Tuesday, December 23, 2008

Christmas Presents

Wrapping Christmas presents reminds me, quite frankly, of running the bowel during an autopsy. Catch a good pair of scissors at the right angle, and you can fly. If you did a good liver block, your duodenum is mostly gone, but you still have miles and miles of jejunum, ileum, ascending, transverse, and descending colon. Lastly, the rectum.

Running the bowel is a much stinkier endeavor than wrapping Christmas presents. The entire structure is a tube. The small intestines consist of many feet of coiled grey-brown double thumb-thickness pipes, like a bag of worms. The outside, called the serosa, is smooth. Running along one edge of the bowel is the mesentery, which is like a linear mass of fatty scrambled eggs, housing lymph nodes and blood vessels in a protective cushion. We run the bowel on the anti-mesenteric side. When you get to the larger colon, there is a guide. The tenia coli is the muscle that stripes the anti-mesenteric side. It puckers the colon with its narrow, 0.5 cm existence.

Opening the bowel creates foul smells that permeate the autopsy room, your scrubs, and your nostrils for days. If you are lucky, a good autopsy assistant, also known as a diener, will run the bowel for you, in the large toilet-like structure that exists along the wall of a well-equipped autopsy suite. If you are a resident at the VA, or out of favor with the diener, you are generally on your own.

It is extremely bad form to nick the bowel during the autopsy, before you are ready to dissect that area of the body. Intestinal contents, which are better saved for quick evacuation down the toilet, will spill out into the body cavity amidst the blood and organs, making it both tough to see and breathe while you continue your work. An autopsy party foul. Sometimes unavoidable, in a body with numerous past surgeries. This creates multiple adhesions that bind and tear at the bowel during dissection, like dense sticky spider webs obscuring vision and masking landmarks. Don't ever say adhesed (i.e. "The intestines were adhesed to the liver.") Dr. Styles will have your head at autopsy conference. Instead say "The intestines were adherent to the liver." Adhesed is not a word, and she is a red-pen wielding, very grammatically correct disciplinarian princess. I mean that in the best possible way, as she is a good friend of mine.

My daughter saved me tonight. She is only five, but when I was stressing about wrapping presents over dinner, and worried about being up until the wee hours of the morning, knowing that I not only have to work tomorrow but am also hosting an extended family Christmas Eve of approximately thirty, she said: "Mom. Get the presents up here already. I learned how to wrap with Babcia (Polish for grandmother, my mom) today. I would LOVE to help. Please hurry."

So we had a very Montessori wrapping experience. Jack was pulling too-large pieces of tape, creating multiple wrapping paper adhesions, but learning how to tear and shorten the tape to prevent waste with my gentle correction. Cecelia was happily wrapping various candles and kitchen soaps with the confidence of a much older child. I was curbing my natural tendency to perfect her attempts in order to build character (both hers and mine).
So now I have time to write in my blog. And to make a CD for a friend in the gross room. And to think about the meaning of Christmas. Which is more about what we did together, tonight, than all of the presents they will receive from relatives in the next couple of days.

A couple of Friday nights ago, I took Cecelia to the store to pick out some tins for an ultimately failed candy-making experiment for her teachers for Christmas. I plan to try again when I am off next week. And I will not to use peanut butter this time (this ingredient was not the only problem with the candy), which I forgot was banned from the school, due to allergies. We stopped at the hospital to get the recipe I had left in my office. We wandered around the halls, and bumped into a thoracic surgeon that I work with. He winked at me then bent down and asked Cecelia,

"So who are you most looking forward to coming to see you on Christmas day?"

She paused, looked mildly confused, then looked up at him with a big smile and answered with shy confidence.

"All of my family."

He glanced up at me, surprised, then back down at her, answering her smile.

"That's really great kid."

From the mouths of babes. Merry Christmas.

1 comment:

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