Most likely to eat you when you're dead
by fiona
A few weeks ago a few of the pathology residents and I were chatting in the residents room, and the conversation turned, as it usually does, to the topic of pets that eat you when you die. One of the residents is particularly interested in forensics, and has done a lot of work at the medical examiner's office, and this is what she has to say on the subject:
What is the dog that is most likely to eat you when you die?
The dachshund.
The weiner dog.
Yes, that tiny, elongated, vaguely comical dog will eat out your eyes if you die. "They are burrowing dogs," Tracy the future medical examiner said, "Don't ever die naked around a dachshund." They will eat into your soft bits and dig themselves into your body. Medical fact. She has seen it.
A golden retriever, on the other hand- those guys are often found starved to death, lying next to their fallen companions. Such noble, loyal friends. Not the shifty-eyed little weiner dog. They are found plump and healthy at the scene of the crime, blood dripping from their viscious little mouths.
But then again, if you were a dog and your owner died and your were trapped inside a cold apartment - wouldn't you?
Posted on December 30, 2004 | Comments (12)
Mike got me an iPod!
by fiona
MIKE GOT ME AN IPOD!!!!!
Posted on December 26, 2004 | Comments (0)
I made Mike a pink and brown scarf
by fiona
Posted on December 26, 2004 | Comments (1)
Have yourself a scary little christmas
by fiona
Every year my siblings and I (or whatever combination of us are together) get an official Christmas photo taken in front of the tree. This year my sister Joanne came down to portland, and we opted a less traditional holiday pitcure: the Garlich sisters wearing weirdly unsettling masks and posing with a large greyhound wearing antlers and a "Santa's Helper" t-shirt in front of a 3-foot pink tinsel tree. An instant classic!
Posted on December 26, 2004 | Comments (8)
Sink cat
by fiona
The Admiral's new favorite spot.
Posted on December 11, 2004 | Comments (4)
Burritos
by fiona
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.
Posted on December 10, 2004 | Comments (9)
A little well-regulated holiday spirit
by fiona
I just got an email from the department of Environmental Health and Safety at OHSU. They are the folks who usually deal with toxic spills, and chemical exposures, and other unfortunate events that might pose a danger to patients, health workers, and medical staff. Apparently one of the things that falls under their jurisdiction is also how to prevent unsafe situations. They are trying to deal with biggest threat to OHSU right now, which is, apparently, the risk that a carelessly placed holiday decoration may burst into flames and burn many people to death.
The email is entitled "Use of Holiday Decorations."
In their words, "This message includes guidelines for the use of decorations in OHSU facilities during the holiday season by individuals or offices." What follows is a bulleted list of guidelines and regulations regarding the purchasing, placement, and composition of holiday decorations. Here are some examples:
-- No university funds are to be used for trees or decorations.
-- Only UL-listed, miniature lights may be used on green trees. Regular 7.5-watt tree lights are not permitted on decorations of any kind in university facilities. Artificial trees with exposed metal surfaces should not have lights on them, but may be illuminated by separate spotlights. Because most fires are electrical, only grounded, heavy duty, 14-gauge or more, UL-approved extension cords shall be used
-- Departments must designate individuals who are responsible for ensuring trees remain in water. Those individuals also must have authority to remove the trees when they become dry and needles begin to drop.
-- Trees must not impede doorways, corridors, stairways or other means of egress.
-- All trees and holiday decorations must be removed from OHSU facilities by 5 p.m., Dec. 27, 2004.
And my personal favorite:
-- No more than 20 percent of a wall surface and 10 percent of a door surface shall be covered with combustible decorations.
Isn't that amazing? I'm not saying that these rules are ridiculous - they make a lot of sense. I'm sure hundreds of people die every year from prevantable christmas decoration-related mishaps. Seriously. But a list like this is inherently funny because someone had to come up with it. Someone, most likely some sort of environmental engineer, had to figure out the exact percentage of door coverage by combustible decorations that crossed the line from Harmless Holiday Fun! to A Deadly Inferno Waiting to Happen. Who is that guy? And why 10%? Is 20% just asking for it? "Folks, you may see a cute rudolph cut-out with moveable legs, but I see a monstrous death trap that is just begging to burn your skin off."
Thank god for that guy.
Posted on December 8, 2004 | Comments (3)
It went ok
by fiona
It actually did. It went fine. I did get to speak spanish, and I didn't mess up too bad. And I correctly diagnosed all of my cases (1 acute sinusitis, 1 viral bronchitis, 1 muscle tear, and 2 infected ingrown toenails). I didn't do the best job of presenting the cases to the attending, which is something that i have always been bad at, and apparently will never get better at.
"Presenting" to the "attending" is when you explain a patient to the doctor in charge, and present all of the relevant information to them in a concise, organized, and interesting way. Like, "So, Ms. Rodriguez is a 54 year old woman with a 3 week history of a dry, hacking cough. Blah blah blah." It seems so simple, and when you watch anyone who is good at it, you immediately see that there is no other way that you could possibly present that case. But I'm bad at it! I put things in weird orders. I don't do a good job of relating the chronology of an illness, and there are always important things that I forget. Like, does the woman with a dry hacking cough smoke? Hmmm. That is indeed a very relavent question. Let me go back and ask her. Which looks incredibly professional, let me tell you.
But I want to tell you about the patients I saw with the ingrown toenails. First of all Wallace Medical Concern is a non-profit volunteer clinic for low income folks without health insurance. It is located at the back of the lobby of the Estate Hotel, a seedy residential hotel in Old Town. And IT IS RUN BY ADRIAN ORANGE'S SISTER!! Jennifer. Born Jennifer Orange. Can you believe that? I just found that out last night.
Anyhow, the lobby of this seedy hotel is, on clinic nights, filled with people sitting on cheap folding chairs. A large proportion of the folks there are spanish speaking, and a large proportion of the people in the lobby are their children, who are invariably bored, antsy, hyperactive, and infectious. So I walk into a room to see a young mexican guy with an ingrown toenail. With him in the room are his mother, his aunt, two small children, one teenage boy, a pregnant woman, and her husband. All in this small exam room! 8 people! It turns out that the pregnant lady also had an ingrown toenail, so the family decided that she should come too, to be seen at the same time as the kid. Why not? It was fun, though. I got to say things like "has there been any leakage of pus?" in spanish.
Pus by the way, is spelled the same in spanish and is pronounced "poos."
I liked being there. I realized that I like seeing patients. I enjoy that interaction and the sense of being able to help someone out. It does make me very sad, though, that clinics like this are forced to scrape by on meager funding and donated supplies in a space that is completely inadequate. They are doing such amazing, important work. And yet the waiting room is always jam packed, the appointment slots fill up instantly, and they are always having to turn people away. I had to tell the poor family with the infected toes to call at exactly 8 am on monday to make an appointment to see the foot specialist next Thursday. There are only 4 slots every 2 weeks, so I hope they get in.
When will this country realize that health care is important?
Posted on December 3, 2004 | Comments (2)
Yo soy estudiante de medicina
by fiona
Tonight I am going to volunteer at a free clinic called Wallace Medical Concern in oldtown Portland. This is in a desperate attempt to maintain some semblance of clinical technique as I slip further and further away from my 2nd year knowledge. During 2nd year, I actually got to a point where I felt fairly comfortable talking to patients and doing basic exams. I am so far away from that place right now.
I am pretty nervous about tonight, because a) I haven't seen a real live patient in about 6 months, and b) my Spanish skills have dwindled to the point where I am embarassed to say that I was a spanish major in college. Honestly embarassed. Like any native spanish speaker will think I am playing some sort of weird joke on them by saying "I majored in Hispanic Studies" in stilted, incorrect Spanish, and then asking "How long you be having cough sick, Senor?"
This could be very akward.
Posted on December 2, 2004 | Comments (2)
Face-eating Tumor!
by fiona
I have recently learned about a horrible cancer that has sky-rocketed to the top of the Diseases Not To Get list. Midline granuloma is a tumor (actually its a kind of T cell lymphoma) that starts in your nose and rapidly grows to completely devour your face. If not caught immediately, midline granuloma is invariably fatal within months, as the tumor blocks off your airway and eats into your mouth, sinuses, and orbits (eye sockets).
There is a horrible picture in one of the pathology textbooks of a poor lady with this disease. Its actually kind of a before and after shot. The first shot is her with a blackened, disfigured stump of a nose in the middle of a normal face. The next shot is of her, many months later, where her face basically doesn't exist anymore. It had been entirely replaced by a giant mass, and it appears that she no longer has eyes or a mouth. She died soon thereafter.
The other day, while contemplating this horrible disease, I decided that if I got this diagnosis, I would probably kill myself. I do not say this lightly. I consider suicide to be an acceptable response to a rapidly-approaching inevitable death, but usually only in the case of extreme pain and suffering (and even then its not an easy choice). But with a disease as disfiguring as a lethal face-eating tumor, I think I might want to end it at the early stages, just to save my loved ones from having to see it progress to the end stages.
I would take a nice vacation, throw a big party, and then surround myself with my famiy and closest friends and take a lethal dose of a sedative. God, I don't know. Maybe I couldn't.
Anyway, midline granuloma - don't get it.
Diseases Not to Get:
- midline granuloma (#1)
- Naegleria fowleri meningoencephalitis
- aplastic anemia
- metastatic melanoma
Posted on December 2, 2004 | Comments (172)