Wednesday, October 26, 2011


The other morning I was looking at a prostate. I love getting prostates - it is a huge chunk of work that normally sails by. Not the biopsies, they can be excruciating - it is easy to miss a small tumor gland so perseverating inevitably sneaks up on you, whiling away the time. But whole prostates are nice. Certainly you have to note the important things - apical margin, base margin, peripheral margins, extracapsular extension, seminal vesicle involvement - but overall it is generally pretty easy.

Floaters require a little explanation. I always thought it was funny that floaters on glass slides carry the same name as the slang term for dead bodies found in the water. I don't see floaters very often in my practice - our histotechs are very good. After the techs cut the thin slice of tissue embedded in wax after overnight processing, they float the wax/tissue square in a cold water bath prior to placing it on the glass slide with forceps. The water is changed regularly and very clean, but occasionally a stray piece of tissue from another case will find its way onto your slide. Most of the time it is so obvious that we just circle the stray tissue on the slide (thyroid in an endometrial biopsy??!!??) and write "floater." If it becomes a diagnostic dilemma (does this cancer really belong here!!??) it is easy to check the wax block and do a recut if necessary - the floater will not be there the second time around.

Floaters can be so anomalous to what you are doing at the time, and such a surprise, that your brain is sent into a gentle tailspin until you wrap your head around it and realize what you are seeing. I was looking at the prostate, following my little mundane protocol, and I picked up the urethral (penile) margin. No cancer, but what was that fuzzy pink stuff off to the side? Was that brain? Just as I realized it must be a floater I grinned from ear to ear. I ran into my partner Michelle's office.

"This is the best floater in the history of floaters. This is a penile urethral margin in a radical prostatectomy."

She threw it up on the stage, and started laughing so hard she almost fell off of her chair. I joined her, and when we finally caught our breath, I said, "Maybe I should send it around? Show everyone?" She looked alarmed. "Not the guys." I said, "OK, just the girls, then."

A few minutes later she came in my office. "Maybe most of the guys. Not all of them." We were both thinking about a senior member of our group. He can definitely take a joke, but he has an air of decorum about him that rebuffs tasteless humor. I said, "Let's try it out on Rex." She agreed, and we wandered to his office next door with the slide. I gave him the intro, and he was quiet for too long, while Michelle and I were unsuccessfully suppressing giggles, like junior high school girls. I looked at her, "Maybe he doesn't get it."

Rex said under his breath, peering down into the microscope, "Yes, I get it."

I said, "Oh," as he handed back the slide. Gave a sideways glance at Michelle. "Well, he was our test guy. It didn't go over too well. You were right, maybe we should just show it to the girls."

Later in the day, Rex came into my office to render his opinion on a breast case I had consulted him about. "I'm not sure why you want my opinion since you called me a dick brain earlier." I smiled. "Not you, Rex! It is a joke about the male species in general." He wasn't supposed to take it personally. Just enjoy the wonderful pathology spin on the age old joke. I have enjoyed the license to call him a dick brain, the last couple of days, and I think he has mellowed since the original presentation. I can't wait until my parter-in-crime, Dr. Woods, returns from vacation. To see his response.


The Red Humor said...

I love blog posts that start "The other day I was looking at a prostate". You are my people. Well, perhaps a very close cousin of my people. Pathologists do tend to have wicked senses of humor.

Gizabeth Shyder said...

I remember you and your munch! Wicked, or wickedly nerdy. The subject matter is definitely inspirational.

Kyla said...

Haha! Poor Rex.