Ascension Day

So I went to the Dr. Lounge for lunch. Their pizza is sooo good. I just discovered it last week. Already had sausage, sausage and veggie, and veggie. Their veggies are fresh and amazing. My brother Michael told me it was because all of the restaurants are so slow coming out of shutdown that mass servers, like hospital cafeterias, are getting the best produce around.

Today was cheese. I sat down next to Ali, an excellent and very friendly GI interventionalist. He told me about a girl he once worked with from India who was a strict vegetarian. She told him thank goodness for pepperoni pizza, it was what she lived on. He kind of did a double take, wondered if he should inform her of her error, and decided to tell her that pepperoni WAS meat. She thought it was sliced peppers or something? I wondered whether she was sad about all the meat she had eaten and he told me she was more sad about not getting to eat pepperoni pizza anymore.

We were on one end of a table full of hospitalists. One was telling a story about a husband and wife across the hall from each other who had COVID - he was taking care of them. The wife went home earlier, the husband had not yet been discharged. He walked in one morning and the husband was dressed up in a tie and jacket and was in the middle of a Zoom meeting for work. He didn't have time to talk to the doctor during the meeting. Needless to say, he was discharged that day.

Then my other good friend Eric, also a hospitalist - he and his kids live in the house that Mike and I lived in on North Spruce street years ago - told another story. He was taking care of a woman 90 years old who slipped in the tub when her 60 year old daughter giving her a bath left the room for a minute. He ended up getting into good relationship with the daughter, who was preparing for her upcoming wedding at the Capitol Hotel and enjoyed describing her wedding dress. He asked who she was marrying - she said, "Well, you know him." Eric wondered how. "He's Squidward." Turns out the voice actor who is Squidward graduated from Central High School and has made tons of money throughout his lifetime doing lots of voice acting. How cool is that? Eric pulled out his phone and showed me a picture of the wedding, you of course know the theme - the cake had a pineapple on the top and a video he showed me played the SpongeBob SquarePants theme song. Everyone was dressed formal and nice. I even caught a glimpse of the famous groom.

Ascension day is celebrated the 40th day after Easter Sunday, so it varies from year to year. It commemorates Jesus Christ's ascension into heaven according to Christian belief. Most people aren't aware of this day, I've found - I polled quite a few. The Bible says that Jesus promised the disciples that they would soon receive the Holy Spirit, and asked them to remain in Jerusalem until the Spirit had come. I just copied that from Google.

Despite some snafus, we are doing relatively well with testing - I'll save some entertainment in that arena for another day. Numbers are still good at Baptist. As of yesterday (5/20/20 - I just love those days where the day matches the year - it's thrilling to write) we had 16 inpatient positives, and 2 patients on the vent. I'm sure the Arkansas data is easy to find somewhere so I won't repeat those numbers. I'm headed to my favorite place on Earth, Eureka Springs, for the long holiday weekend with my husband. New place - a cabin on Beaver Lake. I can't wait. I think I'll have a bonfire. With lots of accompanying food and drinks, of course. Happy Thursday. Much love, E

*Cross posted at my blog - www.gizabethshyder.blogspot.com

Covid-19 has Ushered in a New Era of Fashion More Suited to Ladies on the Go

I'll admit I was crushed when, the day before I was due to get my every 6-8 week highlight job, they closed the hair salons. How long would it be, I wondered, before I could get my touch up? I bought an at home bridge dye kit from my beloved hair stylist and still haven't taken the time to learn how to use it. I watched my beautifully manicured toes slowly deteriorate. Now all that's left is a couple of spots on my big toes - the rest are au naturel with my distinctly bad hurried nail clip job. I had stopped drying my hair a couple of months earlier and was reminded of how much time this saves me and my curls come out when I am not violently taming them with my Dyson hair dryer. I thought of Linda Hamilton. Not from the first Terminator, the one I saw in the theater with my Dad when it came out but the new, aged, experienced version of Linda - the one where she is in her 60's and her roots are grey and she is beset with substance abuse issues from her traumatic past but is still a righteous badass.

Would that version of me give a crap if my toes looked like they do? If my brown roots are nearing two inches, rendering my dirty blond hair much dirtier? Hell no. All those random bruises and cuts I get from bumping into things - I'm a klutz - suddenly took on a new, cooler significance. I imagined them being battle scars from fighting the evil empire over all this Covid testing - keeping the false Gods with their promise of accuracy hiding their lies and desires to make money off of this pandemic at bay. I started to show them off, be less insecure about having them. Abandoned the desire to get those roots touched up with my at home kit. Also the desire to do my own pedicure - that can wait, shouldn't be too much longer now.

I scheduled a hair appointment today for June 11 - first available that works for both myself and Deidre. I cannot wait to see her - our relationship spans about 17 years and we have become almost like armchair therapists to each other over the years. In the meantime, I'm going to embrace those roots - even Deidre texted me that roots are actually in now. I'm not going to worry about that strange piece of white that is on the cherry red polish left on my left big toe. I have wondered what it is (White out? Caulk? - None of those make sense really) and tried to pick it off to no avail. It no longer seems important, thank goodness. I see a future full of scrubs and roots and not perfect pedi's looking actually much cooler than someone who is perfectly coiffed (although it is fun to dress up sometimes and I will continue to do so if it works for me). Back to 90's grunge, with a lot more experience and know how.

Happy Monday! It's been a while. As I teach my kids, sometimes you have to put on your own oxygen mask first in order to be your best self to others. And if that best self can look shabby on the outside, it doesn't matter, because she shines on the inside. Much love, E

*cross posted at my own blog, Methodical Madness

Doctors Make the Worst Patients (Part 2)

You can take the girl out of the mania, but you can't take the mania out of the girl.

That doesn't even make sense, I know, but most of December not long after I was diagnosed with hypertension was senseless. When I went for a follow up two weeks later the nurse asked if I forgot to take my medicine. "Are you on Adderall?" she asked. Heck no. This beta blocker is just about the only prescription drug I've taken in my life besides rare antibiotics. "Well take a deep breath. Maybe I can get some better numbers. You know you've gained three pounds." This, a pet peeve of mine. I hate when I tell them I don't want to know my weight due to my OCD tendencies with numbers and they make comments about it. I reminded her we are in the middle of the holiday, everyone gains weight. She smiled, shrugged, repeated the study. Still sky high. So my doctor started me on a second drug, told me to take my pressure once a day to make sure the numbers were going down, and come back in two weeks.

Sure enough the numbers came down, but I was in despair. Two prescription drugs? Hypertension doesn't even run in my family. I bumped into my cardiologist friend in the cafeteria on call New Year's Eve weekend, and shared my story. He told me to get on a low salt diet, specifically the DASH diet. I promised and walked over to get my normal lunch - a cup of soup, which to my alarm had almost as much sodium as a normal person needs in one day. I withdrew from the soup stand in fear and grabbed some fresh veggies from the salad bar.

Now I've been on a lot of diets in my life for various reasons - gluten free to calm down IBD, watching calories, etc., but I learned over the next few days avoiding salt is like avoiding the AIR WE BREATHE. It's in everything. Last year I was so proud of myself for buying unsalted butter but I needed to get a little more serious this time. Soup was out the window. Soy sauce, even the low salt OMG. Salad dressings. All preserved and canned foods. Most things pickled. The yummy salami and pringles and cheese that my impossibly and aggravatingly fit husband brings to the couch to watch TV after a full dinner every night; somehow he can do this whether he's riding his bike or sitting on the couch for two months and gains not an ounce of fat. My body is not so forgiving. It has to go.

I made a quick trip to the supermarket and bought every superfood to lower blood pressure I could find on Google on New Years Eve. Ordered ground flax seed off of Amazon.  Have you ever eaten naked beet chips? If you do, when you go to get that little bit out of your tooth don't worry, as I did, that your mouth is bleeding. And I guarantee one naked beet chip will be enough for the rest of your life. I drastically cut my food intake. I went back to the doctor for my yearly wellness visit a few days later, ugh. I've visited the doctor more in the past month than I have in years. The nurse, again with the weight thing. "You've lost 12 lbs since you were last here." I was startled. I certainly did feel less bloated. I guess I was so salt overloaded I was carrying at dozen lbs. of excess water weight that took only 10 days to shed. In retrospect I did spend much of the first two days in the bathroom. Current in office blood pressure: 100/70. Whew. The doctor was so impressed he advised cutting back the water pill in half.

Well, that didn't work. The numbers crept up. And thanks to the nurse telling me my weight, I was manically stepping on the scale every morning. The cardiologist informed me that some people have a low tipping point, and mine is obviously one of those - losing a few pounds could help a lot. When four days later my weight hadn't changed despite severe food restrictions and my blood pressure was so sky high it scared me into taking the second half of that pill I had an uncharacteristic ugly cry meltdown in the shower, laced with intermittent screams of rage at lack of control. The very same me that read The Untethered Soul two months back and decided my soul had transcended any Earthly need for control. I took a deep breath. I am the same person that looked at myself in the mirror admiringly a month ago without knowing the numbers. No more numbers. And what was that diet the cardiologist recommended again? I googled and found there was a book! On the DASH diet. Whew. I can do anything with a book. I ordered it on Amazon and learned it is ranked #1 Best Diet Overall by US News and World Report. It was developed as a heart healthy diet and turned into a sensation. And better yet there was a new one published advertising eternal youth as well! Well, younger you anyway.

It arrived Sunday and I skimmed it over an hour. Got the gist. To my relief I can actually add food to my  current restricted diet, a lot of it, if I just eat the right things. And it's really easy, except the suggested recipe part that almost gave me a nervous breakdown. And the part where it gives examples that seem to require I quit my job and tie myself to the kitchen to create such a varied diet. Luckily I can largely achieve the basic formula with food at my grocery store and in the hospital cafeteria. Maybe try a recipe every few months if I get a day off. And it encourages daily red wine! Perhaps not as much as I'd like but definitely a plus. I'm just waiting on my food scale from Amazon to learn what four ounces of fruits and veggies are, guestimating in the meantime. Reminding myself that this doesn't have to happen overnight. Hopefully if I keep it up a few months I can get off of the meds. I'm 44 years young, I've got a lot of days left in this meat suit. I've got to keep it going - there's much more to do.

Doctors Make the Worst Patients

     I have always been blessed with great health. When I got my life insurance a few years ago, I got the best rates because my blood work was so good. I have always taken pride in that, kind of like getting straight A's or being number one on a test in medical school (ok, that only happened once, and in pathology, my future profession, but it happened! Out of a class of 150!). So you can imagine my despair last Fall in the midst of wedding preparation when my OB incidentally discovered I had hypertension. I'm not talking minor hypertension: my systolic would swing up in the 2 teens and diastolic would go over 100 easily. I know, because I bought a sphygmomanometer (I love that word) for home and work, and became obsessive.

     My OB recommended a family doctor and he prescribed me with metoprolol. I have been long acquainted with beta blockers - learning from a friend in med school that they are good for anxiety inducing situations such as giving talks in front of large groups of people. I applied this knowledge to many situations - that time I was interviewed about the swine flu on TV, going out on excruciating first dates on match after I was divorced. They are great for calming your physiologic response to stress without messing with your thought process. But the same bottle lasted me almost ten years and learning I had to take it daily really upset me. I have always run low, why the sudden change? I learned that I accidentally gained 26 pounds after I got engaged, and was determined to lose half before the wedding.

     That was two months of mania. It didn't seem to me that the beta blockers were doing much - I checked five or six times a day and my blood pressure was all over the map. I was religiously weighing myself every morning - something I normally stay away from doing. I managed to carve my weight gain in half before I got married. I was texting my cardiologist friend and hospitalist friend weekly with my numbers and quizzing them on how to get them down. "My systolic is way over 200! My diastolic is over 100! Should I take another beta blocker? Go to the ED? AHHH."

   About a week before the October wedding when I finally fit in my dress I had bought in June I was like ENOUGH. I made myself stop getting on the scale. I stopped checking my pressures. I was determined to enjoy my wedding and honeymoon. On a follow up appointment with my family doc in January, my pressure was fine. Not low, but systolic was 130, diastolic mid 80's. "I wouldn't treat those numbers," he said, and I breathed a sigh of relief. It was the weight gain, the wedding, the holidays, I told myself. This is over now. I'm back to perfect health.

     So you can imagine my surprise three weeks ago at my yearly OB check-up when the nurse asked to take my pressure again, "These numbers cannot be right. Are you symptomatic? Do you have a headache or anything?" No, never. My OB recommended another appointment with family doc. His nurse measured it twice too. 164/100. "Stop talking take a deep breath let me do it again." 152/90. I looked at her expectantly, "That's not very good, is it?" The doctor in me knowing it wasn't but the perfectionist in me wanting reassurance. No such luck. "No, it's not. Are you stressed?" I told her no, I was on vacation, I spent the entire weekend watching Homeland on the couch.

     Family doc decided to re-start the metoprolol daily. I told him I cannot go back to the manic numbers oriented person I was last Fall. I made him laugh describing crazy texts to mutual colleagues. I said, "This is your territory, not mine. Can we keep it that way, is that ok?" He laughed and told me to come back in six weeks for a physical and we would check it then. I asked him to review my blood work from last fall. He said it all looked great. Cholesterol was fine. Then he said something with utter surprise that filled my bruised ego with pride. "I think that is the best LDL I've ever seen. Yup, I've never seen one lower than that."

     I could think of worse things than having to take a daily beta blocker. It sure made me chill in the face of a large cooking project yesterday - not my area of expertise. I had to call my pulmonologist friend in Philly in a panic when my Instapot wasn't working, but I managed to figure it out without blowing up the kitchen or burning myself. I guess I keep going on as usual - working out a few times a week, eating as normal (my low salt diet attempt last Fall was dismal but I'll keep it in mind) and healthy as possible. Aging is tough, but I guess we all have to do it.

The Harvey Effect

I can't help weighing in on the news cycle over the past few weeks. The number of men being finally held accountable for sexual harassment and assault is making me dizzy and ecstatic (with respect to those women who are being triggered, I know from personal experience that can be pretty intense and awful). I wrote about sexual harassment in the workplace in 2011 on the blog in this post, and why it is easier to speak out when you are finished training than when you are in training. I haven't had any encounters with harassment in the workplace since then, but I can't help but think it's my professional standing and reputation that prevents me from this behavior - my word could be a lot more damning at my hospital than many women around here without as much power, at least in society's perception.

Every day a new scandal erupts. The quiet woman's network that tries, sometimes succeeding and sometimes failing to warn each other of predators finally seems to have a voice worth listening to. One day Hollywood producers, next the local legislatures, television journalists, magazine editors, the art world, movie stars - the momentum against misogyny is at an all time high. I hope it continues. No workplace on the planet should hide and condone this type of behavior yet it is ubiquitous. I like to think there are a lot of serious offenders out there shaking in their boots, waiting to be called out and fired, dare I hope also prosecuted for past misdeeds.

I have a lot of female friends and I've heard a lot of stories of assault and harassment over the years. Some subtly angering me, others shocking me to tears - all whispered in confidence. Every single one left scars and doubt and shame. I have a 14 year old daughter who makes me proud. She is so much more confident than I was at her age, but I still fear for her. Enough to tell her not to drink anything that is handed to her at a party - it has to be a container she opens or brought with her. I warn her about sexual abuse and harassment and talk about the buddy system. I want her to enjoy her teenage years but I also want her to be on guard and to know what actions by men are not normal, and that nothing she tells me about alcohol or drugs or men or any situation she might fall into at any point in her life will make me love her any less.

The news cycle is giving me hope that society will protect my children (I know there are female perpetrators and male victims but their numbers are much less) in a way that many generations of children and women have not been protected in the past, only hushed and shamed. Every day I breathe a sigh of relief that women are continuing to be heard. I hope having to summon bravery to report this type of behavior will someday be a thing of the past.

I read a story in the New York Times years ago by a woman from another country who was telling a story about being a victim of sexual assault. It happened to her (gang rape if I recall) and when she told her family they hugged her and cried and asked how they could help her. It happened also to a girl down the road whose family shamed her and labeled her an outcast. She became a respected professional in society with a family. The girl down the road committed suicide - she burned herself to death. That story had a profound impact on me. If we just listen to the women around us, believe them, how much higher could we lift them up?

High School

My daughter started high school this Fall.

I'm 43, I mean 44? Hard to keep track these days. So I'm old enough to have a daughter in high school but it is so surreal. Cecelia is 14, Jack is 12, and all of a sudden the physical challenges of raising small children has transformed into the higher emotional challenges of raising conscious human beings.

I have spent the past five years cultivating relationships with Cecelia's friends mothers through book clubs and trips. Thinking I had all my ducks in a row for the tough years. All of a sudden, this Spring, she upended me by deciding to attend high school at Little Rock Central High. Up until now, she has always been in small private schools. I longed to leave my small private school for Central when I was her age, and logistics prevented me, so I supported her.

As you might know, the Little Rock Nine are history. Bill Clinton was here last month for the 60 year anniversary, along with members of that brave tribe. We didn't make it, I was out of town, but I'm still super proud of my daughter for going from a class of 60 something tops to a class of over a thousand in a place steeped in history. I've been in the building exactly once. She's braving it solo. Attacking model UN and AP physics with aplomb. Making all new friends, to my carefully planning chagrin.

Last weekend I was added to two group texts - one tackling homecoming pre-party and the other a post party sleepover. I know none of the parents. It was a giant text stream of numbers. At one point, right before breakfast on Saturday, I replied to the larger pre-party text, thinking it was the smaller sleepover text. Got confused. Stepped on toes. Newcomer face plant. I was very apologetic to the one person I actually met for five minutes, and they were very kind, but UGH. I thought I had this all under control.

That's life right? You think you have it all under control and it changes. Control is a huge illusion. Life is life is life. We like to operate and mitigate it through our own interpretation but really? If we shut those eyes it would all go on without us. So you just have to sit back and roll with the punches.

I was on call last week. Friday night after the football game I dropped my daughter off at a house to socialize. All I want to do on busy call weeks in the evening is veg in front of the TV or a book (hell non call weeks too). But I've got to meet these new friends and their parents, one of whom was having an after party until midnight at her parent's house. Emboldened by wine, I marched in at 10 while the teenagers were dancing in the driveway and hung out for over an hour. I met a woman, challenged by fertility issues, who adopted two sons from Ethiopia. I met another women who is an airport engineer who travels all over the country. I became reassured that even though this is a brand new social circle, these are good people. I volunteered to do the 11:30 carpool the next night from the dance to the sleepover.

Six glamorous excited chatty girls piled into my car the next night. When your kids are teenagers, you glean much more information about their lives by listening to them talk to their friends than direct inquiry. So I relish carpooling them around. They appeared disappointed in the turnout, despite what looked like hundreds of teenagers hanging out around the venue, then started plotting basketball homecoming. They played music I have never heard of on Spotify. They took selfies with their phones. I got caught up in the moment - the excitement of youth.

I think I'm ready for high school. I'm glad it's not me. That wasn't my favorite time of life, but I'm going to try to make sure my daughter enjoys the heck out of it.

Cecelia and Jack, pre-homecoming festivities. He is dressed up to see Kinky Boots with my husband, myself, and his friend. We all wore jeans and nice tops but he surprised us with jacket and tie. I'm hoping to convince Cecelia to let me use this on the Christmas card this year.

The Devil You Know - A Book Review

I get really annoyed by those people who declare, "I only read non-fiction." And it's ok, if that's you, but don't say it snootily at a party when someone asks you if you've ever read this great fiction book. That's left me speechless and a bit shameful on more than one occasion - the person acts like fiction is non-fiction's red-headed bastard stepchild. And really, if I could go back in time - let's do that right now - I'd tell that person off. Fiction, I'll argue, is way more difficult to pull of than non-fiction. And I'll be damned if you can draw a straight line between the two. Fiction authors often weave autobiography into their own work, but instead of just spitting out what already happened they birth a new child. And that's pretty impressive, in my opinion.

I met Fizzy on Mothers in Medicine years ago when I first started. We became e-mail friends, she supported me through my divorce, I learned a little about her life. She is a very private person. I've met her for dinner once and I still don't know her last name. I respect that, and it comes with mystery and intrigue. We don't e-mail as regularly as we used to, but when she asked for me to read her new book a few months back and let her know what I think I felt like I had received an e-mail from Madonna (that's a nod to the book, by the way). I read it in one afternoon. Well, it bled into the evening a bit.

I read the first book, The Devil Wears Scrubs, years ago. I loved it, and talked about that here. What I loved about that book was how it captured the angst of medical school and training. What I love about this more is it captures the angst of mothering and working as an attending. It is a stand alone book - you don't have to have read the first one, but it was fun for me to reminisce about old characters as they were brought up again throughout the book.

Warning: This book will make you laugh out loud. A lot. Fizzy has always had a great sense of humor and in The Devil You Know she doles it out constantly. There was this one part about glitter - I almost put in a quote but I don't want to ruin it for you - where I was laughing so hard I had to put the book down. She perfectly combines the mayhem of being a doctor and a mother and a spouse - and doing it very imperfectly perfect. If you are taking yourself too seriously this is the book to pick up. I read it again to make this review better and it was a bunch of fun the second time around. One of the best things about it for me was I got a great big glimpse into my very private friend's - one whose blog - A Cartoon Guide to Becoming a Doctor - I've followed for years - life. No one can write a book like this without experience.

I could go on and on about the hilarious patient interactions and bumbling cast of characters at the VA (one of my favorite places on Earth where I trained) but Fizzy herself would stop me - I tend to get long-winded. JUST GO GET THIS BOOK ALREADY: HERE. You won't regret it!!

Side note to Fizzy - who ribbed me years back for never having read a book on a Kindle etc. - I have now read one book on my computer and phone exactly twice - yours.

Stay at Home Starchitect

All Spring my husband researched options. He had a great job, and they loved him so much they gave him leave without pay to get extra vacation time with  me and the kids (standard for architects is 2-3 weeks and I get much more than that), but he was tired of working on multimillion dollar housing projects in other cities - jobs that take months to complete. After exploring other job offers, he met with my financial advisor and decided to take a plunge from the corporate world and form an LLC. He would work from home and start his own business. He gave notice at his job a couple of months ago.

The first week he was home it was as if the boil of logistics that was our life, a life I knew no variation of in this marriage or my last, was lanced. He has always pitched in as much as he could, but this was different. Someone to be there to get packages. Let the bug guy in the house. Get one of our kids to the impossible 2:00 in the afternoon orthodontist appointment. Grab the cake for the birthday party. Get the honey we forgot at the grocery store last weekend that left my morning eggs unbalanced and naked. As end of school transitioned to summer, it became even more rewarding. My kids at 14 and 12 are old enough to be alone now, but having an adult at the house to check in with before they walked to the local pool to meet their friends and receive them when they return is a huge bonus. Someone to drive them to a sleepover earlier than 5:00. Someone to eat lunch with them. And we agreed, most importantly, the bonding of their relationship, stepdad to kids, as the kids are reaching an unprecedented age of independence.

He has already turned our guest bedroom into a sleek home office and is starting to craft a business card and do some research. The many contacts he made in the past have already landed him side gigs. And he is happier - getting a long bike ride in every other day. Not having the pressure of 8:30-5:30. That happiness makes our house happier - not that we weren't before, but it's better in a way I could not have imagined. So much so that I suggested he take some time off. Take it slow. We are traveling much in the month of June, so maybe wait to gain traction until July. He is more than amenable.

I don't want him to become the carpooler come Fall - we both want his business to succeed. So I'll put boundaries around his time - maintain an aftercare driver to get the kids from school and to all their activities. But this level of support is nothing short of mind blowing. So I was surprised one night last week when jealousy reared its ugly head. I didn't share my feelings with him at the time, but it was 12-15 hours of why do you get to do this and I don't circling my angry brain and it came off as crankiness and being short one evening. I was jealous he had lunch with the kids. I was jealous of his time during the day to exercise.

Now, to be fair, last week was one of the hardest weeks I've had in a while - call duties, high caseloads every day, terrible work drama, some family drama, and autopsy drama of all things. So I was grinding my teeth getting work done and working very hard to center myself and approach every issue with as much grace and calmness as I could muster. And I think I succeeded, and am happy I sold away my call weekend so I could get in some much needed chill time. But I knew I needed to explore this jealousy thing, so I did one morning at the scope.

He is very different than me. He tends to work better without boundaries around his time. He can adhere to our family schedule, and plug in to work at night when the kids are not with us. Not me. In the past, when I had time off between my first marriage and med school, I quickly lost myself to entropy. I watched Lifetime all day long. I quit exercising. One or two hours on the couch turned into one or two months. So much so that my then husband worried. "I think you always need a job. Please tell me you will always have a job or be in school." To be fair, I didn't have kids back then, and I was in my twenties, but I think he was right about my personality. I need to be responsible to someone or something in order to feel personal reward. Schedules anchor me. My cases, the patients behind them, the frozens, bronch lab, interventional radiology, it's a fuel that keeps me going and performing. Last week was too much, but most weeks aren't filled with all of that. I would not want to be a stay at home pathologist, not only because I don't think that's possible yet but I also need space away from my house to be productive at what I do. The hospital is my sacred space.

So I breathed and apologized the next night for my crankiness and told him about where it came from. He agreed to make space in the evenings for me to work out like we used to together on nights without kids instead of wanting to eat as soon as I get home. And he brought the kids to work one day to eat lunch with me - the kids hadn't done that in a long time and I know we will do it again this summer we all had a blast.

I remember when I was going through my divorce or maybe a new single mom KC won a well deserved prestigious award for starting this blog. In an acceptance speech she was tasked with advice to being a successful mother in medicine. Her first piece of advice was to marry well. I'm proof that if you don't get it right the first time, for whatever reason, it's possible to get it right the second time.

Work Family

I entered the Doctor's Lounge shortly after arriving for work to get coffee and bottled water. It's newly renovated, homier than the old 1950's linoleum version, but still full of mostly white male doctors. Most of whom are excellent at what they do, but my hospital is still not very diverse after ten years of my own practice.

I wave and smile at the ones I know as I am preparing my coffee, and am stopped by a heart transplant doctor as I'm walking out the door. "Oh, yes, my partner told me about an urgent biopsy today. I'm covering."

"It's turned into a postmortem. He died yesterday afternoon."

"Oh my. Oh no. What happened?"

"There was a rare familial genetic disorder, we were about to test him."

He laid out the details.

"I'm the only AP doc here for the rest of the week. Autopsy falls to me. I'll call the gross room right away to give them heads up. Then I'll call Mayo Clinic and get the details of what they need to get the family the information."

"Thank you so much."

I triaged my difficult needles from the day before quickly, ordering immunos to get the diagnosis, then spent an hour on the phone with Mayo learning about what each of three departments needed from us to help them look for the disorder. Skin. Blood in EDTA. Paraffin embedded tissue.

I learned from a partner mid-morning that he was a relative of one of the most prominent employees in our work family. Internally, I doubled over and fell to my knees. Externally, I resolved to work even harder than I already had. Called Mayo again to verify the details. Gathered the schedule of needles from OR, Bronch Lab, and radiology and decided to schedule the autopsy for 11 am to avoid interruption. Called the work family member and told her I had just heard, why was she still here, I was so sorry, and I was praying for her and her family.

A couple of hours later she learned I had done the autopsy. I knew she knew, because we were problem solving an old case with the lead transcriptionist and she put her arm on my shoulder. I sideways hugged her tight, and gestured for her to follow me into my office. I listened to her talk about the shock.  He was young. He has two children heading into prom and graduation. He looked like the picture of healthy life interrupted. I've done a lot of autopsies, but none has ever hit this close to heart. I can usually detach myself clinically, viewing the body as a vessel that the soul has left behind, but during this one I kept thinking that this was a father and a son and a spouse who had left the world prematurely. The emotional connection deepened my already strong commitment to the leagues of tissue I regard daily with the comfort of my detachment from the lives involved.

Luckily a mind-jarring workload kept me from ruminating too hard during the day, but on the way home I lost it, sobbing uncontrollably all the way into my house. The kids noticed, so I enlisted a larger prayer team over dinner. It took me two hours to wind down enough - cleaning and organizing - to finally sit down.

As I was catching up on social media on the couch, I heard my son talking to his friends from downstairs. He was so animated - a girl he liked liked him back and there was something there, not dating - he's in fifth grade - but a connection that wasn't there before, spurred into public with the encouragement of his friends. He excitedly told his sister, then told me as I was tucking him into bed. I wasn't surprised - he has been talking about her for months. A girl who likes the same video games as he does. That's kind of rare, at his age. Mostly boys in that arena.

I told him I remember liking a guy in fifth grade at Montessori. We didn't call it dating back then either, we called it "going together." Which consisted of buying each other gifts at holidays and being totally awkward at school. His name was Clay, and I was Elizabeth, and I had these Liz Claiborne pink sneakers that I thought foretold the relationship. He had brown hair, and eyes so blue that if he caught me looking at him I had to avert mine in order to preserve my senses. Then Summer came, and he went to another school, and that faded as most of those do.

As I tucked Jack in I thought of how strange this world is. One that can yank a father prematurely from his children and throw joy of first love into it on the same day. I texted my work friend and told her I would do anything to help her and her family. Then I sent prayers. What else can you do? There are days I feel so powerless, but I try to remind myself that we are all on a path, and it's our own, and we can't be responsible for other's path, but we can lend the utmost support and love.

I Am Her Doctor, and Her Friend

I have a good friend named Mary.* We met at 15 (she was 14), volunteering at a camp for severely handicapped children. The weekends were called Respite for the full time caregivers. The campers ran the gamut - Cerebral Palsy to Prader-Willi to Down's Syndrome. We both excelled at our task - this was before service hours were a college application box to checklist. We believed that what we were doing would make a difference.

We became fast friends. In spite of our lofty aspirations, we were also teenagers finding ourselves. She was and still is gorgeous, I was drawn to that. She was also lots of fun. I had a hardship driver's license, and we headed offsite one night to buy a Playgirl magazine at a local convenience store. We got back to camp, looked through the pages, and were profoundly disappointed in the staged pics of men in thongs. "Who gets turned on by this?" we wondered. The Playboy's I snuck from under my Dad's bed when I was a tween were much more interesting than this.

Once we double dated in her small town of Salem - she set me up. Let's call them Dusty and Dylan. I was the only licensed driver. I decided to be the sober driver. They were all drinking Purple Passion. She and I had to use the restroom, so we stopped at the local grocery store.

While we were in the bathroom, the boys were up to no good. We climbed back into my 1983 Oldsmobile Toronado convertible.  I stuck the keys in the ignition, and saw blue lights flashing in my rear view mirror. Seems the boys had decided to steal beer from the storeroom without telling us - stashing it in my backseat. We sat in the grocery store high box, surrounded by plexiglass (remember those?) until we were finally told we could go home sometime well after midnight. Thank God, I told Mary. They are honest.

Mary and I are the kind of friends that while staying the course move in and out of our friendship for years at a time. It's our norm - we both have big circles. I will never forget her support after my divorce. She invited me to everything for a year - her parties, her Florida vacation home. It was a respite for me and my kids. She also recommended her storeroom floor designer to be my decorator, who helped me with my home after my divorce. When I was married last fall, her store's event spinoff furnished my beautiful reception at the Clinton Library.

We hadn't caught up much in over a year, so I was surprised when she texted me last week. "I'm having surgery next week. A cyst the size of a grapefruit. I told the surgeon to send it directly to you."

I texted the surgeon immediately. "I've got this, you don't have to do anything. I've called the gross room."

I scoured two pre-ops on her surgery day, before finally finding her. When in the second one, I asked some nurses to help me find her. One challenged me. "Are you family or friend?"  I answered, "I'm her friend." "Well then you need to check in at guest services. All family and friends must go to guest services. Leave pre-op, you will find it around the corner to the left." I felt taken down a notch - my doctor coat meant nothing to her but a challenge to beat down, and since she didn't recognize me she put me in my place. I was so shocked I just did what she said - I have been in pre and post op many times over the years and have never been treated that way. I vowed, in the future, to assert myself more. I'm not only her friend, I'm her doctor. Albeit one behind the sidelines, but important nonetheless. So if I need help finding her in pre-op, you can direct me to her instead of sending me outside to a queue.

Luckily the cyst was benign - her surgeon ordered a frozen so she and her family were assured right away. But the surgery was complicated, so she was inpatient for almost a week. Affording me to visit her often, share gross and micro pics of her specimen, support the anxieties of her and her family. Catch up. I miss the hell out of our teenage selves. But in our long conversations we proved that we are both still here. Same people, future incarnations.

"Thank you so much for spending time with me this week."

"Seriously? I should thank you. I am normally buried in my scope. Well, except for when I interact with Dr. Woods and Dr. Music. But really you are a breath of fresh air. I am sorry for your circumstances, but proud to support you. I sign out 65 cases a day, and there's no way I could give each person behind them all the attention I have given you this week. But sharing your path, the gross and microscopic pics - makes me feel like a real doctor. I don't do this for other patients. This week makes me wish I could on occasion. And last week, this would not have been possible. I was super slammed. This is a crazy slow unusual week, and I am glad."

Texting her surgeon the day after her surgery made me realize how touch and go it was. She texted back, "It was like someone poured cement into her belly. There were so many adhesions from previous surgery. My partner and I felt like residents again. It was the hardest surgery I have done in practice. I can't imagine her pain tolerance - it must be huge. We freed up a lot of her bowel, she should be much more comfortable."

I hung out with her one afternoon while I was waiting to go to a late meeting. "They said it might be awhile before I can use stairs. I'm thinking of getting a bed delivered to the house."

"Well, that shouldn't be a problem. You are a furniture mogul, after all. Just call your peeps and have them deliver."

"LOL. That's exaggerating."

"Not at all." She and her family have many stores throughout the South. "I'm headed out early. Treadmill/yoga night for me - no kids. Hope you get a good night sleep. I'll visit in the morning, if you are still here."

Luckily she went home the next day. I got to celebrate the good news with her and her husband during an early morning visit by her doctor. When I went back to check on her late morning housekeeping was already scouring her room. I texted her, "I'm glad you are gone but I'm going to miss you so much - let's catch up soon over dinner and wine." She texted back, "Thanks again Giz, definitely soon." I may be her doctor, but I am definitely her friend first.

*Posted with her permission. And her appreciation. She's my first and best audience, and I'm so happy she likes this essay.

Women's March on Washington

When Trump was elected into office, a small movement began on Facebook, one that resulted in the largest march in history. When I texted KC, it was still in its infancy. I had the time blocked off for a conference in Vegas. I've never been to Vegas, but decided it could wait another year. "KC, do you want to march?" "Yes." I booked plane tickets to D.C.

I know KC doesn't want this blog to be political. Neither do I. I've read all the perspectives, Trump garnered many of the votes. I've read lots of essays and novels: I get why so many women and men voted for him; it's a vote to try to change a corrupt system. His presidency is a blip in history; albeit one causing a lot of anxiety. While there were many signs that were anti-Trump, there were many more that were pro-women. That's why we gathered. For Democratic principles.

My friend Ramona knitted us the requisite "kitty-kat" hats. I think we looked adorable. Her daughter, age 12, got the third one and wore it better than we did Saturday night at dinner in their home.

KC and I, in front of the Air and Space Museum, Women's March, day after the inauguration.

For those of you who think we even knew where the speakers were, kudos, because we couldn't figure it out. There were so many women. At one point, we tried to get next to the Jumbotron, and regretted it when we were squashed and shoved and it took us thirty minutes to travel thirty feet to the freedom of the Washington Mall. I watched the speeches the next day on YouTube. 

Nothing lost in missing the speeches though. We saw lots of women and men with posters. We took pics. We found a high perch, relaxed and ate almonds and Cliff bars. When it was time to March at 1:15, we traveled to the marching site nearest us.

At 2:00 we still hadn't moved. A few women and men started chanting: "Forget the March on Washington, we are taking a Stand. This is the Stand on Washington." I got defensive. "I'm marching, if only in place. It's still a March. My feet are cold. It counts, right?"

At long last we eventually joined the March. It was everything my pulmonologist friend from Philly, one who I tried to meet but missed, raved about on text. "This is amazing and energizing! I'm so happy to be here. I'm sad I missed you."

There was lots of signage, but I decided to skip doing it myself so I could take lots of pics. There was one in particular, one of 50-100 that I took, that touched me the most.

And though she be but little she is fierce.

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

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 match.com 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)

Make You Smile

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.

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.

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.

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.

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.

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.