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