Burritos

I came home exhausted last night.

Yesterday was my day to "gross," up here in Surgical Pathology. That means that it was my job to describe, cut open, and submit sections of every surgical specimen that came through our doors. Basically, if it comes out of a human, it comes through my hands (and those of the pathology assistant).

I showed up yesterdy morning to find piles and piles of specimens that had been dropped off the night before. Rows of transluscent plastic buckets with their amorphous, lifeless red contents, cold from sitting overnight in the hallway fridge (its somehow even weirder when they come warm, fresh from the source).

The first thing I did was to put some of the specimens in formalin, so that they would fix well enough by the afternoon so that I could reasonably cut into them without them falling apart under my blade. Esophagus, in formalin. Lymph nodes, in formalin. Colon and rectum with attached uterus and tubes, in formalin - this one took some work, because I had to dictate a description, cut open the colon lengthwise and bivalve the uterus, and then carefully pin them out onto a wax block and then float that in formalin. Formalin, by the way, smells awful and burns your upper airways if you get too close. Which I always am.

Change gloves, wash board, change gloves again. Then go.

1.Rectum with tumor: I went to the OR the day before to open this specimen for the surgeon, who wanted to see how close the tumor came to the anal margin. Stuck my finger up a bum-hole that had been removed from its owner, who was lying on the table a few feet away. This was to feel for the tumor before I cut the rectum open so as not to slice through it. I accidentally did anyway, but the surgeon didn't care. She (suprised?) asked me to send a digital photo when I got back to the lab. Aah, this modern age.

LUNCH

2. Mandible (aka jaw bone): Piece of jaw with attached floor of mouth, with a white, frondy tumor that looked suprisingly like terrycloth. Little white threads, like blades of grass, crept between the teeth from this unfortunte person. We jokingly refer to mandible specimens as "face-ectomies." Ha ha.

3. Uterus: Opened this one in the OR as well. "The uterus is bivalved in the Operating Room to reveal multiple small polyps diffusely covering the endometrium and extending into the endocervical canal" (per my gross dicatation). When we called the surgeon back to say that microscopic examination revealed invasive endometrial adenocarcinoma, she said "Crap." Crap for the patient, and crap for her, because now, at 4:30 pm, she had to begin an extensive search for pelvic lymph nodes (to see if the cancer had metastasized).

4. Rectum and colon: I was proud of myself because I grossed this monstous thing in in like 1 and a half hours, just in time to load the fixation machines. Big tumor, turned firm and ulcerated from radiation. The thing with colon/rectal cancers is that you have to look for nodes. You have to cut off the fat that surrounds the bowel (which everyone has, nomatter how skinny you are) and meticulously sift through it, cutting it strip by strip and mashing it, feeling with your fingers for small, firm nodules that might be lymph nodes. This is usually a daunting task, especially in someone who has been radiated, but unfortunately for this patient, the nodes were big and white, filled with tumor. Cutting into a node like that is like looking into a crystal ball. The cancer has already spread. Not much time left.

6:30 pm, sigh of relief. 8 hours of standing, slighly hunched over a cutting bench that is too short for me. I felt good, though, working hard and getting a lot done. Two months ago I wouldn't have been able to do it. Writing it down now, what stands out to me is the detachment I have from the human side of all this. I see these specimens as tasks, as things that must be processed a certain way and then examined microscopically, looking matter of factly for things like "postive lymph nodes," "extent of invasion," and "tumor present at surgical margin." Yes or no. Positive or negative. Its hard to remember that that organ sitting on my cutting board comes from a person, who is waking up disfigured and in pain, facing a life-time of going numner 2 through a hole in their abdomen, with a deep seated, gut-wrenching worry about what our final diagnosis is.

But it all turned out ok yesterday. Because after all of that I met Mike at Cha Cha Cha for burritos.