Tuesday, April 12, 2022

Raw and Bloody

     I'm supposed to be writing an overdue bit of my part for a contract bid but holy hell. I only realized I was overdue, thought I was on top of the shit, at 3:00 today. Overly apologized and it's gonna be ok. I walked into Melody's office this morning after presenting an effing epitheliod rhabdomyosarcoma at ENT tumor board and said I'm raw and bloody. Feel like my skin has been peeled. She laughed. That's an apt portrayal of how my month has been so far. It's weird, every day we think it's not going to get worse bc it couldn't but it does. So we have stopped hoping we are just pushing through.

    My attending at my three months in residency at ACH was the international expert at rhabdomyosarcoma. So I've seen a lot, and gave a good presentation, although it's such a zebra this is my first real case. The outside derm diagnosed it as melanoma in situ collision tumor with atypical fibroxanthoma (AFX) and well. They got it wrong. They also screwed us over years ago with pod labs in a subcommittee of the Arkansas legislature (who I knew (the subcommittee) at the time had no idea of what was going on so it was freaking useless) so LOL. Karma is a bitch. It's usually in kids, not 83 year olds, so even the rad oncs were like IDK? Need to review the lit? Treat it like a high grade son of a bitch, said Scott Stern.

    I was also on the hook for an organ harvest until 9 last night which frayed my every loving bloody nerve. I get this once every 5 years so I always have to print off articles on liver viability evaluation by frozen section and Batts and Ludwig criteria, which I dutifully did. Christian, from ARORA, seemed to think he would know if he needed me or not by 7:30 but it's always a bit of a toss up and when I texted him at 8:30 after I finished preparing for 7 am conference he said they were just getting a visualization on the liver and the kidneys.

    I had looked up the patient earlier - the donor - and she had a history of bad polysubstance abuse. No judgement here, but I was thinking that means the liver is probably shot to hell and I won't have to go in. Giddy optimism. I chided myself. I should be thinking of the recipient not the donor what kind of monster am I. When he texted at 9pm no biopsy I was like thank fucking god sorry for all those out there who need livers. There was an Arkansas storm of the ages who wants to drive in that shit.

    I was triaging cases this morning and saw that I had a testicle at 9am. I fing hate testicles. The tumors are so hard and so uncommon I sent the last off to Jesse a year ago. Then I saw grossly on the slides that they were bloody as hell and got optimistic. Maybe torsion? Testicles and ovaries do this occasionally, painful as hell from what I read, but treatable with surgical excision. I dove into the chart and the patient, young, thirties, was visiting a friend and was a drive by shooting victim - they hit his thigh and his penis and his testicle. Easy for me, unthinkable for him. I told Melody, we may be bloody and raw as hell, but there is worse. She agreed.

    It's early in call and work is taxing but doable, I told Jack. We had a long and fruitful talk tonight about family and friends and many other things. I'm emotionally over the edge but sharing with partners helps and they share with me and we bond? Most of us. Rare ones are lost causes. Melody is a gem. Shaver is having trouble with a cold but overall supportive. I'm counting down the days to Sedona, and Vegas, and Eureka - all happening within the next month (AND HALSEY!!!). Happy Tuesday, much love, Elizabeth.

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