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.