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