Friday, July 18, 2014

Boston Bound

I'm taking a few days off with my kids to head Northeast to visit Uncle Effie and Aunt Mike. Sometimes I accidentally say this, to my kids amusement.

I'll leave you with this.



I encounter this on my walk from the doctor's parking deck to the super high security wave a magic card to open the heavy back entrance lab door into work each day. What is this even called? I have no idea. An electronic arm. A gateway. Once, when I was really angry, I imagined I might rip it from its anchor and whack something (a bowling ball? a giant boulder? the person I am pissed at?) all the way to another planet.

Sometimes, when I am leaving work, I am texting and forget it is there and almost bump into it. Often it is up, and I don't have to worry about that. Occasionally, I will be walking along oblivious, see it coming down in my peripheral vision and scatter frantically out of the way. Would it really hit me or does that anchor have the sensitivity to avoid objects? And if it does how big does the object have to be? Am I big enough?

Once I had a pretty near miss that left my heart pounding. I imagined myself sprawled out on the asphalt. Now that would be dumb way to die. And an embarrassing way to be discovered dead.


I love my job, so I like walking into work. But they way out to the parking deck, especially on a Friday before a week of vacation, is always a little bit brighter.

Enjoy your week. I know I will.

Thursday, July 17, 2014

Tonsillar Hypotropathy

The things that are written on requisition forms are often amusing.

Today, this one made me think of a homeopathic expert in tiny tonsils.

Of course they meant tonsillar hypertrophy, the reason most tonsils are removed.


Wednesday, July 16, 2014

Big Time Doctor

Conversation between me and the kids in the car. I was driving (duh), Jack was in the front seat playing his ipad game, Cecelia was in the back seat.

Jack: Mom, why can't we spend the night at your house?

Me: It's Daddy and Miss Rachel's week. I just got you for quick dinner, walk through new house before closing, and ordering camp trunks. I've got to go home and prepare for Breast Conference. It's early in the morning - 7:00 - I would have to get you up super early anyway so I could get there on time. You like to sleep in in the summer.  I'll see you Friday to pack for our vacation.

Jack: Mommy, you know how flying pigs are good look.

Me(?): No, I'm not sure what that means. Is that a part of your game you are playing? Do they have good looking flying pigs?

Cecelia: No mom, good LUCK.

Me: Oh! I didn't know flying pigs were good luck either. You'll have to explain that to me, but good luck makes more sense than good look.

Jack: Why do you have to present at a conference on rest? What is a Rest Conference?

Me: No, not rest, breast.

Jack: Oh. What is that conference about?

Me: Well, it runs about like any other doctor conference, sort of. It's me and lots of docs and nurses. The surgeons present the history of the patient, and the problem. Usually it's a breast tumor like cancer. Then the radiologist shows the pictures on a light box - kind of like X-rays. Not a picture of the patient, but of the problem in the breast. We all gather around and take a close look. Then the surgeon talks about what they did during surgery, and then it's my turn. I show pictures we take of the slides, talking about the cancer. Pictures of the things I see in my microscope. Then the oncologists - that's the doctor that is in charge of treating the cancer, talks about how they are or plan to treat the patient. It's a learning thing for all of us. It's good to know what everyone is doing in these hard cases. It helps the patients.

Jack: So Mom, are you a Big Time Doctor?

Me, laughing: Well, yes Jack, I'm pretty big time. I solve puzzles all day long. The puzzles I solve are the key to getting the patient good treatment. It's pretty fun. But sometimes the doctors call all day long wanting to know the answers for their patients. I feel popular, which is kind of cool, and I don't tell them this, but it's frustrating when I have so much work to do. But I really enjoy talking to them because I usually learn things that help me be a better doctor. They are only calling because they care big time about their patients.

Jack: These flying pigs are really good luck.


I love this album. It came out in 1987 - but I didn't discover it until 1990. Made it to Lollapalooza twice in Dallas to see them live during college. The first was probably it's inaugural year. The second time I went the Beastie Boys were there and it was raining hard but no one cared the mosh pits were muddy and intense and even though I was only brave enough to grace the outskirts of those pits I felt like I was at the Center of the Universe and time had no meaning outside the pulse of the music.

Tuesday, July 15, 2014

Do Not Resuscitate


I was looking at a fluid of a 93 year old man. Checking out his H&P in medical records to see if there was anything important I might need to know. I came across this sentence at the end of the Plan.

"He indicated that he wants to be a Do Not Hesitate status. We will respect his wishes."

It was obvious from the rest of the note that the doctor meant Do Not Resuscitate. What an ultimate autocorrect - I thought.

If I ever end up on a gurney in the ED with no capability to communicate I am saying it here and now so everyone knows:

My status is Do Not Hesitate.

At least until I get my kids a little farther along in life. Unless it's a hopeless case, of course. I don't want to be a in a gorked out state for an extended period of time no thank you.


Monday, July 14, 2014

Dia - REAH

Me: Will you look at this and agree with me? I think it's a REAH (Respiratory Epitheliod Adenomatoid Hamartoma).

Partner a few hours later: I agree with you. I had to look it up. I've never seen or heard of a REAH.

Me: I haven't either in real life. As you saw they are really rare. I learned about it in residency from great attending now at Cleveland Clinic that we send cases to all the time. It took me 15 minutes to find it I knew what it was right when I saw it but I couldn't remember what it was called. I got hung up looking up Pulmonary things in the ENT WHO index.

Partner: Well that's what it is.

Me: Me and Dr. Woods used to drive Cleveland Clinic doc crazy with our abbrevations. It was so fun. For example when we were surgical pathology fellows we would write on the working draft of a case DHUT, or tell him it was D-HUT. He said what the heck is D-HUT what are you talking about. Duh, we would say, ductal hyperplasia of the usual type in the breast (A common B9 entity).

Partner: That's funny.

Me: We loved aggravating him. He is so smart and unflappable it was a big challenge to get a rise out of him. But Dr. Woods and I, we love a challenge, so we rose to the occasion.


Caption: Picture of a REAH.

Sunday, July 13, 2014

Vermin in the Basement


I swam a mile on Saturday - first time to exercise by swimming in years. It felt amazing. I am still sore.

Last week at work I was talking to a criminal defense lawyer turned path assistant - his time with my group predates my own. He tells cool stories. We were waiting for a frozen. We started on music, and that somehow turned into a David Lynch love fest. While emerging from that mutually beneficial intellectual undertaking, he recommended "Even Cowgirls Get the Blues" directed by Gus Van Sant. I told him I remembered wanting to see it based on the previews but it got such poor ratings I never got around to it. His reply, "Well, the critics often get it wrong. Because most people are stupid. You need to watch it." I did tonight. It was bizarre and amazing. And (surprise) dedicated to my childhood heart throb - River Phoenix.

I'm excited to turn over the call pager tomorrow morning.

I'm closing on a new house Friday. I haven't managed to sell mine yet. Anyone want to buy a house?

I love wearing band t-shirts and frayed, torn jean shorts and edgy snake sandals and bumping into school moms at fancy grocery stores. Will she still allow her kid to play with mine? I think so based on our conversation. Who cares, really.


Saturday, July 12, 2014

Vail


Caption: Rev Room July 12, 2014


Caption: Me and Deeds 


Pathology call rocks. But not as much as this band. It's amazing. Check out Vail on itunes.