Fecalith

I walked into the gross room this morning and was greeted by Bob, whose look of surprise ("I haven't seen you around here in a while, doc!") melted into a broad smile. He gave me a quick rundown of today's cases.

"You've got a couple of big ones, doc! Guess what? There was an 8 centimeter fecalith!"

I looked up at him, not sure if I was hearing right. His navy scrubs hung loosely over his large frame, and silver hair ringed the lower half of his cranium. "What?"

"Yeah, doc! I've never seen one that big in my career. Can you imagine? It filled the whole cecum. There was a great big abscess - they had to take a big chunk of the colon to get around it."

A stone of shit. Well, that is a fitting case to start off the day. That pretty much defines the latter half of my week - having my phone stolen, owing a boatload of money to the IRS, missing my kids (they are back tomorrow!) and trying to sort out the most economical next move to make, phone-wise. House is not even being viewed, anymore. I'm getting lazy about forgetting to run around and turn all the lights on (it's expensive, and it's not working). But what the hell do I have to complain about? At least I don't have an 8 centimeter stone of shit lodged in my colon. Thank god I don't have to look at it under the microscope - we grossly identify these things and move on. I'll check a few colon slides to identify margins and confirm the abscess. But we do not section fecaliths.

"And your other big case is a 7 centimeter breast cancer. It's a day for big stuff! Can you believe a breast cancer got that big? I guess she must have been in a nursing home or something."

Or she was so well-endowed, I thought to myself, that it was hidden well. Then I wondered if that was really possible, and decided no. Surely not. Bob's explanation was more likely - nursing home, maybe with a touch of Alzheimer's. I would hope, however, that in a care facility someone would have noticed the nipple retraction and peau d'orange (orange peel skin) that was surely grossly noted by Bob the day before (it was, I checked his description) - I could see evidence all over the slides of nipple involvement and even foci of pagetoid spread in the skin. Sometimes it's better not to know how these things happen.

Like the time I was training and I got half a face to gross in. Actually it was a little bit over half of a face - have you ever taken sections for margin evaluation on half a face? It is hell. The removed portion of the face (jaw, mouth, cheek, nose) was being eaten away by a common slow-growing skin tumor. I was shocked to learn the face belonged to someone who was not only married, they also had a job working at a meat-packing plant. I would have thought someone around him would have tied him up, stuffed him in the back seat of a car, and taken him to a doctor. It must have taken years for it to get so bad, and could have been nipped in the bud, when it began, with only a tiny skin scar for evidence.

Oh! I just got more cases. Time to get back to work. Hope your day is as full of big stuff as mine is. Watch out for stones of shit. Mine just hit.