Friday, June 16, 2017

Tumor Board

Newest onc, I remember her pregnant. She just had her third baby. Long dark hair, eyes you can trust: So I want to present a case. I sent a pic to rad.

Rad: Yes, I remember - you sent it last night while I was at dinner! How do we get it to project on the big screen? Should I just pass my phone around?

Assist: If you can send it to a CARTI email I can get it on the big screen.

Hushed anticipation by twenty docs.

Onc: I'll tell the story while we are waiting. So this guy comes in the ED with a sternal wound. Seems he was biopsy proven squamous cell carcinoma of the skin four years ago. He didn't tell his wife, and it grew. Now it smells. I debrided it, and am wondering what to do from here.

Ancient crusty surgeon with a pronounced Southern drawl: Call wound care. Let them get it real clean. We can see where it goes from there.

Rad: Here's the pic.

Collective gasp. Wow. This is like half an orange depressed wound right in the center of the sternum, in the middle of both nipples. Red and raw, but no pus.

Surgeon: Pretty impressive Grace. I imagine that was taken after you cleaned it out. Let me give you a bit of advice, if you are going to be doing this on night call. Get some cinnamon extract - local store should carry it. Put it under your nose if you encounter this again. All the best surgeons carry it around.

Everyone laughed, but it got me thinking. We pathologists use menthol for the autopsy suite, but I've only really needed it for the decomp room at the Crime Lab. Cinnamon might be a nice change.

Surgeon: Seeing it, It might be amenable to surgery. Gotta get the bad cells out, but we could fill that in. Get some tissue from another site, do some grafting. But I'd get wound care first. That might not be necessary.

Onc: Thanks a bunch. I'll start there. His wife was so mad.

I was thinking, how could you hide that from a spouse for four years?!!?

Other onc: Seeing that pic, makes me feel brave enough to want to show you all my Stage III squamous cell carcinoma of the anus.

Me: Only if you send it to rad while he is eating dinner.

Rad laughing: Yes send it to me at dinner!

Everyone else: No thank you.

The Nightingale: Next case?

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