Support

     For an essay title that's pretty bad but if there was a theme this week, that would be it. I've been continuing to provide daily support for C and she is moving in the right direction. She and Christy and her new beau are all at the Format Festival this weekend. Christy called this morning - she said it was hilarious bc there was no cell service, it was in the middle of nowhere, and it was like a comedy of an entire (very professionally done, she told me, good, I said, Woodstock 99 docs have given me PTSD) fan base, security, food vendors trying to get cell service the whole time. I just told Cecelia she and her friends should bring lighters tonight, that's what we did back in the day.

    Monday was kinda crazy - Jan in transcription's daughter was upstairs delivering her first girl and Tina was at jury duty and Kimberly's brother Kyle came to ED for second day in a row. C'mon let me help you get some info. I grabbed my white coat and walked into the Dr. pod. I introduced myself to a Dr. Melton, they only one in there. I saw Wayne, who I went to med school with, and Lane, who I went to high school with, but I don't know you. I'm Elizabeth. I'm Shane, we all rhyme he said with a deadpan burnout voice but then found Kyle in the queue, told me to talk to the head nurse Michael over there to find out the wait, and honestly tried to talk us out of waiting for the sx he was having.

    I went into the overcrowded waiting room that immediately made me hot and dizzy and grabbed Kyle out of the throng of sick people to explain what he could and could not expect out of the ED when our name was called. As Shane walked in he said that was fast and I said I promise I did not pull any strings that's not my intent here but I appreciate it. Turns out Shane went to the same Methodist church in Bryant as Kimberly and Kyle's dad and stepmom and spent ten years doing house calls and supporting them through his multiple myeloma before he passed. So even though Kyle didn't get what he needed (they will not do an EGD in the ED for outpatient stomach pain unless you are coughing up blood and need to be admitted) I told Wayne when I brought two dozen Boulevard cookies for the break room the next day that I see all the posts in BMD. Insurance is squeezing out primary care who are leaving in droves bc they are so miserably overworked then you go to an urgent care bc you can't get in for three months and they tell you to go to ED with a 6 hour wait it's just such a fucked up system. You are under appreciated and overworked heroes. He smiled and said thanks, Liz, it's not a problem. He was always so laid back.

    Jan's granddaughter was delivered without problems and that was a high then we found out that Tina got picked for jury duty again and we were like what? Second murder case in a year she has been picked for jury duty. Like she's got a target on her back. We tried to entertain her a little through text until she got back on Friday. It was a nightmare, she said. Evidence was terrible. Forensic path was that new girl I had on the autopsy presentation I forget her name. Ended up being a hung jury. Lots of highs and lows, in transcription this week. 

    Poor Frankie in micro came out of retirement from being a med tech at ACH to help us during the pandemic. She is no nonsense, in her 70's, with short bristly grey hair and wonderful black blocky glasses, we talk books sometimes. Her hairdresser saw a suspicious lesion on her scalp, she showed me a pic, and wondered if I could help her get into derm bc she didn't want to wait three weeks. She just went through a large melanoma diagnosis and re-excision with her sister in Memphis - I helped interpret reports - so I texted Ahmad and he is going to pull some strings to get her in with Hayden Franks on Tuesday, Christy's derm. I texted you for Dan Smith - yes, Ahmad said, he is my first choice, but he's here vacationing with me. Oh! Tell him thanks - S's alopecia is gone.

    Thursday was our annual shareholder's meeting at LRCC and that's two weeks in a row I had to perform on a work night and that just is really hard for me these days. Last week Jack wanted me at this Clinton Library thing to support and watch Hillary and Chelsea's new show Gutsy, which was cute but smacked a little bit of we sophisticated people go back to LR to show you our hillbilly roots, and since Jack mostly hung with his student council friends and sat with them and wanted to talk with them afterwards I got an Uber bc I was ready to go. Thursday night I missed the dinner part supporting Cecelia and I was spinning I was so over it. Choked up a little in front of my partners but regrouped bc I wasn't about to hijack the evening with my issues. I sat there while they talked way past dinner on an empty stomach and three drinks and almost fell out after I tried two Ubers - one said 22 minutes one said 30 minutes as the bill was being paid but luckily Shaver offered to drive me home. 

    Thursday at four I was working on two hard cases - a metastatic urothelial cell carcinoma to the lung hilar nodes - Moeez (pronounced Mo-ez) Beg, a new interventional pulmonologist, had used me for a wet read the day before. And Gary brought a stat case for a 20 something female with HIV who came in with pneumonia. Pneumocystis all over the BAL. I don't know those NLR docs but this is stat and I googled her to call her - Zafirah Salman. She's stunning, and looked like maybe has ties to Pakistan and a small girl she was tweeting about it. I was worried for any possible family or friends she had over there bc it's drowning (yet we still let Trump and Musk and Putin dominate our news cycle eye roll). She thanked me for the phone call, I told her I knew she probably had been pre-emptive tx her with Bactrim but it was still a very impressive GMS stain. Pneumocystis jeroveckii everywhere.

    When Beg called me Friday morning about his case I found out they are brother and sister in law and I was the discussion at their dinner together Thursday night. I got so excited I grabbed the GMS from micro (I had presented the case in huddle and left it for them to see) and took pics and sent them on group text. WOW THAT's AMAZING (no all caps but they loved seeing it they were ebullient). Made me happy. 

    I'm having a calm girl's night Ms. Kandi Noah's caretaker and Becky Langley who I've know for years and first went to Crested Butte with - she started our single mom's Sunday school which has fallen apart oh well. There's a time for everything. Anyway they are coming over I said let's do a heavy app potluck and I'll have a key lime pie I just cut up the strawberries for it. I'll also do a cheese and cracker and fruit tray. Let's have dinner and swim (suits optional I emphasized - women need a safe space our bodies are so over scrutinized and under appreciated for what they can do) or just put your feet in the water and watch the sunset. Next M-W I'll be in Jefferson City, MO for a lab inspection - the last one ever for just NLR we finally got the two hospitals combined. Conway is a little too far away for that so the CAP inspections will continue there. So more business but for now, calm. Happy Saturday, much love, Elizabeth

    

Way Off Kilter

     It's been a doozy of a call week, and while I've had hundreds of cases (no exaggeration) I'll tell you about one. Brian and Jamie Burton are a OB/GYN onc duo. I referred a BFF (deeds) to Brian a year or so ago - she'd been seeing midlevels for years (Ugh don't get me started midlevels suck go to a freaking dr.) and he's revolutionalized her life. I don't care if that's a word or not. I made it one.

    Anyway, he had a frozen mid-week. And he's not a normal freezer. But this chick came in with a boggy uterus and he sent a sample of her cervix. Malignant, I said. Maybe Squam? That would be common, but it's horribly discohesive on permanents and I showed Melody bc I was like WTF? Three rounds of immunos later I was texting Jesse on Thursday morning. I can't get anything to stick. Can you help? Are you on service? We do crazy (Cleveland Clinic), he texted back. I'm happy to help.

    Meanwhile Jamie is calling me on the way home from work Thursday telling me she will see this chick on Tuesday. I'm on the way home, she is on the way to a football game. I'm telling her nothing stained but blush synaptophysin which I do not trust as far as I can throw it. Can you call it malignant, so I can get a PET scan? Absolutely, I told her, I'll revise the report ASAP. The ins and outs of insurance are a nightmare I'm happy to accommodate. 

    So honestly that one is up in the air. Along with many other balls I'm juggling right now. My oldest is dealing with a bombshell that was predictable but still. It's eating at my every fraying nerve. As a parent, you want to fix. As an adult mom, you just support. And that can be really rewarding but really hard. Give me back my toddlers, ASAP.

    After call Saturday (creating ten more cases for me to tie up on Monday) I came home to lovely Jack in a crunch creating multiple meals for he and his non-binary friend Rory (I spilled the news to his Dad last week on the phone and Jack is grateful. We are testing patriarchy and I think he might be chameleon enough to jump on board) to got to Ozark for a music festival of cover bands I think? With C and her friend Leila they were camping I cannot wait to hear about it.

    Jack was making chicken fried rice and homemade banana bread muffins from scratch and trying to get out the door by one which changed to 2 bc he slept in. My contribution was cleaning the kitchen. I told S, can you imagine? Any teenager preparing this much for a small town music festival? If he did all this for me - I tasted the CFR it was mouth melting - I'd invite him to every freaking music festival for the rest of my life. 

    So Christy's French lover turned out a dud. Those French guys do have a tendency to be an ass. But, she found a new guy on social media. Her friend Hayley told her if she want so date she has to get on social media so she doesn't look like a serial killer. Good advice. She's now with a guy Trey, who is as emotionally supportive as he is fun in bed, which is really important. Much more so, IMO. He's also from Harrison, and the mom's know each other, which is cute as can be they talk about the relationship in the local grocery.

    We had them over last night. Grilled, I remember that, but I tapped out early and we still have a key lime pie in the fridge I feel guilty about bc I never presented it. Maybe eat some tonight. Happy Sunday. I was born on a Sunday. Much love, Elizabeth

The Wizard of Oz

     It's a good thing the weekend was so good or I might just throw in this GI crap towel. Last Friday the casework was insane - I'd forgotten to take my beta blocker that morning and was having chest tightness by noon. No need to check the old blood pressure I could feel it. I knew I probably had a refill left at the pharmacy so when I told Mike to call in some Paxlovid for Jack (he tested positiveThursday night) I decided to get some more Metoprolol too, so I could have a purse back up.

    Jack's second round - so our weekend of plans and S's dad coming and projects disappeared before our eyes. Quarantining for him. I told Jack everything happens for a reason, and we honestly needed the R&R. He got to cancel his last few shifts at the sno cone station and we didn't have to entertain (although S's Dad is pretty laid back and fun). I actually ate a few bites at each meal and didn't need cough drops. Read two novels. 

    Was still feeling good Tuesday morning - making plans for long neglected friendships and tackling cases, but by noon it was unraveling. I got fish and wild rice from the dr. lounge but started dry heaving after two bites and had to toss it in the bathroom trash across the hall. Went back down to get the vanilla soft serve yogurt - they recently fixed the machine and I'm so excited - it's more like milkshake, honestly, they need to turn the temp down, but I'll take it.

    At 3:30 I puked violently into my trash can at work. As I left for an appointment with Paula, I asked Dr. Quinn if he heard. He worried I needed a cold wet towel for my forehead. No, I'm fine, I'm used to it, it just normally doesn't happen at work. It's sooo loud. S can hear it from the pond and the garage. I'm thinking about putting out an advert to do a voice reel for exorcism horror movies. He smiled, but his eyes were sad.

    Paula was great and a lot came up. When I was little there was nothing I loved more than The Wizard of Oz. We had a tiny toy black poodle named Toto that was the joy of my life. Once, when my Aunt Sheeran learned from my mom of my obsession, she bought me the novel for Christmas, I was maybe six or seven? The Nestrud's had driven down from Chicago and Minnesota for their annual pilgrimage to Arkansas with their dog, aptly named Tinman - a Great Dane maybe? Huge to me. I was so excited to open the book I accidentally tore the cover with the movie picture on it, one of the biggest tragedies of my thus young life. In retrospect, the red cover with gold lettering and the author's name on it - L Frank Baum, was infinitely cooler than the movie cover.

    So all this is coming up - you don't just go into other dimensions you relive memories, and I told Paula it was so ironic that those were coming up bc there was a double rainbow Monday night and all I could think of is that I was Dorothy, and there was my Oz. Not too far away. Just gotta be patient. In order to process all this I set up a meeting with Yousef tomorrow - it's been a while. I'm off until Monday, and after being up all night with the runs and puking again in my trash can spectacularly at 11am I need it. I finished up my cases by one and my partners volunteered to cover the OR from 1-4 so I could go home. It is so fucking hard for me to ask for help when I need it. But they all looked at me like I was a trooper for even trying to show up to work at all.

    I've been seeing a lot of good results online from Paxlovid, and Kewen Jauss called me about a case Friday and said her entire family was ravaged a week ago and it really helped to mitigate the symptoms. Jack had a rough first day but by Saturday morning with the meds on board he was upstairs in his velvet Harry Potter cloak and his N95 mask baking lemon pound cake and stirring wild blueberry jam into the batter. Genius! I told him. This will be one of the best memories of my life. It tasted so amazing with the brandied strawberries that had been soaking for 48 hours. 

    Well I'm going to chill and maybe go to bed at an ungodly early hour because I have no obligations until one. Still need to work on my mom's 75th bday project - I got the whole family to pick wishes and I need to sign each wishers name on the back of their wooden token wish and wrap and Fedex but I've got Thursday and Friday. Headed to a VRBO on Lake Hamilton for the weekend - Laurie has done it twice this summer and I admired and booked. Happy MY Friday:), much love, Elizabeth