I am sitting in the

I am sitting in the resident's room in the back end of the OHSU pathology lab. I have been here since 7:30 am (its now 10:00) and have done almost no work whatsoever. Its kind of weird.

I had to be here early to "cover frozens." I will translate. When someone is having surgery to remove a tumor or some other part of their body that they don't want anymore, the surgeon often wants to know something about that body part before they finish the surgery. For example, they may want a diagnosis if they don't already have one, because if the tumor is malignant it could change the course of the surgery. Or they may want to know if they "got it all," meaning - does the tumor extend right up to the edge of where they cut? If so, they need to cut more tissue out. Or they may want to know if the tissue they removed is really the tissue they were supposed to have removed. For example, parathyroid glands are very small and often look like a glob of fat or a piece of thyroid. Did they actually take out the parathyroid?

To answer these questions, the surgeon sends the tissue to... (insert triumphant superhero theme music here)... SURGICAL PATHOLOGY!!! Or Surg Path, for short. And they want an answer within 15 minutes. That's where I come in.

The instant that I receive the specimen from the hospital's magic tube system, I time stamp a form. This reminds me that a patient is lying somewhere with their insides open to the world and a lot of anxious impatient people are standing around them waiting for me. I quickly look at the specimen and decide what part of it or how much of it should be used for diagnosis. I then place the tissue on round metal stage, or "chuck" that I have covered with a clear gel called OTC. The chuck is located in a machine that is kept at -23 degrees, which quickly freezes the gel and gives me a tissue that is embedded in a solid frozen block. Hence "frozen section" or "frozen."

Inside this machine there is a very fine blade that can be set to slice things as thin as 5 microns (for reference, a red blood cell is 8 microns in diameter). I then proceed to cut this frozen block into very thin sheets, and by deftly maneuvering a small brush, I peel one of the sheets off and put it on a slide. In reality this proves to be very tricky. I then stain the slides be dunking them in a series of dyes and fixatives to make everything visible and recognizable.

Then I track down the attending physician who looks over the slides with me and renders a diagnosis. Then she or he or I will call the OR and relay the news. Then I time stamp the form again, usually revealing that I have gone over 15 minutes, but I usually feel pretty proud of myself anyway for getting everything done.

Anyway, sometimes they will send you frozen after frozen, one after the other, keeping you running around for hours. This happened to me last week. I was doing this straight from 8am til 1:30pm. Or sometimes, like today, there will be nothing. So I check email. And catch up on my blogging. And think about the magic tube system.
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