The Aftermath

     When my Mom warned me about tornadoes last night I looked online and was like Meh? Not us. It's never us. Usually not. I was the teenager that drove around during tornado warnings thinking I was completely immune. Jeep top down. Ignorant as bliss. Dumb as shit. Not so much in my almost 50.

    I looked last night at the weather and it seemed to not be going to Pulaski County. I woke up at 4:00, anxious about finishing my stupid American Board of Pathology questions before the deadline. 18 of them. I always push it to the last minute. Melody, not so much, she does them right away. Different personalities. Me, peaking at the deadline, her, the ever loving amazing schoolgirl getting it all done up front.

    I was at work so early I finished my cases at 1:00. Started looking at the storm news and freaked out. It was like Hurricane Michael, which destroyed my parent's house. It went from 0-100 in a few hours. I don't like driving in storms these days. Jack called and said he was headed to NLR for an appointment and I said hell no go straight home postpone that. I called S and asked him to come to the hospital - I was covering frozens until Shaver finished a meeting and an errand.

    He thought I was being an alarmist, but I never usually am. Still, blood pressure was mounting and I took a Hydroxyzine (fancy Benadryl) to calm my chest pain. When at 2:30 Shaver finally returned to let me go he told S don't leave right now. I had already heard the secretaries talking about touch down in Chenal and the Rodney Parham Kroger. Let's just wait this out for a bit, I said.

    We decided to go to the gift shop to waste time but that was a bad idea. I had already heard they were evacuating patients at ACH (Jan's kid works there) and the front of the hospital, usually teeming with visitors, was empty. Med Towers 2 was completely in the dark (Tornado protocol? Generator failure ? No clue). I was scared walking in front of the windows, and the creepy vibe of the visitors and patients in the Med Towers huddling in the dark scrunched down in the hallway from the windows made my anxiety shoot through the roof.

    After the danger passed I just wanted to go home. But the traffic, holy hell! 430 was completely at a standstill. I know a way through Shackleford, I said. but it was completely impassable. Tried to get through Bowman to Mara Lynn to Green Mountain but it seemed like every time we got to a place to get free a shitload of cops blocked the intersection. WTF? They are making this worse, I thought, seeing cars blown into buildings at ridiculous angles. Cartoonish people making poor decisions at the defunct stoplights. Clogging up the intersections. 

    There were miracles, too, just like in the movies and TV shows. After the cops blocked up all the intersections, clownishly, forcing us into a never ending circle. Chenal was the only route home. Still agonizingly slow, but there were two adorable youngish girls directing traffic, think long neon braided hair and fancy dresses, helping us poor tired motorists at the last bottleneck in middle Chenal. I wanted to hug them.

    Lots of pics shared, in group texts. Foxcroft looks destroyed, Pavilion in the Park looks like the victim of a monsoon. Middle Chenal had trees downed everywhere. One of my micro techs, who lives near Rodney Parham has significant damage to her house. So funny how it skips things, I wondered in the traffic. Like Crohn's disease. One block intact, one part of the intestine intact, the other part annihilated. 

    So far everyone I know and love is accounted for. But the pics on FB! I hope there weren't too many casualties. What a storm. Rivercrest looks untouched. Planning long needed lazy weekend and my only work day next week is Monday. ZERO plans for Tuesday through Friday. Maybe a massage. Book reading. Speaking of, I read Demon Copperhead last week and I've read most of Kingsolver's body of work but this was definitely one of my faves. Happy Friday, much love, Elizabeth

    

Low Hanging Fish

     Rage, is what I'm feeling. Past 48 hours. Full of it. Finally knocking the wind out of my sails. Can't really discuss why, sometimes you have to reign it in instead of airing your dirty laundry for the whole world (at least my 22 or so hits a post) to see. Writing is like activating the steam valve. Like S's riding of bikes. We joke, he's riding, I'm writing. Or like singing, for me anyway. It helps stem the urge to curse the shit out of anyone and everyone.

    I ran out of my blood pressure meds on Sunday and yesterday, well it went by way of the water and yogurt and berries in my stomach that cut my day way short. Luckily I hit the trash can. But embarrassing. It's like the Exorcist girl, for all the office with the thin walls to hear. Today when I came in to see my work was taken care of I cried to the secretary in relief and gratitude. Shaver came in this morning and gave me a loving lecture, much needed. We are family. We need to depend on each other. You aren't the only one who gets sick. I didn't even know you went home.

    I should have told you, I said. I was just feeling helpless and weak. To ask for help? Unthinkable. More sign of already weakness. We were happy to plug in. You know that breast cancer case (I had done half of my work but couldn't stay around bc I was running hot and cold and felt like I was going to blow off to histology, them bringing cases too slow to get me out of there). I did ask Staggs to cover my afternoon frozens, I said. But thank you for recognizing and absorbing. There was a micromet in the lymph node that you half worked up. You didn't see it, I didn't either, on the H&E. I told him that's why I always tell the gross room cytokeratins are important, on these breast sentinel nodes. Order in advance. I've seen two of those, since January. You cannot be too careful.

    I went to get my metoprolol about 6 hours after I turned in the slip to the pharmacy. Usually you text me a lot sooner than this? She spent an excruciating ten minutes looking through the drawers. It's not here. An agonizingly slow consult with the pharmacist revealed that I cannot pick them up until April 1. You picked it up last January 23. But that's not until Saturday, I said, my blood pressure rising ironically. Do you want me to wait until Saturday to control my blood pressure? Thinking, they are acting like I'm begging for Vicodin or something. 

    Well, she finally said, under pressure and the state of my duress, we can get you some but you have to pay for it. Fine! I said. How much can it cost? Um 10 dollars and 49 cents. That's well worth my while to get it, I told her. And you will have extra! She said. What the fresh hell is this? New insurance rules? I've never been denied the one med I have needed over the past few years.

    My financial advisor came for a regular update today. Things are looking good. He's smart, I learn a lot by listening to him but this is not my area of expertise, like physics, so I sometimes get lost in my head. We were discussing ways to save money. How about running one of those audits on our checking account? To get rid of those miscellaneous charges. I've seen it advertised on TV, I asked. Or is that just a low hanging fish. Drumbeat. Fruit I meant, and we LOLOL'd. He said I was thinking catfish maybe? Or flounder! I quipped. Absolutely not a low hanging fruit. Give me a year's statement, I'll get James on that ASAP.

    So then we got onto the subject of our upcoming vacation in May for two weeks. I've never done two weeks in a row - years ago Maria told me it was the best, you really get to unwind. My first European trip was a few years ago with S and his Mom to the small town she grew up in, Bad Herzfeld. It was nice, scenery beautiful, but no one spoke English. No menus in English. S's mom can speak fluent German, but doesn't have a lot of reading capacity. I'd order something on a menu and it would come out like a fish head floating in jelly, something completely unedible. S said this was not the case before the Wall fell. Everyone spoke English. Like the rest of the world, people are getting more territorial.

    So I was super claustrophobic planning this trip. Katherine Lu was recommended by Scott Marotti and Laura Sanders. Needed a change from at least in my recent experience overpriced and incompetent Poe. You will be fine, my brother told me. There is Google translate now. Katherine created a super personal 16 page itinerary. I know that this sounds like a lot, but it is very detailed. 

    I want a terrace or balcony every place we stay. Check. S needs access to a bike. Check. We don't want that experience of running around like chickens with our heads cut off, we need built in free time. Check. We want English speaking tour guides, and when we go to a wine tasting in Bordeaux, we want someone to transport us there that speaks English. Gotcha, in a Mercedes SUV. Ah bliss.

    When I was in Chicago last week Mike and Effie took us to a restaurant. In Chinatown, we went to a hot-pot - new to me. Three amazing bubbling broths in the middle of the table to dip a million things in that was staged. Watermelon slush so yummy I ordered an extra pitcher. Kimuki? Maybe? Which I splurged on the 22 bc it was Michael's bday. 35 dollar cocktails, more than the small plates. I had the smoothest Japanese whiskey on the planet. Effie and Mike told me they were world-known for their cocktails (and I can't spell renouned so we will leave it at that).

    So I'm excited for food in Spain and France and not feeling like I'm hemmed in by not knowing the language. Thank goddess I'm not on call this week. Too much else is going on. Happy Tuesday, much love, Elizabeth

Strange Conversations

     Ugh I have to go in Monday to finish a lung cancer case bc of course most of our over 200 blocks (that's a busy day) came after noon so immunostain turnaround same day got fucked. I've lost all hope in getting communication about these mishaps. They always seem to happen on Friday. Thank god my plane to Chicago doesn't leave until Wednesday.

    Crazy story Tina got a call (Wed? Thurs? I've lost track) from a patient that was so angry that her HPV test turned up positive. She was in her sixties, hubs was in his seventies, and they'd only had sex four times in their marriage (yikes). Tina has the patience of Job. Anyway, the OB had told her to call pathology and Pam, head of cytology, had turfed her to Tina of all people. Pam is over the HPV DNA testing. 

    Tina said she was yelling on the phone. I'm having this test repeated and if it is still positive I'm going to come up there with my husband because this makes no sense!! Apparently she also shared with Tina that he had a penile implant. Kimberley quipped she's answering her own questions! He's obviously not using it on her! And we all LOLOL'd. I'm taking that day off, Tina said, and I told her I didn't blame her. You've already done enough.

    I was getting some cheddar scones at Boulevard on Friday and I was telling the story to Scottish Brian and he said I've been getting these really weird texts? I told him my unknown texts have been increasing too. He said let me show you! He proceeded to show me a series of crazy texts. Um, mine aren't like that, I said. That is creepy as fuck. There were girls draped across countertops begging him to text them back. Some were asking how come you don't text me anymore? Where have you disappeared to? Um, mine are just strange stores asking me to reply yes or no to get on the text list. Yours are next level.

    C has been around all weekend we took Senel (I don't know how to spell it it's pronounced Chanel Jack chided me for screwing it up in a text message) from UK out Friday night for Mexican and she's lovely, a theater major - C plans to spend half of the summer with her. This morning I woke up to the laughter of Jack and C and a new friend to me Evelyn. She rooms with Annie West - Kandi's daughter (the one who bought Wordsworth) and is also a theater major.

    I asked her about Cabe. Paul Guthrie, my college bf, was theater. I told her I did a lot of backstage production assistance, it was really fun. Cabe is still around, she said. I told her Mary Ruth Stewart teaches English at UCA and has a feminist theater production in Conway, I just found out about it and started following it on Instagram last week. It is such a small world. 

Oh! Evelyn and C told me they are starting a band. Amygdala (my suggestion) Darlings. I asked Evelyn what do you play? Nothing, she said. I just sing. C too. Me too, I said. Like The Secret Sisters? I asked. She had never heard of them, but loves Gregory Askimov I was impressed with her musical knowledge her parents did well. Happy Sunday, much love, Elizabeth

Manic Monday

     Goodness Saturday call sucked. I had a big stack of surgicals and about 9:30 Van brought me a big stack of cytologies he screened. Any of them cancer? I asked. All of them, he said. Ugh. Lots of stains ordered and I worked longer than I have in a while - 4-5 hours maybe if I'm not exaggerating. I told Melody today I haven't had as hard a call Saturday as when I got 13 bone marrows back when I did CP. She visibly shuddered (they most they get is 4-5 these days lucky young ones). Luckily I'm more efficient than I was back then - that was a 12 hour day. But the volume still takes a lot out of you. I slept three hours in the afternoon and left Kim's bday early at Sullivan's after drinks and apps. 

    So this morning when my alarm went off at 5:30 I spent a half hour in existential dread of cleaning up the weekend. Was a little stomach sideways this morning so skipped coffee but the adrenaline of the day supplanted caffeine. Paul Williams called me about a case and I was confused? Thinking in my head I'm on call not cytology. Then I looked at the schedule and saw I was on EV today. On top of over a hundred surgicals and everything else. 

    I went to a bronch at around nine - Cydney. He told me the hx and said he had two more. Normally on call we cover morning frozens and guess what? I was also getting called for frozens running around like a chicken with my head cut off. At around 10 I called Shaver in NLR. Did you mean to have me cover all this? NO! I'm so sorry Michelle took off at the last minute and I am covering her there and I didn't fix the schedule. All good, I said. Get Melody or Quinn to cover frozens, he said. I will if I need to. I'm feeling like Superwoman. 

    When I was placed on my third bronch standby at 11:30 and they called me for more frozens I said Melody. Help. I'm officially in over my head. Of course, she said. You are covering for me, actually. I thought I could got it alone but there was just an add on bronch at 12:30 and I'm swimming/drowing in cancer. I can't do it anymore. 

    Luckily the afternoon was a bit slower but not much there were personal emergency phone calls with friends with medical issues and this happened twice last week and now Monday and I'm happy to help!! Sit in the waiting room. Get cozy with the nurses in post op. Review CT's and path reports. It's my forte, and it makes me proud. But it's been a lot lately. 

    The Oscars finally got it right. Everything Everywhere all at Once, although I watched it a while back, was amazing. The mom daughter scene at the end made me cry. And WTF with the Fabelmans? I was so bored I quit before it was halfway over. And the Banshees of Inisheerin? The beginning was amazing and the acting was so good but it took a psychological turn for the worst that honestly felt abusive and made my stomach turn. 

    Got dinner with Melody and Padma and Laurie at Three Fold this weekend and then Spring Break (finally I need a break) and then a couple of days off bf Chicago. Need the time off. Happy Monday, Much love, Elizabeth

Products of Conception

     This is a common thing. I don't mean to be triggering, but a lot of them result in a D&C. Meaning they don't come to fruition. Scientifically this is the norm. Mental health wise it's probably disturbing. Not a hard thing to read - immature placental villi and decidua, but still. Prayers to all the momma's with lost babies out there. Lots of POCs.

    I got a call from a genetcist last week. Really? I asked Jan. I'm path. I've never received this call. She really wants to talk to you. Ok, put her through.

    This doesn't happen very often, she said, but the testing reveals that the parents are related. This might be an abuse situation, so we have to report it. Well, this is Arkansas, I told her. But it's common practice in the Middle East, she said. There are shared chromosomes. She isn't a minor, but still. Goodness news to me.

    I gave her the OB's clinic and personal cell number. She said she would try the clinic first. I saw him this morning in the Dr. Lounge.

    Did she reach you? Yes. So bizarre. You need to follow up. I know, he said. They are from another country. Might be cousins? Hopefully, I said. Not an abuse situation, just common marital practice.

    God this world is so crazy. Luckily I found out yesterday I'm not on call until Friday through Thursday bc I was at the end of my ever fucking rope, GI wise. Today was better. Happy Virgo Full Moon. Clean and detoxify. Much love, Elizabeth

    

Index Finger

     I overslept today! First time in a while. No worries, I wasn't covering OR until noon to four, but still. Had a wonderful long shower and bfast alone. Went in at 11 was done by 3:30. Life is good.

    Had two index fingers this week - distal tip. I've said before legs are common as dirt, like tubular adenomas and hyperplastic polyps of the colon. But fingers? No. I had to look in the charts. Rubbernecking, as they say. One was a persistent infection after a dog bite, the other was a victim of Raynaud's. Such a zebra, the latter. A board question. Hers was so bad the distal finger got gangrenous. It's like a cancer, only not. You just get your circulation damning your extremities. 

    So much happening this weekend! Plans to have dinner with Christy and Jerry (her fiance lots to unpack here but I love him already) and maybe Jerry Sr. who they care for religiously (it's super endearing). If he's not sundowning. He sat next to me at Cocaine Bear last weekend and we shared popcorn - it was everything I wanted it to be and more thank you Elizabeth Banks. Allsop and Chappell rez tomorrow at 5. Then rez at Yaya's for 10 am brunch on Sunday with S and his mom. She had a bday a couple of weeks ago and I felt bad I missed it. She always sends wonderful cards to me on mine.

    Then, in true Pisces fashion, we are celebrating C's on Sunday night with blended fam dinner. What is Rach cooking? I asked C. Maybe fried chicken (hers is amazing) maybe something else not sure. Can you bring cookies and cream ice cream and a yummy dessert from Fresh Market? Easy Peasy.

    What are you doing for your bday? I asked. I'm on call next week/weekend. Mia's is on the 11. Mine is 10. We are planning a joint party in Fville. Can you send a little extra $$ for decorations? Of course, I told her. I swim with fishes. C, both brothers, S, I'm a lone lion amongst Pisces. Trynna ride the waves.

    Talked to a lot of fam this week. Everything is coming up roses. Cannot wait to see Mike and Effie over Spring Break. C and Mia and Harper are coming too. Blakely will be there with her family. Got them a double queen room at Windsor Park Hyatt to enjoy the city and not overwhelm Mike and Effie. A little hesitant based on the recent past to be happy? But cautiously optimistic. Happy Friday, much love, Elizabeth

Cloud 9

     I'm on it. This reverse psychology is working. Kids are great, fam is great. Did I tell you my Dad's right heart got severely insulted during a routine surgery a few years ago? Well he just had a cath at Mayo Jacksonville and guess what? It's back to normal after three months of diet (if it tastes good, spit it out, it's bad for your heart lol nutritionist) and cardiac rehab and meds. So he's in the clear, and can live a normal life. What an effing relief. 

    Med exec committee was last night, and I presented. Blood bank stuff Melody asked me to. Apparently if you hold a blood bank drive, and you collect under 25 units, it's a financial hit. Double, bc you can't get a discount from the Red Cross. The table showed that over the Baptist system this has happened a lot in the past few years.

    I told Melody in preparation that this is partly our fault, we aren't getting the word out. She said no, Krista sends out a lot of emails. Not to me, I thought. Not to everyone. My thoughts were echoed on the Zoom call. Even though some of the Chiefs were getting emails, there was no information about where the blood drives were. We are short, I told them, and we need to drum up the staff. They can make appointments, and we are working on incentives. It's a global problem.

    They asked me where to go, and I was perplexed. This is not my area, I told them, but I will get the details when Melody returns next Monday and present them at the next committee. Didn't they used to be in Shuffield Auditorium? But now that's overflow ED. So I have no idea. Mandee said that there was no info on where to go. Again, I said, I will get to it next week and lyk.

    Bumped into David Shenker (new CMO he asks amazing questions I think it's a good choice he is very analytical) on the way out today. Is it your last day? I asked. The phone meeting is a little hard to hear. No, my last call, he said. Friday is my last day. I'm excited to drum up blood giving. Let's keep in touch. Yes, I said, I used to give regularly but I've been having ill health for the last three years no energy. But that is changing. And honestly? I remember loving giving blood - it makes you a lightweight. He laughed, and promised he would circle around the issue until there was some resolution.

    About to watch TV and wind down. Happy Tuesday. Much love, Elizabeth     

Ugh

     Oh my god this week seriously could not have been worse. Just when I thought I settled my family my work family blew up to hell and back on Friday. A little too much for public consumption, but just saying. When the LRPD gets involved, you know you've got a doozy.

    I told Shaver and Melody I'm sick of 2023. I'm fing sick to death of wishing each week would get better. I'm putting some reverse psychology on this shit. It worked on my kids, so why not try? Instead of wishing for a better week, I'm wishing for a shit week. Then maybe I'll get something good. It's worth a try.

    Grey's Anatomy continues to be entertaining bc I scoop the dx easily but I need something new bc the story line is soap opera-y and boring as hell. Got a long list from The Guardian. Will explore when I recover from the past week. Got tix to the matinee tomorrow - Cocaine Bear. LOLOL Even if it sucks popcorn and Coke Zero what more can you want in life after a week from hell.

    There is lots to look forward to. Finalizing trip to Spain and France. Getting travel insurance. Paying the balance. Maybe Japan next year? I've got a travel itch. But imminently, Chi town for Spring Break with the fam. Happy Friday, much love (holding on the best I can), Elizabeth.

    

Cryptococus neoformans

     On call again this week and it is hell. I think I am growing new calcifications on top of the old ones in my neck muscles - the work just won't stop. I had an incredible diversion today - one of the cytotechs called crypto in a spinal fluid. This is a board situation - a once in a lifetime dx. I googled the images and it was convincing enough that I decided to let micro in. Tommy, a seasoned tech, said he would order an India ink. They don't have a clue, I told him. They think it is aseptic meningitis. They are covering him, this confused man, for all the bacterial things but nothing antifungal.

    He said let's tell Todd in serology. Surely enough, there was no crypto antigen ordered, so we decided to perform it. I continued onto my other 40 to 60 cases bc medicine is not like House. You don't get a week to study one case. Or Grey's Anatomy, which we've started. I'd never watched it. But when you think your January couldn't get worse than your December, and you were woefully wrong, you need brain candy. It's like a soap opera, yes, but it's also really funny when you dissect the disasters of what a medial show gets wrong, with your expertise. I keep pausing it to explain it to S, who even recognizes the improbability of some of it without medical training. I think I'm impressing him with diagnosing the patients before the dr's figure it out. And how are there so many dr's covering three patients an episode. That's luxurious and crazy.

    And speaking of, there was one episode a couple of nights ago where the surgery interns (??!!) decided to do an autopsy without the family consent. OMG. WTF. When they got caught by the attending, she defended them to the family bc the daughter of the dad alcoholic had been adamantly against it. They found grainy substances on the heart, indicating hemochromatosis. It's genetic, so you need to get tested bc they probably saved your life. So dramatic. So not how all this works, in an entertaining way.

    Hemochromatosis is a build up of iron in your organs that requires treatment (bloodletting, if I remember correctly? Regular drains). I was pretty sure you could only diagnose it with a microscope and an iron stain showing lots of iron but I wasn't sure this is not my area of expertise. I googled it today, and the only gross finding is a grey black pancreas I was right about needing path and stains. No grainy stuff on the heart. SMH.

    Tommy came to grab me mid morning - come look at the India ink. There was a single organism with the classic look (another google image - that's a board question) but it was very impressive. There was a big line of techs oohing and ahhing and we kept having to move the slide around bc it was running around the slide like it was on a marathon. I told Tommy one organism is not enough - we need more evidence. I had ordered a crypto mucicarmine and a GMS that wouldn't come out until the afternoon. 

    The one clue we found in the chart that does not point toward aseptic meningitis was that the CSF had low glycogen, which doesn't make sense. Something is eating those carbs, I said, and that strengthens our case. When he came to my office around noon announcing that the crypto ag we performed was positive, but the titers were still pending, I decided to call the ID doc and let him in.

    We were in med school together, Jason Hammack and I. I had to get his cell from his office. I told him what we had so far. I'll text you when I get my stains. Only one on the India ink? He wondered. Yes, but it was classic and very impressive. I got my stains 15 minutes later and Melody and Tommy were as convinced as me. Win for the lab. Tommy said you nailed it! I said no Van did, my cytotech, he deserves all the glory. I've never seen this zebra before. I'm excited to present it in huddle tomorrow.

    When I checked the gross room this afternoon they were overwhelmed again. Jessica said our theory is that everyone is just now getting caught up and rescheduled from the ice storms. So, another grueling day ahead. But even though I work Saturday, I've got fun dinner plans with Melody and Laurie, who are also on call. Padma was supposed to come, but she's sick. Next time, I told her on text, we are going to make this a quarterly thing. I told Melody how much they supported me through my divorce, and how we've fallen apart with kids getting older and the pandemic. Thank you for letting me in, she said. It's kind of a celebration of Laurie's bday, so we have gathered creative and thoughtful gifts. 

    I told Melody that Laurie is the queen of creative gifts, so this will be good. She made my kids personalized bulletin boards when I was going through my divorce, bc she noticed the ones in my office. We have coasters with pictures of all of us on them, made by Laurie. Laurie told me the other day that she is loving The Hall. I'll have to check it out when my life slows down. Small music venues are so much preferable to large concerts when you get older. Happy Wednesday, much love, Elizabeth.

    

    

Day off

     I was planning to go in in the morning to finish my cases but the Universe had other plans. I slept until almost 2! Guess I needed that. My clingons were two cases - a mandibular resection and mores from a mastectomy. Mores are when you need more slides on a specimen. You have to tell the PA's to go back to the bucket. This instance was a call from one of my fave breast surgeons, Dana Abraham (highly recommend) who called me Monday night because I only saw one focus of cancer and there were two on mammogram.

    I know, Dana, I told her, I saw that, and made Laurie pull the gross and look at it. They were so close together, and looked the same, I said, so I thought maybe it was all one site? But I'll look again tomorrow. Laurie pulled the breast, called me, and we put some hemorrhagic parts through for me to look at today. Bonus. I found a 7mm separate site. Dana is a bird dog, but it sometimes pans out. I called her and she was happy. Are my margins still negative? Yes, of course. That's the only thing the surgeons care about their margins lol.

    Speaking of, my other clingon was a John Sims case. He trained at Mayo - where they freeze every fing thing. So he doubled our frozens when he joined us. I went into the gross room to say hello, they are my peeps, and he was there waiting. Love that he comes in. He asked me are you doing my frozens? I said no, I'm off, just releasing your osteoradionecrosis of the mandible. I was worried - there were too many plasma cells in the marrow. I'm having Maria do stains, make sure it's not clonal. He doesn't need additional dx, but we are making sure he doesn't have myeloma. She's already talked with Ryan Hall. But no residual cancer.

    Shaver hadn't turned up yet and I told John these are my people. Waving. Amber, Ethan, Savanna, Laurie, Bob and Jessica. This is my department, one of them. He made me laugh when he said I'm pretty sure I'm not popular with them. They all laughed. But at least you are nice, they said. Who's covering? I asked. Shaver. He's not here yet. I'll read your frozens John. No worries. A B C D and E were dead negative but I was worried about F. I told him let's get a consult from Shaver when he materializes.

    Shaver agreed that they were just jazzy reactive hair follicles, no tumor. You are around the cancer. John said thanks, this was originally a papilloma and turned into an invasive squamous cell carcinoma I need to get around it. You did. Ah it's nice to be off. And to be there if need be. Fielding calls from Grace Raja about tumor board tomorrow. Thinking Staggs and Harrison will take care of it. Happy rainy Wednesday, much love, Elizabeth

    

Baptist Drug Store

     I noticed yesterday I was running low on my new favorite dessert. If you mix the Ozark brand chocolate covered cashews with the salted caramel cashews it is a, what did I call dark chocolate Reese's cups years ago? An oralgasm. I had to hunt through the display over-filled with cinnamon pecans and other stuff but I finally found them. When I got to the register, the line was four deep.

    A guy immediately got in line behind me - he was tall and about ten or fifteen years older than me with frizzy curly white hair.  Then another guy got in line behind him - he was short and 40ish with a bald head, a big beer belly, a stained white t-shirt, baggy tan slacks, and dirty white tennis shoes. The line is never this long at the Baptist drug store, but I had the last bags of my desired food items in my hand so I had to suffer it.

    It moved slowly. The guy behind me said something, it took me a second to register what it was and that is was directed at me. I asked him to repeat it. Do you know what the most popular candy bar in the country is? I'm in the food service industry, I've worked in grocery for years. I looked down at the Smorgasboard of candy bars just below eye level right when bald guy said Snickers.

    I said no. Cannot be. I hate Snickers, always have always will. No he's right, frizzy hair said. See how it is right by the register? You place them according to popularity. I was actually at the factory once that makes them. It's in Waco Texas. You should have seen the production line. And they pack them up thousands and millions filling semi trucks to deliver all over the country. Not for me, I said, I like Reese's Pieces and Butterfingers and Reese's cups. Those are all popular too, he said, but Snickers are the most popular because they are a little less sweet and adults like them better when they outgrow their sweet tooth. The logic of this statement seemed faulty, but I didn't argue.

    At this point the woman in front of me had finally finished her payment and it was my turn. I wasn't sure what to say so I quipped - that would make a huge mess if the truck wrecked, especially a fiery wreck. Then I searched for a way out of this bizarre conversation and saw Eyad Abochale, my long time pulmonologist friend. Hi how are you? I asked - he was headed over to Boulevard the long way. He grabbed my elbow - this is unusual he's not touchy, and said fine. How was your weekend? I asked cheerfully to steer frizzy into a new direction. Um, it was ok.

    This is not Abochale. It was like he was carrying an emotional cloud I've never seen before. But it was my turn to pay. Donetta, who works the register and at Subway, exclaimed at how long the woman before me took to find the right credit card that would go through after I said I've never seen it this busy. Donetta a single mom with young twins. Her mom passed of Covid a few years ago, and I noticed a lovely tattoo about a month back with a woman holding two kids and exclaimed over the detail. I finally saved up enough money to get a tattoo of my mom holding us kids, she said. I got a little teary. Tina told me her mom worked the front entry to Baptist for years, helping people find direction. Tina said she was lovely, and I relayed that to Donetta the next time I saw her.

    As I was exiting the gift shop I saw Abochale about 20 feet behind me so I held back outside the gift shop. How are you? I asked. How is your day? My mom, she's 80. She lives alone. What? Your mom? She's in Syria. In my brain I chided myself. I knew that he was from Syria and I'd just read about the earthquakes but he told me that over a decade ago and I'd forgotten. Is she ok? I just read about it. 7.8 then 7.5 depending on the news source with aftershocks expected.

    He told me the first one went off at four in the morning. She ran out in the street and the panic and crowds terrified her. Then the second one went off and she ran again and she was so scared. I just got off the phone with her. She said Eyad, if it happens again, I'm not running. I'd rather die in my own surroundings than get crushed to death on the streets. God, imagine being at work and having that happening to your mom a million miles away. 

    Eyad told me that he was questioning God. I mean, Syria is already rocked from civil war and many of those people have no water or electricity and now this happens? I said I know, in my head thinking fuck Putin he deserves a terrible death and many terrible lives for the rest of time. I told him I did read one story about a father who was running from the house with his wife and kids in front of him and a door fell on his back. All his neighbors died but the family lived bc they were shielded by the door. Good things come from tragedy, but at what cost. I texted him last night that I'd be sending daily prayers and love to his family and mom for a while.

    Gotta go in for a bit tomorrow to finish up some clingon cases, as we call them. But I've got the rest of the week off and looking forward to Eureka this weekend. Back at the Peabody, where I've got a balcony and it's winter so we can see the downtown. I gave up on the Basque history books they were boring even the NYTimes bestseller ones. Plus I want to learn when I get there and if I read too much I might school my guides. Kevin Wilson is freaking hilarious I'm dying laughing at his newest book. I texted Kandi about it Sunday. She said she tried to get her daughter to go to Sewanee she loves him so much. So new body of work to read. Kandi is in my new four docs and the new Wordsworth owner (she bought it!!!) book club. Staying small. Happy my Friday, much love, Elizabeth

    

Ice Storms and Right Knees and Orgies

     Good god it's been a couple of weeks. I thought January couldn't get worse than December but my foot is officially in my mouth. Last Tuesday I went and got a much needed pedi after work. It was raining, I was thinking to myself all day. Great time to go. Won't be crowded, no wait. Well that was true. When they put the flimsy pedi flip flops on me they warned. Careful. It's wet, these can be slippery.

    I've been wearing these flip flops for over 20 years and never slipped. Asphalt, fine. Pebbly driveway, no problem. When I pulled up into the driveway I noticed the lights in the garage were on. It was raining heavily. I asked S to open the garage so I didn't have to walk in the rain all the way to the front door. That was my death knell.

    As soon as I hit the smooth cold 1969 concrete garage floor I wiped out hard. So much so I almost passed out and had to lay down for 10 minutes before I could get up - I was seeing stars. When I went to get my ruined front toes repaired the next day (they do this for free, so nice) the woman working told me she always tells her clients to take them off if they are wet in the car before they go in the garage. I had one client break a hip! She said. So PSA to all your loved ones that enjoy pedis. 

    It was functioning, no need for ED, but it hurt so bad. Why don't you take Advil. S said. Good idea, I never think of that. I take it like once or twice a year. The bruise is EPIC. When we checked into the Marriott Courtyard for the ice storm Monday night (one night is best, two ideal, but the third night you kind of go stir crazy and the OR NEVER DIES so I had 11 frozens on Monday and 7 yesterday and I'm not even on call!) I went out the patio door to the non-existent patio to watch for ice and guess what. Fell on my right knee coming in again. It was a soft fall, but I laid there in shame for a few.

    So imagine how terrified I was to walk in the actual ice. Tam and Shay in the Dr Lounge were oohing and ahhing over my bruises from the garage the other day. If I fall this much without ice? My demise seems imminent. I did crack some docs up about my story, so there's that.

    We were coming back to the house today and I checked the mail and a notoriously super cute but creepy vascular surgeon's name was on the envelope. I exclaimed in shock. His wife worked in the dean's office when I went to med school and there were tons of rumors of their escapades. They came to med student parties I hear (I was married to Mike) and recruited marginal women and men for orgies. 

    I told S I think this house was used for orgies. They had destination orgies, Cancun and stuff was rumored, but when I asked about him recently to another vascular surgeon she said that he had moved to another city, new job. This shit is more common than you think. One of my attendings who is now in Michigan said she had to fend off another doc who was preying on her husband. They get the husband, then they get the wife. He was clueless. Her mom had warned her appropriately. 

    I have some fantasies, but orgies are not on the list. We saw Infinity Pool last weekend and it was nuts. Seeing that vascular surgeon's name after so many years made me think of the drug fueled orgy scene. Mia Goth is my new fave actress - her wine fueled diss of her prey on the hood of the car was Oscar worthy. But who recognizes horror. Or minorities. Not the Oscars. You just gotta go with it and keep creating. Even if you feel like you are screaming into a void.

    Also recommend The Lodge (Jack's rec) and kind of brain candying on this stressful week with You People and Dead to Me. Reviving book club this weekend with Amanda and Kewen at Sky on Saturday. Had wonderful reunion bfast at The Root with Carrie and Annika and Jack a couple of Sundays ago we plan to do it again soon. Gonna do a Eureka redux on the 10-12 (last one sucked). Allsop and Chapple is really good - Melody recommended it. That's all I've got for now. Happy Thursday, much love, E

Medical Executive Committee

     I hadn't been in a while in person. Autopsy was virtual bc dry heaving and in person presenting don't go very well.  Missed the Christmas party at Yaya's due to ED visit. So it was nice to be there. A lot of financial stuff that makes my mind drift, and the cheesy admin goals that made Ward Gardner pop off so bad Wendell had to check him. Ward was Mike's classmate, I've known him for a long time. He's  a hothead, but he's smart - Chief of ENT. His observations and challenges were astute, but a little disrespectful. I think he forgets he's the only one in the room who isn't under contract with Baptist and gets paid in RVUs. Baden in radiology (they are having as hard a time as we are finding docs), myself, surely the new Peds chief Barr I haven't met yet, all have a little animosity but you gotta play the long game. 

    I saw Mackenzie for the first time in a while and told her that I'd heard the gross room was being completely redone. Jessica already has a shoot for the moon wishlist, I told her, and even though it might not be financially feasible she agreed you should always shoot for the moon. I learned that Angel from Heme (new lab director in LR don't want to short her she's super kind) and Paula lab director are touring the country to look at other tissue labs? I need to be a part of that. They don't know tissue labs like we do. Shaver has already ok'd PTO for this. I am the director of it, among other things. Don't exclude us, I asked Mackenzie. She said I'll keep you in the loop.

    Crazy Monday - cleaning up call cases and fielding a bunch of new ones I think I have calcifications in my neck muscles. We have had such an uproar in our practice family in the past few weeks - more than in my entire tenure here. It's horribly stressful. My therapist said I need to widen my circle back to pre-pandemic. So, to start off, Jack and Annika and Carrie and I met at the Root for Sunday brunch it was lovely to catch up it's been years. Jack and Annika weight lift together and have been trying to make it happen for a few months. I finally took the reins (never give teens the reins) and we had so much fun we plan to do it again soon.

    Also starting a book club back up - we meet February 4 to plan. Starting off small - Amanda Ferrell and Kewen Jauss and Laura Sanders and Kandi West. Kandi was texting a couple of weeks ago - she's the best reader I know - she bought Wordsworth! One of my faves. Carrie Mensik said she is building a new house at the end of Foxcroft Road and wants to start a book club too. Maybe if I can get my health in line I can resume yoga and hiking. Baby steps.

    This weather not weather maybe weather event tomorrow night is stressing me out. Jessica presented a new inclement weather policy in QA last Thursday makes sense and makes things more fair. But I'm getting ready, got gas, got brandy, Jack got food since Med Exec popped up on me unexpectedly. Will get hotel near Baptist if necessary. Cancelled Paula for the immediate future. 

    Unplugged on Sunday on the couch and watched X, which was freaking amazing. The origin story Pearl was a little slow for me but the cinematography was incredible and Mia Goth? Big time acting chops when she did the soliloquy to the sis in law it reminded me of the beginning of My Town. I thought she must be the muse of Ti West but turns out she is married, divorced, and married to Shia LeBouf so they are just collaborators. So hard to find good horror these days, I told Savanna in the gross room this morning. We desperately need new content. There is a new horror movie with Mia in it coming out this weekend - I might just have to make it to the theater. Oh and The Meal - highly recommend. Happy Monday (not on call) much love, Elizabeth

Back to Baseline, Sort of

     Well, we moved Cecelia and her million pounds of stuff into Hendrix Sunday. I told her that people were probably watching and marveling from their dorm room windows. She got assigned to the Dickinson House, which didn't exist when I was there. It's named after my Dickinson family who got their money from a rock quarry in Pine Bluff maybe? It built most of the roads in Arkansas. I was charmed to see the plaques with Uncle Haskell and his dad Tyndall and mom Carrie on the outside of the building, and flabbergasted to see the portrait of Mama Carrie and Tyndall elevated above a common room that was like an atrium. That portrait was in the house Haskell and Peggy (dad's little sis) live in now, the one Mama Carrie and Tyndall used to live in on Palisades. I grew up looking at that portrait when we would go for Christmas or pool parties or birthdays or whatnot. It felt like a homecoming.

    It is right next to the Browne house, which I didn't know existed until I went to Hank's life celebration a week from last Thursday (slide show). Mary and I don't keep up regularly these days, but we go way back to Aldersgate when we were 15 and first met. At a surprise coincidental pedicure visit a few months back we caught up and she told me he was suffering from glioblastoma but had managed to live a lot longer than anyone expected. She looked elegant at the Clinton Library in a tailored skirt suit and as I waited in the slipshod receiving line to give her a hug I admired and squinted at the sun setting through the window of where I had my wedding reception in 2016.

    You look like a Madonna, I told her, the way the sun is framing your face as you are talking to people. Can I get you a glass of wine you are empty handed and this is so packed. I feel like a president's wife, she quipped. And no but thank you, I'm not going to drink until I get home then I'll get shitfaced. No judgement there at all.

    Speaking of Aldersgate, Cecelia called me today ecstatic. The last time she worked there was a couple of months ago, a respite weekend. There was a girl who was 9, Rennie's age, in her last week or two of life due to brain cancer. When Cecelia learned this she devoted her entire weekend to the girl, singing and laughing and playing with her. M was wheelchair bound, and struggled at this point to voice her thoughts. Cecelia devoted time in her Hendrix application essay to M, and the lessons she learned, so I became quite invested. The mom was so thrilled with C she got her cell from Katie, the director of something at Aldersgate, and called C the next week to thank her effusively.

    Cecelia told Katie that she wasn't going to volunteer this weekend because she needs to plug into her new college. Her suite mate is cute as a button, Sophie from Greensville SC and premed major Spanish minor. C got a call from Katie today and the girl, don't want to violate her privacy by naming her but it's an unusual beautiful name, is going to be there this weekend. She entered a clinical trial and is doing fantastic. She hasn't been this healthy in 6-7 months. C and I both ugly happy cried on the phone together this afternoon around 1. I drew so much attention Kimberly and Tina came to check on me.

    Who knows what the future brings but you take the good and you process the bad appropriately and move on. I'm on call, and had a late frozen yesterday (if you call 4:15 late LOL). Stern was doing a direct laryngoscopy on a patient with a large laryngeal mass and a shit ton of big lymph nodes. He needed a diagnosis. Lindsey cut the frozen. We looked at the gross (think 2 mm of WTF). It was pink, and fleshy, and we worried about lymphoma so she saved half for flow. Turned out to be run of the mill squamous cell carcinoma. That directs treatment. If it was lymphoma, stop. Squames need to be excised. Happy Tuesday, much love, Elizabeth

    

Happy Weekend!

     Good god. Why does life continue to throw you shit to fragment your mind. Oh well. It doesn't work. Well, to be fair, almost. 

    Nothing new here. Going to be on call on Monday, back to the grind. Not a bad thing. Oh! Looking forward to dinner tomorrow night with Christy and her new beau Jerry and his father who is suffering from Alzheimer's. Kemuri west. Christy knows the owner. We have a 4:30 reservation. Old folks time. He always comps her drinks or apps. Looking forward to meeting him. Might be a good contact.

    Hopefully S will test neg for Covid tomorrow - he had it back in February with horrible sequelae. Alopecia, requiring derm intervention. I told Melody I think I must be Covid immune. Exposed twice, and never symptomatic. So I haven't ever tested. When S tested at 4 am yesterday I was surprised. It's like a pregnancy test, I told him. Looking for the lines.

    Excited to move C into Hendrix on Sunday - she is going to come over tomorrow to start packing. Mike and Rach are having a weekend in NOLA so they are taking care of Rennie. I've done enough of her laundry to last a lifetime. Just checking in. Happy January. Much love, Elizabeth.

Comparison and Confidence

     I've noticed something weird about the guys in our group, I've talked to Melody about this before. Women are more communal, guys tend to approach us like aliens - trying to compare and make sense of us. Rex, for example, would compare me to Diane and marvel at the differences. Once Shaver, years ago before I got divorced, came into my office. He told me about his relationship with Carlisle - a co-resident of his who works in Fort Smith. We played practical jokes on each other all of the time. It was really fun.

    Something in his voice made me wonder if he wanted that with me - another practical joke player. Maybe I was reading into it, but at the time I was not in a situation to be that person. I gave him a blank stare and smiled fake. That's nice, I said. When Melody was hired, one of the guys, can't remember who, marveled to me that Melody was different from me, she likes sports. Again, I thought in my head, it's because we are different people. 

    I'm not trying to make this a gender thing, I've seen more OCD partners get frustrated when their male counterparts aren't as OCD as them. A big fight erupted one call weekend a decade ago. The AP person called me in free fall. It's ok, I told him. I make typos too. When the CP person vented to me, I told him that guy is different than you. Certain things don't eat at him like they do you. It doesn't make you or him any less or more, just different. 

    But women do communicate more. A lot of the hubs of Bad Mom Docs piggyback on our posts, with the wives permission. They wish they had a similar space, to laugh and vent about their spouses long shits and their tendency to start long inane projects five minutes before they are hosting a party or leaving for vacation (although those are guy things - they would need something different to make fun of, of which I'm sure there is plenty). I like the funny posts - the Christmas pic fails etc. But there are a lot of anonymous trauma dumps, and people get into that - leaving hundreds of supporting comments and reality checks. I occasionally participate, but for the most part I need a laugh in my day, not a trauma dump.

    When Shaver told me I was Chief last Fall, based on doorway conversations, I told all my friends and family. The next day he texted us and asked everyone to vote on me being Chief. I was perplexed and disturbed. I thought this was already decided, I told Melody, I don't want to eat crow, why is he doing this? It was excruciating. A few hours later, he announced on text that it was decided. Only two people dissented, he said. Elizabeth won by majority.

    The next twenty seconds seemed like an hour of Hell. I got super paranoid. I decided quickly who those two people might be and went into emotional tailspin. How will I go on, I wondered. Melody jetted into my office and told me that Shaver planned it all as an elaborate practical joke. I told him not to do it, but since he did I came into your office as soon as the text went through to straighten things out. I warned him you might be upset, but he was like she's so confident how will she believe it? I did. Michelle was equally alarmed. Why did he do that? If I had joined in on the practical joke thing years ago I might have not gone down into the trenches, but I had not, so I did.

    Our self esteem has such a shallow veneer. Melody knew that, and Michelle, but a confident white male might not see that. I laughed and went along and forgave him. Even asked him the next day to be my co-chief. You do PLA, I said, I'll do Baptist. I can be a face and a problem solver, but I don't want to deal with the finances. It's not my forte. Michelle has her MBA and Melody is more OCD about finances than anyone I've ever seen (I mean this as a compliment) so there are plenty of checks and balances without me getting involved in matters I'm no good at and could care less about.

    So I'm in a weird headspace that I'm objectively trying to crawl out of this week. Still. But as I said last week, writing helps me process. Looking forward to Eureka this weekend - Christy is independently going with a new possible beau and I've made reservations to meet them at The Grotto Saturday night at 7:30. Reading a lot about Basque culture. Vicente Suarez, who S thought sounded like a gigolo (No, he's a very handsome very gay man who seems to be independently wealthy) wants to meet for dinner in Barcelona - I talked to him on Insta for the first time since he was a foreign exchange student at PA in high school when I was in Florida last week. 

    Bonus. I found out yesterday I get back Sunday and work Monday and then have the rest of the week off to help Cecelia get organized for her big move. And lunch and shop with Christy. At my insistence Cecelia booked us massages next Friday. And work? Thankfully half of all of December each day so far. Its creeping back up, I'm not jinxing myself, but the respite has been a nice change from what felt like a literal fire water hose of cases being shoved down your throat - you, trying not to get plastered against the wall. Swimming. Happy Wednesday. Elizabeth