October 2004 Archives

One of the most interesting aspects of this pathology fellowship thing is the wide variety of surgical specimens that I get to examine. Some are boring - you got your biopsies, your lung wedges, your lymph node dissections, the occasional placenta. You know, your regular, run o' the mill bits and pieces. But every so often you get something a little more interesting. A giant boob from a total mastectomy. An entire colon fillled with ulcers. 80 lbs of abdominal fat. An entire leg. A fetus.

And then, every great once in a while, you get a speciment to write home about.

Yesterday morning I arrived at the VA path department for our weekly Friday morning 8:30 conference. We meet weeky to go over the slides from the interesting cases of the week. When I got there the early morning conversation was a little more animated than usual, and when I asked what was up I was directed to the gross room. "There is a specimen that you might want to take a look at." "Its a foreign body specimen."

Intrigued, I left to investigate. Accompanying me was one of my colleagues, a fellow med student fellow, and we began to speculate as to what it could be. "I bet its hip replacement hardware," said my colleague. No, too boring. "Maybe its a giant breast implant," was my only offering.

We walked into the grossing room and there, lying on a tray in a plastic bag, was The Specimen. A kind of long, fleshy looking item. At first glance it looked like an amputated arm without a hand. "Is that an ar- -?" Before I even finished the thought, I saw.

It was not an arm. It was a giant dildo.

An enormous, fleshy, realistically-sculpted silicone cock. A giant dildo! This thing was honestly huge. Probably, oh, atleast a foot. At least 4 inches in diameter. Keep in mind, I thought it was an arm.

I checked the requisition form. The specimen came labeled: "Foreign body, rectum." Some guy - some veteran of the US military no less - had gotten a giant dildo stuck up his ass. And he had to go to the emergency room to get it surgically removed. Can you imagine that moment? That moment where you realize that you have a giant dildo stuck up your ass and its not coming out and your are honestly going to have to go to the ER. Can you walk? Do you have to call an ambulence?

And what's almost weirder is why the surgeon decided to send this particular specimen to pathology. Where you usually send things to get a diagnosis. Um, I think you know the diagnosis, doctor: Giant dildo stuck up ass. They have to have sent it as a joke.

But the best part of all of this, the most priceless thing, is my colleague's reaction. My colleague, my fellow fellow, is a very conservative, very christian, very homophobic girl who is a bit naive about the ways of the world. She's the one who, when she learned that our chief resident was visiting family in San Francisco, responded with, "You know what happens in San Francisco? There's all these gays down there who have orgies. Its disgusting." This from a future doctor. Very reassuring, eh?

Well, the giant dildo blew her little mind. She didn't know what it was. She had never seen a dildo before. She didn't get it. She didn't want to touch it because she was worried that she might pop it. "Is it inflatable?" (Um, if so, I bet they could have figured an easier way of getting it out). And I revealed that it had been removed from a rectum, whe was literally shocked. "Why would anyone put that up there? .... That's so disgusting."

And she had to gross it in. She had to measure it, describe it, and dictate a diagnosis. The giant dildo! Amazing.

Here is something very funny.  In the labs at the VA hospital, they have these emergency guidelines for what to do in the event of a toxic exposure.  And they have tried to make it a catchy acronym that everyone will remember, but they totally fail!  Check this out:

R.I.N.S.E.

Rescue - if applicable and safe to do so.
Incident Command - provide first aid to spill victims, control access to spill area
Notify - dial #20 and report the situation as a "Code H"
Suppress - contain the spill as much as possible
Evacuate - when the HAZMAT team arrives

Incident command! "Oh my god.  Jimmy spilled Xylene all over himself. Ok, RINSE. Think RINSE.  Somebody needs to rescue Jimmy.  Ok Jimmy is safe. Ok. Ok. Oh my god!  What does the I stand for?  What does the fucking I stand for!? Nobody move.  Put the phone down, Rodgers. We need to figure out what the I stands for, ok?  It.... In..... Incident?  Incident Command!  Incident Command! What the fuck!!?  Somebody command the incident.  Now.  Oh my god.  Jimmy is totally going to die."

I really want to make one up that's even more ridiculous and obscure.  Like "T.O.X.I.C. - A.L.P."

"T"erminate behavior
"O"ptimally survey the area
clean up "X"ylene, or other dangerous chemicals
"I"nitiate call to authorities
"C"arefully suppress the spill and rinse eyes
dial x4900 "A"nd report a Code Red
"L"isten
"P"lan ahead for a future spill and take necessary precautions

Oh my god.  I am laughing so hard.  People keep asking me - what is it? Something good?  Yes. I am writing an entry that is so funny that I can't stop laughing at my own comic genius.

Oh my god.