Wednesday, June 15, 2016

Awful-topsy

Autopsies aren't so awful when you only do them once every couple of years. A lot better than getting slammed with five in one day on autopsy rotation in residency.

I was surprised on Monday - I was up, my turn, and even though it blew a hole in my already busy double workload on call I wished I had dressed even more carefully for the occasion. The morgue, the smells, the ritual, the discovery - it reminded me of returning to a Catholic mass.

When you are in residency, autopsy is largely an academic endeavor. We don't need it - radiology and ever advancing labs render the ritual archaic. But every once in a while, as in this case, the clinician needs an answer. This makes the exercise more meaningful. To be surprised by the interior of the body, to discover things no one else could find, to aid in closure for the family and the clinician, lends light and art back to a profession being squashed by insurance companies, administrators, and pharmaceutical corporations.

I've had three twelve hour days in a row and tomorrow, after morning tumor board, I will have the highest case load in my ten years of practice. To be stretched is exhausting and rewarding. Tonight I got to take my kids out to dinner - Cecelia and I shopped afterwards while Jack and S played video games at the movie theater. Stepmom dropped the kids off at work around 4:30 while I was in the middle of a complicated brain frozen - they hung out in my office and waited for me.

I sent them to Boulevard with my debit card to charm my friend Mercy who works there so I could finish the work that was leftover. When they got back I asked if anyone wanted to go with me to the gross room and radiology - my end of the day sweep on call to make sure it was ok to go home.

C: "No mom. Gross. It's the gross room."

J: "I want to go! I want to see a brain."

He held my hand and as we walked down the hallway. I tried to protect the PA on call from Jack's desires - she has a one-year-old waiting at home, but she was all caught up and happy to retrieve a brain from a bucket. She laid it out on the gross station. I put gloves on and took over.

"This is the cortex. This is where a lot of our conscious thought arises from, as well as our feelings. Here is the brainstem. It is responsible for making sure we take breaths, so if it is damaged it might end a life. Here is the cerebellum. Balance. Gait."

I'm not sure if he was paying much attention. He was finding his own set of gloves. He had a mission.

"I want to touch it Mom. But I'm scared."

I massaged it with my hands. "Don't be scared, Jack. It's here for us to learn. There's no person here. Just a brain. Our bodies are vessels for our souls, and there is no soul left here, it's moved on."

He held out his finger and placed it on a gyrus on the left cerebral surface. There was a prominent vessel running through the adjacent sulcus. I watched him experience the moment, and retract with pride.










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