Dear scalpel, please do not slip

I have left the suprisingly slow world of autopsy for the more glamorous, fast paced whirlwind that is surgical pathology. The hosptital autopsy service saw last month a grand total of only 4 cases, a considerable drop from the 20 or so that I have seen on previous rotations. Not that people aren't dying. I guess they are not dying mysteriously. Which is good, I guess.

Unfortunately, all of the 4 autopsies that I did last month were on children under the age of 5. Cutting open a baby is, needless to say, a very intense experience tinged with sadness and awe and a profound sense of the extreme harshness of the world. It is easy to get quite cavalier about performing autopsies on adults, especially after you have witnessed many. But a baby. They are so unbelievably adorable, even in death. Their big old heads, their wide eyes, their little baby fingers. And the knowledge that a parent is somewhere nearby, completely devastated, struck down by the impossibile horribleness of what has just happened to their child.

We do our fair share of autopsies on fetuses, who have died in utetero for a variety of reasons. But this is never as bad. Its the ones from like 5 months old and up that are the worst.

Mike and I would joke about it, with that laughing-about-death humor that is usually always funny, in spite of, or perhaps because of, the intensity of the subject. "Did you cut up any dead babies today, honey?" he would ask me. "Sure did, sweety!" That reminds me of one of the only three jokes that I know. You guys remember Dead Baby Jokes? I think it must have been a national phenomenon in the early 90's. Here goes: What's the difference between a truck full of bowling balls and a truck full of dead babies? You can unload one with a pitchfork.

Oh boy. I am so going to hell.

But I have left that world for good (last autopsy rotation ever) and am now doing my last Surg Path rotation. Surgical pathology, home of biopsies, tumor resections, and surgical consults. Good bye, dead children ... hello hepatitis C.

The other day, at about 2 in the afternoon, I found myself in the position of dissecting a chunk of fresh liver that was infected with both hepatitis B and hepatitis C. Both are intense blood and fluid-borne pathogens, and Hep B is one of the worst contagious viruses that a person could accquire, as it is likely to cause severe, progressive liver damage and comes with a high risk of developing liver cancer (hepatocellular carcinoma). I have been vaccinated against the B, but the C would still suck, as it is no stroll in the park either. Anyhow, so I am double-gloved and arm-guarded and aproned and cutting on this piece of liver with a very sharp scalpel, attempting to shave off small slices so I can freeze them for fast sectioning. The surgeons are waiting in the OR for the results. And this is something that is very hard to do without holding and balancing the liver with my fingers - the forceps are just not giving me the maneuverability that I need. And all the while I'm thinking ... I have not cut myself all year ... please do not let this be the time...

... steady, steady kind scalpel.