Friday, April 30, 2010


These kid weekends are fun to plan, now that they only happen every other weekend. I started in the middle of the week. What to do? The new bug exhibit at the Museum of Discovery, or Aladdin at the Children's Theatre? My friend Carrie voted for Aladdin (that one was her idea), and got us tickets today.

She was also stoked about my Sunday morning plans to go to Toad Suck Daze in Conway, and decided to tag along. I've got fond college memories of Toad Suck Daze. Looking forward to going with kids. I imagine it will be a totally different experience. Hope the weather passes.

We had a respite last year, as far as tornadoes go. Tonight the sirens are screaming intermittently. Competing nicely with the thousands of frogs in my pond in the backyard. I finally got the kids settled down at ten after watching Sleeping Beauty with frequent storm path checks. Didn't want to spend a needless evening in the basement like we did a few weeks ago - although it was rather fun playing with the voices app on my iphone. Chipmunk! Exorcism! Dark Side! Cyborg! Fun House! Turtle! The kids shied away from the scary ones - after all, we were in the basement shielding from an impending weather disaster.

Tonight, even after the sirens died, they were scared of the thunder. I tried to explain - probably poorly - "It's when the hot air and the cold air collide - well, they don't like each other, and they start doing this crazy dance, and it makes a lot of noise." I reached for an explanation that would make them laugh off their fears. "When they are doing the crazy dance, their butts bump into each other. That's the noise of the thunder. The butt bump." They laughed uncontrollably, and I finally got them settled.

Fear. I coasted into Friday - got a lot of my cases done early - enough time to spend researching summer camps for Sicily and buy a birthday present in the gift shop for a Sunday afternoon party. I was aiming to get out by around 4:00 to pick up the kids and head out to pizza with mom and dad. I called the gross room to triage a fallopian tube more case - told my friend that rather than pass it on to someone Monday I would just have them hold it until I get back to work on Wed. Surely no one would miss a fallopian tube for a couple of days - I will be busy getting the house ready for market Tue.

My friend said, "Aren't you covering P.M. Frozens? We have a frozen. Come on over."

"What? I am covering frozens? I had no idea."

Normally, since I rarely cover main OR frozens (although I handled a bundle of them quite nicely covering for a partner who had to go to a funeral Wed. morning), I get a little anxious about doing it. Not because I can't, but because I am not used to it. I laughed thinking that the idea, a few months ago, of covering main OR frozens in the afternoon would keep me up late the night before and keep me away from the coffee machine all day. I would have frantically gotten the OR schedule and looked up every possible patient in the computer - learning as much as I could in preparation. Now my fears are off my radar.

"What is the frozen?"

"It's an ovary."

Ewww. I hate ovaries. They are hard. The tough thing about going to cover frozens when you aren't used to the personalities of the surgeons, is just knowing what they want. How far you have to go. How you can cover your ass and satisfy them at the same time.

"I'll be right there."

I got to the gross table, and the tech cutting it had sliced the at least 20 cm ovary (normal is 3-4 cm) in 1 cm bread loafs. She said, "It looks bad. Where do you want to take the sections for freezing?"

We hunted for areas of viable tumor - there was a lot of cheesy necrosis and hemorrhage. I pointed to two areas and said, "Why don't you freeze both of these. I'm going to go to the doctor's lounge and get a coffee. Be right back."

When I got back, she wasn't ready - having trouble freezing. I sat by the scope and called my mom. Then I called my favorite estrogen lifeboat - she covers frozens all the time.

"What does he want (the surgeon)? How far do I have to go? If I am not sure if it is borderline or malignant, do I have to make the call?"

She assured me that I needed only to hedge - it's good not to try to be a cowboy on ovary frozens, especially with surface epithelial tumors.

I got the first frozen - the ovary. Looked under the scope. Weird. I didn't know what it was. Decided it was probably malignant. Can I say that? Favor malignant? So wishy-washy. While I was looking at it, the tech brought another slide - one from the fallopian tube. I hoped it would give me a clue as to what I was looking at in the ovary. Instead, it sent my brain into a tailspin. Looked nothing like the ovary. But also maybe malignant. God, the surgeon was going to think I was an idiot. I called the OR on the intercom.

"The ovary is very poorly differentiated. I think it is malignant, but I have no idea what it is. The fallopian tube is probably malignant too, but it looks different."

The surgeon asked, "Is the ovary a primary or a metastasis?"

Huh. I hadn't thought about that, and admitted as much. "Honestly, I can't tell you on frozen, where this thing came from."

"Can you send them for genetic testing?"

"Of course."

I laughed with the tech when I got off the phone. "I gave him no real information, and he was satisfied! I think I could handle this!"

In the meantime, the call pathologist came in and I made him look at the slides, for his opinion. "I'm going to my office to release my cases. Please let me know what you think." This guy is AP only, and all this ovary frozen stuff is old hat to him, so I was hoping for some enlightenment.

A few minutes later, he popped his head in my office. "That is a really strange case. Looks like two different processes. That tumor in the ovary - it may not even be primary. Could be a met."

It feels so good to have your thoughts validated. Sweet satisfaction. I'm on the right track, even when I am on a the track of a road less taken.

Now that I'm feeling so happy and confident, it's time to royally screw something up.


Ginger said...

That was interesting. I had never considered the pathologist's side of things before.

Cheers, to a great weekend!

MomTFH said...

Wow, I thought hurricanes were scary. I don't know if I could handle tornado sirens.

Yeesh, I find pathology to be one of the most intimidating of the specialties. Your story made me feel nervous, and no one was even expecting me to figure out what was going on in those sections.

rlbates said...

Have fun at Toad Suck Daze!

Gizabeth Shyder said...

Great so far, thanks escape fantasy! Had some afternoon sun after Aladdin at the Arts Center to check out the baby ducks and geese at McArthur Park. The kids were enchanted!

Tornado sirens are scary - but the weather is so sophisticated these days it is easier than when I was a kid.

One of the most thrilling aspects of pathology is the "wet read." Frozens and touch preps in the OR and CT4. I think every specialty in medicine probably has its equivalent.

Really looking forward to Toad Suck Daze - thanks Ramona! Hope to get together soon.

Spud said...

It has never occurred to me how stressful it is to be a pathologist. Pathology in med school was all about deciphering (or rather taking a stab in the dark) slides; but you just put things into perspective! :)

Gizabeth Shyder said...

The most stressful moments are trying to decide if what you are seeing is macrophages on frozen, or signet ring cell carcinoma. Surgeons get really mad when you call a margin on an Ivor-Lewis negative (inflammation) and it is all cancer the next day on permanent. Happens (rarely) to the best of us. Some things are grey - not black and white. Grey areas exist in every arena of medicine.