Case of the Week (COW)

More like case of the century. I've never seen one.

I was headed into the gross room around 9 am. J, the gross room PA, said, "I need you to look at a specimen after you do the frozen."

Another brain, ugh. I had a two hour brain frozen the day before. Was praying this was an easy metastatic carcinoma but no. I had to call Dr. Bell again, for the second time in one week. Feed the megalomaniac. Luckily I like him, and his wisdom and experience more than make up for the humiliation of needing help.

"Ok, J, finally done. What do you have?"

"It's a didelphic, diduph, di-what? Help. It's a double uterus."

"What? I've never seen or heard of that."

"Me neither. Help more experienced gross room PA?"

"It's a didelphys uterus."

I walked over to the stainless steel table to look, and was amazed. Two uteri, divided by a septum.

"Why did they take it out?" A chronic condition, one that's not too serious, but if it festers it can become dangerous. I assessed the situation visually. Two cervices. Two uterine cavities. One much larger than the other.

"There's no way this can bear children, is there?"

"Well, I saw something like this on a Steve Harvey episode."

"Who is Steve Harvey?"

"Kind of like a Jerry Springer. Afternoon talk show. She was pregnant in her bifid uterus by two different fathers. One pregnancy was farther along than the other."

Well, I guess that's plausible. I suppose one could be 9 months along, the other 5. One could deliver before the other. Later on in my office, while I was studying my cases and stewing over this, my dad walked in. I eagerly shared the case.

"Yes, that can happen. Pretty rare. The danger is that if one is growing in the smaller uterus, it can be squashed. I've heard stories about Vietnam prostitutes (human trafficking victims! - some, anyway) being pregnant with twins. One uterus, but two different fathers. Happened in the same day."

You think you know it all, but you are constantly surprised. I was excited to get that case the next day. She had borne children. Wow. Both endometriums were in the same phase - proliferative. The surgeon who removed the uterus had a late case that night. I called him on his cell.

"This is really selfish, but my dad's birthday is in two days and I am taking him out for dinner tonight. Do you need me? Late? I'm happy to stay just let me know and I'll reschedule the dinner."

"No you go. Have a big time. Tell him happy birthday from me. I don't need to know anything tonight that will change what I do during surgery."

I was grateful, had just finished a lung frozen. Was exhausted from the day.

"Can I thank you by texting you a pic of the uterus from yesterday?"

"I'd love to see it."

Kind of looks like an octopus doesn't it?All the girls in PMG pathology are as amazed as I was. That's an ariel view of the fundus. I wish I would have thought to take it in panoramic mode. To the right and left are the individual uterine cavities, opened up.

Girl's Night Out

Girl 1: We need to plan a trip to Eureka before your wedding this fall. A bachelorette? There's a great lingerie shop up there. Not like Dillard's - a true sex shop with lots of other fun things to look at.

Girl 2: We went there together not too long ago - it was great. We shared a couple of bottles of wine over lunch, left the kids in the magic shop nearby. I was a little nervous, but she just plowed right in. I heard an oof from the dressing room and queried in alarm, but she said the shop girl was just tightening her corset. We ended up getting outfits that kind of matched.

Girl 3: Y'all were in a different kind of magic shop.

Girl 2: Oh, and I also tried the tightening cream.

Girl 1: I wasn't really into trying the tightening cream.

Girl 4: What? There is a tightening cream? I thought only surgery could do that!

Girl 2: Yes. It really works, it's amazing. You apply it by rubbing the cream on the inside, and by the time you are done with that part you are already halfway there ;)

Girl 4: So how does it come? Like in a toothpaste tube? I've never heard of it.

Girl 2: You find it in the corner of the store. It comes in a fuck's worth.

Girl 4: What did you say?

Girl 2: A fuck's worth.

Girl 4: That is the denomination? So I guess you want to buy more than one.

Girl 5: Does it work on the guy too?

Epiphany

I met her this morning. She is incredibly beautiful. In profile her face boasts eyes that crinkle in smile and recognition. I can tell when she is happy, she swishes away with a mermaid/dolphin tail and splashes me with water. Her fierceness is alarming; it looks like a phantom orange/red profile of an angry ghost trailing fire and smoke. Showing strength, her torso rises from the ocean, arms stretched to the heavens. Feeling maternal, she rises on angel's wings and invites me to emerge from the ocean and dance with her in the clouds, carrying me on her back. 

The Gordian Knot

On the last leg my summer vacation trip I was re-reading an old fave - Dress You Up in Corduroy and Denim, by David Sedaris (finally a perfect fit!). I'm a big fan, even though I still at 42 years old have to look up the spelling of Corduroy - twice argh. I saw him both times when he came to Little Rock to read some of his essays. Wasn't quite brave enough to stand in the autograph line, but I imagined what I would tell him if I was and it sounded really stupid. To me anyway.

So was that his first book? I can't remember I read them so quickly. I think it was definitely short-listed for some big award. And it was really good - read in the hotel bathroom so I wouldn't disturb anyone until the wee hours of the morning addictive, leaving myself only a couple of hours of sleep before I had to catch a plane. When I finished it on the plane today I got to a part that reminded me of others, and was a little frustrated.

See, I remember one thing about my past. I had a plan. Two plans. And they were MY plans. But somehow somebody else got to enjoy those plans (I guess? Is this really happening? What really happened?), but not me. That's not fair. Am I MPD? Am I so well versed in self-loathing that this was yet another protection mechanism to propel me to this day with my sanity intact? Or is this just those darned Gods again? (having completed a cycle of traditional Freudian psychoanalysis, he has moved on to shamanic journey work and studying the cycles of the moon. Whatever is happening to him, it feels like a Gordian Knot. I guess he's got to channel Alexander the Great. He's going to untie this damn thing, or slice through it with a sword. The latter might be more satisfying).

But I diverge. I'm taking a break now from DS to read a book I've been wanting to read, edited by an Arkansas author, Erin Wood: Scars / An Anthology. It brought tears to my eyes three times in the first 40 pages, and I've already hatched a plan to e-mail her and introduce myself. Anyone who can bring this amount of intelligence and emotion into paper form is someone I want to meet. And I've got lots left to read. That makes me happy.

Products of Conception

There is just so much to absorb when you are in a new country. All I can do is try to photograph to be able to process it slowly over time. I feel like every time I turn around I keep getting hit over the head with a new thing. "There can't be anything better or new" my mind screams, but I am proven wrong every time.

I'm reading this book (Part III) In Other Rooms/Other Wonders by Daniyal Mueenuddin. A National Book Award Finalist. Same thing. Hit over the head every time I turn a page. It's a trip.

I was in my very favorite Facebook group today, PMG pathology, and someone posted something that reminded me of the book. Products of conception (POC's) are a junk routine surgical. Usually they consist of only decidualized tissue and placental villi. Sometimes you have to put the whole bloody mess in to find the placental villi. It's important to document the truth: that it was a pregnancy, that someone was there even though it never came to fruition.  Rarely you see fetal parts under the scope. Sometimes immature brains, sometimes immature guts. Never limbs. At least I'd never seen it until today.

Yes, that's a human hand. A very small human, one that didn't quite make it.  It can make you sad, or it can make you wonder. It makes me wonder, and it reminds me a lot of the book I am reading right now. That's part of our job in pathology. To document things that no one else will ever see. Honoring the invisible.

Brazilian Wandering Spiders

Manuel Antonio National Park, Costa Rica

Me: What is that? Pointing to his necklace

Tour Guide (aka Johann, aka Joe Patience, aka Fang): A scorpion in amber. I love scorpions.

Me: I used to see those a lot when I was a kid. At sleepovers. In basements and garages. I never see them anymore in Arkansas. Also wolf spiders. I saw them a lot. Not anymore.

Fang: We have one species of wolf spider in Costa Rica. The Brazilian Wolf Spider. Phoneutria. You won't see them during the day, but if you do a night tour, you might. They have the most painful bite in the world. I've never experienced it, but I hear it opens up the pain pathways to your brain and makes it seem even more painful than it really is. Something called capsaicin.

Me: Oh! My brother has studied that. He's a food scientist. He's written an article on it. That's the ingredient in spicy chili peppers. It's supposed to be really good for you. It's in animals too?

I read online that it was discovered in tarantula venom in 2006. Causing maximum pain to bite victims. Animals can defend themselves by activating the sensory nerves of their enemies, just like certain plants do. And they are doing research with capsaicin and cancer cells as we speak, using it to kill the neoplastic cells and their progeny. Wow.

Pain and pleasure exist as a continuum, in the brain. The amygdala is a big source of neurons that are the epicenter. When I was a teenager I was fascinated with the amygdala. I started my own comic book with that title. Drew a few comics. Imagined it as the name of a band. That never really went anywhere.

I think (this is just me here, not research or the internet) that experiencing both pain and pleasure is good for us. Opens up neural networks, allowing us to think bigger and wider. Sparks creativity, to help find solution. Reduces conformity.

So maybe when I do the night tour of the park this Thursday I need to try to get bitten by a Brazilian Wolf Spider?

I'm not that crazy.

Me to young bartender poolside last night: Martini. Straight up. I like vodka. Grey Goose. Oh, and I like it just a little bit dirty.

I held my fingers up, thumb and index, to show him how much.

Bartender: I've heard that about you.

I honestly think this is such a small, quiet resort that they talk about us and our preferences and he was communicating that, but I couldn't stop laughing.

Roots

I See You

My horizon

The eye of my hurricane

The vortex of my tornado

The rolling wave against my undertow

A siren from the deep.

This is me walking back into the ocean after a large wave caught me unaware and knocked me over, tossing salt water up my sinuses and throwing my body against pebbles and stones.

Scorpio Moon

I'm glad it's almost over. I'm ready for Sagittarius.

Some days you get your hands dirty. It's thrilling when it's not 24/7.

Heart. Papillary muscles, left ventricle. That's a pretty thick outer muscular layer. It's been working hard for a long time. The papillary (tree) muscles look a little attenuated. But still trying to grow, like a cactus in a desert. 

This is me. Circa 2001/2002 I'm not certain. VA morgue. Brain cutting conference - no, those aren't cookies; I'm searching for the amygdala. Thanks Dr. G for giving me this print. Hangs on a bulletin board in my office, with many other things I love.

Pagers and Placentas

I've been trying to find a good place to put my pager. It's an awkward dated device, one that the liquor store guy laughed at recently. "I didn't know those still existed!" When I wear it on my skirt band, especially if I am wearing a high waist skirt, it can ruin the outfit - a long top has to hike up, making me feel lopsided. I don't need anything extra to make me feel lopsided.

 I tried to put it on my shirt, tucking it around the fabric gracing my shoulder. This works well if you are not getting paged. When I got paged, my eardrum screamed in protest. After three times, that had to be stopped. Now I'm wearing it on my watch. I love this placement. My watch is on my left wrist, and the pager doubles as a lever for my arm while I am reading slides on the scope.

I read something yesterday afternoon in PMG pathology that cracked me up. One of the funniest questions I have ever read there, and it was one of my best friends from residency (Trishie! Hello!).

"What is your policy on giving back grossed-in placentas to the patient for ingestion? Our grossing station and tools are definitely not sterile and I really think we should have a policy prohibiting this."

Funny comments include:

"Yes to Texas law saying moms can have their placentas, but as others above have said, this is direct from Labor and Delivery. Once it hits the pathologist's hands it is ours."

"What? Ew. No."

"Placenta with chorio and funisitis? Very yummy."

"No. This is a big no."

"I don't think we have a specific policy for this, but the only thing we give back after grossing is a fetus for burial."

"Sooooooo gross. I have been grossing placentas for several years before I delivered and was COMPLETELY GROSSED OUT by my own placenta. Just ewwwwww."

"Oh my God. Yuck."

"What is this bizarre obsession with placentas? I read this funny Dave Barry commentary about childbirth recently. He said looking at placentas should be considered a form of punishment - for example, Judge to offender: I sentence you to look at 5 placentas. If you are truly evil you must also gross them."

My friend: "Ok, so if the patient wants to consume the placenta, OB gives it to her directly to bypass the lab. So helpful, I would love see a copy of the policy, thank you so much.

Gotta love female pathologists. And placentas.

Moments of Clarity

I was sitting in my office today sneaking 20 minutes of a novel I'm reading. Not That Kind of Girl, by Lena Dunham. The one I read before was called Oblivion by Josephine Hart. I love book jackets, they are excellent covers, pun intended, and they are also built in bookmarks. This one seems kind of like a sequel to the other one, but don't try this at home because your perceptions and reality are very different from mine. I was about 39-40 pages in when I read something that caused my soul to fly out of my body and splat against the ceiling in the corner of my office. My soul stared down at my body, through milky white soul eyes, to find it sinking deeply into my office chair. My arms were reaching out to my desk, grabbing it, trying to stay grounded.

I hovered there for about 5-10 minutes, not quite believing or grasping what I read. I've seen denial, I've seen it do strange things. I've seen people with tumors the size of golf balls growing out of their neck attribute it to a car wreck they had 8 months ago. I will never scoff at this again. When you are living in a state of perpetual chaos, I suppose that the recesses of your mind become caverns, entrapping your most fervent wishes and desires. A place to covet, a place to shelter you from things that don't fit your version of yourself. I'm pretty darn good at escaping reality, I learned that trick at a young age. I know I've done this a handful of times in my life to protect myself, but I've never regretted it more than this time. When you have such a major world shift about your past, subsequent events become much clearer.

God love the phone. When it rang my soul flew back into my body. "Ready in CT4." I shakily pulled myself out of my stupor and went to do my job. Thank goodness for work, it keeps me sane. There was a moment not long after my divorce, when I desperately messaged a friend on Facebook. I was floundering, single mom craziness, and I needed clarity. The information I gained from that exchange made me realize that I was OK, I was sane, I could go on. I never thanked her for that.

We all have lots of moments of clarity in our lives. I've been grateful for many, and I look forward to more in the future. I don't have much to offer, but there is this. There is one moment that forever changed my life and has propelled me to now where I have hope, dreams, and desires. I was at a backyard party, holding my toddler son in my arms, keeping a watchful eye on my daughter. I looked over toward a park bench under a tree and saw a turtle. I imagined a female turtle - I've always been much more comfortable around women even though I'm fiercely attracted to men. It was just a turtle, but it was a big turtle. It must have been a trick in my mind but for an instant she dwarfed the park bench. I didn't see her face, she was still deeply in her shell. Simultaneously I was struck by lightning; it rattled my soul and energized my body and I had to lean against a tree to keep from dropping my son to the ground. I looked up at the sun in the sky to verify that it was a clear sunny cloudless day. I looked back at the turtle.

I'll never stop chasing that turtle. Even though I'm like a rabbit; no more dolphin honestly, I cannot keep up. I love how in life just when we think we are on top of our game - there's nothing left to learn, nothing new to know, we are sideswiped; knocked to the ground. It's good for us. Keeps us humble, keeps us trying. I've enjoyed watching the turtle morph into it's true self - the She-Bear. Love is a mystery, but I like to think there are grand puppet masters pulling the strings. The Divine, if you will. If I meet them someday I'll thank them then I'll clock them. Death is not an end, it's a restart button. Life happens over and over infinitely, which is both comforting and thrilling, like being in the front on a scary roller coaster with your mouth wide open breathing in all of humanity, the good and the evil, filtering it through your soul.

Women of The Word

We've been tossing around a title for a couple of weeks. I think this one is going to stick.

My daughter went to Camp Ozark a few weeks ago - she wanted to sign up with some friends last Fall. I didn't know it was a religious camp when I paid for it. When I belatedly realized, I told her she had better be ready to "Get your God on."

She laughed, she doubts like me; but to both of our surprise, she came back hungry for knowledge. My devoutly Catholic sister sent her a teen devotion book and a journal, both of which she immerses herself into, and emerges peaceful.

Ironically I bumped into an old friend at the Racquet Club a week later. "We are starting a Sunday School class for single mothers. My friend's idea. I would love for you to join."

"It sounds like a great space. I searched for it hungrily when I was divorced. The only place I found was led by a male therapist, ugh. I wanted a female vibe. I'm in."

I don't know much about the Bible but I figure if C wants to learn, I need to as well to keep up with her.

There are some important things I have learned in the three weeks I have attended:

If you hit a deer with your car, you can call the Food Bank and they will process it for the hungry.

There is a charity called the Arkansas Hunger Relief Alliance. They will send volunteers to collect the grains that farmers leave behind, before they torch the fields. They use the leftovers to feed the hungry kids in Arkansas. Bear with me here. Ruth is a great biblical figure who revered her mother-in-law. When they were starving they traveled to find food, and did the same for themselves. While they were collecting leftovers an estate owner fell in love with her and took them into his home.

There are many inspiring women in the Bible who were prostitutes. Mary Magdalene - questionable. Rahab - not.

You don't have to be a single woman to belong to this group. You can be married. You can be never married. You don't need to have kids. Most are divorced but this is not a requirement. Much to my relief I will not be kicked out when I am married this fall.

I learned in my first class that the Bible is a story being played out to this day. It's not all judgement and damnation - a story I learned as a youth - it's much more. No one cares what you believe, you can just learn the story. One full of sin and bloodshed and yes, redemption. So many parallels to our current angry climate. The Old Testament is like the Old West: Scary to be there, yes, but we are here today like they were back then. Drawing guns and choosing sides.

But there are no sides, there don't have to be anyway. Like I tell my daughter, it is more important to be heard than to be right. This small group of women is a beginning of a chapter. We are going to get organized, to discuss The Greatest Story Ever Told (one I have yet to learn), and to talk to each other. We want to make the invisible our mission. The women and children. Education and hunger. Simple but important.

My brother told me he had a great mentor during his training as a criminal defense lawyer. He is a musician, like my brother. He said, "The Beatles got it wrong. It's not : All You Need Is Love."

"It's : All There Is Is Love."

 Church newsletter photo. Becky, my friend, is on the bottom left. Art teacher, single mom, mentor to me during my divorce. We traveled to Crested Butte together with our kids, along with my friend Katie, on my first Spring Break as a single Mom. Melissa, royal blue standing up second to left, is the brainchild of this endeavor. I'm so excited to be getting to know her and eternally grateful for her counsel.

Metal Chutes and Stars and Ladders

I arrived at my office at around 8:15 am, after CARTI tumor board. There was a tiny amount of water on my office floor. I looked up and saw that the bloom of water on my ceiling one of my partners pointed out to me yesterday was growing. No active leak, but I was scared. This partner is currently a hobo, traveling among empty offices. His is under reconstruction after several heavy floods that have damaged his books and journals. We wandered in his office yesterday and noticed new water stains on the new ceiling. I apologized to him after I took the Lord's name in vain, he is super religious. He replied, "No worries. Holy Hell."

I asked the transcriptionist to send a request to maintenance - you cannot call them anymore, which frustrates me. The temperature in my office is always 5 degrees hotter (with extra humidity) or 5 degrees colder than what I set it to be. I have learned to regulate my temperature with water - cold from the water fountain outside my door or room temperature - and coffee - hot or cooled to room temperature - based upon the whim of my office.

As I was looking at a stain I ordered yesterday, polarizing it under the light, a familiar maintenance man wandered in. I bumped into him in the hall yesterday.

Me: "When you asked me about my office temperature, and I said it was OK, this hadn't happened yet."

Him: "I'm going to set up a ladder. I hope that doesn't bother you."

Me: "Not at all. At least you aren't drilling brick walls in my ear. That happens a lot these days."

I returned to my casework and five minutes later he surprised me.

Him: "Can you walk up this ladder in those shoes?"

Me: "Are you kidding? Yes. I have three pairs of these heels. Gold, silver, and gunmetal black. I could climb Pinnacle in these shoes."

Him: "I want you to see what is going on here."

I climbed the ladder and observed a large amount of condensation under a square metal conduit. I loved seeing the bowels of the hospital that resided right above my head. "Can we put a towel there?"

Him: "Not sure. Need to call my superiors. I'll let you know. They don't like to use towels as a stop gap because we forget about them and they mildew. Can I tell you about this system? It's old. Your heat and air at your house? It runs on gas and electricity. It's dry. This one runs on water. That's why you see all that condensation. I believe all of that construction out front is drawing in warm air, that's why this is happening."

Me: "The hospital where I trained? There was this one toilet I used in fellowship. A single one. It had really hot water in it. In the bowl. It was so steamy I could feel it when I sat down. Very weird I've never experienced anything like that. Do these old units explain that?"

Him: "Um, no. I've never heard of anything like that. I have no idea what caused that."

Me: "This is my home (hole)? I can remember to change the towels. In two months I'll call is that OK? We can change them. I had what I thought was allergic rhinitis all through residency and when I came here it disappeared. I think I was having a reaction to something in that building. Maybe a mold. So don't worry, I'm on top of it."

Him: "Well my superiors just Ok'd what you recommended. Where's the nearest place to get towels?"

Me: "ED. I've got code to the back door want me to let you in?"

Him: "No, no get back to your work! Don't worry about this anymore. I'll take care of it."

I turned back to my scope. Excitedly pulling out the lever to polarize. Gout doesn't get biopsied much these days, but occasionally a clinician will be surprised. This was soft tissue around an olecranon - they thought it was bursitis. I knew when I looked at it last thing yesterday it would light up like a Christmas tree with the Shidham's - careful, our new Chief told me years ago - they don't get that stain request very often and it sounds like Shit them. I only see it once every couple of years. I've never seen so much of it. It overwhelmed and thrilled me. I balanced my iphone up to the scope, and carefully captured an image.

 Uric Acid Crystals, Bird's Eye View (4x)

Happy 4th of July

Fell in love with three year old Willa. "My first name is Angela. Like the angels. Stop taking pictures - you are missing it."