New Mascot: Shitbucket

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

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

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

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

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

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

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

    

Bad News Friday

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

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

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

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

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

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

Happy Saturday, Much love, E

Queensland

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

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

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

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

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

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

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

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

    

Post Vacay Call Monday/Summer Solstice Eve

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

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

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

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

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

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

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

 

I'm Off!

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

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

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

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

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

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

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

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

    

Mass Chaos

     When I came into work one morning this week and saw there were Tulsa shootings at a hospital I freaked out. Tulsa recently came to inspect us for our CAP inspection, and although I didn't know the head guy, he said his partner was the internet meme notorious Anne Herdman Royale.  I've known her online for almost a decade. Messaged her on Insta. Yes, she said, that is my hospital, he killed two orthopedic surgeons one of whom is a Saint (the targeted one) and I am soo over this. Her cytotech was in the waiting room as one of the next patients to see the surgeon who was killed, and luckily wasn't the unfortunate patient who was in the way of the docs. Sending healing love, I said, no thoughts or prayers.

    And WTF happened in Texas? I was reading the NYTimes this morning and apparently the small six member police team went in first and after two officers got grazed by bullets big boss man delusional style turned an active shooter situation into a hostage negotiation? While big bad wolf was eating children and women they were trying to call him? Poor itty bitty scared officers built a vast perimeter while children were stuck under dead teachers and one survivor managed to call 911 twice - one call 13 minutes another 17 while armed police were holding back parents with audible shooting. SMH. Some border patrol finally got fed up after an hour (and many more life losses than were necessary) and got janitor keys and despite the fact they were ordered not to go in they did and killed him. 

    Big boss man was silently sworn into City council after the shootings and I honestly hope he goes the way of Anthony Weiner and Harvey but we elected Trump? And apparently the NYTimes even worships Elon Musk enough to cover the shit out of him. And the whole world even my best friends are excited about the new Top Gun? Tom Cruise ugh. So who knows which way that flag will fall. It's a mystery.

    We had a going away party for a micro lab tech who has been with us for 17 years. Bradley is moving to Indianapolis to be with his cousins. We got on the discussion of shootings. Everyone was surprised there was one at the zoo last weekend. A 7 year old was killed, I said. Not sure if she was inside or outside the zoo but my friend Christy knows someone who was at the petting zoo and tons of shots were fired they all barricaded in a bathroom where some unfortunate individual was taking a massive dump. Eww. I tried to read about it but it was essentially buried by the police as an isolated incident. Isolated incident my ass.

    One of the techs Marla who lives outside of LR said that at their shooting drills at her kids school (elementary age) the teacher keeps soup cans in the closet and trains the kids to throw the soup cans at the shooter. I rolled my eyes and had to backtrack a bit bc it doesn't do good to bring up politics at work. I can see how giving children an actionable thing to do might empower them, I said. In my mind I was like holy hell. Soup cans against AR-15's. This is their solution. Might have been better for those Texas kids to have had a bunch of soup cans than a freaking massive police force. I told my transcriptionist Tina after the Tulsa debacle we had better bring some freaking soup cans to work.

    I had another student shadow this week Lawren she was amazing had a ton of questions and wants to be a pediatrician so I threw in lots of stories about my dad and had Jessica talk to her a lot about the logistics of baby autopsies and miscarriage handling (the hospital does it very well with lots of time for mom to hold baby and pics and handprints and footprints. The one time in training I got held up doing an autopsy bc mom wanted to hold her child a bit longer I was like hell let her hold as long as she wants I'll wait forever this is not an inconvenience to me).

    Met with new admin Mackenzie on Friday and gave her a tour of PLA - she was as fascinated as the premed students about the gross room and played with a brain so long she thanked us for indulging her. Looking forward to developing a relationship with her - we had some good convos about inherent ageism in the system. Her grandmother who is sharp as a tack is recovering from stroke and is at BHRI I told her all about my dad and his ordeal and empathized. Ageism, racism, sexism, we are fighting a huge battle but pollyanna me thinks we will still win. Happy Saturday, Much love, E.