Showing posts with label Gizabeth. Show all posts
Showing posts with label Gizabeth. Show all posts

Thursday, June 30, 2016

Louis Gene Singleton: A Tribute

Gene is from Cherry Valley, Arkansas; somewhere between Wynne and Jonesboro on Hwy 1. As a boy he fished in a creek on Crowley's Ridge. He remembers his mother frying the small fish, bones and all, to feed their family. His rural farm childhood shaped him, and although I don't know much about his service as an officer in the Marine Corps, I imagine that shaped him as well.

I met Gene when I interviewed for my current job. He jestingly boasted to my father, a neonatologist, that I was to be his replacement ten years ago. I felt proud to be set up for that position. I learned that he had three children and 16 grandchildren; a fact that left me in awe. Now he has six great-grandchildren.

When I first started my job after residency, I was naturally fear based. Gene was my rock. I showed him so many cases in the first couple of years I worried for him; but his patience, calm and good counsel kept me coming back for more wisdom. He never gets angry, I heard the gross room physician assistants say. He never gets flustered, I heard the histotechnologists say. If he raises his voice, said the collective voice of the laboratory, then something really bad has happened. He doesn't need to get mad; he just subtly draws boundaries, and you get it. He quietly leads, and people follow.

So I followed, and I learned. He taught me when to dig down deep in the books, and when to send a case out for expert consultation (rarely). He taught me how to subtly and sweetly correct a clinician when he or she was missing the point. He taught me when to let go of my dogged pursuit of righteousness for a greater good, always keeping the patient in mind. That's why we physicians are ultimately here: for the patients. Being right among our peers is less important than being of service to our community. Early in my career one of my diagnoses was attacked by an outside pathologist, and he stood by my side and defended me to show me that this is what the world can be like, and that part of our job is to protect the truth.

There is an art to medicine, one that is lost in our current climate. Gene is the embodiment of that art. I have gathered over the years that he is a religious man, but he doesn't wear it on his sleeve; it is discerned through his actions. He retires tomorrow, and I am heart broken to lose him as a consultant. He went part time a couple of years ago, and I am constantly reviewing the schedule to see if he is here when I am. When I bumped into him in the hall yesterday I realized it is time to let go. He has promised to visit, but he will no longer be a fixture here. Retirement is not just an end, as I learned from my father at the ocean last week. It is the beginning of a new journey.

I've been grieving lately, taking my own stroll through the five steps - denial, anger, bargaining, sadness, and acceptance. I'm finding comfort in the knowledge that his qualities and characteristics will live through myself, my partners, and my future partner joining us next month; our first hire in the ten years I have been here. I need to teach her some of what I learned from him; a job as much daunting as exciting.

The best servants of God leave the strongest imprint on this Earth. Their legacy is the future. A part of Gene's legacy is the countless number of patients he has helped from behind the scenes. While I will  miss Gene's daily presence, I look forward to witnessing his next step in life, and know that he will only be a text away. People have real ages and chronological ages. His visage belies his actual age by about two decades, so I am comforted that he will be around for a long time in case I ever need him.

I wish him well. I wish that he will enjoy his children and grandchildren and great grandchildren. That he will continue to honor and support and enjoy time with his wife in the same way I have witnessed throughout the years. That he will find a way to continue his chosen profession in a new configuration; once a doctor, always a doctor. That he will know that his partners revere him, and that we will continue to be there for him whenever he needs us, as he was there for us in countless ways throughout his career.

Gene Singleton is one of the best fathers, friends, and pathologists. He's the best mentor anyone could ever hope for, and if I can be half of the mentor and pathologist that he was to future members of this group then I will be proud. I'm going to miss you Gene! Hail to the Chief:). Sniff.

Much love, Elizabeth

Tuesday, May 17, 2016

A Proposal

I walked into the Dr.'s Lounge this morning and bumped into a hospitalist. I had heard over the weekend that he had been through a rough divorce three years ago. I see him daily and we talk about kids once a month but somehow I missed this.

"I'm sorry! I must have been living under a rock. Divorce is so awful I wish I had known."

"Oh who told you? Your new neighbor? I met her at a crawfish broil last weekend."

"No, not her but she is sweet we had a big neighbor cookout two weeks ago love her. It was dance moms - Cecelia's (13) big recital was last weekend. And don't tell your son you heard it from me but C told me he's the hottest ticket in town."

"His head is getting so big we are having trouble keeping his ego in check."

"The dance moms were showing me a picture of your girlfriend on social media she is super cute."

"What?" He looked confused.

"Short blonde hair?"

"Oh where the heck did they find that? That was over a while ago. It's so hard, dating and divorce. There's so much baggage."

"Yeah, I had a year of hell on but finally got lucky. I met a great guy almost four years ago. He has never been married and doesn't have any kids - not that I would have minded if he did, but it is easy. The kids have their chance for a sibling with my ex and stepmom's toddler." I smiled, "he just moved in a month ago I'm so excited."

Last Saturday I caught up with an old friend I hadn't chatted with in 15 years. We talked on the phone - she's in DC - until 12:30 am. I sat out on the back deck.

"So tell me all about him!"

"Well, he's lived all over. Born in Arizona, elementary and middle school in Plano,Texas, high school in New Jersey where he started biking - rode with George Hincapie up there, biking and art school in Kansas City, then the Twin Cities and Seattle to pursue his photography. Once he delivered a pizza to Eddie Vedder in Seattle!! He decided to go back to Kansas to pursue architecture and finished his degree when Wall Street crashed in 2008. He worked in L.A. for a year then came to Hot Springs. Now he's in a nice office in downtown Little Rock with a large national firm based in Memphis - they did a lot of work in downtown Memphis. They had their Christmas party at Graceland it was so fun! We did a night tour. I had been lots of times growing up but it was his first."

"So are you going to get married?"

"Well, yeah, we talk about it but. . ."

"But what?"

"He hasn't asked me yet. I mentioned never getting married again so many times early in our relationship I think he is afraid to ask. I would be."

"You ask him."

I was flabbergasted. "I can't do that!!! You're crazy!"

"Yes you can. Do it. Ask him."

I've been thinking about it non-stop for the past two days. It would model great bashing gender stereotypes to my children. We have talked about it a lot recently, especially since things have been working out so well since he moved in.

Thinking about it has made me reflect on our time together, and on him. How we both disagree on our first date to the tour the U.S.S. Razorback submarine - July 22 or 23? Luckily he saved the tickets so he can usually find them and prove me wrong. How we disagree on our first kiss anniversary two months later - we spent a lot of time hiking and going to movies and getting to know each other before that. September 22 or 23? Depends on when midnight struck neither of us were paying any attention.

He met the kids late that fall at a picnic at Pinnacle Park - one of our favorite hiking spots. I still remember Jack grabbing his hand while stepping down a bank to the creek and his surprise then ease with the contact. The kids and I later took him to one of our favorite hiking spots that has the Cat in the Hat painted on a tree stump. He did art projects with Cecelia - a Valentine's box in the shape of a nose (her wacky idea). They painted the girl and boy mascot clay statues of the Nashville Sounds in a tux and fancy dress and won box tickets to a game - his dad and stepmom were in Nashville at the time. He easily blended into our weekend lives and a year later got a job closer to Little Rock and an apartment two blocks away, so he has been a fixture for the past two years.

There are so many things I love about him and I am really bad about expressing them to him. It's a lot easier to think about them in my head and type them hiding behind this computer. I love how he points things out to me with his photographer and architect eye that I would miss buried in my books or music or thoughts. A coal barge on the river. A detail on a building. A rock to watch out for on a bike ride. A cardinal in the backyard. I love how he collects watches and gave me one on our first trip out of town to New Orleans. I still remember him telling me he wanted me to wear it. It's a Tissot - very clean and classy - he told me then that Grace Kelly wore this watch and I was amazed he knew that.

I love how he is with kids, so easy and quiet and agreeable. How he jumps on the trampoline with Jack (10) when I worry he is stuck in his iPad too much. How he goes over Cecelia's study guides with her the night before tests - he is her favorite study buddy and calms her down much better than I can. How he rides all the roller coasters and goes on all the waterslides that I am too scared to do with them. How we take turns wishing them goodnight when they are here. Some nights Cecelia keeps him down there talking way too long and I love hearing what they were talking about when he comes back up.

Most of all I love how he is with me. He's dragged me out of my books into TV series and we are having so much fun with Ray Donovan right now I can't wait to settle kids at night. He hikes with me and bikes with me. Lately we have been getting into cooking with Blue Apron. It's so fun to put on the classical music he grew up hearing at symphonies with his father and wind down the day preparing a meal together - both of us learning how to cook. He fixes all of our computer issues there are lots! Last Friday night he volunteered to be one of the drivers with me in a Scavenger Hunt birthday party with fifty kids we had so much fun. We got kicked out of the mall by a power tripping cop; I loved that he enjoyed it as much as I did. He puts up with my singing when I've had an extra glass of wine. He's my knight in shining armor when I've had a terrible day. And he's helped me focus more on the right in me than the wrong, which I have a tendency to do.

I love that when he catches me looking at him he gets defensive like there is something wrong but really I just love to look at him. He is so handsome. I want to live in the corners of his eyes when he smiles. I want to breathe in every time he breathes out so I can catch his breath. I want to be buried in the smell of the crook of his neck. I want to spend the rest of my life with him.

So, SPS, here's the question that has been making my palms sweaty and my heart anxious, ever since my friend put it in my head to ask. It can be a small wedding, no frills - I know you don't like being the center of attention - me neither. Just you, me and the kids. I'll console Cecelia by throwing a huge party inviting all our friends and family with a band and good food and wine. I've got no ring but I've got these words and I know you value art over things so I think it'll be ok. And I'm not down on one knee but I'm hiding behind this computer on mothers in medicine which was my safe spot and my outlet in one of the hardest times of my life. So here goes. What do you say? Will you marry me?

 At P.F. Chang's - a top spot with my kids, awesome friend histotech and bestie P.A.
 Hiking a black sand beach in Hawaii at a path conference on the Big Island

Click the link below, babe (Elle King)

Tuesday, April 26, 2016

How Re-Taking the Pathology Boards Ruined My Year

With all due respect to the American Board of Pathology last year sucked.

I am both lucky and unlucky. I only have to re-certify every 10 years (so sad for my 6 year OB/Gyn friends and my 7 year Peds friends). Lucky. I was the first class in pathology - they were a little behind the rest of the specialties - to have to re-take my boards. Unlucky. I could combine my general and subspecialty re-certification into one test. Lucky. I think this whole process is a ridiculous money making scheme like most other doctors in the country. Unlucky.

I started studying in early 2015 on a plane on the way back from a lab inspection. I wanted to take it a year early in case I had to do it again. I was really frustrated that I would have to take it in Tampa - most other specialties could do it at a testing site in their city. I signed up to take a half a week off and fly there in August. My path bro-in-law was going to do it with me, and a friend. We learned early on that there was a study guide online, which made me so happy I took a deep breath and a couple of months off. Path boards are very comprehensive, and while I sailed through the first time, I've never studied so hard for a test in my life.

I geared back up again in the Spring until I got an e-mail from the Board at the beginning of June. They were offering for me to be a part of a pilot program to take the test online. Not in August, but probably in September. I was so excited (no flying to Tampa!) I signed up right away and took a breather. Still, having that test loom over your head is like that kid in Peanuts with the rain cloud over his head, even on a sunny day.

Even with the study guide it wasn't easy. There were three hundred topics. Some of the topics on the general re-cert were so broad - "drugs and their metabolites" and "cerebrovascular disease" - that it left a lot of material to cover (in the case of the latter - it left me wondering what the heck to cover). On the cytology subspecialty exam guide it listed topics like - "thyroid, benign nodules" and "thyroid, malignant neoplasms" - um ok, so pretty much all of thyroid. I took notes during the summer.

It is a lot easier to study for your boards when you are coming out of your residency and you are so stoked to finally be doing what you set out to do and getting a decent salary for it after years (10 in my case) of training. Stuffing tons of minutiae into your head for months is a challenge but hey! You are at the end - so close to the carrot. Ten years later you have the carrot - you are living the life. And it's hard, it's different than what you expected, there are unexpected challenges but if you are like me you also get really excited by what you do and that helps you get through the hard days. Studying ten years into your practice is hard because you know that all that minutiae is at your fingertips whenever you need it and it is so pointless to stuff it all into your head again just to spit it out and get a certificate saying you can continue to do what you are already damn good at doing. But we doctors are mostly type A by the book individuals. So we do it anyway. But it doesn't mean we are happy about it.

August came and went and I got a call from my brother-in-law, who did fly to Tampa in August. I was so jealous of him being done. "You'll do all right, but I'm sure glad I studied." When he found out he passed and elatedly called me in October, I was still waiting to get my two week window to take it online. The computer program they were using was delayed, still working out kinks. The woman in Tampa I corresponded with in frustration was very kind and empathetic, but still. Rain cloud.

October passed into November and we pilot computer people finally got a nice extended window right around the holidays. Again many apologies and an offer to let us take it in March this year because of the delays and inconvenient timing. Hell no. I was getting that monster over with. I downloaded the program with the link - can't remember now why but that process took hours. And I did it on my own mac laptop - no hospital PC would take it. My brother-in-law had a partner taking the same pilot and their group had to buy her a laptop with a camera because she did not have one.

The technology blew me away. I was able to sit at home - they recorded me taking the test and there were all these rules for bathroom breaks and such. I was sitting in the exact same room I am in now typing this blog. I did set up a desk and chair instead of sitting on the couch because it felt more official and I was so nervous. It was nice to be able to have a glass of water next to me, and being at home was a lot easier than being at a testing site. I took it in late November. I felt really good about part of it but not about others. Anyone who has ever felt like they aced a general exam I'm jealous; I always feel like crap after they are over.

Here's another beef and I know I was a pilot but come on ABP 6-8 weeks??!! My friend who took the peds boards re-cert a month before me knew she passed within that week! It's on the computer how hard can it be to grade? I waited over the holidays and finally got an e-mail in mid-January learning that I passed. I was so elated I couldn't get my work done for two hours and had to stay late.

When I look back at last year - skipping weekly lunches with my partner to squeeze studying in, ruined weekends of cramming because I refused to study on vacation or on my time with kids, and overall being more testy in general and pessimistic about life I get really angry at this whole process. I know that pathology is closely following what internal medicine does, and I hear rumors of making this process a lot more palatable (shorter intervals, smaller tests, more related to your current practice), but the nice woman at the ABP who was my phone buddy last year tells me that is years down the road. I hope not ten. I don't think I can do that ever again.

Thanks to my sweet boyfriend and wonderful kids for putting up with me last year. And congratulations to my friend Trishie who found out she passed her MOC boards today (that she took at the beginning of March!) on the way to Disneyworld. She got me thinking and inspired this rant.

Friday, October 24, 2014

Incentivizing Grades

I really don't think incentivizing is a word, but you know what I mean.

My daughter made it through the first quarter of middle school, and she's doing quite well. But I can tell that things aren't coming quite as effortlessly as they were for her in lower school. She seems to have an external locus of control about studying and grades - her friends that study just "know how to do it and I don't." I'm working on changing her worldview here - giving her more of a sense of control. I'm not really worried about her grades so much as her learning that effort brings results. Natural talent can only take you so far. I'm reminded of David Brooks' 2009 opinion article about 10,000 hours.

I get that organization is a learning curve when you go from having primarily one teacher to having a complex schedule that changes every day with seven different teachers. My daughter is very organized and is slowly learning to be tech savvy; the school posts most of the assignments and tests online.

Her dad and stepmom and I have recently been having discussions around putting incentives around grades - just to make her a little more motivated. She gets lost sometimes in back episodes of Glee on Netflix - a recently discovered obsession. I worry about putting incentives on grades but the more parents I talk to I realize that this is common. Some even put incentives on practicing sports and music. I'm primarily bumping into monetary incentives - like $20 an A at the end of each semester.

One mom told me, "I go to work because I get paid. Why shouldn't my kid get something for his/her effort?" I'm not sure I'd like my work quite as much if I didn't get monetary compensation but I do love what I do. And I've got to pay mortgage and bills and student loans somehow.

Any advice or thoughts on this subject would be very much appreciated. My feelings are all over the map.

Wednesday, October 8, 2014

Flowers for KC

Our fearless leader KC organized a meet up - first IRL (in real life) for MiM's in DC this past weekend. I can't remember the birth date of the blog because I wasn't here but I've been around for a few years.

It was small - we are a busy group so many couldn't make it but I got to meet T, Mommabee, Juliaink, m, and KC.

KC sandwiched us between two conferences - one in New Hampshire on education and another in Chicago on blogging. She coached soccer Saturday morning for her son then met us at the Smithsonian Museum of Natural History. It's her I want to write about here.

Although I hadn't yet met KC in person, she is an incredibly supportive ringleader for our unruly bunch. If I e-mail her a question at midnight I have an answer waiting on my phone at 6 am. She has guided me in the perils of people trying to pull you in to advertising a seemingly worthy cause just to promote a marketable item. She has listened to e-mail rants I would like to make online about working situations or frustrations, knowing that it would be inappropriate because they were too fresh in my head. It's better to turn that anger into thoughtful pieces once the mood has passed. And she probably does that and more for all the other MiM's here - that's a big responsibility.  She protects us like a guardian angel - she saw too many negative comments a few years back and made the commenting process less anonymous, not only for the writers and guest posters but to keep the community supportive and the commenters accountable.  When I write on MiM I'm writing to an audience, but I also feel like I am writing to KC since she invited me here in the first place.

Mentors are people that you encounter in your life that create a space for you to grow and flourish and learn. I've been lucky to have many, and I definitely count KC as one of them. I had seen her picture in our Big Tent discussion group, but I wasn't prepared for her huge presence. I say huge, but she is a petite beautiful woman whose Chinese roots are evident in her features; dark hair, tea-colored skin. She has a bright smile that made me feel instantly welcome in DC, a city I was becoming acquainted with for the first time. Her fashion sense is impeccable. I learned she grew up in a New Jersey town not far from where my boyfriend, who accompanied me on the trip, attended high school.

My emotions surrounding the weekend were enormous - I imagined breaking down upon meeting her but it was just like meeting the popular girl in high school you were so intimidated by but she turned out to be a really cool person. Her accolades, at a year younger than myself, are astounding. Woman Physician of the Year for creating this space. Three amazing children - I delighted in conversing with her older son about animals and following her daughter through a museum crawl space that took us to a display about common insects we reside with in our homes. Mommabee instantly charmed the youngest boy; if she was here in Arkansas I'd recommend her as a pediatrician in a heartbeat. KC's supportive husband whom she met in medical school was entirely focused on the children and not at all interested in being the center of attention at our meet up at the museum.

Dinner with KC and m Saturday night was incredible - we chatted about posts and long time followers whose comments we loved and future directions and personal goals. KC seemed to take the back stage - she did all weekend - I convinced myself it was by design to let us shine. When drawn out in conversation her words were sparse but invaluable. More substance than fluff. M asked her, "What is your favorite outcome of starting the blog?" Her answer was immediate. "The readers. Whether encountering them face to face, or through e-mail. When they tell me how much it means to them to have found it. How it helped them." It was almost 11 pm when I met my boyfriend at the Metro to head back to our hotel.

I reflected on some of KC's words at dinner on the Metro. "I am invested in creating a space for our contributors and guest posters to write about what they want, when they want to say it. I don't want to control the content, I want to support creativity. A space for people to just be themselves." I must admit, I've been angry at KC. Misplaced anger, derived from guilt over not writing for months when I have had trouble writing. Anger that she didn't hold me to my pledge to post once a month. Then intense gratitude when she welcomed me back into the fold when I was ready to write again.

After some fun spa time on Sunday morning I learned a little more about KC. She has blogged in the past about her husband's year long deployment to Afghanistan when her youngest was two weeks old and her older two were toddlers, but I learned more about the challenges and fears surrounding that time. Another mentor-worthy feat - the insurmountable becomes existence and manageable day to day. Because if you look at it from a distance, how could you handle it? I asked her, "So is it done? Is he home for good?" She replied, "No, he could be called out any time."

When T showed up for brunch Sunday morning with us, she was full of regret. "I wanted to stop by a florist. But it was closed. I wanted to bring you flowers in appreciation for all you've done for us." T lives close to KC - they have published many articles about social media and medicine together since they have met. Juliaink was a pleasure to meet - I got to tell her in person how much I loved a poem she wrote years ago. I couldn't help thinking during the brunch, what a perfect idea for a gift for KC. A flower. A mirror image of her - something that packs a powerful punch with its image and color and strength, all the time belying a fragility that lies within it - within us all.

She is more than a flower, though - she is the gardener here. She planted the seeds. She waters us and helps us grow and find our own voices and learn from all the amazing voices in this community. I have had many mentors in my life, fabulous in their different ways, but none shares the quiet but unyielding support of KC. Now that I've met her maybe I can get her off of this pedestal and be her friend.

Happy birthday KC. You deserve much appreciation. My emotion didn't come out in waterworks this weekend, but hopefully it can be conveyed in this post. You are an inspiration.

Wednesday, September 24, 2014

Moving Misadventure

This one's not about mothering. Or medicine. But at least it has an "M" in front of it, so I'm plowing ahead, competing for the worst moving tale out there.

I've moved a lot in my life. My ex was pretty ADHD about buying houses, and I went along for the ride seven times in our thirteen year marriage. All in the same city; but it was pretty chaotic in retrospect, although simultaneously exciting and exhausting at the time. So I consider myself an expert on moving. No degree, but lots of experience. These last four years in the same house after the divorce were the longest years I've spent in one place since high school.

My boyfriend found this new house for sale while wandering the neighborhood - it's only two blocks from my old one but the space layout is much more efficient for me and the kids - and it has a large backyard with a creek running through it. It backs up to green space. We see a doe and her fawn from time to time - once while eating breakfast. The backyard alone is worth the price of the house, which was a lateral financial move.

I did the reverse of what all the books tell you to do - I bought the house, put mine on the market, and had a stressful Summer. But at the midnight hour I had some buyers come in with a good offer and I unloaded my old house before I had to pay two mortgages. They were living in a hotel, moving from another city, and wanted me out so quick I didn't have time to pack. I worried, but my neighbors said, "We always hire packers, you are going to love it. They bubble wrap the most ridiculous things, like toothpaste." A bit of a splurge, but considering I had no free time until the move I hired a packing and moving company with a decent reputation around town - I learned it was under new ownership since I last used them.

They packed so quick I figured the owner must have dispatched 10 workers. The day of the move, not this past Saturday but the one before, my boyfriend, kids and I were back and forth between the two houses. I had spent my Friday off lining kitchen and bathroom drawers. At around three in the afternoon I got a call from the movers - I was making a quick grocery run. "We have two trucks loaded and will be there in about thirty minutes, after a quick lunch." Game time.

On the way back from the grocery I drove by the old house on the way to the new - smiling at the lack of moving trucks. When I got to the bottom of the street to turn left toward my new house, I encountered a scene. Ambulance, fire trucks, police cars, tons of gawkers in the street. Everyone was looking at this:

It was a moving van, crashed into the corner of a house. I tried in vain to wrap my head around how it might not be mine then decided to pull over and check it out. Apparently the truck's brakes went out ("We serviced them in house three weeks ago!" the owner assured me) and the truck careened down the hill at 40 mph. The passenger mover bailed out onto the street in fear, damaging his ribs, and the driver went to the ED with back and neck problems. One of the head movers I had gotten to know pretty well told me it was all my boxes, the furniture was on another truck. 

The owners of the house that was hit - they were inside watching a Razorback game - said they thought a tree had fallen on their house (it happened to them two years ago during a winter storm - tree narrowly missed killing their son. They wondered aloud if this was a sign to get the heck out of the house). All the living room pictures flew off the wall onto the floor. The front door frame was off; a sure sign of structural damage. Windowpanes were cracked upstairs and down. I'm not sure I started off on the right foot as a new neighbor. 

My stuff was finally offloaded to another truck at about 10 pm so the wrecked truck could be towed. My daughter and I brought the movers dinner. They had a messy job - crushed vinegar and bleach dripped onto their legs from wet boxes. My anxiety creeped in over what further damage was being done to the contents of my life. My daughter took this pic at the front of the van - scattered with my and my kids scarves and mittens; many boxes ruptured and contents flew. "Mom, look! The ultimate Elf on the Shelf. Funny it ended up on the dashboard."

The owner blew in for about five minutes during the evening blustering and blowing off the event, worrying over his troubles, "Another of my vans ran over my employees' car last week! And now this!" without much empathy for my stuff. The next day no one showed up until 1:00 - my boyfriend and I worked for three hours until they arrived. We both got cut - there was tons of broken glass. I learned why the packing happened so fast - it was the most slipshod job I've ever seen. Unpacking was like an emotional roller coaster - joy at what made it and sorrow at what didn't. Hopes and talk of repair. Kid gifts over the years, vacation mementos, art, picture frames; all shattered. For the first time in seven years at my job, I thought of calling in. But work was comfort Monday compared to the chaos of the move. 

Caption: Cecelia baby footprint butterfly plate broken in four pieces: this is in the repair pile.

As the week wore on insult was added to injury. The entire contents of my bathroom was poured into one large box. Cleaning busted make up meticulously off of curling iron cords and plugs rendered unpacking each box a glacial event. Soy sauce off of every food item. As I opened each box, I kept expecting someone to pop out and say, "Guess what, you are on Candid Camera!" When the owner asked for the money for the move on Tuesday, "I thought you would pay me and then I would reimburse your damages at 60 cents per pound," I told him my damages had already far exceeded the cost of the move (I did tip heavily and buy dinner for the movers both nights). Twenty to thirty percent of my dishes and glasses and vases were crushed. I was so angry at the beginning of the week I was calling lawyers but by Thursday and Friday I was just sad and tired and defeated. 

And now I am ready to move on and put it in the past.

Good news: 

My new house is awesome Jack has a zillion new friends they all play outdoors and ride bikes and run up and down the creek - he is in Heaven and not on his ipad quite so much.

My just as OCD as me artist/architect boyfriend and I spent the entire weekend making my house look amazing.

My daughter showed amazing empathy - giving up her goal of going to the new local popsicle shop that weekend (I snuck her there late Sunday in gratitude) for helping arrange, after her room, my medicine cabinet and kitchen. 

Other moving tales I've heard that rival mine:

One of my partner's friends were moving out of state to Wisconsin about ten years ago; the truck caught on fire and they lost 90% of their stuff.

One guy I told knew someone who hired a not mainstream company - the movers took their car keys and came back in the middle of the night the next night and stole their car.

Funniest quote from the hell weekend, as told by my boyfriend:

"When you called me and told me about what happened from the scene of the accident, I was sitting on the back porch with C and told her. She said, 'I guess this means we aren't going to Le Pops tonight.'"

S said, "I'll bet going to Le Pops tonight is the last thing on your mom's mind. Our biggest job right now is to keep her head from spinning off of her neck. Let's not mention Le Pops."

To his and her credit, she didn't. Which is why I was moved to take her Sunday night - snuck away while the boys were eating pizza with the movers. She had salted caramel dipped in milk chocolate and finely crushed cookie crumbs. I had salted caramel dipped in dark chocolate and crushed almonds. We both declared, moaning between amazing bite after bite, that we very much deserved it.

Monday, August 25, 2014

Eureka Moment

I was wrapping things up at a rare early 3:30 today and filed my slides. What to do? Attack the pile of journals three months thick sitting in the far left corner of my desk. I flipped through the Journal of Arkansas Medical Society, the latest CAP Today, and the Arkansas State Medical Board newsletter. Picked up the August edition of Archives of Pathology and Laboratory Medicine. Hit an article titled "Smart Phone Microscopic Photography: A Novel Tool for Physicians and Trainees."*

I'm a sucker for the latest tech tools, so I read the easy page article eagerly. I was flabbergasted. I could hold up my iphone to the left eyepiece, steady the camera, and take a microscopic pic? One that rivals my $2K microscope camera that is so complicated I get anxiety whenever I decide to use it? Without an app or anything? Unbelievable.

I practiced the image capture that the article described - they were right the steadying of the phone while taking the pic at just the right moment took a bit of practice but five minutes later I had this:

Which I found in a gallbladder. Just kidding. It's a honeybee mouth. I got it at a local science store a few years back, along with a planaria and an ant and a couple of other fun bugs for the kids to play with under my scope when they came up to the office with me occasionally on the weekends.

I used the zoom function on my phone and got rid of the shadowed vignette, just as the article recommended:

Well it is still framed by iphone bars but I imagine this can be taken care of easily. Note how little energy bars I get in my lab basement. The ease and accessibility of this is astounding. Conferences. Sharing hard cases with co-workers (HIPAA restrictions intact and observed, of course). And as the article mentions, high-quality images suitable for presentations, posters, and publications. With your phone.

I ran around in nerdy glee showing off my newfound skill to my fellow pathologists - all as excited and disbelieving as I was and practicing with varying levels of immediate success. My fraternal rival good friend partner caught on quicker than I did capturing a fantastic picture of the lung pleura he was examining (he crowed that it must be his new workout routine). I copied the article and placed it in everyone's box, and noticed that it was written by a dermpath doc I haven't met who works at the University of Arkansas at Medical Sciences - he is a recent transplant and although I spent a day last week visiting all my former attendings and fellow residents (below me!) who are now attendings I haven't met him yet. I hear he's quite good but dermpath is one area I stay away from so I hesitated outside his door and decided familiarity was more important in my limited time off. I enjoyed chatting with a former co-resident who was just hired as chief of pathology at the VA, as well as many others. Man time flies.

*Smart Phone Microscope Photography. A Novel Tool for Physicians and Trainees. Morrison, A.S. and Gardner, J.M. Archives Pathol Lab Med - Vol 138, August 2014.

Tuesday, July 29, 2014

A Scientifically Stellar Lunch Date

"Education is the kindling of a flame, not the filling of a vessel." - Socrates

I was trying to set up a science birthday party for my son back in May. He was turning nine and wanted a mad scientist theme. I wanted a mad scientist to take the pressure off of me. I hit a wall with the local science museum, and decided to try the school to see if any high school students were interested. As the upper school administrative assistant was giving me the names of the science teachers, one rung a bell.

"Did she have an old last name that was -----?"

"Well, I don't know. Since she has been working here that has always been her name. I could ask."

"That's ok, I'll just ask her myself. Can I have her e-mail?"

After I sent a query I remembered a few months back when I was sitting at a low bleacher in the gym. My daughter was picked as the lower school representative to read a passage at a convocation and I got covered to watch and support her. She was confident and well spoken; it was a thrill to witness. As I glanced back at the audience I saw someone who looked like my high school physics teacher, plus 24 years (both of us!). Surely not, I thought. Now I knew I was wrong.

I left my phone number and she called me that evening. We were both rushed and excited to catch up (me more than her - she is eternally calm). She said, "I told my husband this is a first. To have students matriculating toward high school that are the children of a former student. I am overwhelmed." We planned an early morning before school meeting within the week. I met her in her classroom and we reminisced. We were her first class. I remember relating to her because she was young and enthusiastic and intelligent and female. She reminded me she had just come from California after training back then, but grew up in Arkansas. She charted her career trajectory - teaching to business then back to teaching - and I reciprocated. She promised to try to help me find a student for the party. She reminded me of the plaque we designed for her to commemorate her first class. I told her I thought I had a picture of our class giving her that plaque (it was a small class - numbered in the teens) and I would try to unearth it when I moved later on this year.

The students didn't work out, but that was for the best because my son was the scientist at his party and he was awesome. But the door I opened to my teacher was worth the effort. I e-mailed her after the party was over and invited her to lunch and to tour my work. I told her that if she had any interested students I would love to host them for something similar - I am always trying to recruit future pathologists. I was over the moon when she accepted and we set a date for mid-summer.

It was a Monday not too long ago. I was covering cytology, so radiology needles. I checked the schedule in the morning and asked for a window so I could eat lunch with my science teacher. The tech told me that 11:30 would work best, so I texted my teacher to set it up. The radiologist covering that day was accommodating.

"You are taking your high school science teacher to lunch? That is so amazing and inspiring. You are making me want to do something similar. But I didn't have any good mentors that I remember."

"You mean that you can't find anyone in your history to give credit for your current awesomeness?"

He smiled. "Well, maybe I can think of someone. I'll work on it."

After my third needle of the day I raced to the lobby to meet her. We hugged and had a good heart to heart over soup and salad - she insisted on picking up the tab. I showed her pictures of my son's birthday party. She said, "You are a true scientist. You hit some obstacles but didn't let it stop you from formulating a new plan. And it looks like it was a great success." I glowed in her praise, just as I did when I was 16 and I figured out a physics problem or successfully completed a lab experiment.

I showed her the Gross Room and Blood Bank and Microbiology and Histology and introduced her to most of my partners. I think she had as much fun experiencing a different world as I did when I alighted her classroom a few weeks back. We were interrupted by a student who was taking a make up test and needed help. I was awed by her calm reassurances and professional demeanor. I cannot wait for Cecelia and Jack to soak up her carefully and expertly doled out knowledge like the sponge I was back then. I hope she inspires them as much as she inspired me.

They are well on their way to becoming scientists. A little expert guidance always helps to kindle the flame.

Thursday, June 26, 2014

Doctor's Lounge

I have been working at my hospital for almost seven years. That's a long time.

I walked into the lounge at about 9 something a.m. this morning to get hot water for a cup of black tea.

There were three women sitting at a table by the front door. I introduced myself to one of them two weeks ago - she is a newish PM&R doc. Works mainly at the rehab tower. The other two I didn't know. They looked young and hip - I imagined they were residents. I looked over at another table and saw a woman sitting with a man. Two women were standing at the food station getting some of what was left of breakfast. That's seven women, counting me, and one man in the lounge. Unprecedented.

I felt like climbing onto a table and dancing and singing at the top of my lungs. I didn't. That would have looked crazy. Instead I walked over to the table with the one doctor I knew in the room and said, "I have been here seven years, and I have never been in the presence of this much estrogen in the doctor's lounge."

It is usually an all Caucasian male crowd, with a few exceptions to the former descriptor. Rarely women. I could sit down and chat, but why? To listen to random sports talk I had nothing to contribute to? I usually just get my coffee and maybe a hard boiled egg if I forget my bean burger for lunch while eavesdropping. I leave quickly.

I wandered over to the coffee area to make tea, still resisting the urge to sing and dance something crazy and free and female-oriented. Alicia Keyes was running through my brain. "This Girl is on Fire"

After I made my tea, I walked back over to the table by the door. The PM&R doc said, "I was just telling them who you were." I introduced myself to the other docs by my first name. "I'm Gizabeth." They had super cool first names that complemented their appearances, which were not all Caucasian (I am Caucasian, but of the dark-skinned variety, so I'm not being prejudiced against that. But finally University melting pot in the doctor's lounge!). I learned that they were both new PM&R docs at my hospital. They trained all over the country. I thought of my friend Fizzy, and resisted the urge to say, "So what exactly does a PM&R doc do?" Because I knew. Thanks Fizzy. But I still don't entirely understand. No offense. My job is weird too.

After we chatted and I learned a little about them and they learned a little about me I really had to go. As I was leaving I said, "Looking forward to seeing you around here more often. There has been a dearth of estrogen around here for years. I think we need to create a balance. So that we can initiate our eventual takeover." We all laughed. Kidding. Sort of.

Wednesday, June 18, 2014

Apical Core

I was looking at an apical core a few weeks ago. The surgeons take these cores at the apex of the heart when they are putting the patient on mechanical heart support. Most of the time there is bizarre cardiac muscle nuclear change from hypertrophy. Fibrosis. Iron accumulation. Amyloid. Pathologists look for different things based on the clinical history we read in the chart. This core was clean as a whistle. No fibrosis, tiny box-shaped nuclei. I looked at the patient age - 20's.

I delved into the chart to read about it - a 20 something year old that needed mechanical heart support? Was this viral? Genetic? The history showed no clue. A previously vitally healthy human being had gone downhill to this moment in just a few weeks. She was a student, a daughter, a musician.

A couple of days later I was rushing to finish my cases to leave early for my daughter's fifth grade graduation. I wanted to do something for her - something simple and sweet and manageable. I walked over to the hospital flower shop to chat with the florist. It was under new management and I enjoyed talking to the young energetic successor to the former manager. I explained to her what I was wanting and she pointed to a small basket of flowers.

"I was thinking more along the lines of a single flower. Something that would be easy to carry and give. Maybe a Gerber daisy?"

Her assistant came out of the back room. "What are the school colors?"

That's a good question. I had to reach. "Green and yellow."

"We have one yellow Gerber left."

As the assistant began to package the flower and tie a beautiful dark green ribbon around it I chatted with the manager. She was asking me about what I did at the hospital. The assistant suddenly joined in.

"Do you ever look at hearts?"

"Yes, actually I have an interest in that area. I see lots of explanted hearts and look at biopsies for rejection of transplanted hearts."

"I am asking because I have a friend in the hospital. It's her daughter. We are very close. I'm wondering if you would have seen her pathology. She was just put on support and is waiting for a transplant."

Oblivious, thinking about my schedule and my daughter and my day, I answered, "Oh yes we look at apical cores for mechanical support all the time. I saw one just the other day."

"Oh I wonder if it was hers? She's young, in her twenties, and we are all praying for her. Do you think you saw it?"

I suddenly put two and two together and became hyper-aware of HIPAA in my head. I told her, "Well, a lot of us look at those and we see them all the time. I doubt it was your friend's, but it could have been."

I turned the conversation back to the manager as she was ringing me up. The assistant became increasingly desperate with her questioning. She seemed to really need to know if I had seen her friend's heart core biopsy. She didn't need to know about it, but her entreaties and interruptions into my conversation with the manager were too much for me. I didn't want to violate HIPAA. I didn't want to give out any information. The manager seemed to feel my pain and supported me. "She is a pathologist. She doesn't know the patients, she just reads the tissue." I recoiled in defense.

"Well, that's not exactly true. I read every patient history. I latch onto the stories. Of course I am reading the information to get a better handle on the tissue, but every clinician adds a new piece of personal information to help me see the patient. I don't meet them, but I feel like I know them - some more than others. I'm just a voyeur, but I'm present."

The manager and I started talking again and I did something I'm not entirely proud of but it seemed like the right thing to do at the time and I am glad in retrospect. To placate the assistant I managed to slip in the 20 something year old's musical area of expertise innocuously into the conversation I was having with the manager. Whatever I said or didn't say worked. She relaxed and smiled and interpreted my silent acknowledgement as some sort of reassurance. Suddenly she said, "I have to show you a picture of my friend's daughter. I just want you to see her, even if you weren't involved in her care."

The manager said, "She's busy and she is in a hurry."

I told her to take her time I would wait. I would love to see her friend's daughter. She pulled up a photo on Facebook on her phone and showed me. I was totally unprepared for my response. She was incredibly beautiful, and suddenly and surprisingly tangible in a way so much of the tissue I see isn't. I had seen a piece of her heart just the other day. I never get to see the patient. I read and read and read but there is never a human face connected to the tissue. My eyes welled up and I choked back a sob.

The manager told her assistant, in a loving but chiding way, "Look what you did you made her cry!"

I replied, "No, it wasn't you. I am a little emotional about my daughter." I looked the assistant straight in the eyes as mine were trying to clear of tears. "Thank you."

Wednesday, June 11, 2014

Online Mothering Mentor

Her name is Catherine Newman.

I've only commented on her blog once or twice.

I found her when I was pregnant with Cecelia, and she was pregnant with her daughter Birdy. That was 12 years ago.

I followed her weekly "blog" on before blogs even existed.

I read her book, even though I didn't need to because I read all those posts.

I followed her when she left to start her own blog.

She now writes on Dalai Mama, among other things.

She is a fantastic cook. She posts recipes, and when I try them once or twice a year when I have time they are fantastic.

Her crack broccoli is a fave go to at my house for a veggie on a school night. Her fried eggs with sizzling vinegar is one of my most beloved dishes.

I occasionally read what she is reading. Buy the games she is playing with her family. Recommend them to my friends.

I am still catching up on blogs from when I did not have internet on vacation last week. Catherine has been writing articles for New York Times on Motherlode over the last year or so. I read one today that brought me to my knees. It's not the first of her articles to do this to me.

That's why I'm writing this post. To share this fantastic article. Give kids your undivided attention - Or no attention at all. I'm taking an evening weekly six week parenting class from a highly experienced social worker based on a book her husband co-wrote - Parenting the Strong-Willed Child.  She trained in urban Atlanta and rural Mississippi and has two grown children. Catherine's article reminds me of what I am learning there to supplement my own awesome but lacking in some areas (aren't we all?) parenting. Strategies to gain control of your relationship to your kids and help them prosper and grow with capability and responsibility and love. I've got fountains of knowledge from this class from both the social worker and other parents despite only being halfway through it.

Thanks for everything Catherine. You don't know me but I love you!! Thanks especially for all the substitute mothering.

Wednesday, May 21, 2014

Brain Candy

I met Fizzy here years ago, and long ago posted one of her first cartoons on my blog when she spun off this blog to create her own space at The Cartoon Guide to Becoming a Doctor.

I was amazed by this cartoon. It spoke to me about my experience as a resident/mom in such a good way. She made light of the angst and agony that I had recently been through, and made me laugh about it. I was already hooked to her writing here on MiM, but that cartoon drew me in to her blog and made me an avid follower to this day.

She's funny. She's droll. But most of all, she's unrelenting. I have periods in my blogging where I lag and shut down. She never stops. She's like the Energizer bunny of blogging, and her constant wit and presence amaze me. Not just me - she has built up an enormous following of readers that also recognize her talent. I like to secretly pat myself on the back for being one of her first readers. It doesn't surprise me in the least that she has come this far.

I bought her first book (see above) and it sat on my coffee table until I caught my daughter reading it and asking me questions I wasn't ready to explain. Now it's tucked away in the reading cabinet for easy access. And I had the privilege to beta read her first novel - The Devil Wears Scrubs. Do you read brain candy? I do. I don't watch brain candy on TV, but I read it religiously during stressful times in my life. Chic lit - it takes the edge off. The Devil Wears Scrubs is the best kind of chic lit. It draws you back into that horribly abusive space in time of training when you have no control and you are at the mercy of warped personalities. It allows you as a reader, like the viewer of her cartoons, to make lemonade out of lemons. Her razor sharp wit and her sarcasm brings a new element to the genre. She's a pioneer.

If you haven't read her book, you're missing out big time. I hear there's more coming down the pipes. I remember standing in line for hours waiting to see Guns N' Roses at the Memphis Pyramid (I had to pee really bad - good training for OR cases). I remember camping out all night in front of BeenAround Records to get my college boyfriend Metallica tickets (his band not mine). I remember pre-ordering the next Harry Potter book during residency and counting the days until it was released. Here I am again at 40 dying to read Fizzy's next book. I hope there's lots more to come. I can't wait.

*This post was based off of one I wrote last week on my blog.

Tuesday, April 29, 2014

Rocket Scientist

My daughter Cecelia (11) has never wanted to be a pathologist. She is completely disgusted by what I do. She likes looking under the microscope, but when I showed her the Blood Bank a couple of years ago with refrigerated stocks of blood and she saw an amputated leg (shrouded by a red biohazard plastic bag) one day when we visited the gross room - "What's that Mom?" - she was mortified. She wants to be a rock star. Fine by me. I'm all up for supporting dreams coupled with education.

Jack (8), has always wanted to design video games. But he's also great at math, graduated from struggling to read Skylander captions at the beginning of this school year to hungrily devouring novel series in weeks (Percy Jackson, Hunger Games - I know, but he begged for months and had seen the movies with his dad and sis so I finally gave in), builds lego sets, and loves winding down at night making me and his class Rainbow Loom bracelets. They adorn my wrists and serve as office decorations.

But no pathologist admiration yet. Over the weekend I bought Jack an air blaster gun and he has enjoyed building the flat paper characters into 3D figures to "blast" with the air gun. One he was working on this morning while I fixed lunches had a lab coat. "Mom, you have to take this one to work with you! It's The Evil Pathologist." He wrote it painstakingly and lovingly on the back of the head.

Cecelia chimed in. "Mom, you have to put it with your rocket ship microscope cleaner." So today when I went to work I created a moon scene to show them tonight. The Evil Pathologist, my rocket scope cleaner, some "moon" sand Cecelia made for me years back, and a nice bright Emergen-C background that looks I think a little otherworldly; planet like. C said it just looked like Emergen-C packaging. Oh well.

I don't need my kids to want to do what I do. But I'm happy they finally think it's kinda cool. Confession: I wiped the dust off of the shelf before I took the pic.

Wednesday, April 16, 2014

Consumer Driven Healthcare - Where is it Going?

After I read Red Humors blog on Open Notes, I struck up a discussion with a radiologist friend. We commiserate over laws and loopholes in laws that cause system abuse. I am so happy that Obama recommended to close the loophole in the Stark Law in his 2015 budget. That loophole has created some rampant abuse.

I worry about and applaud the possible effects of patients being able to read their notes online. We doctors need our own forum to make notes without worrying about hurting our patient's feelings. But patients also need to be able to review the discussion in the doctor's office in their own space, with all of their mental focus. Open Notes seems like a step in the right direction, but not entirely. We need two spaces. One for the patient, and one for the doctor.

When I was in CT, waiting on a specimen from the lung to review, I was telling the radiologist about Red Humor's blog topic. He told me that there is a push to the radiologists for the patient to be able to see their diagnosis online, as soon as it is available, before they have even discussed it with the clinician.


I wrote a post here before, called Poker Face. In a nutshell, it was about me accidentally conveying during fellowship a patient's negative diagnosis by delaying my answer too long when being probed directly by the patient. It was an excruciating experience that taught me to use expert words to delay the fact that I knew someone's cancer had returned or was diagnosed or had metastasized. After all, I am just a pathologist. I have no treatment options or good perspective on prognosis and treatment. That is Red Humor's job, not mine.

The radiologist worried, as I do, that all the great tools and information that our oncologists and clinicians have to offer a patient will not be there, in the privacy of their own home, while they are reading the ominous information. He worried aloud that the information might overwhelm them. As he was saying that he mimed a gun to his head. I completely agree.

There is way too much misinformation out there on the internet and you need an educated professional to reassure and guide you through it. I depend on my mechanic to fix my car. I depend on my accountant to do my taxes. As doctors, our patients need to depend on us to pick them up when all seems lost.

Last week the New York Times released a big article allowing patients to look up how much their doctors received from Medicare over the last year. It's telling information, but muddy. We doctors enjoyed googling each other to find out who is getting what. Pathologists are at the bottom of the list. If you consider Medicare reimbursement is about 30% of overall practice (in conjunction with private insurance), the information is not enough. It's a step in the right direction, but like many steps mentioned above, it falls short.

I see the need for change in healthcare. But the problems are multifactorial, and it will take lots of time and energy to fix them. In the meantime, let's try to keep a proper perspective to protect our patients. Let's delve back into the reasons we went into medicine in the first place. To help people, to protect and serve. Don't give them information in the privacy of their own homes that they aren't equipped to deal with, or anything that might hurt their feelings. That's a nasty can of worms that doesn't need to be opened.

Saturday, April 5, 2014

Sentinel Lymph Nodes

Sen.ti.nel: A soldier or guard whose job is to stand and keep watch.

I have a close friend who was standing in the shower one day and noticed a lump under her arm. She is in medicine, and despite trying to blow it off she knew what it might herald, and eventually manned (I mean womanned!) up and made herself an appointment with a breast surgeon. Ten years ago she was diagnosed with metastatic breast cancer. She had a mastectomy with lymph node dissection. She had treatment. She got off her meds, had a child at 47. She has a handsome first grader. She is in her early 50's and she looks like a movie star in her late 30's.

I look at a lot of sentinel lymph nodes. Sure, there are other ones besides those in the breast axilla, but they are by far the most routine. The surgeon injects a radioactive tracer attached to blue dye around the tumor and follows the  path to the nodes that the tumor cells would take to locate them. There are a bunch of nodes in the axilla, but chances are if the cancer is not in the sentinel nodes - the guards - then it won't have traveled any farther. There are exceptions to the rule but like most rules the exceptions they are few and far between.

In the gross room we receive the sentinel nodes and our techs do a gross analysis. Lymph nodes are floppy and brown-grey, much the size and consistency of a kidney bean. Massive metastases are grossly obvious - stellate, white hard infiltrates scream positivity, which is easily confirmed by microscopic examination. But many metastases are insidious - not grossly obvious. We do step examination of multiple levels of sentinel lymph nodes (sometimes there are more than one) which can fill a tray or two of slides (20 slides per tray).

When I get a tray or two of sentinel lymph nodes I often wait until I have a cup of coffee to settle down and look at them - it takes time and major focus. The kidney bean shaped node is full of small round blue cells called lymphocytes with reactive germinal center follicles - white round circles dotting the blue landscape. The border contains the sinus of the node - the most likely place (a small space) for occult isolated tumor cells or clusters of cancer to sneak into. If you blink you might miss some. It takes slow and methodical cruising at high power. I occasionally sub at breast conference for my partner who presents at it regularly, and I am continually amazed at the tiny, almost invisible foci my partners unfold. I know how hard it is to really see that. I have great respect for the amount of time and effort it demands to discover it. I know, I do it too, it's part of the job, but it continually amazes me.

These days we routinely use pancytokeratin immunostains to look for small, isolated tumor cells and clusters. While this is a nice adjunct to help us sleep better at night, it is not a safeguard or panacea to allow us to slack on the job of the routine H&E slide. I have seen cancer cells on H&E that are cut away on the special stains. I have seen cancer cells on the special stains that are not on the H&E (this stands for hematoxylin and eosin - the pink and blue Easter egg colors that we use to stain all tissue for examination). It's enough to keep you up on a bad night, wondering what you might have missed.

You would never guess my friend had metastatic breast cancer - I didn't even know for the first few years I knew her - she was diagnosed before I met her. She has shared struggles with treatment side effects but doesn't touch on what I know I would obsess over - fears of leaving behind my children. She is a perfect picture of poise, elegance, and grace. But she has this underlying Tiger Mom thing, an aggressiveness and intensity that I know must have come with what she has faced in life and dealing with the unknown of the future. Sure, we all have unknowns - I could die in a car crash tomorrow but I haven't dealt with nearly as much adversity as she has in my own personal health arena (yet!).

I love the definition of sentinel. The guard. The lymph node that tries to hold it all in check. I can empathize, as I am sure my friend does too. We women in medicine, and mothers too - we are always on constant watch and hyper-vigilance. For our patient's health, and for that of our children. We can't protect our charges from everything, but that doesn't keep us from trying with all of our power and might. It's the best we can do, and it's good enough.

Tuesday, April 1, 2014

On the Move

A few months ago I bumped into a pulmonologist in the doctor's lounge I enjoy chatting with. She likes to travel, and I enjoy hearing about her latest trip - I like travel too and would much rather sock new car or house or clothes or jewelry money away and spend it all on traveling. As we were finishing up the conversation she cocked her head, looked at me straight in the eye with a slight smile on her face, and said, "I am so jealous of you pathologists. You get to stay put at your microscope. Do all your work at the same hospital. We are running around all day."

I was so shocked I didn't answer her, but as I walked away I thought "What a false impression she has of us!" We run around from hospital to hospital, covering different ORs and radiology rooms in shifts. Maybe not in one day, but certainly up to a fourth or more of the month. Increasingly, outpatient clinics are putting in histology labs, necessitating more travel to do cases - this can demand travel to two or three different places in one day. Furthermore, we dole out lab directorship amongst ourselves, covering the many different labs we service in our overall domain.  This requires weekly or monthly travel to fulfill clinical pathology duties, which are more and more demanding every year with increasing regulations and education requirements. As our designated lab inspector, I travel to different hospitals around the state and outside of it with teams of expert lab technicians as part of our duty to regulatory agencies that certify us as an "approved" laboratory, meaning we hold up to the scrupulous demands that we require of the labs we inspect in return.

This means that I know how to use many different EMR systems and up to four different sign out programs - some of which are hospital based and some of which are internet based. I can access my home computer remotely to juggle work couriered in from different hospitals in attempt to even out the workload amongst all of us, as it changes daily (I do not envy the math that the gross room has to coordinate daily based on workloads at multiple different hospitals and different clinics!). Yes, I am grateful that I am more of an information-gathering voyeur than an interactive participant in the EMR system, for the most part - we do write notes on fine needle aspirates we perform, as well as apheresis procedures. But I think we make up for this on the back end with our individual dictation and report release software. It's ever evolving and more and more confusing as the years progress.

The days of the hospital-based pathologist sitting (hiding) in the office behind a microscope are over, for better or for worse. We are on the move, my dear travel pulmonologist friend - someday I will explain.  In the meantime, envy me with your wrong impression and I will continue to envy your world travels. I'm starting to catch up. Conference in Hawaii in February and Spring Break ski trip last week to Colorado. I'll break the borders as the kids get older. In the meantime, I'm busy enough traveling for work.

Thursday, March 13, 2014

Sick Day

The other night, my daughter Cecelia woke me up at 1 a.m.  The day after her 11th birthday. "I'm sick."

She took me into her bathroom. It looked like an emesis crime scene.  Buckets of puke on the toilet lid, leaking into every crook and cranny, spilling over onto the tile. Spattered walls, spattered glass shower barrier. Spots on the ceiling. I wondered briefly if I could leave it for my house cleaner the next day, and laughed at myself.  After settling her into my bed with water and Pepto pills, which she soon tossed elegantly this time into my toilet, I rolled up my sleeves and cleaned. An hour and two paper towel rolls and a carton of bleach wipes later, it was passable.

The next morning I asked her, "Have you ever heard the phrase 'Tossing your cookies?'"

"No Mom, But I can guess what it means."

She had quite a fill on her birthday - cookie cake at lunch and Baskin Robbins Grasshopper Pie after dinner. It had only a vague resemblance of its original splendor as I was mopping it up, pinching my nose against the odor.

I have been reading Generally Medicine's sad and sorry posts about sick children, congratulating myself about my children's overall good health. I must have jinxed myself. Jack threw up all last weekend. He is being treated for Strep, and has just regained his appetite after two weeks.

The upside - Cecelia came to work with me today. Luckily I found a comfy couch for her to rest on day one after the emesis escapade; my parents were in town and willing to help. I did not have the heart to send her to school when my mom went out of town today - she was puke and fever free but still nauseated and only up to clear liquids. So she came to work with me - an embarrassing first. It was a blast.

Luckily I had made it through the busy post-all-nighter (not a fun college one!) day one - overly busy with a lunch presentation to an audience of around 100. I was uncertain if the queasiness in my own stomach before the meeting was butterflies or bug onset. Butterflies, thank goodness, in retrospect.

This day was slower work-wise.  Not easy, but doable. I did not have a toddler, I had an 11 year old, ultimately savvy with her ipad - busily reading and making silent videos with props in my office while I read slides and made diagnoses. I spaced morning and afternoon visits to the gift shop (she had bday money to spend) around needles in radiology and the ED. We had a long blissful lunch. "Mom, I'm so excited to go to the place you eat work at lunch. I've heard you talking about it for years but have never been." Ugh, really? Am I that far removed? Her eating a turkey sandwich, me munching on a salad - both of us talking about the Divergent premiere I am taking her to next weekend. I'm reading the book so I can help her and her friend get dressed up for it. I wondered tonight what I'm going to wear - I'm that excited.

As I was releasing cases and she was packing up her pillows and gift shop loot she started to do this thing she does when fun things are ending. I used to get really frustrated about it. She focuses on the one negative thing in a day of overwhelming fun and positive. She was trying to leave me a secret fun note under my microscope and was getting angry and upset that I saw. I told her that I worry about leaving my microscope light on and obsessively check it as I'm heading out the door - it would not spoil the surprise because I had no idea what the note said. Last weekend my boyfriend and I took her and two friends to the Lego movie and shopping and she kvetched endlessly over not getting to spend enough time in the mattress store because they spent too much time in the shoe store. I think I'm finally getting it. It's just sadness at ending. It's better to empathize than get angry.

I'm going to miss the hell out of her at work tomorrow - I think she's well enough to return to school. I can't wait to see what that note says. And I am kind of looking forward to more sick days with both her and Jack, now that they are old enough that they don't need my constant attention.

Happy 11th birthday and recovery, sweet and wonderful Cecelia.

Wednesday, December 11, 2013

A Different Perspective

The title for this topic week is change; specifically how becoming a doctor alters one's life.  There is no question of change, only how.  For me, the most profound change is the perspective I have gained from training and experience, which has been both comforting and distressing.  The ultimate goal is to find a balance in the enjoyment of what you do despite the inside look at inherent system and personal flaws that are revealed on that long journey.

As a pathologist in a large group practice, I work intimately with my co-workers sharing tough cases.  As a fresh trainee I had a lot more defenses built up about showing a "stupid" consult.  Over time, as I have become more comfortable and developed relationships with my partners, it has become easier.  Some cases are diagnostically challenging, and just as a clinician doesn't always nail the patient's disease with the first test they order, a first glance at the tissue doesn't always provide clarity into the disease process.  Even though we are all trained to render similar services, we each have our strengths and weaknesses based on training level and personality types, and I am thankful that I do not practice solo because we are so much better as a team.  And I don't mean just us pathologists - I am also thankful that I can open the EMR and get input from radiology, pulmonology, oncology, and all the clinicians or just pick up the phone.  Communication often makes a difficult case crystal clear.

Numerous recent articles are highlighting the drawbacks of our medical system, and having inside perspective makes a lot of it ring true.  "You're Getting Too Much Healthcare" by Jamie Santa Cruz was published in The Atlantic this week and Elizabeth Rosenthal is doing an illuminating series in the New York Times I have been following called "Paying Till It Hurts."  Sure, every system has its positives and negatives, but it's easy to become disillusioned when you get first hand experience navigating the real world and jumping through all the hoops that seem distant from your idealistic image of yourself as a pure patient advocate.  One of the most challenging things I work on is finding value and purpose in the many things I do that help the patient, and not getting too frustrated over the more mundane and nonsensical aspects of medicine that I witness - many of which appear business driven.  Having a rich life outside of work with children, family, relationship, friends, exercise, etc. - all of that helps round out the negatives.  An alternative would be to bail on the system - something I have witnessed a handful or so of my classmates do over the last ten plus years since I have graduated.  They have found happy and fulfilling lives outside of medicine.  I don't think there is a wrong choice; everyone has their own path to follow.  Mine is certainly in constant evolution.

Up to this point in my journey, I have shed a lot of the insecurities of youth but gained insecurities of experience; the latter being much more tolerable and rationally tackled through knowledge and resources.  I have been elated by success and ravaged by missteps.  I have been buoyed by support from this community of women and also retreated from it to nurture myself and my kids.  Change is inevitable when you choose this road.  Although some of it feels reactionary, which can yield cynicism and doubt, the most important changes are those gained from knowledge and experience - lifelong processes - the kind of glacial change that affects your core being.  This kind of change brings a sense of control, purpose, maturity, and peace into your daily challenges and decision making, both inside and outside of the hospital.

Friday, August 30, 2013

Poker Face

As a pathologist, I am one step removed from the patient.  This is comforting for the most part.  I render my diagnosis and another clinician communicates it to the patient.  It is best this way - I have no treatment options in my own doctor toolbox to give meaning to the words I communicate.  I learned this the hard way - in fellowship training.

Once I was doing a fine needle aspiration on a small sub centimeter mass behind a patient's ear.  The patient had a history of melanoma, and they were very anxious.  After I aspirated some cells I looked at them under the microscope.  I had a good sample.  It was pretty obvious, despite needing stains to prove it.  Metastatic melanoma.  I sighed internally and turned around.  The patient asked, "Well, what is it?  Is it melanoma?"  I was nervous, still in training, and I hesitated a second too long.  The patient melted into tears, guessing the answer by my lack of words.  I communicated some soothing words and did not hesitate to ask a nurse to call the oncologist two floors above.  Wisely flaunting routine the doctor arranged to meet the patient immediately to discuss treatment.

I learned from that experience.  Now I tell the patient up front that we won't have results for at least 24 hours, although at least half the time I have a pretty good guess at the results when I triage the sample on site to see if it is good enough material for a final diagnosis.  The clinicians appreciate our discretion, and as I said, it is best overall as we usually need special stains or additional material from a cell block for a definitive diagnosis.  And most importantly, we cannot offer treatment options.  This leaves us and the patient at a huge disadvantage if we jump the gun.  Giving a diagnosis without a next step is mental torture.  I sure wouldn't want to be on the receiving end of that.

As a long time member of the community in the hospital where I practice, I encounter situations, not infrequently, where a family member of a patient will text me or facebook message me and ask if I can look at/triage/let them know when the results are out/ of a biopsy of a family member.  I am always happy to help but at a loss for many reasons I mentioned above, not to mention that to communicate results to someone other than the patient, even a family member, is a major HIPAA violation.  I try to offer support and information but fall short of giving away any information about the actual diagnosis - letting it fall naturally in the clinicians hands to communicate themselves.  I know this is for the best, and appropriate, but when your friends are in need diversion can't help but feel deceitful.  I have actually called clinicians, during working hours, letting them know that my report is out and I have a patient or family member calling me.  The clinicians are always gracious and helpful, despite my natural reticence to add to their workload.  I have usually fielded many calls from them about patients in their office - wanting a preliminary diagnosis or a personal phone call when the final results are out - so I understand it works both ways.  And once the diagnosis is out, I am more than happy to discuss it with a patient.  Although that doesn't happen very often it is a rewarding experience.

Sometimes I wish I was back in college when a poker face was just that.  A poker face.  Texas holdem.  Seven card stud.   I wasn't good at it then, bluffing is not my strong point, but I have developed a fantastic one in my field.  It's a skill I didn't anticipate having to master when I chose pathology.

Friday, July 26, 2013

I'm Nervous, And I Think That's a Good Thing

I've been practicing pathology for about 6 years, after 4 years of medical school and 6 years of training.  Cases that I used to pore and sweat over have become routine.  Sure, there are always cases to challenge your brain, share with your colleagues, or send out for expert consultation, but after 6 years I have cruised into a "more comfortable" zone.  I can triage efficiently, and getting called to radiology for wet preps or to the OR for frozen sections is no longer a paralyzing experience (for the most part).  The wall I built around myself, the mask of confidence hiding insecurity, has slowly come down.  I can relax and banter with my colleagues while deciding if there is cancer on the slide or not.  I think this is true of all pathologists that are a few years in - I laugh when I think back to what I agonized over during my first two years in private practice.

Last year the partner in charge of CAP (College of American Pathology) lab inspections retired.  I volunteered to take his place, as a team leader.  We are in charge of lab inspections for three hospitals - every two years each hospital assembles a team to lead an inspection.  I did my first one last November - whew it was a blur.  I had a veteran compliance officer leading me through.  "Even a blind pig can find an acorn every once in a while," I kept thinking as I went through that inspection.  I was prepared, but shell shocked by the strange experience.  This time she is on vacation.  I am in charge.  Luckily I am leading a brilliant, experienced team that will make my job much easier.

I became a pathologist to hide behind a microscope.  With a few exceptions, such as being interviewed on TV with the Swine Flu breakout, I've been able to maintain my anonymity.  Lab inspections fly in the face of anonymity.  I interview the hospital CEO's, the lab directors, the medical Chief's of Staff.  The team has specific information to mine and report in a very short amount of time.  We summarize our findings in a large room at the end of the day.  Then we go out to dinner and celebrate a hard day's work.  That's the part I'm looking forward to.

I find, as I am preparing for this inspection, that I am grateful for new challenges and experiences to shake me up. It's what got me here in the first place, but it's easy to forget when it becomes, all too soon, remote.  And as the butterflies circle in my stomach as I am going to sleep, I wonder and hope that my fellow MiM's also have new experiences to keep them from banality and boredom.  They must.  It's a part of the job description.

So if you are reading this today, wish me silent luck.  I'm inspecting.