The Fine Line

I'm not sure why it is that whenever I am off for a few days, I think of my GI office - the one where Michelle and I currently are the only pathologists who hold privileges to sign out. Two of the other pathologists have pending privileges, and if I knew how I would sabotage the bureaucratic paperwork because a) it is really fun to drive around and go off site even though keeping up with caseloads at two different locations - GI office and main hospital - can be hairy at times b) I do not have to cover an OR or cytology or apheresis procedures so I can occasionally go out to lunch or run an errand and c) the staff are cool and different.

Take the head honcho - "GI doc." I was telling my friend from work the amazing stories about the young women who dressed up in leather minis and wore garter belts just to try to hit on him during a procedure, and how the wild and red-headed nurse would send them home to change. I told her the story with shock and amazement. She looked at me strangely. "Duh, Giz. He is hot as shit." I looked at her, surprised. "Really? I never noticed. I'll have to study him a little more carefully."

He is sort of an African-American equivalent of Matthew McConaghey (sp? too lazy to check). He is so nice and down to Earth and family-oriented - I never considered his appearance. Our first interaction consisted of him apologizing profusely for some commotion that had occurred next door in the procedure room that I hadn't heard. I guess I was so intent on what was going on in the scope that I didn't notice the screams from the patient undergoing a colonoscope. "They usually don't go on like that. Our sedation is more than adequate. I hope it didn't disturb you." No worries there.

My GI office is about four times larger than the one I inhabit at the main hospital. It also has a (squee!) window, which proved to be exciting in May but a little frustrating in July and August when the temperatures hovered above 100 - the office is not well ventilated. Keeping the blinds closed and running a fan were enough for me to maintain ambient temperature - luckily I am cold-natured and was happy not to have to run a space heater all day.

In addition to a large table that houses the scope, which is a Nikon - a nice change from my Olympus - the optics are mildly superior - there is another table with a computer monitor and a bunch of puzzling technical equipment. One day GI doc came in and sat down at the table and turned on the monitor. He was working quietly, and I became curious.

"What are you looking at?"

"I hope I am not disturbing you (love the Southern hospitality theme going here). I'm just reviewing the gross findings in a patient's small intestine. This is from a pill endoscopy."

I scooted closer in my chair. "Oh wow! That is incredible. I've read about it - a patient swallows a pill that functions as a camera, right? So you can see places where the scope won't take you."

"Exactly. Look here - these erythematous patches are a little worrisome. And I can find masses that might need to be sampled. I am puzzled by this patient's symptoms and I am trying to find out if there's something I'm missing."

He was trained elsewhere, and accordingly he samples an area of the duodenum routinely - the bulb - that I am not generally familiar with. Michelle and I joked one day about the duodenal bulb.

"The lamina propria is so jazzy! Don't you just want to call it active duodenitis, until you have looked at 30 of them and realize that is the norm for the bulb?"

Michelle agreed. Strange to have to go back and hit Sternberg after you have been in practice for a couple of years to avoid overcalling active duodenitis.

The last time I was there, a couple of weeks ago, I was fighting sleepiness in the warm sign-out room. Suddenly I heard moans. Lots of moans. Tough to ignore, now that the new place was old hat. All of a sudden I wasn't in the GI office, I was in a motel listening to nocturnal activity through paper thin walls. And I smiled, because I realized what a fine line there is between agony and ecstasy. If you can't see what is going on, it's hard to tell which one it is.