Looking for things that aren't there.

One of the pathologists came into the gross room at the end of the day to look at a multi part case
from early last week. It is always worrying when they say something like, "well, what do you think it was?"

There was nothing like this...

Eek! It didn't look like anything particular... but at least I threw out an option that was plausible  based on what I saw grossly. It wasn't right, but I'd argue that it made sense given what the surgeon thought was the primary and better than not having any answer at all.

Meanwhile we went back to the bucket to look at one of the parts, where he was interested in one particular area...already knowing before he saw it that the primary tumor should be there... Except it wasn't.... at all. There was a nearby tumor but nothing where we were looking.

Which is infinitely comforting. The idea of missing a tumor is terrifying--especially when it is a specific and semi diagnostic sort of one.

On a related note, I get paranoid when large swaths of bowel are removed for "neoplasm" and all that is in there is a lipoma or a little polyp. I always have to worry that there's something more sinister that I'm just not seeing.

That might be the saturation point...

I think I might have hit the point in studying where I feel comfortable, where all of the words are starting to look more and more familiar. I woke up this morning to consider what I felt like I needed to study and...there just wasn't anything pressing. I'll keep reviewing here and there, but there isn't the feeling of compulsion to keep reading/making notes/reviewing.

And what did we learn, boys and girls?

We learned that if we blog about getting legs and how gross they can be, you tempt the universe to send you more legs. What the heck? Between end of last week and the start of this week I had more legs than all of last month.

But! We've had students coming in from a local career center touring the various things we do in the laboratory and since they've been coming in I haven't had any legs! The only plus side to them is that they make a very interesting visual aid (and potentially fun Halloween decorations if you were so inclined and wanted to scar some children for life....) for when you have people coming in to see what you do. People know what a normal leg looks like, but very few people without a medical background know what a gallbladder looks like. I do like showing them gallbladders though, because there is the potential for stones.

A lot of the students are interested in nursing and labor/delivery or pediatrics. So at least I can bring out a placenta and show them the membranes and where the baby would go, etc. It helps to have something relevant to their interests.

She's got legs...

Oh legs. I don't know anyone that likes legs. On my best day, with a not particularly bad leg, I don't mind them. On the wrong day, I dread seeing one come in the door.

Why? Well, they are unwieldy and just won't stay where they're put. Sometimes all the vascular margins aren't clipped so if you grab it blood shoots out the resection margin because of the pressure you've applied. And they're fresh. They're fresh and bloody. They are the single largest exposure I have to unfixed, biohazard-y tissue (which I'm not particularly concerned about, but at the same time puddles of blood aren't exactly my favorite).

And the smells. Oh the smells! Gangrene is a popular reason to have your leg amputated, plus non-healing wounds, ischemia. These are not nice legs, these are legs that have allowed toes to rot off and nails to get hoof-like. Legs with popliteal arteries that are thrombosed and wide enough to stick three fingers in. Sloughing skin and muscle turned gray, green, and purple with rot.

The legs get wrapped up, in layers and layers. The more layers, the worse it smells generally, more layers to try to contain the stench. The last layer is the worst, it is a sort of adhesive plastic that sticks to the skin. Sometimes it comes off easily, and sometimes removing it brings part of the foot with it. 

At the end, it all gets re-wrapped, put back into a biohazard bag, thrown into a rigid biohazard box, and then put into the morgue fridge. The temperature keeps it from rotting too much more, but you still hope that you never have to go back to it. Time is not kind to detached legs.