon (I know, shouldn't support Bezos, but it's so fast) and I told her I would get balloons from Party City, which is right across the street. Turns out they are out of everything purple. Balloons, decorations, and candy. WTF. Planning to stop into Fresh Market tomorrow after work to try to find something festive and purple. 

    Cecelia called me last night and asked if she and her friend Blakely could spend the night tomorrow night. Hell yes! I was so excited I bought Boulevard pimento and cookies. Mike and Rachel are going to host a brunch on Sunday morning. Can I wear my pajamas? I asked Rach in text. What can I bring? Something fruit tray related. Easy. Done. They are coming to support their friend and go to the mom's funeral at 2pm at Wildwood. I had only suggested she live stream it I didn't want to stress her out but I still remember seeing Marcie Lewis' face at my grandfather's funeral in high school and feeling so supported so I am super proud they are making the trek back here. She's going through a lot, I told C, but she will remember this for the rest of her life. I'm so proud of you for making the effort.

    I've had two 7am meetings back to back this week - CARTI general tumor board (Joe Beck is a hoot) and BHEC QC (Bob Searcy is even more of a hoot). Long story short Admin cuts off their nose to spite their face. The head nurse waxed eloquent about division support and market analyses to try to determine why we were losing money all of a sudden. Keep up with the times. Pay the senior staff better so we don't lose them. Travel nurses have no investment into long term care, and they are more expensive. Bob was like speak English to me. Give me a name, not a nameless department. I'll give my recommendations. 

    Problem is, Admin has blown up over 300% since the mid-seventies. And they are making money decisions that don't bear fruit. I'm not trying to alienate myself from the powers that be. I want to influence them - I'm Chief now - and I have my first med exec committee next Monday. I saw a statistic that there are now ten admins for every doctor. And they make helluva lot more than we do. But we are on the frontlines, and there is a shortage of medical workers, so we are as much in a state of disarray as the rest of the world. 

    I was problem solving a health issue Lucy was having last week - hadn't talked to her in months. She's one of a kind. She told me a few months ago that astrologists have been looking at this time for hundreds of years. We are not close to being out of the dark, she said. It's going to be a few years of hell. Five, maybe more. So take a breath and get ready. That calms me, when I get stressed. My GI issues are thankfully abating. I'm having more energy to work out - also catching up on QA I have let linger for the past year. But when you open the news and read about all the voting and abortion restrictions it's hard to have hope.

    Easy peasy call week so far Jess and I were marveling this afternoon. It's so quiet, we had better not talk about it too much or we will jinx ourselves. Oh the hand! I forgot to talk about the hand. I got a hand today, five digits really. Amputated for wet gangrene, which I embarrassingly had to google today bc we only see the dried mummified version of gangrene on the feet. Since we so rarely get hands, I deep dived into the chart.

    Patient on ECMO. Got Covid in November. Vaccination status unknown. Supportive family. Wet gangrene is the kind with active bacterial infection. So pus, wounds, blisters, chance for sepsis. I had a little PTSD reading the charts, bc I remember when my dad was on ECMO. The machine doesn't take care of you as well as your heart, so the extremeties get cold and blue. We had around the clock family care - my little bro took the night shifts, because you really need a patient advocate no matter who you are. We constantly asked for heating pads - they have the fancy twist activated ones but if you aren't in attendance they will fall off and no CVICU nurse, as amazing as they all were, will watch out for your hands and feet as well as someone who loves you. Thanks to us, dad still has all of his digits. My next plane flight is to see them in February and their new house. Can't wait.

    Happy Friday. Much love, Elizabeth

Shit for Brains

      I wandered into the gross room at a quarter to four to check on possible late frozens. After the holidays and the deductibles things tend to slow down a bit, and we are just now seeing this. Jessica still had a pile of placentas but the more critical specimen table looked good, not overflowing like it has been for the past couple of months. I think the OR is winding down, Jess said. I'll go check, I told her. After I looked at the board I told her the only one that concerns me is the retrosigmoid approach to a craniotomy by Conner? What the hell? How do you go behind the sigmoid colon to get to the brain? Seems a little circuitous to me. She laughed. I already looked that one up. It's some artery microdissection. Not our concern. But I've seen that occasionally before. Not sure - is there a part of the brain called the sigmoid?

    Not that I remember. I'll have to google that, I said. Jess yelled it's shit for brains! Lol. Still haven't googled, but oh well. I got a text today from my Dad's Apple watch at 10:38 that scared the shit out of me and made me sweaty and shaky. Rick Nestrud has had a hard fall. You are receiving this because you are an emergency contact. Here is his location on maps. WTF? I called Mom and sure enough they were in downtown Port St. Joe waiting on an ambulance. Long story short, he's ok, he had a nasal fracture and a radial fracture - both non-dislocating, but he's got a lot of cuts and bruises and is in horrible pain. When I called Stephan and Christie to tell them they both said, I guess it's genetic. 

    When we finally ascertained in group text with sibs and Aunt Sue and Uncle Chuck that he was going to be ok, just a little battered and bruised, I said someone needs to start researching walking assistance for me, Mom, and Dad. Mom had a compound fracture in the Spring which required external hardware and much OT - we have been commiserating. Also a fall. I said I want a cool staff that makes me look like a witch or a wizard not an unsteady mess in disguise. Matt found something on Amazon that lights up! Bonus for nighttime. 

    In a flurry of oh shit I'm falling apart again I have had four dr. appointments in the past two weeks. Good news. Mammogram is clear as a bell. What are you doing? New breast rad - daughter of chief of ED who I have worked with on the phone but never met was incredulous. Look at last one there is tons of fibrocystic disease are you taking Vitamin E (well now I am) or hormones? Nope. When I called Amanda Ferrell to bitch about aforementioned surgeon she said that she's seen that happen during menopause, but it took her about a decade to recognize the pattern. 

    Also good repeat fasting labs were COMPLETELY NORMAL hallelujah no organ transplants in my near future I almost cried when I got the phone call Wednesday. Blood pressure is good as well no need to add anything to the beta blocker and with regular exercise I can probably get off of that too. Checked in with new gyno Amy - she is Cindy's BFF and I needed to see her since I haven't seen anyone since Cindy moved to Santa Fe earlier this year. She is hilarious I'm excited to be her friend and invited her to book club when Covid finally ends (if. Sigh.).

    I sound boring and old. Can't remember if I told you Cecelia's new mission in life is to become a sexual wellness doc. She wants to write a book and become famous and revolutionize the industry. Feminist me is super proud even though mom me cringes a bit at her candid discussion but that is what our kids do right? Bring us forward. She predicted her National Merit Finalist and President of Central when she was a Freshman so I've got no qualms that she cannot do what she sets out to do. 

    One of her new BFF's at Fville was the mom that tragically and inexplicably died while paddle boarding last week. So I've been plugging in a lot with her lately. How to support friends who are grieving. Hell I melted down thinking about it on Sunday. When C discovered she was missing on Wednesday night through her friends Insta she frantically and full of empathy told me I was never allowed to paddle board again. Well, I said, I'm pretty sure my OT would agree with you. Tongue in cheek, that was, but watching the fallout since then, from the police boats we could see from our window Wednesday night to the discovery Sunday has been holy hell. 

    Dad is good. A little embarrassed I kept receiving texts from his phone during head CT, etc. I just talked to him and was like hell no I want that info. Turns out if you go unconscious and don't disable something your Apple Watch will dial 911 and share your location. Melody said all of her and David's parents have one. Also picked up my dad's A.Fib a few years back. So good investment for a loved one, especially if they are on their own. Happy Tuesday, much love, Elizabeth

NastyGram

     I got fired on Friday, by a belligerent surgeon. Of course it was relayed to me by a partner - this person is borderline as hell. You do everything the same, 99.9% of the time you are right, but that .01% that you cannot predict all hell breaks loose. Did you defend me, I said? Stand up for me? What's there to defend. You did everything right. They probably made a promise to a patient, that they were trying to uphold. Well I don't stand over them in the OR and tell them how to do surgery. I'm nothing but professional. 

    I called a fellow doc to vent Friday night. You are preaching to the choir, she said. I get a nastygram every two years saying what a stupid doctor I am. And now that their notes are in Epic? They are throwing everyone under the bus. It's like a bad boyfriend you cannot predict or break up with, I said. They are the bane of our existence, she lamented. I love my job, very much, but this is a stick in my craw. 

    I want a New Year's makeover. And I tried - postponed my plans while Jack was in quarantine but Christy tested positive for Covid on Sunday after I spent Saturday with her and S is sick as a dog. He tested negative by PCR this afternoon. So maybe bad flu? Who the hell knows. I called employee health this morning - the same department that required a negative antigen test before I returned to work last week after coming into contact with Jack. No we are not testing anymore, she said. Just wear a mask, even if your husband comes up positive, we won't test you. That is new, I said, different from last week. Yes, the rules changed last Wednesday? Maybe Thursday. Just stay masked and don't eat with anyone this week - no unmasking at work. I LOL'd. So this is why there are so many CDC memes on Facebook. You are throwing us to the wolves. She laughed, and said just don't forget to mask up. If you need testing for peace of mind, do it elsewhere. If you become symptomatic we will test you.

    There is an Omicron update from Mandee that I didn't watch today - I plan to tomorrow. But anyone with access to the news can see that this is a huge shit show. Are they altering their plans for the good of the community? Or the good of the hospital business. I think the latter. I'm just going to lay down low and N95 it up and keep working. Christy dropped by some home testing kits today and was wondering about my results. Well, I decided not to test. It was recommended by employee health, and if I do test positive, it will wreak havoc among my group. A false positive would be a death sentence. We are all spread so thin, and this would put us into a spiral. 

    There are highlights of the new year. Figuring out hard cases. I had a gallbladder cancer in an early 40's patient last week. I have only had two other gallbladder cancers in my career and both were consults. About 50% of them are incidental findings - they think, as in this case, that they are just gallstones. This was not subtle, it was ugly as hell and all over the margins. I called the surgeon's nurse. Oh hell, she said. Can I give him your cell phone. Of course, I said, if he has any questions tell him to call me. This has a horrendous prognosis - 5% ten year survival maybe I looked it up last week but there has been a weekend since then. 

    So I still want a do-over. Sent Woody and Cecelia to my mom and dad's for a long weekend they had a blast. I'm a little jelly C saw their house before my planned trip in February but since she plans the summer in Spain this was a good thing. Other good? Ack not sure. Station 11 is still captivating and we just cheezed out to the fourth season of Cobra Kai. I hear that Euphoria and Righteous Gemstones just dropped new seasons too so there is no lack of content. Planning to finish Samantha Power's autobiography soon, it's fascinating. No more days off until February so there's nothing to do but work. Happy Monday, thank God it's almost over, Much love, Elizabeth

    Speaking of Gods, there are no Gods in medicine. There is only teamwork. Some clinicians fail to understand this. Well, we are entering a new era. Time to hold the Godheads accountable. 

    

Covid Cats

     It's funny how you can be over the moon and something comes along and knocks you on your ass. In this instance, it was a phone call the day before Christmas Eve informing me of some wacky labs. I don't know why, maybe it's my job, but I go from skewed labs to multi-organ system failure and brain infarct in the blink of an eye. My labs were the first I'd done in three years, and I wasn't fasting, so I go again in a couple of weeks to make sure they were real. Nothing can make you feel more vulnerable and human than feeling out of control. Meantime I course correct (after I beat myself up for being a terrible person). There is more than one reason for getting on the treadmill and if I fixed my blood pressure and borderline high cholesterol once maybe I can do it again? Curves be damned I want to live as long if not longer than Betty White.

    Jack is finally out of quarantine today after testing positive on a home antigen test at Mike's last Wednesday night. I'm glad I've missed him. It threw our house into chaos for a few days but everyone else tested negative - M, R, and S by PCR, me, C and Joelle by rapid Ag. I took one look at that PCR line at Baptist on Friday morning and said screw this I'm on call. Went to the front lab desk and tested Ag negative in 15 minutes. I know PCR is gold standard, but I told Joelle and C if we get symptomatic we will do PCR but since we are not this is good enough for now. Just mask up and stay away from Jack and Noah.

    Noah ultimately tested negative yesterday by PCR (his brothers and sisters were pos) even though he was symptomatic, which made us wonder if Jack was one of the 1/100 false positives on the Ag test. Rachel's friend Whysper caught it - she had to get it from somewhere and Jack is the likely culprit since they all went to RKS together. It is so strange how indiscriminate the virus is. Jack and I wondered aloud if maybe Noah had extra ammunition on board since he was the only one who had the original Covid before he was vaccinated. Who knows. Jack ultimately decided he'd rather not spend the last couple of days of his break getting a PCR test. I agree.

    Happy New Year! It was pretty uneventful around here. The most exciting thing was spraying the cats off of the couch with bottled water in the evenings (they bed downstairs in the Covid lair). Jack was kind of happy to have an excuse to cancel his NYEve plans. I told him he could have six kids bc I was on call, and even if I wasn't, I don't want the house to turn into a wild party for 16 yos. He was getting lots of pressure from his friends to increase the numbers and it was stressing him out. Jack is not wild, he is quite the opposite. He's not an early thrill seeker like C was (the apple doesn't fall far) he is into his health and natural weight lifting (I'm all natty for my health, he says). He eschews drinking and vaping, he's tried the former but isn't impressed. He schedules lunches with his favorite teachers on break and gifts them books. He hasn't had a serious girlfriend since he was about 10, and we know that even if your emotions get carried away then it's kind of just a tip of the iceberg thing.

    Jack's friend Izzy stayed here for a couple of weeks in December while her parents were getting situated to move back to Little Rock from a Vermont experiment that failed after 6 months. I asked her one night about Jack. Told her I knew he had some vague interests but some new discovery about the person always led him to keep his distance. Not that I'm judging, Mom, he says, that's just not the person I want to date. Izzy said Jack is picky. He watches his friends get all giddy and then it turns into a train wreck and he congratulates himself for not going down that road. Not that it's been all roses for him. He is highly sought after, which has led to some very awkward situations that he's learning to get out of more smoothly as he goes along. 

    C was laughing about one of those situations recently. He's so heartfelt, I said, he doesn't want to hurt anyone's feelings but the poor girls are probably mortified the more he tries to explain and mollify. He such a good kid too. You probably wouldn't have hung out with him in high school, he's not wild enough. You are right, Mom, but he is so good. He's going to be a great catch someday. I told C I'm just glad he's old enough to start going to concerts with you. He's a great protector. I'll sleep better. Happy Sunday, much love, Elizabeth