The Calm Before the Storm

     I think we managed to have the best Spring Break at CB ever. It was nice to have an extra mom around to shop and plan and cook. "Runaway" Rennie - her ski nickname, always had an older kid to look up to and by the end of the week she was describing riding black moguls like it was a walk in the park. She constantly competed with and bested her dad, which entertained me to no end. She's clearly the center of her mom's world, as she should be at this age. Rachel has an amazing sense of humor and her quick sarcasm garnered many laughs as she shot down Rennie's requests for more things on the shopping expedition. But she gave in when it was appropriate. A good balance.

    Harper and Mia were delightful. They are both introverts and book readers and Harper is a music lover and loves horror, so we had lots to talk about. Harper looks like Snow White and sounds a little like Amanda Seyfried's portrayal of Elizabeth Holmes in The Dropout - and she was mortified when I told her that (She's so terrible! She did that on purpose!) that I backtracked and said you just have the best low inflections that ring that bell for me but I still jokingly called her Elizabeth later in the week and was secretly delighted that Mia and Harper were both familiar with the whole thing. 

    Harper was like a kid whisperer to Rennie - she is an Earth Science major and is thinking of working in National Parks but isn't sure. She knew the Arkansas State flower and the state mammal and the state bird (all of which I knew) but she also knew the state rock!! I didn't know there was a state rock, and it was a complicated name that I've forgotten it so I will have to look it up. They shared favorite animals (Harper's is the capybara, I can't remember Ren's) and Ren often chose Harper to snuggle with on the couch at night.

    Mia is like a ray of sunshine. When I got frustrated there were no real checkers at Wal-Mart and I'd have to self check out a shit ton of food she said in her lilting soprano voice No Worries! We will help you. It will be fun. She and Harper ended up doing most of the work and it indeed turned a stressful situation into something fun. The morning after a total disaster for the girls that it took me a bit of time to piece together I said how was Gunnison? She cocked her head and smiled. "Usually those kind of plans don't end up the way you want them to."

    The night before Rach and I stayed up late talking and the girls, who should have been exhausted, had found out about a party from some guy on Tinder and were getting dressed up to go. Rach ok'd me having a talk with them. Mia promised to stay mostly sober and Cecelia told me that Harper checked the bus schedule and what many parents might frown about we gave the green light bc they are all 19 (all of them Pisces!) and they need to learn to be responsible. I emphatically told Cecelia that the adults will be drinking and there will be no one to rescue you between midnight and 3am, bc we probably wouldn't hear the phone. 

    Harper read the bus schedule wrong and they ended up in the ED bc, not sure how, but it is a smart place to spend the night if you can't get a ride home. A nurse urged them to hitchhike but even though my shuttle driver yesterday told me it probably would have been safe they smartly declined in alarm. A guy ended up taking pity on them and driving them home safe, so when I woke at five to check that they were all in their beds I was happy to see them.

    Noah is a joy. Not a punk ass, S says, like most boys these days. He's genuinely appreciative and kind and happy. He has not been snowboarding since he was seven and his dad took him. It's one of his fondest memories, so he's been excited about this trip for months - constantly sending Jack videos of skiing and snowboarding. When I took him to Panama City last year we were all genuinely alarmed - his self esteem nowhere near matched his looks. He's had a lot of tragedy in his life (haven't we all - but his is a lot). We spent the entire trip - C, Joelle, J and I trying to lift him up.

    I was happy to see him more self confident this year, but still with all of the same wonderful qualities. He's a year ahead of Jack. He's planning to go to welding school, which I think is a great idea. I told him when I was going through my divorce and going to hiking meet ups I met a welder couple - they were DINK's looking to meet other hikers - and they were very happy and well off. Much more so than people who go to college and get into terrible debt and drop out bc our whole system sucks like hell. But I'm getting tangential.

    When Jack and I were grocery shopping this afternoon he was stressing about the week and I said let's just enjoy today. I've got a lot too. I'm on call this week, and Med Exec Committee is meeting at Trio's tomorrow night. The fing American Board of Pathology was texting me on vacation reminding me of my damned quarterly questions due March 31st (I fing tried to do them on Friday and there were technical difficulties and no one answered the GD phone) which I texted back minus the cuss words but I'm sure it fell on empty ears. I'm finally switching CPA's from Christie's ex's company so I need to fill out the tax form and we meet with the new guy (Anna's boyfriend! She's the rock hound at Boulevard. I'm so excited to support someone she loves) on Thursday. And it's time to do some other major things in our business and there are due dates at the end of April but I'm gonna lean on my partners and roll with it. 

Read Maus at the airport yesterday and started and am halfway through with Diana Beresford-Kroeger's To Speak for the Trees. Both really good. Nice to be reading. Happy Sunday, much love, Elizabeth.

Crusty Butt

     I don't know if it's daylight savings time or work stress or world stress but this week kicked my ass. I woke up every morning at 4am - too late for wine to function during the day unfortunately, and this morning it was a whopping 3:24 so it feels like midnight now. But I'm off for a week! Rach and Mike and Ren are already in Denver. We leave tomorrow at 1pm with an unavoidable four hour layover in Denver on the way to Gunnison so we will not get to Crested Butte until late - I just texted the family gressage to save S and I the second best room and get breakfast essentials for Sunday. Rachel and I both aren't skiing so we plan to shop Sunday for cooking and am looking forward to spending time with her reading and being her sous chef and snowshoeing and spa-ing. 

    Cecelia and Mia and Harper are leaving Fville in an hour and plan to stop in Oklahoma City at Mia's house - we cooked for her and her mom for brunch on the way out of Fville the other weekend. Mom is orthopedic nurse in OK City. She's nice - I'm glad the girls have a place to rest for a bit before the long drive. Blakely bowed out of the trip - she's missing her family in Illinois - C was sad but understood. Sometimes you need to plug back in with family to rejuvenate. I told her it was a blessing in disguise her car is so full of her stuff I wondered how four girls and their stuff would fit. Her dorm is tiny - she can't wait to move to a condo for next year.

    I started some laundry earlier and accidentally threw in a dryer sheet instead of soap - I realized my never made before mistake within a couple of minutes and fished out the dryer sheet and added soap but holy hell. I was so frustrated at work today, the luckily lightest day of the week, bc I was trying to take the quarterly ABpath stupid test for continuing education and maintenance of certification, which I have heard is getting more and more ridiculous in Path Mom group on FB. The pictures are so bad, apparently, that when the correct answer is revealed everyone groans. Yes, we know what that tumor looks like, and it looks nothing like the pic provided, so there was lots of begrudging. 

    I signed into ABpath and there was another level of security - a new added one. We will send a code to your email to verify who you are. WTF. Who would actually try to impersonate anyone to take a stupid continuing education test. I checked my email, and kept refreshing to no avail. I asked Melody for help and she echoed the stupidity level as an all time high. She showed me how to check my junk mail (she's really good at computers, beyond checking junk which I realize is super easy but I couldn't find it) but the code wasn't there either. I called ABP for the first time and got a long recorded message and got sent to voice mail. Left a terse message to fix the computer glitch, this is such a waste of my time, so we will see how it goes. I've got until the 31st to complete it so hopefully it will be worked out by then.

    March Madness is in full swing and although I never join Jessica and Tina and the majority of our work family is excited. Jessica organizes it every year. Melody has won twice in the past few years. All of my partners are in awe of her basketball knowledge, comparing her to my lack of. Jessica always says that the winners are usually the ones that don't know bball but just filling out a bracket and figuring out the shared app daunt me. Tina, who is about like me, has won the first two rounds. She was so excited she bragged about having more than one drink last night to celebrate. Jeff, the security guard I go way back with, was sleepy today too - he stayed up late watching the Arkansas game. It was a nail biter apparently, he told me the team they played, it started with a V, but I forget. He was so pumped up with adrenaline after it was over he couldn't sleep. Me neither, I said, but for different reasons.

    Since we are now sending our autopsies to UAMS (yay!) I was super relieved bc we got another request last week. These heart doctors are out of control. We had trouble getting rid of the body bc it was a younger guy and the UAMS pathologist was worried the family wanted toxicology and forensics which is something they, and we previously, don't do. PSA - if you order an autopsy don't ignore your phone for three days while the body sits in the cooler. Finally it went over Monday morning. I heard Jess in transcription and yelled, Did you get rid of that body yet??!! much to the delight and amusement of transcription.

    Dragon is fascinating. Learning that has been a little stressful too. I'm getting the hang of it and it's slowly learning my voice. A is mistaken all the time for 8. TTF-1 is PTF-1. I won't even try to tell you how bad it mangled meningotheliomatous meningioma or bilateral salpingo-oophorectomy but it gets better every day. I'm still dictating my cytologies bc there's a lot more steps which I was able to manage on Monday but when I got deluged on Tuesday and Wednesday I gave up. The secretaries are more than happy to listen to my voice, they said. They are having a long overdue relief without all their typing. I'm happy for them. The gross room loves it, they play games trying to trip up Dragon and laugh at the results. I had to go too slow at first - I'm an auctioneer and Dragon didn't like that, but it is slowly getting better. It's amazing how you can say a string of sentences and watch it pop up magically in the field. CoPath and Epic don't communicate well - and we've had to make a lot of adjustments. But when we get Beaker in a couple of years (they have been touting that for almost a decade) it should be more streamlined.

    Happy Friday! I'm looking forward to sleeping in and packing. Hopefully the blended family experiment goes well. Jack and C are excited to share CB with their other family and I'm excited that even though it has been a helluva hard couple of weeks there is relief on the horizon. And my health, while still not optimal, has improved so hopefully this year will be much better than last year. Watching The Dropout. It's fascinating - so addicted to the Elizabeth Holmes story I read the book a couple of years ago and Amanda Seyfried is amazing as her. Much love, Elizabeth

    

Non Binary

     Jack had some friends over last weekend. This doesn't happen very often, so I was really excited. After call, I went to Walgreen's and bought lots of Easter candy and went to Catering to You and bought gourmet popcorn and firecrackers (they were the most popular). A Southern tradition - I remember first learning about them at a Conway Regional potluck years ago. Soak saltines in butter, add copious red pepper and other spices, and bake. They are like crack. Noah and Jack polished them off quickly.

    I asked Jack who his friends were - Van and Nova are both girls I eat with at lunch, he said, but they identify as non binary. Oh boy. Another thing for me to learn. Lucy taught me all about transgender. She was only 20 when I met her and she had been transitioning with hormones for a year. She was loudly transgender in a state that wasn't quite ready for her, but I was. She aspired to be a model, and wanted to save her money to move to Ventura CA to be with her chosen family and realize her dreams.

    Which was a good thing, bc she was all pink and pretty when I met her (it was honestly a joy to be associated with someone so incredibly beautiful). Avery sometimes got frustrated with her when she worked at Boulevard bc she thought Lucy's definition of woman was to be admired by men. There's more to being a woman than that. Aww, let's cut her a little slack, I said. She's only been her true self for a year. She's young. She'll learn. Avery said that she was very awed by how much she was able to save money. And it paid off. She moved to CA last month, I learned on Insta. I see some of the clothes Christie and I bought her on her first ever shopping spree in her shoots and am proud to support her in a little way.

    She got black, I was worried, after she tried to start dating online. Arkansas (hell the whole world - my yoga friend Matt said they are demonizing the transgenders like they did the gays ten years ago) was not friendly. But she is confident as all hell and she recovered. I hope she has more luck in CA. She deserves it. She's young and gorgeous and set to conquer the world. We both celebrated when Sports Illustrated featured their first transgender model. 

    I was determined to learn what non-binary meant. I asked Sean, who worked at Boulevard Baptist last week for the first time in months - I gave him the biggest bear hug and Avery told me he is coming again tomorrow (Yay!). He said, Liz, honestly, I identify with LGBTQ but the definitions often confuse me. I'm really not sure. Christie didn't know either. Her son identified as gay from a young age but recently entered a relationship with a woman he met in college. Non-binary, I learned, is not identifying with any particular gender. 

    Not that I would bring anything up with Jack's friends but I wanted to understand what they identified with as a human being when I met them, which was around Saturday at noon when I was on the treadmill. I made plans to go to a movie with S to get out of their hair while they made mole and watched a movie. We saw Cyrano - I leaned over to S and groaned when they started singing. I didn't know it was a musical, I said. It's ok, he replied.

    Early in our relationship I took him to the movie Les Mis and it was a nightmare, he fell asleep and even I had to admit if fell flat, as a lot of musicals converted to movies do. He much preferred the live version at Robinson a couple of years ago. Cyrano had some good songs and some good scenes too, some I'd revisit, but not the movie overall. The awkward kiss reveal at the end felt like a girl forced to kiss her dying Uncle. But overall I love what Peter was trying to do. And boy can he sing! I just wasn't invested enough in the characters to feel emotion.

    On our way out we both had to use the restroom after copious Coke Zero with popcorn. S exclaimed in surprise that a girl had just exited the boy's bathroom. I laughed and elbowed him and called him an old man. Welcome to the new world, I said. It's gender fluid. Jack teaches me this. Lucy too. Cecelia has included LGBTQ issues in her sexual health organization. We don't always get it right, but we try and make mistakes and course correct. Happy Tuesday, it's the ides of March. My cousin Tommy's birthday. I think of him often. Much love, Elizabeth

It Snowed on the day my bro was born (March 9 1984)

     I still remember it. I was spending the night at my friend Melinda Fan's in NLR - she's now the breast path at freaking Harvard, and my parents called her rents to ask if I could stay longer bc mom broke her water. The sun was shining. It was snowing. It was really beautiful. I was so excited to meet Matt.

    This week started off ok? Tina shared a gross with me Monday morning that made me LOL. This girl doesn't know her bra size, but she wants the surgeon to get her down to a C or a D, so her boobs don't point at the floor. I'm like, who doesn't know their bra size, first of all, and second, where does she want them to point? Like headlights, or to the sky? Does anyone ever ask for a side eye? WTF?

    Then it took a turn for the worse. Crazy cases, tons of adrenaline. Not to mention the shitty war in the Ukraine. I was so strung out Thursday morning I shot out of bed at 5:30 worrying that I was late to CARTI general tumor board and skipped shower and got dressed in a hurry. Halfway down the hill I realized I was not only not going to be late for Sbucks I was over an hour early. A couple of egg bites later and a coffee down I was crying about a story I read in the news. Deep breaths. This is our new norm. Part of change. I'm here but not here for it. 

    Thursday I was so wiped I sent a present for Super Girl's friend Kim's bday with Jessica the thought of driving past 6pm was antithesis to my being. Luckily they sent lots of pics - trivia night at Mellow Mushroom. I checked in with the gross room this morning, slept and refreshed, and Savanna said that Jessica was stuck in an elevator with placentas? She texted me to log in all the specimens, that was her only request. 

    When it started snowing this afternoon I decided to check the OR schedule at hour early luckily it was dead. Lindsey, my on call PA, was busy picking up her kid, about Rennie's age, from childcare they had canceled aftercare. I asked Jess what was up with the elevator.

    We were going from one to ground. It faltered, lights went out, it was jolting, it was scary. It was me, a cart full of placentas, and a woman who's sister was air flighted last week to Baptist for a stroke. I learned everything about her life, over the course of an hour. Apparently Jess pushed the emergency call button and the Baptist help came to say they just needed to refresh the elevator but 20 mins later they said it didn't work and they called Schindler. Luckily that worked but it was hairy - the elevator drifted down to the ground floor then slowly and creepily up to the tenth floor where she got off and caught another elevator to get the placenta's safely to the morgue. Round two went to Bob she was done. Jack has a visceral fear of elevators - I'd better not share this story with him.

    My god the landscape is eerie and beautiful. I'm on call but going in late tomorrow to ensure the roads are ok. Went to Pantry West tonight with S - very early to get back before dark. A friend gifted me a large gift certificate. I remember going to Allouette's when I was little with my parents tasting escargot for the first time. Then in my 20's Denis was head chef - his pic is still on the wall. He was dating my friend who was a beautiful blond waitress less than half his age. A lovely scoundrel. He was the light of all of our parties, and he always made me lol. Loved seeing his pic. He lived loud. Happy Friday, much love, Elizabeth

    

Pisces New Moon

     New beginnings. I'm honestly tired. It's been a rough and busy week. Fun things, not all hard things, but still. I'm glad we are heading into the weekend. Jack and S and I are headed to Fayetteville tomorrow after work/school to do early bday celebration with Cecelia (19!). I got reservations at Cheers in the OPO early Saturday evening - they were booked from 6-8 when I called yesterday so I got a 5:30 slot. Menu looks amazing. Gonna be cloudy and rainy so I packed accordingly - luckily no calls for winter weather. She's invited Blakely and Woody. She seemed in good spirits when she called this morning - but had a packed weekend. I reminded her that Jack is supposed to be staying in her dorm? But the VRBO on Oak Street we got should accommodate him if she was too busy. She decided to try to cancel some things in order to hang out with Jack. That girl is always trying to fit 10 things into one slot. And she's always late. A character flaw, she acknowledged. But she has so many strengths that it's kind of easy to overlook.

    I had my second med exec committee Monday night and am starting to get the flow. I noticed they ask all the departments for updates - most decline, but it made me think I need to bring some juicy lab stuff to the table at the next one - we lab people need to insert ourselves into the conversation. Baptist is treating us to Trio's on the last Monday of March - no alcohol, Greg Crain asserted, you can buy that yourselves, but we will buy food. I'll take that. I'm starting to rethink this position and ally myself with admin. Cody Walker brought us surprise free strawberry banana smoothies yesterday - I was thankful bc I was so busy I forgot my 2:30 snack and it was already 3:00. It was lovely, I told him in the Dr. Lounge this morning. So appreciated. And my employees really appreciate Baptist giving them free meals if they stay at work during the storm. If the Ukranian president can try to negotiate with Putin, getting in good with admin should be a walk in the park. I'm softening. Getting to know people does that, no matter what side you land on.

    In med exec committee they bring raw policy changes to the table and we hone them. Last month it was how to treat physicians over 75 and everyone thought the plan was too punitive. So we fixed it and approved it on Monday. This time it was surgical time out - they are trying to make it better and the head of surgery presented their proposal. In case you don't know, surgical time out is something we have been doing for years to try to prevent operating on the wrong side. There was a neurosurgeon in my training who operated on the wrong side of the brain, so this is important. It was modeled after the airlines. A checklist. Involving a white board, and radiology, and verbal checkpoints to get everyone's ducks in a row to prevent mistakes. 

    The surgeon's decision was to mark everything with a marker before you operate. There was quiet dissention. Julia Goodwin, the chief of OB, said I have to mark the vagina with a marker? Not happening. She was so deadpan I almost LOL'd. David Shenker, the Chief of Staff (another OB), proclaimed that he would never write on a woman's perineum, no matter the policy. Some suggested they just make and x on the suprapubic abdomen. What's the point of that, said Julie. That's not even where I am operating. Seems silly and redundant. 

    Whit Goodwin, who I bought my Tallyho house from, had come to present something even though he is not chief. He seemed a little miffed that he missed the Trio's treat by a month. I hate to be a fly in the ointment, he said, but us rads often try to get a line in and if it doesn't work we move to another spot. So you want to remove procedure exemptions and make us do it too? It will always look like we are screwing up. Chief of ED echoed that. Sometimes in an emergency it's too crazy to do a time out and mark a pleural tap. So that one got sent back to committee for revisions. 

    ENT tumor board was Tuesday morning at 7 and I presented  a couple of weird cases for Sims and Stern - a pleomorphic dermal sarcoma (sorry guys I had to google that but it has none of the high risk behaviors like abundant necrosis and size over 3cm and invasion into muscle so I think it will be a good actor) and Merkel cell carcinoma (unlike PDS this is a board question however rare and this one behaved like a book). I also finished Q/A for the last six months of 2021 yay!!! Only backed up two months now. We all look really good. We are a stellar group. Turnaround time, comparison to outside diagnoses (I look at 50-80 of those every month). I'm proud to be with PLA.

    I'm the only one not trained on Dragon but everyone is raving about the efficiency. I think possible conversion to digital will be even better. My friend from Russia who is in my book club, Natalya, took her premature baby boys home this week and is planning a meet and greet with tea and cakes. William and Alexander are beautiful - she sent pics, and Kewan and I told her we can't wait to hold babies again. Things are busy, but everything is coming up roses. Happy Thursday (not birthday - everyone gets that wrong with the mask but hopefully that will be over soon). Much love, Elizabeth