Tuesday, April 4, 2017

Alternative Facts

You know your day is going to be long when it starts the day before. I got a call from my chief carpooling my son home from after school activities.

"It's 6:30, I'm still here, this call already sucks. (Don't know if you remember, but the pathologist's motto is When the Clock Strikes Four - We Hit the Door). I need to tell you there's an autopsy tomorrow. It was ordered Saturday, but there was a problem with the EMR. We just found out about it at 4:30, you were already gone. I'm up, but since you are covering me tomorrow you will have to do it."

OK, I'm thinking, his call sucks and I have an autopsy tomorrow that was already ordered and supposed to be his? While I'm covering call duties and OR? "Have you called the physician? Maybe I can get rid of it."

"No I haven't. I think she died two hours after she got discharged. It's been chaos."

"An autopsy isn't an order, it's a consult. I'll call the physician in the morning, don't worry about it. Take care of your wife." She was having a minor medical procedure, and I was covering him so he could support her.

I called the cardiologist first thing in a.m. Explained our policy. "We do this pro bono for physician inquiries. We refer families to private autopsies. Do you have a question?"

"She's pretty young, I just want to know if there's a PE (pulmonary embolus)."

"OK, I can do that for you. No problem. This is just a big bomb into my already full day. Can we limit it to lungs and heart only?" I'd heard she was pretty big. I didn't feel like mucking around in guts all afternoon.

"Absolutely. Chest only."

I entered the gross room about 9 am to set it up with the deaner. He's the head of the gross room. Got a new motorcycle recently to match his long silver ponytail. An ex criminal defense lawyer. He's got two speeds - gruff and silent vs. entertaining and loquacious. This morning it was the latter. I perused the death note. "It says here she died in the hospital. I was told she died at home. Where the heck are we, Washington D.C.?"

"Propaganda. Smokescreen. Rumors. Alternative Facts."

"Yes! Alternative autopsy facts. We don't need that around here. Let's set it up for 12:45. That will give me time to eat lunch after covering morning frozens."

Thirty minutes later I get a call from a secretary. "They are ready for you in bronch lab."

"Um, I'm not covering EV this week. Where the heck is Palmer."

"He's at jury duty. If he doesn't get picked, he will be here around noon."

After covering bronch lab I send a text to chief. "WTF??"

"My fault, he told me but I didn't tell you. Autopsy chaos." My angst leaked over to my head transcriptionist. "Did you just cuss?" "Yes, I'm sorry, I'll try not too."  "No, I thought it was really cute. I've never heard you cuss." "Ok, I'll do it more often."

So I'm covering OR, bronch, and scheduling an autopsy. Unprecedented, in ten years. It was a helluva busy morning. I went to PMG pathology for support. Got lots. Someone made me a meme. God I love PMG pathology.



I called the morgue at 1:00. "Can you please call me when you are ready to open? I'm trying to get through my surgicals."

Head down the morgue about 1:30. Get lost (it's been almost a year and it's confusing down there). Get guided. I enter the morgue and there are 10 people, mostly young women, gloved and gowned and masked around the dead body and my deaner, who is clearly enjoying the audience. "I'm sorry, we used up all the gowns. There aren't any left."

"No worries, I'll just steer clear of the juicy parts. I will glove up though. I plan to stick around for the eval of the PE, then I'm headed back upstairs to work."

"These are all nursing students. Happened to bump into them and they helped me load the body on the table. It was hard."

"I know a tech at the VA who is still drawing a check from disability after dislocating her shoulder moving a 600 lb. man onto the table. This one's only half that size. Glad you could get help. I get the gowns, but why are they all masked? This scene looks crazy."

Nursing sup spoke up. "I'm their supervisor. I mandated it."

"No argument there. Students need the most protection."

The deaner started the Y-shaped incision, fueled by the nursing students surrounding him and asking questions in awe. I laughed internally at two of them earnestly holding the massive breasts that were now covering her face. As if it was helping. As if they were needed. Well, damn, we all need to feel needed. I told a few crime lab stories to add to the entertainment.

One girl couldn't handle it. "I see deer all the time, but this is too much. I'm going to go sit in the other room."

Others were manic. "Never seen deer here, but this is so cool!"

The deaner preened. "No no, she's the MD. I'm just a JD. Now look at how I can find the right junction between the cartilage and the ribs to use the scalpel. Oops, no, this is too hard."

I asked him, looking at my watch, "Can you just get the bone saw?"

"Oh, sorry, I know you have a 3:00 appointment."

"I'm just going to stick around for the evaluation for the PE. Then I'll leave you to your teaching exercise."

Finally the sternum and the ribs were excised. The heart, when pulled from the chest, seemed abnormally large. Unusual - large people have normal sized organs. There was no PE, deaner confirmed, after first accidentally searching for one in the aorta. I met his eye. "I was thinking that wall looked too thick to be a pulmonary artery. Let's fix the organs and finish at the end of the week. Thanks for your help."

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