Friday, July 29, 2016

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.

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