Wednesday, March 31, 2021

Gross Room

     I was watching a taped version of Mandee Novack's talk on CLABSIs, you know central line associated blood stream infections, this morning around 10 am while waiting for slides. They have these physician metrics that you have to meet every year and they tie it to reimbursement somehow and it's always really boring for us pathologists because nothing is very pertinent it's all for clinical docs not lab docs. But all my partners have been talking about how great it was. This is her second one, and I just texted her and said girl you gotta stop knocking it out of the ballpark or they will make you do every one. She is seriously engaging and entertaining and has the ability to summarize massive amounts of data into useful information that's super rare in my experience. She said aww thanks I was glad to get that one over with the subject of CLABSIs is about as boring as watching paint dry. Not if you tell interesting stories to make it meaningful and have lots of gut churning pics (for a pathologist anyway - give me parts and dead bodies over live patients any day) as examples of bad insertion site maintenance. 

    I paused it when I got paged to go to the gross room for frozens. It was Muesse, a pleural rind, and I couldn't find anything malignant. I looked real hard because last time he was so incredulous there was no malignancy I looked again and found a tiny focus of probably cancer and called the OR back. The next day I was sweating bullets bc it got cut away on permanents but luckily he sent more pleura for parts B and C and it finally showed up in C. I showed it to Hal and he was like wow! You got so lucky! I cannot believe you called that flat out on frozen but you are right it's there so subtle. 

    While I was waiting on Jessica to stain - he sent two frozens so I decided to hang out and chat in between, I noticed Laurie grossing in a large leg. It looked kinda good so I wondered aloud why they cut it off. They had done multiple revisions of an ankle fracture and she was still in pain. I said that's a lot of leg for ankle. Laurie cursed when she could not get around a metal rod and Jessica from the stain line wondered if a bone saw might help.  I wandered over to Jessica and she said there was a blue light special on legs this week, everyone is doing legs. I looked in the glass front fridge and saw a big pile of legs - they put them in red plastic bags and tape them up. Lotsa legs.

    Jessica told me one guy came into the ED and had a history of a remote motorcycle accident with lots of surgeries on his tibia; his whole foot was red and swollen they took it off. She said oh my gosh most of his tibia was eaten up and hollowed out like a tree trunk someone had sawed into and I'm surprised he was still upright I would have thought he would have keeled over. Here I got a pic I've never seen anything like it. I looked and think cross section of a leg but not very clean there's ragged skin and lots of bloody meat and in the center the tibia looked like 4/5ths necrotic dark brown goo I have no idea how it was bearing the weight of a human without snapping like a twig. She said another guy must have been sitting home alone for a year the leg was so rotten. Anything else? I wondered.

    Oh we got an apple from the anus! I was like what???!! I laughed incredulously and said I sure hope it was a crabapple! She said no it was not and she eyeballed it grossly for measurements and description she did not touch it or look for a grocery store sticker but her guess was a large Mt. Fuji. I commiserated, not sure I'd want to touch that even with a glove. People are sure interesting. Happy Wednesday. Much love, Elizabeth

Edited to add I picked Pele today. The awakening. Very cool meditation sequence it reminds me of my last one with Lisa in Colorado a bit. I'll have to try it.

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