3:09 AM

     That's what the digital clock read when I convinced myself this morning that I had GI lymphoma. It must have been a half dream, but the circular fans were cycling overhead and I felt like it was real. Far from dismay, I started to plan. Ugh I'm going to have to get an endoscopy for a diagnosis. Hopefully, and I was kind of sure of this, it was something low grade. Maybe follicular, or a MALT driven by H.pylori. This is doable, I decided, I just had to get my big girl panties on like when I had small kids and was in residency. The more you have on your plate the more efficient you become. I'll take Rituximab, if that is still the thing. I haven't done lymphomas in over five years, and things change. 

    I guess I still could have a GI lymphoma cooking, but what a relief to wake up and it be all a dream for now. I think it was probably work anxiety - Sunday's after a holiday are particularly stressful. Mine almost went South with my headspace after the family left but Jack saved me with a Merlin and a deep dive into Season 2 of White Lotus made it hard to stay in a funk.

   This morning was challenging. I told Michelle after I called her about a consult that I misjudged Friday, we all did. It was horrible. Lots of crazy cases, took me a couple of hours this morning to climb out from under them all. Michelle said, yeah, I always forget the Monday after Thanksgiving is the good day. The Friday isn't usually that bad, but the last one was a doozy. 

    I thought I was on call when I woke up, and I knew we had a med exec committee meeting at YaYa's from 6-8 tonight (what crazy person dreamed that up as a good idea the Monday after a holiday?) so I dressed to the nines and was so relieved when Tina told me no, Shaver is on call, not you. I was even more relieved when after consulting Shaver about a degenerative specimen that fell out of a lady's uterus in the ED over the weekend (he helped me with wiggle words - CYA type sign out) he told me to leave when I was done. Which was before 11. WHEW. Time for chill and nap before dinner.

    I am also having one of the worst GI days I've had in a while, will not bore you with details. It started off fine, I entered the dr. lounge and greeted Shirley who works there and asked how her holiday was (she worked the cafeteria on Thanksgiving). Then I noted Zach Roe was sitting down to a big breakfast as I was getting coffee. Hey Zach! I said. His sister shadowed me a couple of times a few years ago. I've not seen him much since.

    How is your sister? I asked. He said I was just texting her she's in her first year of medical school. Thanks for asking about Grace. Tell her I said hello please. I told him one of Cecelia's best friends is a scribe in the ER Anushka, we ate with her a few weeks ago at Three Fold. I told Zach that I had gone to high school with Lane England and to med school with Jon Palmer and Wayne Lyle so I feel like I know the whole ED. I told him I asked Anushka who is your favorite? She said Zach Roe.

    He smiled and said she is such a good scribe. Hendrix grad, trying for med school. They all are, I said, it's good experience, one of my recent shadows is in his first year after scribing for three years after college. His dad is a med tech in micro I've know for years. When people get as good as Anushka, Zach said (I could be spelling that wrong but it feels right over Zack) we silently and selfishly vote for them not to get into med school. Although we are always appropriately happy when they do. I've worked here long enough to see scribes finish residency, Zach said. I'm no spring chicken either, I quipped. It's fun to watch the new generation. Happy Monday! Much love, Elizabeth

Thanksgiving Week

     Ack I had the kind of a Monday that makes a five day weekend disappear. But oh well. 202 blocks, not a record but close. Lots of breast cancer. And I was brushing up on a case I signed out a couple of weeks ago to present at ENT tumor board tomorrow morning. Low grade mucoep in the parotid with a met good God - to the intraparotid lymph node. Not common, enough so you need to grab the books and show it around. 

    Seems Thanksgiving snuck up on everyone this year. It did Alyssa - she forgot she had planned a dinner Saturday night. We were going to go have a girl's night at her new lake house in Cherokee Village on Thunderbird Lake (there are seven lakes there!) but instead we did a day trip. It was fun - Hardy, which I've never been to, reminds me of a super tiny Eureka. Shopped in an apothecary, an antique store, and a record/boutique shop after having white Russians on her back porch all morning and eating lunch downtown in Hardy. 

    I said no worries about the plans. Things happen for a reason. So I got dinner reservations for S and I at a restaurant two blocks from our boutique - ALL DIGITAL SO WEIRD - hotel Saturday night. Whenever I make hotel and restaurant reservations S worries bc I accidentally sometimes delete important emails (Um, when you get forty a a day in this horrible climate it's easy to do). Friday while we were touring Alyssa's amazing pandemic renovated home, he made me forward him some emails. The key was digital at Intersect 311. You had to download an app to open the door. Gah! Too much work. Give me a freaking key. Interesting concept though. There was no ice, no reception, but a big fridge, and a fancy coffee shop in the basement.

    The Root was Saturday night and we were ordering after listening to the waiter talk about the Ecuador woman and her American husband (or vice versa?) and the gourmet fusion they created in this restaurant - it did not disappoint, although the drinks could have been stronger. Four honey infused Manhattans should have put me under the table but I was only slightly buzzed. A family wandered in and I was admiring the mom jeans on the teenager (only they can rock them) and I saw a familiar face.

    Jessica? Jessica? It's Elizabeth. Lots of big hugs and catching up ensued. Jay Thompson was in my med school class and he's sweet and goofy and we always wondered how he landed the classy as hell and gorgeous Jessica. He gave me a big hug, we talked about studying together long ago - Wayne Lyle and Jon Palmer? I still talk to Jon weekly, he said. You helped us. Kricia decorated my home, I told them. She just sent me an essay this past week she wants to post on KevinMD and I helped edit it and give advice. I see Wayne all the time. Please tell him I said hi, Jay said. Will do.

    The holiday snuck up on me too I thought I would have another weekend to decorate but no. So I did it a week early bc Mike and Effie are driving down from Chicago tomorrow and Cecelia will be home Tuesday. She called me ecstatic this morning with her finance package to Hendrix. She was in NYC the past few days for a psychology conference. God she's growing up. They leave the nest full of confidence and then realize how good they had it at home. I'm happy she will be closer. And it's my alma mater.

    So a week full of family and fun. Work too, unfortunately, but not call. Stopped at Edward's for staple food today and saw Susan McGeorge. Gunti? I asked her. That's what we called her back then. Holy hell. you have not changed. Um, Liz, it's been 15 years? She doesn't practice - stay at home mom. Yeah I haven't seen you since the last med school reunion. It's a theme week. Old friends. I told her about Lys and Jay and Jessica. 

    Mike and Rachel are hosting Thanksgiving for about 20ish people Annie and Dave and Adele and Will and Gretchen and Jason and us. I'm still peeved that our work has us come in the Friday after Thanksgiving but oh well. Baby steps. Iv'e got tons of food coming from Zingerman's - ordered a charcuterie board and pastry basket and cured meats. And the advent calendars are rolling in. Happy Monday, much love, Elizabeth

Friday Eve

     It's mine, so I should be excited, but it was a low energy bad GI kinda day. Last Friday was hell, I told Shaver when we went to the Dr. Lounge this morning and got coffee. I felt like someone had put a fire hose down my throat when I showed up for work and it did not stop. I'm not like Melody or Quinn, I cannot work through lunch I need a break. Thursday was great - I got to run errands, but Friday did not work for me.

    Ever since Bell retired we have been working harder. We have plus days, and we have double surgical days, but we don't often have triple surgical days. On top of cytology. That was my Friday. And on top of that, a new interventional pulmonologist had a two hour procedure that was a fruitless effort. I got called down three times to the bronch lab. Cidney has us spoiled. He is so good and fast. This guy is too, but after three passes of blood in a lymph node there is not much expectation for higher yield (this is scientifically proven. But who acknowledges science these days).  After thirty minutes of looking at slides of mostly blood I told Gary you screen them lmk if you need me to look at something. I cannot babysit on a day like this.

    The weekend was wonderful - Jack had Asher over Friday night and they did art. Noah came Saturday and after I worked I stocked up on chips and Little Debbie's to make a fun sleepover. Noah loves chips and ice cream. He's such a good friend to Jack, and vice versa. Call Saturday wasn't that hard so I didn't have a problem going to Fresh Market Sunday morning to get sausage for their bfast tortillas. Jack was so appreciative. I don't deserve him, he's so good (our kids teach as much to us as we do to them) but I love him, and love to guide him. One of his teachers asked him to let their almost high school kid shadow him at Central. He was so proud. 

    Rennie's turned nine this month and Mike and Rachel are having a celebration tomorrow night at their house. Hamburgers. I asked Rach what does she like? Anything a 20 year old would lol. So I wrapped Cecelia's advent calendar - 15 days of surprise makeup gifts I can buy her a new one. Jack got her a paperback gift box set of Harry Potter, so thoughtful. And Asher's bday is this week too I wrapped a fancy art set Jack ordered on Amazon. 

    Lys's bday is this Thursday. I used to visit her twice a year in Jonesboro. Since the pandemic, not so much. She bought a lake house in Cherokee village during the pandemic. It looks amazing online, I haven't seen it yet. We were going to spend the night there Saturday night for a girl night but she called me last night alarmed bc she forgot she had a work dinner Sat. I told her no worries? S and I will go out in Jonesboro instead. We have a swanky room in a luxury hotel less than a mile from her house. We can do girl's night another time.

    Nevertheless in my excitement I bought a birthday present for her and presents for her daughter Ainsley and her son Beckett and a group gift for her family. Enjoyed wrapping all the presents this weekend. Prior to that, I booked a massage Wednesday with Reiko and Paula Thursday morning and Christy is making shrimp and grits for us and Trey Thursday night. I told Christy I wanted to do an art project Thursday afternoon. Jack and Asher inspired me. Or I can be your sous chef, I told her. Whatever works. 

    C continues to heal and that makes me happy. Watched Everything Everywhere all at once yesterday and I laughed and ugly cried at the end. Such a powerful statement on the mother daughter bond, or lack thereof. Read all about the debonaire male protagonist at lunch. Also watching The English. Highly recommend. And speaking of C? She's pretty much a rock star too. On a different level. She teaches me so much. I'd hate for her to read this and compare herself to her sibling. They are both wonderful and unique in their own way.

    I talked to Susi Jeffus at UAMS last week - had sent her a case - and she was kvetching that she cobbled together a month rotation with SVI and Jonesboro. - private practice rotation. She's been texting us but we have no more multiheaded scopes and are way too busy to have a resident for a month. No one has taken me up on it, since I've created it. I told her I do a two hour tour and she is welcome to give my cell to the residents. I told her a couple of hours might be more palatable than a month. Are you sure? She asked me. Of course. I give college students my number. If they get weird, I can block them. And that has never happened.

    So a Rachel texted me last Monday and she is coming tomorrow. I have learned to give these kids explicit directions - hospital campuses are difficult to navigate. I'm excited to meet her. She reminded me of myself contacting Charlie Sullivan for a job so many years ago. I tailored my career to fit the needs of the group - Rachel seems to want to do the same thing. I hope it works out for us and her, but life and group needs are fluid so no promises just meeting and potential. Happy Friday Eve for me! Much love, Elizabeth

    

Subway

     About a few weeks ago I decided screw gluten free I'm eating it. Paula's work is making my GI system stronger and while it's not completely healthy it's better than it has been since before the pandemic. Cue Christmas Cookie ice cream, cue pizza, cue Subway. Talk about control/self-sabotage I've been doing it all wrong. My journey this week supported that decision.

    When I decided to start eating bread again I went to Subway, which I have been addicted to since my decision. Right about that time my good friend Amanda who works there disappeared. I was worried. Herman, the guy at Subway who looks twelve and had five kids back then, now six, came back after a two year hiatus. I missed him he was lovely. He courted me back then bragging about their guac, trying to lure me to them from Boulevard. Amanda told him she only comes when she need baked Lays. 

    Amanda is a single mom. She worked at Subway and as a janitor for UAMS. Once she complained about the rash she was getting from the mask, she has very sensitive skin like me, and I promptly went upstairs to my derm clinic and bought her my favorite barrier cream - it's fifty bucks, but it lasts a long time and it really helped her. She gave me a big bear hug that week. I will never forget it. 

    Herman refused to talk about Amanda. So did Donetta, the single mom who works the gift shop and Subway to make ends meet. I finally got the scoop from Scottish Brian. They were trying to make her move to a new location for three months. She needed to be in the same location to do her janitor work, and they weren't accommodating her needs. I was livid. 

    Corporate got nasty with her, and they were stonewalling their employees - telling them not to talk about it, I'm pretty sure. I told Herman and Donetta not to worry, I got the information from Brian, I just want to know if she is ok. When Herman realized I knew a half truth, he finally admitted that Corp was so bad with her that he didn't think she would ever work for them again. Fucking Aholes.

    I went to stand in line for Subway today. A radiologist employee, one I have know for years but I still don't know his name, was in front of me. We started talking about our departments, both being crucified by the system. I joked about his footlong sub, before I realized that I was wrong. He got a flatbread like me. He's super cute, so much so that all the girls in the gross room talk about him.

    About eight years ago I diagnosed his sister with lung cancer. I asked about her for two years every time I saw him. The last time I asked, maybe six years ago, she had passed. I extended my condolences. When I was talking about my six foot plus son and how much he could eat he told me about his 12 and 14 yo nieces and their appetites. The girl who actually ordered the footlong apologetically told me this was her lunch and dinner. No apologies needed, I told her. I only joke about men and never women's food intake.

    Cute rad dude was giving his veggie and sauce orders and I said Jasmine! Did you and April save any of the truffles I gave you yesterday (8 dollars worth, a pittance for me, but April and Jasmine screamed in appreciation I love surprising people) for Herman and Willie? Willie is also new, has beautiful sleeve tattoos, and has been giving me free Subway coupons and free cookies. You smile at me, he said. I love when people smile at me. Herman deadpanned no, Jasmine corrected him - we saved a few for the guys! Only if they deserve it, I said. You are in charge of the candy.

    I told rad guy that Jasmine teases me all the time for not getting meat on my sandwich, just cheese and veggies. He said you are probably in the right. I said no, I'm no saint, I eat meat, but it puts me to sleep and I need to be vigilant for the afternoon work. Rad guy was paying at this point and I heard Herman say $18 something which was a lot for a flatbread I thought, but whatever. I claimed my sandwich as he was walking out the door and tried to pay. He took care of your meal, Jasmine said. You can take it and go.

    I was so surprised I turned as he was leaving and said thank you! You made my day. He smiled and left. I cannot wait to see him again and asked about his nieces and make a better connection. S thinks he did it bc I helped with his sister. I think maybe I surprised him by being kind to restaurant workers (who are treated like shit in our society). Any which way, I'm very flattered.

    Christy was horribly depressed about the midterms but I'm kind of jazzed. Nope, we didn't win, and now we have Sarah fing Huckabee Sanders as our governor (Ack) but overall the red wave didn't happen and that's a good thing. Lucy told me change would take years and I think, Pollyanna me, that we are incrementally moving in the right direction.

    Jack has had a tough week - we watched Merlin tonight. I know you don't believe this, I told him, and you don't have too, but between the lunar eclipse and the full Moon this is a shitty electrical week. My journey taught me to weather it through creativity - writing and singing - two things I'm halfway decent at. So that's what I'm doing. Busy call week, lots of frozens, weird cases, what's new? I feel like a broken record. Glad to have Herman and April and Jasmine and Willie and my work family to support me through it. Happy Friday Eve, Love Elizabeth

    

Election Night

     Jeez fuck the news they got Trump so wrong I don't trust them anymore. I prefer to wind down on a Tuesday. Whatever happens will happen, I can't control it so I just go with the flow. I'll check tomorrow and react, hopefully things will go in my direction? But I've got no confidence anymore in this arena.

    Daylight savings time sucks ass. On top of that, I woke up at three thirty Sunday morning bathed in sweat. No prior history of this. I  pondered it for 45 minutes wondering WTF is up. It wasn't entirely uncomfortable at the beginning. We keep the bedroom at 67ish bc you truly sleep better when you are cold and I love snuggling in the covers. So light sweat, not affecting the covers, full body, cool air helping, but when the alarm went off I had an almost panic attack.

    I tried to get out of bed but dizzy as shit. Almost went to the ED but I know the limitations here so I acquiesced. Not flu shot related, I had it last week, so strike out there. Maybe a new viral strain? But I didn't feel bad other than sheen of sweat. Is this a new presentation of menopause that I haven't yet presented? I got panicky when the alarm went off. 

    I couldn't move. Got way too dizzy - was plotting Dr. office bc ED and Urgent Care I totally don't trust these days. But I was starting call Monday so I tried and tried to get to the shower with big fails. Sweating and dizzy this hasn't happened in two years. But aha, perioral numbing and distal fingertip numbing started happening and I was like. AHA. I'm hypoglycemic. I yelled to my spouse to get me ice cream ASAP.

    I have not had ice cream at home in a while, but Jack asked for mint chocolate chip and I saw the Christmas tree cookie and succumbed. It was amazing, I was up and showering in ten minutes, call Monday fail rescued. I think I've got crypto in a lung mass? Mucicarmine pending. There is just so much going on these days. But it's handleable. Happy what? Tuesday? Much love, Elizabeth.

The Penis Edition

     Man it's been a week. A better week. But a busy week. Today there were weird cancers crawling out of the woodwork. So much so that when I exploded around one my partner Melody said I'll do tumor board tomorrow (I was about to send a very inappropriate text to a very kind oncologist. Melody saved me. Again.) Let's trade, you do December 1st, I'll do tomorrow. OK. I acquiesced. It's so nice to be supported.

    Tommy in mycology has a son who is a first year in med school. He worked hard, tried for a few years, scribed in the ER after college, and now he's a freshman at UAMS. Tommy could not be prouder. I let his son shadow me a couple of months ago before he started. He's a gem. He wants to do family practice - the martyrs of medicine. He truly cares. Tommy followed me out of huddle the other day to talk. He said that his son was anxious but performing well - they were already being subjected to patient simulations.

    Gad, I said. They didn't start those until my junior year they are brand new students! It's a different world. My son is doing ok, he said, but something weird happened in cadaver lab. They asked the students to cut off the shaft of a penis. None of the boys raised their hand, but some of the girls did. I LOL'd. I'd totally volunteer for that. But we didn't do that in cadaver lab, or autopsy, or ever what is the new deal? I mean, I'm sure the corpus cavernosum and the corpus spongiosum would be satisfying to squeeze between scissors, so squishy (Lorena would know love her) but what is the point? More foot forward anatomical dissection? Gotta see the vessels and the urethra?

    When I was in cadaver lab there was no looking or dissecting of any GU or GYN parts. External ones anyway. Except this one lady, her head was appropriately covered, who had a clitoris the size of a small penis we all rotated around and looked at it in awe. Gender is truly fluid. No body is alike, and no anatomy is wrong.

    Our patient simulations started junior year, not Freshman. They were new and so fing stressful. I remember back then I had such a bad unilateral sweating problem I researched lots of crazy deodorants many with minerals and once my ex accidentally used mine and was in excruciating pain all day. It didn't hurt me, but it staved my public embarrassment. 

    We had to do a male GU exam on a fake patient actor and ask all the right questions while being recorded and do a penile exam. My silk tank was soaked through at the end, but I got a good grade thank god. One of my friends Melissa was almost crying at the end of hers - we all met at the end in the lobby to commiserate. She forgot to put gloves on, and did the penile exam without them. She's a SAHM mom now, but aimed to be peds. She thought she had ruined her career. It was honestly hilarious.

    I got a penis this week. This is a very rare specimen in pathology, and usually is involved by squamous cell carcinoma. This one wasn't. Poor guy was on end stage renal dialysis and had calcified atherosclerosis and distal necrosis. I struggled with the path - I can count on one hand the number of penises I've had in my career. Had to pull out the old Histology for pathologists and I was right on the mark. 

    Called Bob to ask him a question about it yesterday. He's at lunch, Laurie said. Well, tell him it's not urgent but I have to ask him about his penis specimen. So you want me to tell you to ask Bob to call you about his penis? LOL. Yes. Sorry, I couldn't resist, she said. Bob is one of the last men in the gross room, I'm cultivating a female atmosphere. He tells people that he works with a lot of beautiful women. That must be amazing, his friends say. Um, no. I'm daily subjected to some crazy ass smack. But I think he still loves us. Happy hump day. Much love, Elizabeth.