Friday, December 2, 2022

Up in Arms

     Monday, after I belatedly realized that the med exec committee meeting at Yaya's was December 5th, Christy drove me home. We lol'd as we sang in the car. The anxiety dreams that had plagued me Sunday night continued. Here, I was going to do yoga (if only I had the energy ugh) in a strip mall and all the lights went out and I was a football field away from my car and had to run. There, I was in a public setting and something terrible happened and by the time I got to the scene the only thing I saw was a severed arm. 

    So I was very surprised on Tuesday when I got an arm as a specimen. Legs, toes, feet, transmetatarsal amputations are super common, but arms? Hands? Not a thing. My first arms were in residency at ACH - a young kid got electrocuted, I can't remember how, but I had to gross his arms. It was eerie - such a sensual receptor to lose. I dove into the charts and found out this arm belonged to a woman with multiple medical comorbidities (ESRD, DM2, etc.) who had axillary artery blockage that was not amenable to recanalization so they cut it off to try to alleviate the pain.

    It got me thinking about other arms, and hands. The fetal one under the microscope - I think I posted it here long ago bc I was scared it would trigger someone on Insta but the pic was amazing. The hand I signed out about a year ago from the woman on ECMO - hers had gone gangrenous and it moved me to tears and to text my entire family in gratitude.

    When you are on ECMO it's kind of tough for the machine to get circulation to your periphery - my Dad went into kidney failure briefly that luckily turned around and we had to be very vigilant about his hands and feet bc they were often blue and the CVICU nurses were amazing but no one cares for you like your family. So we scheduled around the clock care and my brother Matt took the night shift. He often had to ask for heat packs to keep the fingers and toes from losing circulation. 

    I went into the gross room Tuesday or Wednesday I lost track? The week after the holidays feels like a freaking year. There was a Sims frozen and it was a softball - Warthin's tumor. Such a beautiful thing with its oncocytes and lymphocytes and motor oil gross appearance. There is also a Warthin-like papillary thyroid carcinoma - very rare - I wowed Jesse McKenney by diagnosing it once in residency. Will probably never see it again.

    After I called the OR with the diagnosis I noticed something different at the bottom of the fridge - a large plastic bin. Jess? What is up with that? Oh, well, they are still complaining about the smell. From the legs. The head nurse came and talked and was really kind and not rude so we purchased this bin to satisfy them. Um why? I asked. There is no smell.

    Apparently, she said, some of the staff and patients see the legs in red biohazard bags and have an olfactory reaction based upon sight. It disturbs them. Well, I guess that makes sense, I said. We are a service industry. Jess said I finally got to retire this. She pointed to a porcelain metal bin with black rust marks under her grossing station.

    What the hell is that? Oh, it's been the leg holder for IDK, thirty years? Evans (a retired PA) probably got it off of the supply dock back in the 70's. Looks like it might have been used to bathe babies in the forties. I laughed. It certainly does, and when they were trying to get rid of it he repurposed it. 

    And what is up with the arm? And I also got an index finger this week. Poor thing had it crushed while welding and they could not save it. Jess said we had another arm this month, and I exclaimed in incredulity. What happened? Some guy punched through glass and severed his brachial plexus and they couldn't save it. Good god, I said. What a crazy month.

    But it's a new one, and I am not on call I discovered this week until January 16! Long strange wonderful hiatus. Heading to Port St. Joe on the 17th with C to visit mom and dad and I cannot wait. Long weekend solo re-reading old books I haven't visited in 8 years or so? Jack called to ask if he could invite friends over and I told him can we table that? I haven't had a weekend alone for as long as I can remember. Don't want to embarrass your friends with my singing. Happy Friday, much love, Elizabeth

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