Friday, December 12, 2008

Stomach Contents

Monday morning, I was fighting the tendency to drift into daydreams more than usual. I had been up most of the night with my son Jack, who was suffering from a cold. Cecelia's colds stay in her head, but Jack's tend to quickly claim his lungs and leave him fighting for air. He inevitably spends the first or second night tossing and turning fitfully, requiring scheduled puffs off of his inhaler to keep him from working too hard to breathe. When I finally got him settled for the fourth time, at 4:30 a.m., I realized that sleep for me was now a futile effort. So I got up and ran.

Thank goodness I ran. At about 10:00 a.m., the supervisor of microbiology popped his head in my door.

"The big Christmas party is today. Would you rather judge the chili competition or the dessert competition?"

I had forgotten it was the day of the lab-wide Christmas party. The hospital I work for is large, licensed to house 739 beds. Currently the numbers of patients run in the 500s. This hospital is also a large employer (around 8,000). It takes a pretty big clinical laboratory staff to support the hospital. Each year there is a three hour festival in a large auditorium with poems, singing, door prizes, and a potluck. The pathologists generally judge the food competitions. Last year, I was not asked, and I remember feeling both relieved and miffed. So I was kind of excited to be asked. The decision was a no-brainer. I choose savory and spicy over sweets, any day.

"The chili competition."

"Are you sure you are up for that? You know that some of the chili has deer meat."

"We cook deer chili in my house. No problem. How many are there?"

"Ten crock pots of chili and six soups. Dr. Hayes is judging as well. There will be a winner in each category. You both had better start around eleven, so the food doesn't disappear before you start to judge it."

Now I had incentive to get moving on my cases. At 11:00, I walked into the auditorium. One long wall was lined with tables filled with crock pots of chili and soup, each with large orange numbered signs in front. Jim and I were given scorecards and plates. I got a bowl of fritos, and he got a plate of saltines, to clean our palate after each sampling. Then we began to taste.

There were good ones and bad ones. I was trying to shield my scorecard from Jim's, so I wouldn't be tempted to cheat or be biased. When we both got to number four, we looked up.

I said, "Well, it loses a point for claiming to be hot. Otherwise, this is one of the best I've ever tasted."

Jim agreed. "We are definitely on the same page."

After that, it became frustrating. There were many more mediocre ones, and I really wanted to stop tasting and wasting space in my stomach. I wanted to get a big bowl of number four and enjoy it. But I had agreed to the job, so I kept going. When I got to number ten, I was once again interested. It claimed to be heart-healthy and meat-free, which is automatically a big warning sign, but revealed itself as a delightfully hearty cumin-laced black bean and sweet potato concoction with green chilis. I don't even like sweet potatoes, but it was amazing. Dr. Hayes did not share my enthusiasm over number ten. So number four was the winner.

It was tough going from chili to soup. We needed a lot of saltines to clear the spices, in order to give the mostly veggie and meat stews a fair shake. I was starting to get really full. But we persevered, and declared a winner in that category, as well. After all that spice, I needed something sweet. The dessert table was twice as long as the chili/soup table, and by the time I was done judging the chili, there were some clear dessert favorites, all of which I felt driven to sample. The winner was a pumpkin cheesecake. My favorite was a homemade candy with a mixture of peanut butter, powdered sugar, butter, and rice krispies in the center, drenched in chocolate. I got the recipe.

As I walked out of the auditorium back to my office (no need to stick around for the winning announcement - didn't want to get booed) I couldn't help thinking. I sure hope that I don't choke, or become the victim of a sudden random crime. I would hate for someone to have to open this stomach during my autopsy.

Stomach contents were one of the funniest parts of an autopsy, when I first started performing them. The stomach is shaped like an old-fashioned leather water bottle, with an oblong angled neck, a large body, and a tapered end like a spout that empties into the duodenum. We cut into it along the greater curvature (larger part of the body) and lay it flat, to examine the folds, or rugae, which resemble the ridges of a desert. We look for lesions, ulcers, and other abnormalities, after we empty the stomach. Many times, there isn't much in the stomach, since average gastric emptying time is about two hours. But there is nothing like opening a stomach and seeing carrots, meat, peas, and corn, to remind you that you are wading around in blood and muck that was recently a person, eating a meal. Sort of a nice distraction for an anxious beginner who is worried more about cutting something that will generate mass ridicule at Autopsy Conference than finding out the reason that the body ended up on the table in the first place.

One of the strangest specimens I ever encountered in the gross room was from the stomach. I didn't know that at the time, I just opened a plastic bucket and dumped out an irregular grey-black softball-sized mass on my cutting board that was firm and surprisingly focally hairy. It did not look native to a human body interior. I looked at the surgical requisition sheet to see what the surgeon's assistant had written under the specimen name. Bezoar.

I had no idea what a bezoar was. I had to look it up. A bezoar is a mass of food or other materials that collect in the stomach. There are many different types of bezoars. They can be made from food, pills, or hair. A hairball is called a trichobezoar. Bezoars can amass in many different mammals, but in humans they are rarely significant enough to reqire surgical removal. If I remember correctly, the patient was a client at a home for mentally challenged adults.

I got a call from my pathologist friend in Iowa yesterday morning when she was on her way to work. She is covering a small town about an hour away from her house this week, so she gets the dialies. I asked her what came to mind when I said strange stomach contents. She replied, "I got a toothbrush recently. As a surgical specimen. It was boring a hole through her stomach. She was a psychiatric patient, I think."

Two hours after the chili competition, I was not only fighting daydreaming, but also sleep. If I thought a night of staying up with my son was making for a tough Monday, I just exacerbated that feeling a thousandfold by volunteering to judge a large chili competition. But that two hours allowed my stomach to empty. Now I could be the victim of a random crime spree, and not disgust the forensic pathologist, too much. At least by my stomach. I pity the poor autopsy assistant that would have to run my bowels.

Things that speed gastric emptying: moderate exercise, Valium, well-masticated food

Things that slow gastric emptying: narcotics, >80 proof alcohol, large food particles, extreme hot or cold weather, emotional stress, old age, obesity

April 27 - National Hairball Awareness Day

Spitz and Fisher's Medicolegal Investigation of Death


Unknown said...

Capsaicin also speeds up gastric emptying, which makes sense. Interestingly, it actually raises esophageal transit time (all other things considered equal), due to reasons I'm not quite clear on.

Gizabeth Shyder said...

So does that mean we should add it to the duck gumbo at X-mas so we can eat more?? Looking forward to seeing you!
Love, Liz

Unknown said...

Heh, actually, it also has been implicated in creating feelings of satiety. The effect exists both when ingested as a pill and as a fluid.

Amazing stuff, those trigeminal irritants.

Gizabeth Shyder said...

No wonder I like spicy food. It makes me feel full, and I don't eat so much. You are a font of food knowledge.
Don't forget to e-mail me your old CIA blog address so I can read it.
See you Sat.!!!