Tuesday, December 27, 2022

Thankfully Back to the Grind

     Not that I had a bad holiday, but it was intense. I learned about two things that happened to Cecelia's friends, both that I know and love, that spun me into mental health instability and more GI craziness. One threw me into such PTSD it was all I could do to hang and shop and make lovely memories, which I did, but not without desperate phone calls and texts to Yousef and Paula and Kimberly. All wonderful grounding forces. It's one thing when you read about the ills of the world, which is important to do despite the unpleasantness, but another thing when it hits the young and the innocent. Ones you know.

    Your workspace is grounding as well - it's where you are in control, where you operate at the top of your game. After a day on the couch yesterday reading a novel and watching two movies (that Knives out redux was amazing and Breakfast at Tiffany's surprised me) I told S I was never more ready to return to work. It was busy, and I had a lot of BS CME Board reporting to do at the 11th hour but I managed to pull it off - almost, I still have a little more but not due until January 5 and that seems like a lot of time. To me. Melody is like Cecelia she has to get everything done in advance to stave off the anxiety. I'm like Jack - I work best under time pressure.

    I got a letter from the Patient Safety Officer tonight acknowledging my ED experience. And a text from Mike Perkins, the new Baptist LR CEO (I think? Admin titles elude me). That felt good. I assured Mike minutes ago that writing for me is processing, and based on all the wonderful experiences I have had at Baptist over the years that eclipsed that one I'm moving on. No need to sit down and talk, I told him. I said my piece. See you at the next med exec committee meeting. Enjoy the holidays and your family.

    The Shop Around the Corner was one of the most pleasant holiday surprises. While we were in Florida we were looking for a good holiday movie. Both that one and Bfast at T's had some terrible cultural appropriation but at the time? Probably misguided bc they didn't know any better. Mia, C's friend who spent her entire high school watching movies, recommended it. I will never forget Jack guffawing in my parent's living room. I shared it with S, and C and J shared it with Mike and Rachel. 

    Ugh I looked at my call calendar today and highlighted the rest of the fiscal year, through October. The reason I'm having such a gap is bc I have two weeks in a row three times in the Spring. Yikes! I've hardly ever done two weeks at once. It happens to Melody more often. But I'll buckle up and survive.

    Can't remember if I've mentioned this but we are planning a trip to Basque country in the Spring. My first ever two weeks off in a row. Barcelona, where I will see my high school friend Vicente, then Bordeaux then San Sebastian. I've ordered a ton of books on Basque history and culture, and C has amazing recs. I'm having a little panic over it. When I went to Germany to S's mom's hometown in Bad Herzfeld a few years ago there was no English speaking. It was beautiful, but I sometimes ordered a dish that was fish heads swimming in soup, accidentally. C assured me it was fine, and my brother told me that with all the advances in Google Translate I won't feel so isolated. You can take a picture of the chalkboard menu, and it will automatically translate it. Whew.

    So anyway. Happy Holidays. Looking forward to hosting C's friends this weekend and getting a little R&R the next weekend in Eureka then moving C into Hendrix on the 15th. She is so good. She's finishing her yoga instructor's degree and making all the fam look good with her thrifting at Goodwill. Jack has friends over tonight watching a movie. I'm hoping for a slow down after all of these patients meet their deductibles but who knows? I see new doctor names every day. It's a grind, but a good one. Much love, Elizabeth



Tuesday, December 13, 2022

Social Justice Crusade

     After I got back to work on Wednesday, which was Hell, I should have taken one more day off, my adrenaline from Monday crashed. But I got through it. I bought Dr. Flamik and Shelby and Katelynn, who blew my vein but she was nice, which goes a lot farther even if you are inexperienced, gift cards to Boulevard and some cookies for the employee lounge. By Thursday I still hadn't heard anything from Mackenzie, and I became worried when I talked to Jeff the security guard who said that happens more often than it should in the ED, with the nurses.

    I had a burning desire to be HEARD. I wrote an essay at 2:30 Thursday about my experience, one much more eloquent and less conversational than on the blog, and delivered it to Mackenzie and Mike Perkins and Pahls on Friday. Not in person, just in a work envelope. It felt a little like I was writing a victim's statement. Monday I had S's Christmas luncheon at his new building downtown, the Arkansas Pharmacy Association, so I had to cancel with Mackenzie but today her secretary rescheduled for 3:30.

    I've had a lot of good experiences at Baptist as a patient, and it feels comforting to see familiar faces. Chandra, head of phlebotomy, did my bloodwork. Jeff checked on me - he spends a lot of time trying to keep the ED, which can be chaotic, safe. My goal here is to educate, not litigate, I assured Mackenzie. Mike and I's goal is not to be victims here, but to try to right a wrong. Mike called me after I shared the essay for feedback Thursday night.

    I hope you aren't mad that I did something, he told me. I took a picture of you on the floor. Mad? Hell no. I felt validated. I shared it with Mackenzie. This nurse was insolent and aggressive and reading the room as wrong as hell, and refuting Mike's polite entreaties to get a stretcher. She asked if she could share my essay with the nurse manager, and I said absolutely. I told her after the weekend my urgency on the matter fell from 90% to 10%, but I didn't want to be swept under the rug.

    She agreed, and I told her I talked to my sister about it this past weekend. She is a P.A. at Scottish Rite (sp?) in Atlanta. She told me she has long been frustrated that physicians and P.A.'s get peer reviewed, but the nurses don't which allows for a lot of bad behavior. Not just insolence, but laziness. They get hired, they behave badly, they get fired. No peer review. I asked Mackenzie if nurses get peer reviewed at this hospital.

    I don't think so, she said. They get annual competencies, but not peer review. That's how we do it in my company, I told her, but we are much smaller and if there is bad behavior? Intentional or not? We root it out and address it immediately. We do not tolerate egos. Power trips. Laziness. She said I agree. I told her when you are vulnerable and someone is aggressive you doubt yourself. I did, I heard Mike doing it too. She said that is a good point. 

    So yesterday and Friday were awful. I became uncharacteristically terse with many employees on Monday and was glad to have a luncheon to go to. Shine, entertain. Get out of my own fing bad headspace. Enjoy the amazing view of the Capitol - there were obviously school carolers singing in abundance on the front lawn, I observed from the second floor which was created as an event space. The grand opening is tomorrow. 

    So if you've never seen carpal tetany I've got a pic. Of me, escaping incompetence on the ED floor. It's almost Wednesday, hump day, and I'm looking forward to a week off. Happy Tuesday, much love, Elizabeth

Tuesday, December 6, 2022

Carpal Tetany

     I was in a pretty bad headspace last weekend. Lots of plans, canceled. Went to bed at 5 Sunday night. Woke up at one. Twisting, writhing. Hot and cold. Surely I had a fever, but I'm a doctor, so nothing in the house to prove it, but I knew. I finally got out of bed at 4am for ice water. Sugar. Had lots of GI issues. But I rallied. Got up, showered, planned a low key outfit for Yaya's dinner. Had bfast with S and his dad, who was heading back to Austin. 

    Second guessed my plans to drive to work (dry heaving in my car), but drove on Cantrell, avoiding the interstate. Managed to get to work, and my head transcriptionist Tina automatically knew something was wrong. I was on her radar. I was dry heaving and shaking. I asked Melody to take my place at the dinner (they want us to represent) and she agreed.

    Finished off a tough breast cancer case and knocked out a few cytologies and decided I needed to rest with a blanket in Rex's old office - there is a nice recliner there. Dry heaving like a boss, and then puked water and half a bagel with peanut butter and cough drop juice and bile spectacularly in Rex's trash can. The secretaries came in, Jan and Tina, worried. This is nothing, I can handle this, but then something happened that I couldn't.

    I developed carpal tetany. This has happened to me twice before in my life. Once, as a teenager - I called my Dad from Allen TX after eating at Applebees. The second time, I had a puking episode all night after eating at a quinceanera at Nina's. Food poisoning, I wondered. Probably just a bad GI bug, in retrospect. I had to call in to my first day at the Crime Lab, one of the only times in residency. I had puked all night, and laid on the cold floor of the bathroom, my arms drawn up like I had cerebral palsy, burning and aching. 

    This time was much worse. I couldn't use my arms they were drawn up and rigid with pain. I told them I knew what it was, it was just an imbalance of electrolytes, and Melody ran to get a Powerade from the gift shop. But I was too far gone. Tina got a straw (I couldn't hold the bottle) and Jan called my ex with my instructions to get to our office ASAP. Before? It didn't hurt so bad. This time? I felt like my muscles and sinews and nerves were about to burst out of my skin. And it didn't let up, I was way beyond Gatorade. 

    I began screaming and moaning with pain. Sucks, being vulnerable at work. Mike said what I didn't want him too - you need to go to the ED. I couldn't stand up, so Quinn and Tina and Mike got me in a wheelchair and took me there. The last thing I wanted was to spend all day in the ED, but here we were. 

    I've got a pretty high pain tolerance. I didn't take any meds post kids (I was breastfeeding!) and the narcotics they gave me after I broke my jaw dulled me and did nothing good, so no pain seeking meds here. Here's where it went even more South. The intake nurse was on a power trip. Mike went back to secure a room with the docs and I thought she called my name.

    When she realized I came without me calling her name (I said Jackson!!! Not Seng!) I apologized but luckily Mike already had the ball rolling so she was forced to acknowledge me. She tried to take my blood pressure twice, and accused me of being uncooperative while assaulting my tetany painful arms. I was moaning and arching my back in the wheelchair while she was insisting on me telling her my name. My social security number. Mike aided me bc I was slurring in indescribable pain. 

    She was horribly rude, accusing me of malingering. Not my jam. Mike asked for a stretcher. She power tripped on him - saying she knew her job and I did not need a stretcher. He politely told her she's gonna be on the floor soon and then you will need one. I mean, he's a doctor? WTF? In all the craziness and confusion my body told me what I needed. A cold tile floor on my cheek, no care it was foul ED floor. Mike had tried to give me a bag earlier to stop me from hyperventilating but the pain was too bad. At this point, she accused me of jumping out of the wheelchair on purpose. 

    I have never felt so dehumanized and disrespected in my life, while I was in so much pain. Is this really the intake of our hospital, I wondered. My hospital. As the staff pulled me onto a stretcher, and my breathing eased and my hands returned to their normal state over the next half hour and my body returned to its normal self after potassium and magnesium infusions that took until 2:30 (I was correct in my dx) I became a little angry.

    My partners gave me the day off today. Melody told me Yaya's was so much fun she joked that she hoped I would be sick next year too. I called Mackenzie to tell her today. Before she responded, Christy came to bring food and gifts. She said she had the exact same experience. Harrison ED? Good. Baptist? I was treated like a criminal like I was lying to get admitted.

    My voice was shaking when Mackenzie called me back today. I'm not good at confrontation, I told her, and I would not be calling you unless Mike and Kimberly urged me too (Kimberly spent five hours of her birthday advocating for me in the ED, much needed). This cannot be our hospital's entryway, we have to do better. I'm more for re-education than punitive measures but this woman cannot be around people for a while, IMO. Mike was a bit more angry. She needs to be fired. 

    Ah the state of our system. Abandoning all that angst today, feeling much better, and wrapping Christmas presents - my partners gave me a much needed day off. I assured Mackenzie all the other docs and nurses in the ED were good to me - Katelynn, Shelby, Darren. Katelynn blew a vein in my wrist (ugh I could feel it happening) but was super polite about it and reclined me when I told her I had a history of passing out with blood draws. She was much more successful antecubital. One thing that angers me is that a question asked of both me and Mike was did they know she was a doctor? This shouldn't matter. GD. Everyone should be treated with respect. But hopefully I can use my stature to right a wrong. Happy Tuesday, feeling good enough to go back to work tomorrow. Much love, Elizabeth

Friday, December 2, 2022

Up in Arms

     Monday, after I belatedly realized that the med exec committee meeting at Yaya's was December 5th, Christy drove me home. We lol'd as we sang in the car. The anxiety dreams that had plagued me Sunday night continued. Here, I was going to do yoga (if only I had the energy ugh) in a strip mall and all the lights went out and I was a football field away from my car and had to run. There, I was in a public setting and something terrible happened and by the time I got to the scene the only thing I saw was a severed arm. 

    So I was very surprised on Tuesday when I got an arm as a specimen. Legs, toes, feet, transmetatarsal amputations are super common, but arms? Hands? Not a thing. My first arms were in residency at ACH - a young kid got electrocuted, I can't remember how, but I had to gross his arms. It was eerie - such a sensual receptor to lose. I dove into the charts and found out this arm belonged to a woman with multiple medical comorbidities (ESRD, DM2, etc.) who had axillary artery blockage that was not amenable to recanalization so they cut it off to try to alleviate the pain.

    It got me thinking about other arms, and hands. The fetal one under the microscope - I think I posted it here long ago bc I was scared it would trigger someone on Insta but the pic was amazing. The hand I signed out about a year ago from the woman on ECMO - hers had gone gangrenous and it moved me to tears and to text my entire family in gratitude.

    When you are on ECMO it's kind of tough for the machine to get circulation to your periphery - my Dad went into kidney failure briefly that luckily turned around and we had to be very vigilant about his hands and feet bc they were often blue and the CVICU nurses were amazing but no one cares for you like your family. So we scheduled around the clock care and my brother Matt took the night shift. He often had to ask for heat packs to keep the fingers and toes from losing circulation. 

    I went into the gross room Tuesday or Wednesday I lost track? The week after the holidays feels like a freaking year. There was a Sims frozen and it was a softball - Warthin's tumor. Such a beautiful thing with its oncocytes and lymphocytes and motor oil gross appearance. There is also a Warthin-like papillary thyroid carcinoma - very rare - I wowed Jesse McKenney by diagnosing it once in residency. Will probably never see it again.

    After I called the OR with the diagnosis I noticed something different at the bottom of the fridge - a large plastic bin. Jess? What is up with that? Oh, well, they are still complaining about the smell. From the legs. The head nurse came and talked and was really kind and not rude so we purchased this bin to satisfy them. Um why? I asked. There is no smell.

    Apparently, she said, some of the staff and patients see the legs in red biohazard bags and have an olfactory reaction based upon sight. It disturbs them. Well, I guess that makes sense, I said. We are a service industry. Jess said I finally got to retire this. She pointed to a porcelain metal bin with black rust marks under her grossing station.

    What the hell is that? Oh, it's been the leg holder for IDK, thirty years? Evans (a retired PA) probably got it off of the supply dock back in the 70's. Looks like it might have been used to bathe babies in the forties. I laughed. It certainly does, and when they were trying to get rid of it he repurposed it. 

    And what is up with the arm? And I also got an index finger this week. Poor thing had it crushed while welding and they could not save it. Jess said we had another arm this month, and I exclaimed in incredulity. What happened? Some guy punched through glass and severed his brachial plexus and they couldn't save it. Good god, I said. What a crazy month.

    But it's a new one, and I am not on call I discovered this week until January 16! Long strange wonderful hiatus. Heading to Port St. Joe on the 17th with C to visit mom and dad and I cannot wait. Long weekend solo re-reading old books I haven't visited in 8 years or so? Jack called to ask if he could invite friends over and I told him can we table that? I haven't had a weekend alone for as long as I can remember. Don't want to embarrass your friends with my singing. Happy Friday, much love, Elizabeth