Tuesday, September 12, 2023

Happy Friday!

     It's mine. I need to go in tomorrow to review some stains on a breast core, I think it's DCIS, but I'm worried about invasion so I need the myoepithelial stains to prove it hasn't left the box. I'm excited to have a few days off to unwind and get some appointments done that I canceled during Covid week. 

    So much going on the past two weeks. I feel like a broken record with my GI issues but they have been improving for six months so I've been upset to have a major setback. I won't bore you with all the details but Friday was a doozy. Major puking before 9:30 am. Kimberly is a saint, she got me Powerade with a straw and blew up one of the new mattresses I ordered last year when the employees complained about sleeping on the floor during snow days. I was shaking so hard she covered me with two blankets and three coats. Tell Shaver I can't work, I told Tina, and they redistributed my cases. I don't do this very often, call in. Can probably count on one hand. It's not kosher. But I was worried about patient care. I slept for two hours.

    So much happening. Annie came yesterday for a meet and greet - we went to dinner at Capers. Elise and Melody joined us it was so fun. She may jump ship, maybe not, we will see how things work out. She has a unique skill set that I think we could use. Also other business things are coming to a head that I cannot discuss online. When it rains, it pours.

    Got my first shingles vaccine yesterday. You can get it when you are fifty. When C had her last bday in March, Mike and Rach hosted. It was lovely but I was tired. Learned from their friend that she got shingles in her vagina. Holy Hell. I guess there are dermatomes everywhere, but I have only heard of it being truncal (abdomen) or in the back of your head (bro Matt). The girl that gave me the shot told me that most people get shingles vaccine bc they heard of someone that had it. It's apparently painful as hell. 

    Got really depressed on Sunday. Couldn't crawl out of bed. Marianne revived me. And Gangs of New York was good, but a little too full of itself. It did pass the time. Flowers for Alice Hart (may have mangled the title) is sooo good so far. Hoping to revive reading soon. Planning hair and dentist and finishing that blasted breast case tomorrow. Then headed to Eureka for the weekend. 

    Elise spent her med school in Australia and was so excited I'm planning a trip there in end of January early Feb. She recommended a lot of great food. She is a gem and doesn’t know her worth, like a lot of women in this world. We discussed Costco today. I've never been. She said her first date with her husband of over ten years was at Costco (we were so poor. they have free samples). She cracked me up. I told her Bad mom docs had a 535 comment thread about Costco finds I read over the weekend. We have set a tentative date after she has taken her molecular boards at the end of Sept. to go there. We have to eat pizza, she said, and I'll show you around.

    When I was little, I had a babysitter that took care of me and my sister Sara for years every Saturday. Her name was Aileen. She was from Australia. She was older, long gone now. She used to let us stay up late and watch Love Boat and Fantasy Island. Then we would watch the stars, which were much more multicolored and wonderful back then. My mom and dad met her when he was in med school - she lived in the duplex next door caring for her husband who had dementia and was a veteran. She promised me she would always take me to Australia. She wanted me to experience the Great Barrier Reef. I'm finally making it happen. Violet crumbles. The best candy on the planet, she introduced me to it. 

    Happy my Friday your Tuesday. Much love, Elizabeth.


Tuesday, August 29, 2023

Happy Tuesday (My Wednesday)

     I won't remember anything about Beaker training when we go live in October but. I passed the test. So there is that. Such as busy post call Monday and Tuesday. We had medical executive committee last night in the basement of Cheers. About twenty chiefs showed up to celebrate Anthony Bennett, who is the retiring CMO after 13 years. David Shenker took over. I hate that the committee is on Monday, told that to Kathy Parnell, and was frustrated to have to go to a dinner post call. 

    But it was fun. I walked in at 6:05 after an Uber and the long table was full. Where do I sit? I asked. There was a round table adjacent to it Shenker pointed me to. So I am the red headed stepchild? No, you get to sit at the kid's table alone. LOL. Ok, I'm fine with that. Actually, he said, four people canceled at the last minute so we will make a place for you at our table. I was seated at the head next to Kathy (vice chief, hospitalist). Whew. She's a lot of fun.

    We got through some orders of business after we ordered our dinner. Tasked ourselves with changing bylaws at the next meeting. Chit chatted, and then we were asked to volunteer testimonies about Anthony. Most were serious, about how he developed governance committees that revolutionized patient care. In lab, it was blood bank utilization. I said you know my retired partner Rex Bell? He used to get so miffed because I always called you Tony Bennett. It's Anthony Elizabeth! Not Tony. Someone pointed out that he died recently. I said of course I don't wish that on you! But may you sing with Lady Gaga. 

    Had another shadow today sent by Quinshell. First she's sent me in a year or so - she's the STEM contact at UALR. He was a gem. Affan. Youngest of three boys. His mom is a homemaker, his dad works a jewelry kiosk at the mall. His oldest brother is in psych residency at MUSC (medical university of South Carolina) and his middle brother is in med school I forget where. I tried to schedule him later in the week but he requested earlier because he leaves for Columbia, where he is a sophomore, on Thursday. 

    He graduated from LRCH, and recognized Cecelia, who is a year ahead of him. We met an OB/GYN in line at Boulevard who also graduated Central. I also bumped into my co-chief Shaver while showing him around - Shaver said I graduated at Central decades ago. Sounds like he wants to go into PM&R (Physical Medicine and Rehab). That's Fizzy's specialty, I said, my author friend from Boston. Rangy (OB) asked him why PM&R.

    I like the body, he said, and muscles and exercise. Turns out he is a bodybuilder like Jack. When you read the news and all the hell going on in the world it is refreshing to hear these success stories. The walls that are climbed. Makes me emotional.

    Tumor board this morning at 7:00 - ENT - will never see Sims the same again since he wore rainbow sequined shirt at my bday party and was a big hit. He was buttoned up again with smart glasses and left early to head to the OR. But was still there by phone. I presented three of Stern's cases, some zebras. Medullary carcinoma of the thyroid. Paucicellular pleomorphic adenoma. Was transferring the pics I took at 7:30 am Monday to the jump last night at 9pm.

    One day last week I was trying to wrap things up early and Sims had a late case. Oh no, I worried. Frozens? No, Jessica said, I looked it up. Some lady got a rubber bullet, I guess, from an air rifle that went through her window and got lodged in her tongue. Ugh, that sounds terrible! He's removing it. Not a cancer case, thank God. 

    Heading to Austin on Friday to see S's Dad and stepmom got an amazing AirBnB. Excited to meet Amanda's baby Braxton he's as cute as a button. Just checked in on Mom and Dad hurricane heading their way I think they are prepared. They are planning to move back to Little Rock (the more hurricanes the sooner). Elise told me today that the reason she didn't settle in LA was bc her grandmother's home was destroyed by a hurricane and she has weathered so many during her life in LA that she decided to make camp in a place that can be a safe haven for people to evacuate to. I presented her at med exec last night, admin is excited to meet her. Happy Day, much love, Elizabeth

Saturday, August 26, 2023


     Ack what a week. It will continue this morning with Beaker Epic training and call. GI stuff flared up as bad as since I went to the ED in December. Trying to ride that wave but on Thursday when my stomach hurt so bad I was laying on my floor on a blanket and getting called for frozens it was a little too much. The pinnacle was when I decided to maybe try to go to the bathroom to get it to stop and I puked water, which I had been drinking all morning to try to regulate, all over the floor. I asked Tina to please put a note on the door on stall 3 and call the janitor. I'm going to lay down in my office, I said, I'm so over life.

    Friday was much better! Luckily the OR died down early all week so I didn't have to stay late. I was checking in on the gross room yesterday afternoon. Savanna had noticed I was under the weather on Thursday and was happy to see me on the mend. Today I'm not puking on the lab bathroom floor, I said. That's my new bar. They all LOLOL'd. 

    OMG I love Elise. She is going to be at Beaker training too she joked about bringing mimosas to Tiina and I yelled I already said I'm bringing wine. I took over reviewing her cases Tuesday. She trained at Mayo for surg path but it was pandemic and they are really weird I'm discovering. They miss the forest for the trees and I'm teaching her gestalt. I told her I'm a product of intellectual incest (born at the same hospital I was trained at) but luckily I had some of the greats come through AR. Jesse. Laura. Yeah, they are at Cleveland Clinic and Michigan now but look! They are on Rosai. We are gonna get you up to speed. Support you until you fly.

    I love teaching. If my academic influence wasn't so toxic I'd still be there. I've tried over the years to plug in to UAMS to no avail. So I'm in complete heaven with Elise. We cheesily pondered the difference between endosalpingiosis and endometriosis and peritoneal inclusion cysts this week, our first inside joke (what is the effing point). She is from a small town outside Lake Charles LA and I worried when I opened the news yesterday when Louisiana was burning about her family. No, I've never heard of Merryville, she said, but thanks for your concern. 

    Plugging into the kids this week with songs. They beg for it, but whether or not they listen, I'm not attached to. When I was at Montessori long ago on Lee street, before they moved to 9th and High, I had a teacher named Miss Ann. Ann Montgomery. I think I learned a decade ago she was murdered. She played the guitar. We all sat around in a circle. Lots of campy stuff like You Can't Get to Heaven on Roller Skates and 100 Bottles of Beer on the Wall (how non PC these days lol) but some really good stuff too. My favorite was Moonshadow. He (Cat Stevens) sang some good songs, but that was a stand out. 

    So here I am, cross legged and six years old maybe? listening to Miss Ann. Full circle. Ugh 3 hours of beaker training and triaging but happy weekend?! Much love, Elizabeth.


Thursday, August 17, 2023

Last Day of Quarantine

     It's been an effing week. Last Thursday I didn't sleep all night from tooth pain. The dentist couldn't get me in on Friday so I called my ex to prescribe Amoxicillin. Must be an abscess, I've never had one, but it is like the worst nerve pain on the planet. Tooth pain was abating with abx but over the weekend I started getting stuffy, allergies? Sunday night was the worst I was up all night drowning in my secretions and put two and two together Monday morning when my brain fog got so bad I was worried about missing something on a case. Went to Dell in micro and swabbed myself and sure enough the PCR came back positive for Covid.

    I had deluded myself that I was immune to Covid. S has had it twice, J has had it three times now, hell almost everyone I know has had it. I called Melody from my office and she said put your cases on the counter outside of your door and go home. Here's the thing about Covid. It's different, then say, the flu. It has this psychological horror associated with it that puts people into panic mode. At one point this week I felt like I should just go join a Leper Colony. I've got the government issued Paxlovid, I was fine by Tuesday, but got a little depressed, bc here I am on vacation and everything was canceled. It's fun playing hooky for a day or two but then boredom sets in.

    I found out Annie got it on her bday too. She said Adele had it first, gave it to Jack, and the rest is history. I learned that it is going around again. Cyclic. More contagious, less virulent. She said people are so paranoid in her school system they have to prove a negative test before playdates, and that they were mad that she was dropping Adele off at school functions when she was still pos, even tho Adele was neg (she stayed in the car with a mask). 

    So between the Amoxicillin and the Paxlovid I've also had an unrivaled upset GI system. I can now understand why toilet paper and Kleenex went into such bad shortage - I had to order a huge delivery from Kroger yesterday. Slept like the dead late into the morning and woke up to 16 texts. I said I feel fine, have felt fine since Tuesday barring some sniffles. Bored as hell. Perfected my Broadway voice ready for my debut, after a much needed shower. Ready to celebrate my birthday.

    Sara and Matt and Joanna, Matt's girlfriend I'm excited to meet, are coming in tonight. After more than a little drama the pool party is moved to Sue's tomorrow and I think I'm welcome? Definitely going to my party (I've spent more than a few K on it) but bought some glittery masks to match my outfit so I can look like the responsible member of the health care profession I strive to be. Happy Thursday! Finally feeling myself again. Much love, Elizabeth

Thursday, August 10, 2023


     Such a busy week workwise. Yesterday I was bouncing between rad and bronch lab like a ping pong ball. Today I luckily had only one needle in bronch bc I had a GI throwback that uncharacteristically made me two hours late to work. I would have called in, if I'm a normal person, but we don't do that unless we are basically hospitalized so I mustered through it. Felt better around noon, but I'm exhausted. I'm guessing all the docs took last minute vacays before school starting next week and they are making up for it in spades. 

    I told Melody today after I started feeling better that I have a predicament so terrible it's funny. All my body wants is cold water and the Sonic rabbit poop ice (as my mom dubbed it) from the Dr lounge but one of my cavities on the left side is sooo cold sensitive I'm lopsidedly drinking toward the right. My dentist assured me this would get better in the next few weeks, but yesterday was so painful I took Advil, futilely, because I realize it cannot touch nerve pain but I was getting desperate. Melody presented me with a simple genius solution. A straw! Here, I have one. I only know this bc I've been there, she said.

    Jack came back from NYC with Annie and her family today - the pics and videos he showed me are beautiful and hilarious. Will, (about 10) and Adele (approximately 13) stayed in an apartment with Jack and after late night and planned fantastic dinners and dessert they were so hopped up on sugar they would terrorize him and he would hide in the bathroom while they mimicked zombies through the frosted glass door of the bathroom. He had a blast. He told me that he and Cecelia and Harper and Mia are planning Smashing Pumpkins together makes me happy.

    This morning while I was still feeling green Jan, a secretary, came into my office. I'll bet you remember this case, she said, someone is calling about it. I thought in my head I've had 60-70 cases every day this week there is no way I'll remember it. But I did, it was a gross only, and I remembered it bc it just said foreign object. Where from? I wondered. The ear? Under the skin of the arm? Usually they tell us this and on a lighter day I might have investigated but I didn't. Foreign object, gross examination performed. Jan said I assumed it was from the stomach? That made me laugh internally too. 

    Jan said the NP is on the phone and is wondering was it a bug? The patient is in her office and insists it was a bug. I rolled my eyes in my head. I told Jan, Savanna described it as three gray fragments in her gross. I never saw it, I don't look at grosses if the PA's don't have a question. If they saw a bug, I'm sure they would have described it. Jan came in a few minutes later and said I told her I'd investigate, but if I didn't call back, there is nothing more to say. YAY! Boundaries. We get pushes and pushes from clinicians that are very weird and it would eat our day up even more to respond to every phone call.

    I had a weird weird case this week - was so blown away showed it to Hal and Melody and got a handle on it. The clinician called this afternoon and you don't usually get phone calls but this one begged a phone call. This is out of my element! He said. Us too. I showed it around and I've never seen it before it makes zero sense but it is what it is. Should we send it out? He asked. Well, that gets really complicated with the bill, I told him. Who does it go to if we are confident in our dx. If she does go to a major academic center, as you predict the oncologist will send her too, they will review our diagnosis as part of protocol. That makes sense, he said. Thank you. He told me a little bit about her, what she does, who she is. I told him I sent up a little prayer when I released the case. I don't usually hear about the person behind the slide, and it made me a little emotional. I mean yes I deep dive into the charts to correlate everything but the personal side, unfortunately, gets lost there in our current state of broken system.

    Good god happy almost Friday. I need a weekend desperately. They are way too short. Elise and her husband came yesterday to work on her new office - the hospital crew has been working on it all week. I was starting to get queasy around 3 so I made sure that rad and bronch lab were done for the day and left early at 3:30. Hal (he's on call) was ok with that. I said goodbye to Elise, and she incredulously asked, are you leaving for the day? Yes, I said.

    Reminded me of when I first started and an eight hour day with more vacation I'd ever had in my life seemed like gold. My partners seemed to take it for granted, as I now do and that's easy. Habits form over time. But we are working, as the rest of the medical world and the world in general, for much less doing  much more than when I was just out of residency. First world problems, I know, but it takes a toll. Happy almost Friday, much love, Elizabeth

Tuesday, August 8, 2023

Happy Tuesday

     So last week was hard. Probably the hardest week in my history. Not workwise (that is this week so far) but work familywise. I'm seeing I tried to compose a couple of drafts but nothing came to fruition. The weekend was mostly R&R. I planned to shop for an outfit for my disco bday party but mostly slept and watched movies and laid out by the pool. It was all I had the energy for. I'm off next week Tuesday through Sunday so I'll find something amidst hair appointments, etc.

    Speaking of the party (August 19th!) just got off a conference call with Jordan and Eleanor and Anna and Aunt Peggy - they were meeting the party coordinator at Fassler Hall and I planned to attend in person but I've been ricochetting off of cases like a ping pong ball the last two days so I attended by speaker instead. We have already doubled our budget it's going to be so fun. Ceiling installation, disco ball, signature drinks. My family is turning this into a reunion - I'm hosting a party the Friday night before that I've already spent a lot of time and money on. Luckily Sue is doing the food - that's not my forte. I'm doing drinks and pool floats and all the fun plates and drink cups and umbrellas.

    So Staggs is gone and Elise is coming on the 14th, it's the end of an Era for PLA, and a new beginning. We also hired a new cytotech, Elizabeth Golden, who started last Wednesday. The Elizabeth's are taking over, and the new female hires are a tipping point. We are mostly female, now. Makes me happy (not dogging men). 

    Savanna and her long time boyfriend Ethan are planning a vacation in September to Eureka, they are staying at the Treehouses, and I'm so excited I've been giving them Eureka tips all week. They are super excited about the Grotto. I told them that the Crescent has the best ghost tour. I told Ethan this morning they have to check into Turpentine Creek. I almost inappropriately texted Savanna at 2am the other night when I remembered. You have to go during feeding time, I told them, which I have never done but heard it's the best time. Savanna told me this afternoon that they looked into it, and apparently Carol Baskin has a financial stake in it. OMG I haven't been in five years I had no idea EWWW. We thought you just had friends in high places, LOL, she said.

    I'm on cytology this week and Cidney is lighting up the bronch lab. There was an extra case today that threw me for a loop. I had one this morning and Gary was doing it - even though he was on molecular he's been helping out all week bc Pam is appropriately reading behind Elizabeth until she gets up to speed. She is from Smackover, was working in Jonesboro so she has experience. She just got married and bought a house in Vilonia. She's a DOLL. Anyway, Gary's case this morning was three slides of blood (not Cidney he's technically the best IV pulmonologist I've ever worked with - also from Jonesboro and trained in New York. Hendrix grad, like myself). I told Gary I don't have time to babysit this guy's bloody slides for an hour please read and text if you see anything interesting. He never did.

    That's about all I've got for now. Don't watch the River Wild it's number two on Netflix right now but one of the worst B movies I've seen on the planet. Carol was very good. Also the Deepest Dive on Netflix. Reading isn't coming easy to me these days but I'll continue to be optimistic that that will change. Hired my old yoga teacher Matt for house visits weekly hopefully with this continued health turnaround (thanks Paula) I can strengthen my core and start yoga again. 

    Was going to try to go to Smashing Pumpkins at Jack's request a few months ago but I gave him the tickets this week to invite three other people or sell. Cecelia, who I chat with on WhatsApp everyday is due back August 16th and plans to try to go but jet lag might squash that ambition. Plus, I learned that Stone Temple Pilots was changed out to Interpol and another band I've never heard of. I tried to listen to Interpol a few years ago when I was reading a Bon Iver article and he said he loved them but it didn't really take for me. Not an indictment (HA HA) sometimes you just have to be in the right mind frame for new music.

    When I learned STP was opening for Smashing Pumpkins I was SOOO excited I've never seen them. It took me thirty minutes of ecstasy to realize that they were opening bc Scott was not alive anymore, despite having read he and his muse's biographies. I wondered aloud to Jack who might be the replacement lead singer, told him they should hire me I do a pretty good Scott. I've seen SP twice and ordered those tixs long before the party and pool party so backed out, it feels less stressful. Guess there was a little more to tell. Happy Tuesday, much love, Elizabeth

Friday, July 28, 2023

Double Your Pleasure, Double Your Fun

     Ack what a week! And I wasn't even on call. Lots of work drama issues, to be continued next week. I brought a book I started last Saturday, in vain it turns out, because there was no time to read it. Hopefully this weekend. Monday morning, I overheard Tina fielding a phone call from Lindsey - the gross room PA in NLR. I heard museum, I heard leg, I had to get the scoop.

    Lindsey called Tina because a guy had called asking to get his leg. He wanted to display it in a museum. Tina appropriately referred the request to risk management - this was unprecedented. I asked Tina for the scoop. He wants to display it in a museum he is building in his backyard. With a UV light. Surrounded by his wife's collection of Uranium. I hope he knows it will need to be embalmed, I said.

    Later in the afternoon I was doing a frozen and Jessica filled me in on more of the scoop. Apparently while he was clearing brush on his property for this museum (he also has a life sized statue of Elvis and Marilyn Monroe) he suffered a compound fracture of his ankle with much exposed bone. There was an attempt to save it with lots of screws involved but he was in so much pain he decided to have it amputated. He thinks the UV light might highlight the screws. Lindsey said in a fourteen minute conversation he discussed WWI, WWII, motorcycles, Military grade tires, Chet Atkins (who?), Elvis, Marilyn M, American pickers, Rockabilly, Uranium, UV lights, California and Monkeys.

    At the end of the day Lindsey called me. Have you signed out so and so's leg? That guy was my amputation, I asked? We've had so many lately, toes, transmetatarsals, BKA's, AKA's. Why do you ask? I do recognize that name. You have to sign it out, so we can release it to him. That happened? I asked? Yup, it went all the way to the top of the food chain and they approved. I remember now, I told her, about a leg that was edematous but normal? So I got into the chart and read about the trauma history. Most legs have gangrenous necrosis from calcified atherosclerosis or diabetic peripheral neuropathy but this was strangely more normal.

    The next day during frozens we were animatedly talking about it and turns out the museum is by invitation only. We were saying we would never go to a place like that alone. Laurie, who was painting the margins of a breast excision, deadpanned if you went to that museum you might never make it out. What if he gets the body part bug, I wondered. People are being prosecuted for selling those. Savanna held up her arm and said like the Big Bad Wolf, I like the way your arm looks, my dear, and we all rolled laughing. Is he charging, we wondered.

    The wife came to get it Thursday and we got more of the dish. She seemed nice and normal, said Lindsey. She had a cooler in her trunk to get it to the funeral home ASAP. I carried it to her car for her. I was hoping to learn more about the appearance of the guy but since he was still post op, I guessed,  he's not hopping yet. Savanna's laugh made me happy. We are horribly non PC. Lindsey got the coveted invite to the museum when it opens from the wife. We warned her against going alone.

    Tuesday I had to google bifurcated gallbladders because I got one and had never gotten or heard of one. Turns out from Google they are very rare. I called Laurie and she was so excited she sent me a pic. A gallbladder duplication, it is called. A quick review of the chart told me they did not suspect this radiologically. One side had stones, the other didn't. Could they put the other side back? Melody and I wondered, but since it doesn't matter really it is not a rational thought.

    Some other docs wondered the same thing when I saw Trip, the surgeon, in the Dr. lounge one morning. He was sitting at the breakfast table with three other docs I recognized, but didn't know. I told them all the story and showed them the pic and Trip was so excited. Can you send me the pic? I'll share with my partners and resident. Of course, I told him. Such a cool case. 

    So imagine my surprise when I got a didelphys uterus yesterday. Like a once in ten year specimen, but at least you have heard of it. Fused double uteri. She had evidence of a C-section, and it was in the charts. So lucky they can bear kids, it seems like a deal breaker in that arena. Did you take a pic, I asked Jessica? No. Got other pics of that. You don't see it much, but you do see it.

    It's so hot, but nice to have cool nights and a weekend off. Christy rented out Kemuri West for her wedding party tomorrow night. C is still hopping around Europe (we talk on WhatsApp daily), but Jack is coming with a friend there is a cocktail hour from 5:30 to 6 ish and we got to pick from four entrees that look amazing. Jack and I are planning Dillard's Sunday to get some new dress clothes for him and try to find an outfit for the birthday party for me. Tomorrow, a much needed pedi. Sinead, can't speak. Her music saved me. Happy Friday, much love, Elizabeth

Friday, July 21, 2023

Happy Friday

     Well I had a lot going on this evening, and this weekend, but everything fell apart at the last minute for tonight, which is a good thing, because it's been a week! I finished the third S.A. Cosby book early in the week. Same great characters, good story, wonderful action scenes, and important threads on racism and LGBTQ hate were addressed well (but if you are on the New York Times bestseller list, you are probably just preaching to the choir). But he did something I didn't expect. He plot revealed way too soon! Served it up to me on a silver platter. I was hoping he was leading me down a blind alley, but my guess bore out. Premature author ejaculation. SMH. I'm still excited to read the new one, but think I'll take a break.

    Bought three new books at Wordsworth yesterday - my friend Kandi West bought and owns it now - so I've got choices. Was picking up the invitations for the party - Eleanor is in Palm Beach - and didn't realize it had moved. And the Painted Pig. And the store is closed on Saturday - since Covid, she explained to me. What's up with this space shuffle in the most congested area of town. Wednesday I finally got done with my tooth issues - had last two cavities filled, and I'm religious with the fluoride toothpaste now. I've been religious with oral hygiene in the past, but the gag reflex led me to avoid the dentist. Never again.

    I was driving back to work from the dentist and passed my old house (It looked much better and less barn like with white paint and black shutters, IMO, but to each his and her own). There was a moving van, and the front door was wide open. I parked my car on the curb and I stood on the front porch awkward and anxious for a few minutes while the owner was obviously talking to the head of the moving company. When they were through, I introduced myself and mentioned I was a doctor at Baptist so he didn't think I was crazy and he invited me into the foyer. I grew up in this house, I told him. Oh, so you are a Nestrud! He said. Yes, oldest of four. Sorry I'm talking funny half of my face is numb. 

    I requested a tour and he enthusiastically obliged. Besides paint, it looked much like when I left for Hendrix at 16. I was flooded with memories - I calculated I hadn't been there in 34 years. He told me my Mom was instrumental in helping him get the lay of the land, and problem solve. I asked how long he lived there - 30 years. He was a retired child psychologist and his wife was a retired PM&R (like Fizzy!). They were reluctantly moving to Chenal for a ground floor bedroom. My parents put in an elevator, I said, and he said they tried to look at that option but there were no real good places to put it.

    This was our add on playroom, my parents put in this built in. Everything seemed so small. While I reached my full height at probably 13 most of my memories are from when I was little. Your parents did things right, he said. This was a garage, correct? Yes, I remember scrubbing my dad's whitewall on his tires when I was little and everyone still washed there own cars. We have changed little, he said. Oh! This is where I did my college entrance essays with those old DOS computers remember those? I was such a procrastinator but my dad would stay up with me until midnight helping me edit. 

    We moved onto the kitchen and the backsplash and the fridge were all the same. I remember standing right here helping my mom with the mashed potatoes at Thanksgiving, I said. And there in the living room was a large TV where we watched first Macy's Thanksgiving parade every year (mom, from NY, was addicted) and then the birth of MTV. Would it offend you if I asked to go upstairs, I asked?

    Of course not, he said. Your Mom and Dad did things right. We had a tree fall on our house a few years ago and because he made the roof tongue and groove, it didn't cause much damage. This house had give, in storms. As we walked up the stairs I told him I remember coming to see the house before we bought it. Must have been five, one of my first memories. These wooden steps and the wall were covered in orange shag carpet my Mom said this has got to go.

    The bathrooms were the same. The retro black and white tile I used to create shapes with in my mind, the bathtub my Dad hid in during birthday parties affixing small toys to our lures while we took turns playing Go Fish. What room was this? He asked when we got to the treadmill room. It was mine. I was in such shock I couldn't remember the eggplant walls or the stereo system behind my melon covered catty cornered bedspread until I was on my way back to work. Pyro me lighting candles and burning things secretly in the closet. I told him about the time I was mad at my Mom and sprinkled glitter all over the carpet.

    Sara's room, our childhood playroom that turned into the boys room, then we came to a room that they used as a guest room. Was this your guest room too? He asked. No, I said, after we got older my mom went back to school to get her masters in nursing. This was her office. I used to hide in that closet to read Stephen King because I wasn't allowed to. He laughed. He showed me their bedroom, the add on I said we suffered through - I told him there was a makeshift stair built outside to get up and down for months I still remember the sound of the rain on the visqueen. I had not remembered my parents put a deck off of their bedroom, or built a cedar closet. 

    I know it's hot, I said, but can we go out back for a minute? Whoa. There's the magnolia tree. Same Hostas. Pool add on - lots of volleyball played there. Did you use that playhouse? He asked. No, I said, I was already in high school they built that for my brothers. The only thing we've done is expand the brick courtyard, he said. As he wished me goodbye and thanked me for stopping by, I thought no I've got you to thank. 

    Was up at 3am the next morning inundated with more memories. Mom tipsy sitting on the stairwell after one mimosa at my graduation brunch (she never drank). Dad presenting me with my 16th rose at my 16th birthday party on the front porch. My friends had planned it - it was a scavenger hunt and I drove around for hours as various boys from my high school gave me roses and the next clue (super awkward as an introvert - some of the hugs and pics were painful but I appreciated the effort). While I was driving around they arranged a girl pool party and had decorated to the max. 

    Jack had his first non-respite volunteer experience at Camp Aldersgate last week - spina bifida - and was enamored. That was my first week at 15. I had such a great bond with a camper she was featured in my college entrance and med school entrance essays. Jack came to lunch one day on break and we excitedly talked about learning transfers. The volunteers don't catheterize, but I did back then. The new pool had water wheelchairs I was incredulous we just transferred the campers to the pool shelf and made sure they had sufficient life jacket support to keep them safe.

    He won volunteer of the week! He was so excited. For a tall white 18 year old he is surprisingly sensitive and empathic and not entirely confident. But I love who he is and who he is becoming. His counselor, Kutorri, saw this as well and thinks he is amazing and needs to shore up his confidence (like mother, like son LOL). Jack shared a video of them rapping Hamilton. One of the campers, he's from a small town, has been texting Jack, the camper obviously considers him a mentor in life. I told Jack one of the great things about Camp is that they finally get to be a majority and not a minority. That does wonders for your self esteem. I'm excited to hear about Diabetes week at the end of the month. I never did that one.

    So when I first read about Barbie movie over a month ago I was excited to see it. Thought it must be coming out that weekend. But now? So much press and hype I want to puke. My strongest memories of Barbie is when I was still at Montessori, at 10 or 11, and we would hide and play a child version of strip poker with them. We would pile on the clothes and play Go Fish or Slapjack or War and the one who lost the round would have to take off another layer. The first girl to get her Barbie naked lost. Seems warped, in retrospect. 

    Christy twisted my arm and ordered tickets for Barbie at 10:30 am tomorrow at the Promenade. She's wearing hot pink, maybe I'll try to find some? Love Greta Gerwig but not so much pink burgers at Burger King. Then Eleanor and I are having an address party on Sunday so I need to shop for snacks and drinks. Long post! Happy Friday, much love, Elizabeth

Thursday, July 13, 2023


     The one at Baptist became ridiculous a couple of months ago. I can no longer get on the internet on my phone or check social media at work. I have to walk 50 feet from the hospital to even open a picture that another doc texts me for a case, or any picture for that matter. That's not fun in the South in the summer. It's impossible to do anything on my work computer because all websites are forbidden, not just porn (not that I ever tried that) but the Racquet Club yoga times or Mickey's Cake Company. What in the hell are they worried about? I might finally get to exercise or commission a cake for my birthday party? SMH. Too many people have way too much time on their hands.

    After two staycations this Summer I have learned that I don't need nine days off in a row, unstructured, ever again if I can help it. My head goes in a bad space after about four and I get depressed and anxious. Definitely keeping that in mind because we are picking vacation right now for next year, fiscal I mean, October through October. One good thing that did happen last week was that I read a book and am on my first author binge in years, S. A. Cosby. I read his second and his first and got the third and fourth yesterday. His protagonists have so much bravado it borderlines on cheesiness, more so in the debut, but the plot lines and the wit are incredible. I get a little spacey when he's geeking out in car descriptions, but the action scenes are incredible. It's fun to compare the books and see the maturation in the writing. Tried to start the third today but man it's a busy call week and we've got a lot going on with our work family so hopefully soon.

    I've been taking different routes home to avoid interstate anxiety after a busy day and my current one is so much fun! It is taking me to my old neighborhood I grew up in and there are so many good memories there. Lynn Clinton was our ringleader, she and her mom and dad Bo and Sissy lived right across the street until their fortunes took them to Edgehill. Katie and Louis Dowell were up the street. My sister and I rounded out the gang. I don't really keep up with any of them, but those were the days before internet and video games when the only distraction you had was Saturday morning cartoons so you played outside a lot.

    Lynn loved to play The Price is Right, she was always the game show host of course and we played along. We were tasked to collect small toys she could gift when one of us bested another. She also staged weddings - she was always the preacher. There was a dearth of men but no qualms about marrying women, which in retrospect I love. Once we were walking down Shenandoah and she spied a glint of gold down the sewer drain, you know like the one where the clown from It resides. Katie was the smallest, and Lynn managed to convince her to squeeze through the concrete to retrieve it for Lynn, who was probably imaging riches in her head.

    We had to find some rope to lower Katie because it was too far down to let her drop. Once she made it, she sent up the gold on the rope. To Lynn's chagrin, it was a plastic gold trophy. When we couldn't get Katie back up she started to cry, but I swear Lynn's empathy for Katie was squashed by her frustrations of a lost fortune. The rest of us ran to get parents for help. I'm not sure if they rescued Katie themselves or we had to call in the local firefighters, that memory is lost to me.

    Legs, legs! We are drowning in them. They are overflowing the large plastic bucket Jessica bought to keep the anesthesiologists and nurses from complaining and when I walked in Monday morning to the gross room there were about eight stacked haphazardly on a shelf in the middle of the fridge because the bucket was full (all in red plastic warning bags). Good lord! I said, was there a blue light special over the weekend? I've never seen so many legs. Jessica said Nguyen must have been working night and day. She said the architects came in to make sure the asbestos removal went well and spooked and ran when they saw a bare amputated leg on her grossing station. LOLOL.

    They are doing lots of asbestos abatement at Baptist and it's noisy and interruptive as hell. Jessica made them do the gross room over the weekend and Savannah took pics - there was plastic drapes from the ceiling to the floor there is no way we could have worked with that. Does this mean I get to sue Baptist when I get mesothelioma, I asked? Now they are doing micro and when I walked into huddle this morning Dell (she's the new director since Amy retired last month sniff) had ceiling tiles recently fall on her head there was plaster everywhere. Workers were bending over backwards apologizing and saying they would fix it as fast as they could. I hope our path offices are exempt from this holy hell of a mess but I fear they aren't. Happy Thursday, much love, Elizabeth



Saturday, July 1, 2023


     Well Cecelia just arrived there from Lisbon and called to chat while waiting on an Uber to the hostel to meet her friend Leila. She knew nothing about the George Floyd-ish uprising happening in France so I told her to watch out. Hundreds of arrests, I said. Cars burning in the streets. She will only be there a couple of days before she moves on but to where? I cannot remember or keep up. Her schedule is so complex.

    I was talking to Jack last night at Three Fold. SCOTUS is gutting all the marginalized communities. How can an unelected right wing body ram us all up the ass with a broomstick. Our nation is deeply flawed. Throwing women, LGBTQ community, and non-whites all under the bus. But I guess the last gasp of the patriarchy can't happen without a bit of drama. If you aren't crying, try to laugh. Climate, oppressed populations, gah. It's all too much.

    Work has been a balm. Solving problems all day long keeps me from worrying about the larger things. Cidney had 5 bronchs on Thursday and they were so complex I'll be going in Monday on my day off to finish up. Bandy came in the gross room for a complicated lymph node frozen last week. The outside read grade three endometrioid but holy hell the node was full of psammoma bodies that heralds serous carcinoma. Back in residency we used to just call these based on morphology, I told the gross room and Bandy, but now there is a litany of stains to distinguish clear cell and serous and grade three endometrioid. I think the outside person got it wrong, I said. Well, said Bandy, as he asked to look in the scope, I think it's all over her abdomen the inguinal nodes look enlarged and necrotic. We've had a lot of these lately? I asked. What's in the water? 

    No plans for the holiday weekend and excited for a rainy forecast next week. Just sunning while it lasts and planning to get two of my four cavities taken care of. Chris at Ava Bella is amazing I scheduled a massage and a dry brush exfoliation followed by Argan oil application (haha that sounds so bougie I'm loling) we will see how that goes. We had an interesting discussion when C and I went in for massage a couple of weeks ago about how it is to be a black male masseuse. Oh the stories he told mimicked the climate of our nation. Happy Saturday! Much love, Elizabeth


Tuesday, June 20, 2023

Flip Flops to the Gross Room

     It's been that kind of a day - almost 12 hours, which is normal for a med student or even light for a resident with small children but for an almost 50 year old almost empty nester it's taxing. Especially when half of us are off - we don't normally allow that but Melody and her husband got Covid over the weekend and I rushed home to get her some Paxlovid right before she spiked a fever at 10am yesterday. She asked for two boxes, I gave her four - her son Seth is still at home and it's always nice to have extra. Jauss told me about it when her whole family got it last summer - and I had Mike prescribe it for S and J's second round it really mitigated the symptoms. When the government offered me 20 free samples since I'm a doc a few months back I jumped at the chance and haven't opened the box until yesterday.

    So we had four pathologists off today, which we don't allow. The workload is too intense. AND, I had to get a permanent crown in the afternoon so it was basically a 12 hour day, starting at 7am at ENT tumor board with Don and John and Scott and I met a new rad/onc Howard. He was asking about my Starbucks bfast and extolling the virtues of Slim Fast energy drinks and chicken nuggets from McDonald's and I was like are you from the 80's? Bc you look way too young. I haven't had any of that since the 80's.

    I presented a benign vascular lesion of the parotid - I'm getting SO many zebras these days. Last week I had an angiosarcoma on the skin of the breast - I had to google an article in the NIH to stage it correctly because CAP had no template (CAP has a template for everything ad nauseum). I trained with Paula North at ACH who has since moved on to other bigger institutions - she was an international guru in hemangiomas and taught me a lot that I have mostly forgotten twenty years on. Jack had one on his nose - they are much more common in kids not so much in adults.

    In kids they have a proliferation phase and an involution phase - luckily Jack's involuted so we didn't have to intervene surgically. The theory at the time was that it was some sort of placental migration, which makes sense - why so often to the face though? Like a stroke, only instead of plaque it is placenta. Paula's husband was Bob Mrak, neuropath, he went on to chair at some smaller place in Indiana if I remember correctly after their divorce. In adults they don't involute, they slowly grow, the gross is kind of like a placenta it's a bloody sponge. So they've gotta come out.

    Paula, who was probably my age now when I was training, told me a story that happened while I was on the rotation. One of her teenage sons blocked up an upstairs toilet and ignorantly kept flushing and flushing and left the house. It flooded, the toilet and tub fell through the ceiling, and her heirloom dining room table took the brunt. God the things we put up with to have progeny.

    I'm on call and life is going good I guess. Air conditioner unit servicing bedrooms finally fixed after two weeks. Furnaces aren't cheap, but they aren't as expensive as air conditioning units (Bill Benton told me he spent 15K on a new one last week). Mom says weather is weird in Florida. Dad on his way back from Virgin Islands. Eleanor and I still planning party, we have migrated from elegant lite chic with jazz to dress up 1973 with 70's music and it's evolving and fun. Happy Tuesday, much love, Elizabeth.

LOL ETA I bring flip flops to wear for the office but never public. I had a severe right baby toe injury over the weekend so no shoes are comfortable. When I got a frozen at 5 (ovarian torsion, I also had testicular torsion yesterday ouch ouch ouch poor people) I was like screw the sandals I'm wearing flip flops. Won't make it a habit, but it definitely felt freeing. 



Saturday, June 10, 2023

Magnolia Trees

     I went on a walk yesterday (four miles) and was drawn to the magnolia trees. Leatherly leaves, big white blooms. When I was a child, there was a big magnolia tree in my backyard. I hid underneath when I was feeling sunny or blue. It was like a balm. My mom told me not to touch the flowers or they would brown, so I inhaled the scent. 3217 Shenandoah Valley Drive. Remember when your address was like a mantra? I still can sing it.

    Root canal Monday and temporary crown Tuesday and an unfortunate canker sore in the back of my tongue has kept me up at night. Scheduled Advil helps. I met with my cousin Eleanor at Fassler Hall on Thursday for lunch. Jon Norcross joined us for a pre lunch photo shoot for the 50th bday party. Let's be silly, said Eleanor, and she is the creative, so I followed her poses and I can't wait to see the paper invite. I'm gonna look goofy as hell.  Just sent forty two texts of the screenshot of the save the date. It's going to be a retro 1973 par-tay. We hired Rodney Block. The costs are mounting but that happens, I know, because I threw a big wedding bash a few years ago.

    Jon was one of my closest friends in college. Him and Brandon - even after college when I was taking pre-med classes at UALR we used to party at Discovery all night long. Dancing and watching the drag shows. We would pre-party at their house on Main Street - quite bougie, and end up in my apartment bed at Brightwaters tangled up fully clothed. I always felt safe with men that preferred men. Jon is now in insurance after hating life as a family practice doc. His long time partner, Scott, owns Mossimo and there are many satellites all over the country. Scott is helping Eleanor with a gut renovation of her Heights home. It was so good to catch up with Jon.

    Much needed staycation looking forward to another one in July. C landed in London safely after a hitch in New York - I told her the wildfires were causing trouble so she wasn't too upset that her flight was canceled and my angry mouth at three am allowed me to support her by text. God don't you love these thunderstorms? Was up at 4am and now another one is coming through the lightning streaks over the river are amazing. Evil Dead, Yellowjackets, The Dig on Netflix, highly recommend them all. Thunder is rocking the house. Happy Saturday, much love, Elizabeth.

Wednesday, May 31, 2023

The Spaghetti Squash Strings With Ease

     Memorial Weekend went by without too much of a hitch but God I was exhausted yesterday cleaning up hard cases after the second Saturday in a row. I think I went to the grocery three times? When Cecelia asked me to go with her to Kroger one morning I forget it's all confusing in retrospect I was like OK because what do you say to an adult-ish kid who wants to spend time with you? Yes. Always. It happens less, and she is leaving soon to spend two weeks with Chanel in London then some time in Denmark with Caroline and she has lots of side trips planned. You'll inspire my next year's vacation, I told her, and she beamed.

    Speaking of Chanel what an amazing human being she's like a cross between Janet Joplin and Bette Midler she has the most incredible sense of style and a beautiful singing voice and a (swoon) raspy British accent and she is magnetic because she is always ON until she falls asleep mid sentence on the couch. That's probably why C is attracted to her as a friend - like attracts like. I got in big trouble for calling her Chenal (it's ok mom because Mrs. Rachel does it too but it's the BRAND. Not the STREET in Little Rock). I was trained over the weekend, bc Chanel came in from London for one day (these kids) - it was supposed to be two, she said, but my Las Vegas got canceled. We chipped in on a new tic she had a terrible day stuck in airports. The Hendrix gals had a big blow out to see her off back to London for good.

    So on Sunday (I'm remembering now) after the grocery trip Jim and Zack were in the pool but Cecelia wanted me to learn how to make spaghetti squash - she did this amazing dish after baking it in the oven then crisping it in the air fryer and mixing it with roasted cherry tomatoes, fresh mozzarella, and Boulevard pesto. My mom had a big stint while I was in high school trying to make my bro Crohn's disease friendly meals (basically non gluten - he gave up on that years ago and I finally broke my gluten free stint it's like torture honestly). There was a cookbook with spaghetti squash spaghetti, we ate it a lot, but I hadn't had any since then.

    Sprinkle it with salt and pepper and drizzle olive oil (not too much or it gets soggy), after you cut it in half and scoop out the seeds. This is a small one, lets bake it on 425 for 30 minutes. An hour if it is a big one. We waited, and chatted, and when it was done she took a fork to separate the squash noodles. 

    It reminds me of a testicle, I told her, to her mortification and amusement. We don't get testicles very often, maybe twice a year. Always makes me cringe when I have one in my pile, torsion is easy but tumors are very tough. I never saw this in training, but when I got to Baptist I was alarmed to see in the gross, I guess the PA's had to be trained by some pathologist on this, that the testicular tubules string with ease. Made sense, based on my own experience grossing testicles, but kind of Eww right? And I have never seen them say anything opposite. What is the opposite of testicular tubules stringing with ease? Can they actually string with difficulty? They actually do resemble mini spaghetti squashes, without the tough rind.

    Jack is thriving at Boy's State - he texted us today about winning the runoff in his political party in the race for Lieutenant Governor. I've had two retirement parties this week - Amy head of micro had a big one on Tuesday (cry emoji) and Van, who has been here many years in cytology, is going to travel to make more money. Big pizza party today to see him off to St. Petersburg. Happy Wednesday, much love, Elizabeth



Thursday, May 25, 2023

Friday Eve

     Whew only a few more days of call then a week of work then I'm off. I have never been so ready. In addition to work, I had some jaw-dropping news in my personal and work family this week that have made me manic. Finally feeling more grounded. Nothing terrible (well the work was a little frustrating), nothing that doesn't make sense in retrospect, but still. There are things that make you change your worldview. Like having a kid. Lys brought me homemade pumpkin bread in the hospital when I had Cecelia, I will never forget how wonderful it tasted. And on the ride home, with little C in her carseat, I marveled at how I will never look at banal things like Toys R Us the same. It's like being cracked open, raw and bloody. Then you get grounded, and realize you have to fit into a new mold now.

    I had Paula yesterday for the first time in a month, it was much needed. The clearing over the last few months has helped my GI issues in so many ways. I only have exorcist moments every month, instead of three times a week. I finally went to the dentist for the first time in two years. Last time, she told me my gag reflex was so bad (she couldn't take films) that I'd have to take a benzo and have a driver to come back. That daunted me. After I broke my jaw, I had two root canals in the middle of a work day. Can't take benzos and go to work. So I learned the other day I needed a root canal then a crown and then she can fill four cavities. FOUR! I have never had more than one at a time. Got the root set up for Monday the 5th. After a mom and daughter massage in the morning.

    C leaves for Denmark and London on the 8th of June. So I'm glad I have that week off to spend some time with her. Pedi's and walks together is on her wish list. I miss you mom, she said. She and Woody spent a few days in Florida with my mom and dad this week and that made me happy, the pics are amazing. Her ETA is 7:00 tonight. I bought lots of yummy goodies to plow her with. Dark chocolate covered cashews, caramelized pecans. Fresh pimento and pesto from Boulevard, chicken and garlic tortellini, and Amanda Ferrell, who came for book club last weekend, introduced me to yet another incredible candy bar. Mayan chocolate.

    Where the hell did you get this? I texted her the next day. You are my chocolate angel. Whole Foods check out, she texted back. Jack and S went to town I had to hide the last two. I enjoyed the chocolate pretzel peanut butter one last night there are lots of varieties. Jauss said her son loved them so much she will also be headed to buy more soon. I'm more of a savory than sweet person but I appreciate a well thought out sweet, if only a bite or two.

    Jess told me there were three autopsies (!) while I was gone - she said the transfer to UAMS has gotten much smoother. Gross room is busy, but running well. Lots of John Sims frozens this week. And neuro. I told Blake Phillips in the Dr. Lounge the other morning at 7:30 you and Burson are taxing me this week with weird cases. Tell me, he said. There was an NF1 (think Elephant man). 7 cm mediastinal mass eroding into the C-spine. This is a first for me. I feel like Shaver and I are on the path to figure it out. Detective work. Not easy, but fun, and hopefully we can help the patient.

    Been emotionally labile, uncharacteristically crying. Surprising myself. Luckily I have lots of support. Singing helps. Writing helps. Connection helps. Looking forward to a full house this weekend, Jack is coming over tomorrow too. S's dad (who I love) will be here and his ex Monica is hosting her oldest son Chris and his adult son Zach. Probably will be some pool fun on Sunday, even though we discovered the pool heater is broken and although we are on a list we cannot get a pool fixer to show up for the second year in a row to save our lives. Maybe waist level? If not at least some sun and books and food and company. Happy Thursday, much love, Elizabeth.



Tuesday, May 16, 2023

Felix and Bidets

     Oh my god Europe was amazing. I got the bug - can't wait to plan a new trip for next year. New Zealand, Australia, Ireland, Scotland, Norway, I want to travel. I was too fear based, unlike Cecelia, in my twenties, but hell if we've got 80 year old presidents I've got a long way to go. Europeans are way more laid back - local parts of the towns closed on Sunday through Tuesday while the Sephoras and the Foot Lockers were open seven days a week. 

    S was super excited that there was a bidet in Bordeaux in our hotel. My expression was like Jessica's when I relayed this story in the gross room yesterday, a mix of shock and horror. Not being judgmental, I have learned in Bad Mom Docs that a lot of people like a good home bidet, but it wasn't something that I wanted to try. When we got to San Sebastian there was another one in the hotel. S urged me to try it - this one isn't as aggressive as the one in France (an aggressive bidet?)  so I vowed to try it, if only once.

    I woke up early one morning while S was still sleeping, and checked out the remote on the wall. Was surprised to learn there is a front bidet and a back bidet (I thought only back?). After using the restroom, I pushed the remote on the back, which I thought was mounted to the wall. It fell down behind the toilet. There was a steady stream of water, at first lukewarm and not entirely unpleasant, but it shifted to hot and I was uncomfortable.

    Surely this will abate after thirty seconds, I thought, but no. I was fidgeting at a crazy angle with my foot to try to retrieve the remote unsuccessfully. Finally I realized this was a bad strategy and shifted back from the toilet to try to grab it with my hands to stop the unmerciful stream of water. Water started shooting all over the bathroom door and floor. Thank god, I thought, I didn't pick the front bidet, it would be hitting me in the face. I grabbed the remote and pushed many buttons before it finally stopped. No more bidets for me. Not in this lifetime.

    I still get really dizzy and spinny with heights, so I tailored the tours to accommodate my weakness. Me, who has ziplined in Costa Rica and hiked mountains. Currently, not so much. We had some non-English speaking transfers, which is fine, but everyone on the tours had a good command of the language. Saying this, I realize my privilege, to not know more than one language (but to be surrounded by French in Bordeaux, after having five years and losing it was a balm). Most of the tour guides were sensitive and accommodated me. But not Felix.

    He picked us up at the last day in the hotel in San Sebastian. The place I wanted to read on the beach (I read four books, only one of which was terrible). It was rainy and 60 the whole time. Felix proclaimed in a heavy Basque accent that he was an amazing driver and had been doing this for 30 years. Red flag. But the trip to the cave and the Witch Museum went without incident, so I wasn't fearful. I heard him talking to S about a place at the top of the highest mountain where you can get good views and buy cheap tobacco and liquor. Thank god I didn't book that tour, I thought.

    We ate lunch at a small town in France with no internet. The food was passable, but when the guide clearly did not understand either French Fries or Pomme du Terres (sorry if I murdered the spelling) I knew he was lying about knowing 5 languages. I saw them everywhere and although we were served them despite our guide's lack of understanding they were soggy and bland. When S went to the bathroom Felix asked me if his driving scared me. No, I said, and this felt like permission, later on, for what happened next.

    S thinks he inadvertently agreed to a trip up the highest mountain. It was at breakneck speed - think of the Pig Trail going almost a hundred miles an hour. I was thrown against the minivan door so much my back felt like it was going to break. He has been cited for his driving, I told S. I accidentally gave him license for this. I'm sick, I cannot get out. I'm a little angry, I agreed to a fisherman's village which should be by the ocean and here we are at the top of the Pyrenees. 

    To his credit, he took it a lot slowly down the mountain after he saw me slumping on the floor of the car and was so solicitous we tipped him as well as any other tour guide. I often tell my kids, when they are going through rough times, turn it into comedy. Own it. Don't be a victim. Like Obama's first book taught me, we learn more from our failures than our wins. 

    Back at work with two weeks of call in front of me. Jet lag has made it tough. Hurtling across the ocean at break neck speed has got to hurt you on a cellular as well as emotional level. Finally recovering today especially since the cases are tough as nails. Cecelia told me she was so jet lagged getting into Spain last summer she was bawling profusely. Made me feel a little better about my struggles the past few days.

    Scottish Brian at Boulevard and I talked about my travels today, he follows me on Insta. I get a pimento only sandwich there - half, and save the other half in the fridge for the next day. I won the free cookie yesterday! Was so freaking excited. A first! He posts a song quote daily and usually by lunch someone has gotten it. Saving nickels, saving dimes. Looking forward to happier times. Linda, I told him. Usually he tells me it's already been deciphered. Monday he said name the song. Blue Bayou, I told him. You win. I want the ginger molasses. You got it. I usually get the quote too late. Ate a third of it for dessert. 

    Today I had a helluva hard case right before lunch. I was trying to pull the undigestible crust off and unprecedentally (not a word, but mine) threw pimento all over my scope and on my light source after the shitty breast case I have to finish off tomorrow, with a lot of others. It took over ten minutes to clean.

    I texted Melody. If I don't laugh about this, I'll cry. I'm in hell too, she said. Is this a Monday? Every day is a Monday lately, I texted back. Eye roll. Can't wait for the new path to start in August. We are running on empty fuel, and we need help. Thank god for vacay. I've got another one coming up in a few weeks starting June 3. Jack's bday! No plans for the summer. Happy Tuesday, much love, Elizabeth.

Thursday, April 27, 2023

The Juicy Stuff Grows in the Shade

     Lab week was so much fun! I say was, bc I took tomorrow off to pack for Spain and France, we leave on Saturday. I had a near panic attack on Monday - histology is so unpredictable and even though our plane doesn't leave until 12:43 I did not want a full day of work with possibly leaving a shit ton of cases for my partners to finish off if I couldn't on Sat am. Too much to cram in. You have a lot of three man days left, said Shaver, so I peeled off a day from my vacay in August. Only one case to finish tomorrow, then I'm off for two weeks.

    Lab week started last Friday, when Hope asked if one of the pathologists wanted to go get the proclamation at the Capitol and get our picture taken with the Gov. I had no clue this ever happened. Why do we need a proclamation? I asked as she drove Angel and I downtown. It's just a thing we do every year, in order to make it official. It was terribly unorganized. A hipster with a messy dirty blonde bun didn't know anything about it, and the guy she promised would showed up 20 minutes later with his tight jeans and We The People tattoo was equally flummoxed. It's ok, Hope said, we can get it later.

    There were five groups of people - we were about 10-15, some from Baptist, some from UAMS, and it was nice to meet the medical director of OBI. Oklahoma Blood Institute, it used to be, but bc we work so closely with them it changed recently to Our Blood Institute. More inclusive. She was a charismatic young woman who asked me if I would help her get affiliation with Baptist - she was having trouble with BHPP. I went to Carla (head of blood bank) and Mackenzie (our admin) on Tuesday to advocate for her and hopefully that will get the ball rolling.

    They arranged us in front of a fireplace and arranged another group in front of a fireplace across the room. It was like an assembly line. Sarah came in at the last minute, the photographer shot our pic, and she moved on to the next group. One of the gals from UAMS told me at least Asa sat with us for 20-30 minutes and asked about lab issues. Talked to us. When I was telling a pulmonologist the story in the Dr. Lounge Friday afternoon, he said we are just a stepping stone for her political ambitions. I agreed, she doesn't really care. A true politician would have thanked us for our work during Covid (this was the first time we revived this tradition since Covid). Without the lab, you are only guessing, said one of the coffee mugs I bought for lab week. Carla showed me a statistic this week - 70% of clinician decision making about patient care is based on lab results. We are not the sideline, we are the frontline.

    Had med exec committee Monday night and it was full of acronyms, like alphabet soup. I had to lean over to Julia Goodwin, chair of OB, during the discussion on FPPE. What is that (I'm terrible about reading the topics emailed to us in advance)? Forced physician performance evaluation. We are just starting it, a way to monitor physicians who are deemed faulty, not the immediate revoking of privileges if you are putting patients in danger or are inebriated on the job but to do a six month monitoring of those in the grey area.

    There was a long discussion. Do we in med exec need to get involved? Or can PRC (peer review committee) and credentialing handle it? Ultimately we decided it needs to start in PRC and be handled by a chief or a designee of the chief and the chief can present the findings to credentialing. Revoking or denying privileges is a big deal, so it needs to be handled correctly. The head of credentialing was there, and he appreciated our input as we talked about issues that hadn't been raised yet in their committee. Later, when they were talking about bringing experts to improve ST (I mangled that I think there is another letter I forget) Julia saved me once again. Sterile Procedure in the OR.

    Sarah, who runs the morgue, was in charge of a lot of the doling out of my lab merch. She loved it. This was the best lab week since I've been here in five years! Finally, I told her, we are included again. It used to be so fun, but we've been iced out with changes in personnel. Our AP vendors delivered today. Corky's for lunch and take home dinners - there was food for days (too bad I hate BBQ but Jack and S are reaping the benefits). It's like the Freshman 15, Laurie said this morning, only Lab Week 15. Yes, I laughed, there has been a lot of food. Cupcakes, Potbelly, cookies, Papa John's. Our vendors aren't like drug reps - they don't give us exotic vacations to cause an opioid crisis, they are just molecular and lab machine people. It's all above board.

    I planned lots of things on Sunday - errands and treadmill but my body said Fuck No low energy you are going to be a couch potato. So I binge watched Beef and recommended it to Jack. The last two episodes are some of the finest TV on the planet. Monday Hal had almost finished it (no spoilers! Of course not, I said) and Kimberly's son's in-laws were watching it and Shaver had started it.

    I was walking back to my office on Tuesday after dropping off a consult to Shaver and Hal surprised me by jumping into the hallway with his hands clasped in a gun shape aimed at me. The juicy stuff grows in the shade! He said. (I may have mangled even that one, but you get the GIST - Gastrointestinal stromal tumor LOL). I laughed. You are going to have to help me, I said. I don't remember movie or TV quotes. Hal and Staggs are like encyclopedias, I can barely remember the Succession from the night before and often google it the next day for a recap. I finished Beef! Oh yeah, I said, I remember that now. We recounted the last two episodes for 20 minutes and laughed until we got exhausted. Happy Thursday, much love, Elizabeth.



Thursday, April 20, 2023

Call Week Number 2

     I remember sitting in the car seat, maybe in the back, curled up around my med school books, studying. It could have been the red Wagoneer, it could have been the Acura Integra. Or the Taurus. Mike went through a lot of cars. Florence, his grandmother, had died in a house fire. Kitchen, in Greensborough South Carolina. We were headed to the funeral.

    A lot of my med school friends skipped their grandparent's funeral, with much regret. We all skipped a lot of things. Baby showers, weddings. The curriculum was brutal. So I was a little bit proud to skip a few days to attend my husband's grandmother's Orthodox Jewish funeral. I don't remember the burial, but I remember everyone going back to the house to stand shoulder to shoulder and wail. Bill and Esta, Florence's kids, were both very secular, which spoke volumes about their upbringing without speaking. Is this called Shiva? I wondered. 

    I had only met Florence once, when Mike and I were dating. We spent the night on the way to meet his Duke educated English major mom who now worked at the Waffle House. Mental health issues can be devastating. Mike warned me. Florence is a bit cantankerous, tough to go to a restaurant with. Everything is wrong. And she thinks Daniel saved me, but I saved Daniel, we really saved each other, so I have a little resentment.

    Sure enough, after a forgotten dinner, she raved about Daniel and Mike was irked. We were tasked to sleep in separate rooms - we weren't married yet - so we took a walk after she and Milton went to bed to vent. It helped. We were on our way to Gaffney in the morning. The next day he took me to his fave restaurant there - Hubcap maybe? Legendary peach iced tea, which I loved, even though I don't love iced tea. Super sweet and refreshing. Giant burgers - I think you got your name on the wall if you ate it all kind of like the plates at The Flying Saucer for your beer consumption.

    Mary was lovely, his Mom. She had made matching pajamas, a soft floral flannel for me and her - Mike took a picture that I continue to adore to this day. Schneider means tailor in German, Suzanne Klimberg told me on an elevator when I was training. Mary lived up to her name. When she passed, Cecelia, then just a tweener, read a poem and held a beautiful doll that Mary had made her. Mary took the kids to the library weekly, and stoked a love for books that I had no time to do. One that my own mother stoked in me. I still have a beautiful stitched potpourri pillow she made me in my office.

    I was up in the night from three to five am on Monday trying to stave off the images of a pathologist in NW AR. One that Melody and Annie had trained with, one that helped with Bill's cancer diagnosis last summer before he passed. Say what you will about Bill, but he moved Milton to Fayetteville and cared so much for his dad it melted my heart. Melody and Annie's friend was killed by her husband, stabbed to death, found in the street in her robe, presumably trying to escape. Melody and Annie had met the husband, a kind but forgettable presence in her background at events. When I was unable to sleep, I fondly remembered Milton and Florence.

    The pathologist's hubs tried to kill himself but failed. So the story will come out in his prosecution. Her story is over, but it will come to life with her friends and family. She didn't seem like an abuse victim, I hear. So what happened. Time will tell. Spinning and spinning on this this call week. How does a relationship get to this? What would this do to our work family, I wondered aloud. The dynamics would be holy hell. 

    Only three days left of call! I've got a 7am meeting - Baptist Health Extended Care quarterly where we discuss infections and falls and metrics and try to meet a fucked up national standard to get the maximum reimbursement. Lab week is next week, and I'm so excited I bought tons of merch on Amazon that I can't wait to disperse. Hope is including us this year. We are having lots of games and a photo booth! Nerdy, I know. Even though admin is still holy hell bottom line I am hoping that we are moving in a better direction. Love the lab. Happy Thursday stay safe in the storm, much love, Elizabeth


Friday, April 14, 2023

Call Week Number One

     Is almost under the wraps. Knock on wood tomorrow is a light day. The week, however, has been a doozy. 150 blocks on Monday, plus three big cases to photograph and present at ENT tumor board in the am. Blake Phillips sent me a late brain frozen. Cerebellar mass. WTF. 99.9% of our brain frozens are in the cortex (and easy peasy met vs GBM). The radiologic differential made my heart race and I had to take my white coat of bc I was getting sweaty. Medulloblastoma. Ependymoma. Choroid plexus papilloma. Low grade astrocytoma. Why oh why do you get this crap when there is no one around to consult? These are once in a lifetime if that diagnoses. I nailed it tho - in that hedgy way. Glial proliferation. Reactive gliosis vs. low grade neoplasm. 

    When Jon Wilson called today to follow up, of course I sent it out to Arkana to an expert, he shocked the hell outta me. Ganglioglioma, I think (very rare). I googled it and the history totally fits. Can you get a BRAF and a synaptophysin on C1? He is a nice guy - I used to do yoga with him at the Racquet Club so we caught up. I hadn't sent him a case in a year. Come to sip and stretch tonight! He said. He and his wife are DINKS like Mike and Effie and travel the world. It's been a brutal call, I said, but believe me it is on the radar. My gut health seems to be improving. Guess what? I sent you another case today so we will talk again soon.

    So it's been a brain zebra theme week. Blake Phillips sent me a frozen one morning and I was like I think it's a pituitary adenoma? Sellar mass. But I've never seen bone in one of those? He yelled back over the OR speaker phone, you and me both! Sure enough they can rarely have osseous metaplasia. Melody and I handled that one on our own. Then yesterday Tim Burson sent a submillimeter frozen from the spinal meninges. I called Melody from the gross room. I'm so sick of these weird neuro cases. Can I bring it to you for consult?

    Of course, she said, and we puzzled together over the tiny tissue. It's a multifocal spinal meningeal lesion. Lots of spots, I told her, in an immunosuppressed patient. They think it might be infectious. What are those clear cells, I asked. I can't tell, she said. I'd just say degenerative tissue no definitive lesional cells seen. Sounds good. Today, something that frozen lost (like I said wax is way better than ice) you could see little capsules in the cleared cells. I jumped up to show Melody. Holy shit cryptococcus. I ordered a crypto mucin and a GMS. Lindley called in the am, ID doc, so I called to give prelim and told him I'd text in the morning when I got the stains. Wow. He said. There is a history. His serum Ag is pos but his CSF Ag is neg so this is a true shocker.

    Tuesday morning I presented the three cases at ENT. Me, David Hays excellent IV Rad I've known forever, Stern, Sims, new ENT Travis, and newish Rad Onc Howard. A few support staff who didn't speak. I presented a nasty sialadenitis (It was like trying to FNA a street, Hays said, and we all laughed). I'm a little lazier that I used to be - when Hays brought up the pics of this from my jump drive Stern said I need my 3D glasses! I laughed. I forgot to put it in portrait mode for these. I didn't go back and retake them. The rest are in portrait mode, I assure you.

    Renal cell carcinoma to the thyroid - that is a board question, I said, what is the most common met but this is the first I've seen it 7 cm oh my. Look at the clear cells and the blood lakes - Hays can tell you why these are dangerous to FNA in the kidney they bleed like stink. It's the second one I've had this month, Sims said, and they do bleed like hell. The other was a once in a lifetime plasmablastic lymphome vs. low grade B cell lymphoma. They sent it to the NIH to see if they can be more decisive, I said. 

    Stern said a lot of time when y'all send it off they are just as hedgy. My heart swelled with pride. I notice that too, I said, but it's good to get an expert's name on it. You know that rare parotid tumor, I had one with Sims a couple of years ago, pleomorphic adenoma ex carcinoma? Bruce Wenig's comments read like a book and seem like they leave a lot of wiggle room. Stern said, oh my god his comments are so long. I imagine him drinking two bourbons when he's writing them. We all laughed, and Sims said I have blacked out trying to read his comments.

    Speaking of Sims, he kept me late on Wednesday doing frozens, about five or six. when I looked up the history I cringed. Adenoid cystic carcinoma? Recurrent? Talking to Savanna, who was covering for Laurie bc she had to go to a funeral. He was using a CO2 laser, and all of the tissue was burnt to high heaven and hard as hell to cut, according to Savanna. John came in to see what I thought of his margins. I sweated and took my white coat off for the second time in a week.

    Adenoid cystic is a really basaloid neoplasm that when crushed and burnt can look like lymphocytes or tumor, honestly. I said John, you are going to hate what I have to say. Atypical, cannot exclude neoplasm, on one and two. Savanna is still cutting the others. So, he said, tell me about atypical. Well you know cytology, I said, there is negative, atypical, suspicious, and positive. I want to break it down further, he said. OK. This one is atypical, favor negative. The other one is atypical, I'm really suspicious. Sometimes I feel like he misses the forest for the trees. But I"m not in the OR digging around in the complex head and neck, so it's hard to judge. I'd certainly pick him as my surgeon if I needed to.

    I made the gross room order permanents today, in order to try to find more viable tissue like I said ice leaves holes and wax is better. Was able to be more definitive on some of the margins. But adenoid cystic? It's like chasing the devil. It is extremely painful bc it wraps around nerves - that's it's predilection - and once you get a hold of a nerve, like a firepole, you can go anywhere.

    In good news I'm planning a 50th bday party with my cuz Eleanor (we had a big 40 too) and she and Anna came for lunch. Sooo excited we discussed possible cool venues and music and interactive guest art (for Eleanor she's the amazing artist) and signature cocktails. Eleanor and I are gonna split it. They loved seeing my office and I told them in a month or so we should do it again and I'd show them the gross room. Anna was thrilled. I want to see breast frozens! She kind of mangled what I promised her (we don't freeze breast) but I can't wait to deliver. Happy Friday, much love, Elizabeth

Friday, March 31, 2023

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


Tuesday, March 28, 2023

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