Wednesday, October 30, 2013

How to spot which child takes after me...

All the men in my household are currently carving pumpkins (I stepped in to help with the gut removal). The youngest child is singing "Knife goes in, guts come out" which if you know the song means we enjoyed the same sort of pop culture back in the 90s. He's gleefully playing in pumpkin innards and making jokes about guts, even going to far as to help his father empty his gourd.

Meanwhile the oldest child is dry heaving and almost threw up in his bag of pumpkin waste... Poor kid, but he toughed it out and hollowed out his pumpkin. I appreciate that he didn't give up.

Tuesday, October 29, 2013

Peeled grapes

My kids were sitting at the table eating grapes on Saturday, and the youngest one asked me why
My family of grim reapers.
people used peeled grapes as eyeballs in haunted houses. And I explained that they're kind of the right shape (although the ones they were eating were not globe grapes) and the right size, and they're wet and slippery. I told him that it wasn't really what an eyeball felt like, but it was close enough for most people. Then we had the following conversation:

Oldest to me, "You don't know what an eyeball really feels like!" (He's starting to get very pre-teen in his outlook on life)

Youngest to oldest, "Dude, seriously?" (yes...this is how my youngest talks).

Me to oldest, "What does mommy do for a *living?"

Oldest, "Oh...yeah." *long pause* "What does an eyeball really feel like?"

*Not that I've had an eyeball since before grad school, and the ones I did get were for generally for melanoma. At Duke the neuropathologists did the eyes for surgpath and on autopsy the techs removed them and one of the pathologists who had an interest in eyes would dissect them (sometimes ophthalmology residents would come down for those). 

Monday, October 21, 2013

Dear Durham, I miss you! And familiarity.

Just thought I might leave this link here... It is a fun town to live in. Meanwhile I went back to visit
this past weekend since I like seeing my Durham BFF on a regular. We made pies! Because at work on Friday, pies came up and it made everyone want pie. It carried over to my visit and Saturday evolved quickly from looking at yelp reviews for bakeries to deciding to spend our whole day baking. The results were pretty delicious, and can be seen at right. I also made cookies from the leftover crust dough used for the top two pies, and they were amazing.

It was a slow week at work last week and today was fairly quiet as well. All fairly normal routine specimens and I found myself today remembering what we were told in school, which is that if you can gross at Duke north and keep up, then you can gross anywhere.  And it makes more sense now. Outside of a major academic center, you tend to see a lot of the same things...a lot more horses than zebras. Which is nice, you start to get really comfortable with those familiar specimens. But because of the exposure from school, even if something unexpected and less familiar shows up on the grossing table, I can't imagine being at a loss as to what to do. Even if something I don't see as often pops up, I poke my head in the other PA's office and I ask her, follow her instructions, and feel relatively okay with what I've done. I can't imagine being anywhere and just feeling at a loss... even though I don't need to be able to do everything I saw in school every day, I'm fairly secure that if it came up, I could do it (maybe with a little extra guidance). No real point to this...just to say that I'm glad that I got the exposure so that if I need the experience, it is there.

Thursday, October 17, 2013

Stink revisited!

I had to go back to the bucket on the specimen that smelled so bad that I blogged about it. Oh misery! And it wasn't that I'd missed sampling something, just that the pathologist wanted to see more of a certain structure that is normally just sampled in one block. The smell had not improved with age. Ah well, you endure what you must.

This week has been a light one. Tuesday, I finished grossing and then deep cleaned the grossing bench. Yesterday I helped the other PA with paper work for a little while. Hopefully it'll pick up next week. I like to have enough to keep busy!

Wednesday, October 9, 2013

Grossing still stinks

This would be a follow up to an entry I wrote even before I started grad school.

In the two plus years since the bar for what I consider the worst thing I've ever smelled has risen. Considerably. The worst still goes to a case that involved multiple rectovaginal fistulae that had been present for some time. Veterans in pathology were taken aback by the smell and it is where I realized that my body opts for the "flight" coping mechanism when faced with overwhelming stench. One moment I was standing and observing one of the staff PAs working and the next I was standing outside of the room without ever having made the conscious decision to move. I'm not entirely sure but in an effort to escape the rolling tide of scent I may have spontaneously developed the ability to transport. Decomposed bodies at the medical examers office (in varying states of freshness), countless colons, gangrenous amputated limbs, and multiple autopsies later the things that I consider to be particularly pungent are, trust me, significantly unpleasant to be around.

Today, we got a specimen in and I started my day off by triaging it. It was an awful smell, to the point where I had to go into histology several times to get air I could breathe. I finished triaging, I hosed everything down, scrubbed the grossing bench down, surface cleaned the outside of the specimen container, and put all the trash that had come in contact with it in a sealed container. The lab tech came in to the gross room to print a few blocks a few minutes later and dry heaved. One of the histotechs was at lunch during the triaging and has a notoriously easy gag reflex, so as a practical joke the other histotech sent him into the gross room on a made up errand. He walked in ten minutes after everything had been cleaned, took one breath, then turned around and headed back out to histology where he dry heaved for a while. As I told my boss, the smell was so bad that my eyes watered and I seriously started regretting the professional choices I had made that led me to that moment.

So there was that... and it was awful, but the worst part came later in the day. I knew the specimen was thin enough to be fixed by the end of day and I would have to gross it in. And I lived all afternoon in dread, knowing that I was going to have to open that bucket again and knowing that it would still smell as bad as it had earlier. I would say that the anticipation was the worst part, but it wasn't. The anticipation didn't help, but having it out on the cutting board, enduring the smell again was the worst part. Seriously, the worst part by a long shot. But now it is done, and I know that things that are truly repulsive are greatly out numbered by the things that have long since become familiar from repetition and once again, I'm quite content with the career path I've chosen. 

Monday, October 7, 2013

That is not where those go... and OCME shoutout

The larger specimens show up in trashcan sized biohazard containers fresh since the formalin containers aren't big enough and are held in the morgue fridge until time for disposal. The specimen shows up in the gross room in the large container, I gross it, and then the lab tech takes them to the morgue which is tacked on to the back of the hospital.

I had a large specimen today and at the end I bundled everything back into the chux pad, put it back in the biohazard bag, and tossed it into the biohazard bucket. Then I triaged a specimen that needed better fixation and grossed a few small things. After a while I started doing a larger specimen and realized that I couldn't find my scissors anywhere. I checked under the cutting board, in the tool cleaning bucket, on the floor, everywhere! The dawning realization came that the only place the scissors could be was the bucket. Wrapped up in a chux a biohazard bag... in the biohazard can... in the the morgue... on the other side of the hospital. So glad that the lab tech is super nice and was willing to go get the bin for me (I wasn't going to even ask her to try to dig them out) since it was a steady day specimen-wise and I had enough work to keep me busy right up until time to go (and my husband is out of town so I had to get home by 7 to relieve the sitter).

So I dug everything out without blindly reaching into the bucket and stabbing myself in the palm.

Also, there was an article in the paper about one of the rotation sites we went to, you can read it here! Forensic pathology can be a very difficult job, but it is good to know there are people out there trying to give names to victims.