More than you wanted to know about autopsies

Hola amigos. Autopsy's been pretty crazy this last week. There's an interesting split in pathology because there's more than one type of autopsy. There are baby autopsies, forensic autopsies, and medical autopsies. The babies tend to involve perinatal circumstances so more to find out why something went down either before birth but after 20 weeks gestation, or right after birth, and hopefully find something to give the parents some idea of how likely it is to happen again.

Forensic autopsies are what everyone things pathologists exclusively do, and also, people think they encompass way less than they do. Essentially, if you don't die in the hospital, you get a forensic autopsy. Homicides, the famous one, but suicides, car accidents, bike accidents, pedestrian accidents, old people found at home, boaters found in rivers, etc. Full spectrum. When you're not the lead on these cases, they're actually less of a pain in the butt then people would expect since mail off labs are the ones that have to do the extremely slow version of all that CSI stuff.

Medical autopsies are the ones that are most important to the residents, and constitute the most paperwork. They give you a benefit over forensic autopsies because you have all the hospital paperwork at your disposal. Unlike most forensic autopsies though, this complicates the course because people in hospitals don't tend to die of really straightforward things. So... what killed this person? Cardiac arrhythmias are a particular headache. If it's not caught on a monitor, we can't demonstrate it happened. An MI will leave evidence (sometimes) but the arrhythmia it triggers? Not so much. We were given a handout describing death not as a loss of structure, but of function, and since we get them after the cease of function, it can be something of a mystery.

An added aspect to medicals is unlike with forensics, unless the forensic has a really medical-ly component to it, is we have to explain it to their clinicians AND families in a write up. This is difficult. Laymen understand why getting crushed by a truck causes death. They do not generally know what an amniotic fluid embolism is, why their mortality rate is so high, why doctors couldn't really do anything about it, and what the mechanism of death is, all without using words like "disseminated intravascular coagulopathy", and I have to explain it without being callous. And cite references.

But it's all good, and ultimately, way less stressful than surgical pathology. My attendings are super cool, and one of them caused me to discover an autopsy scully doll that I didn't know existed, and sparked my long dormant desire (coupled with Slappy mailing me a Scully action figure to replace the one burned by a fire, and yes I am a complete dork) to collect X-Files things. I'm trying to temper it with a more normal grown up habit like buying nice shoes or purses, but damn that stuff is expensive. I feel like a yuppie tool every time I pay 80 bucks for running shoes (worth it) but I saw a pair of Gucci boots that I liked decently online and they were 1100 dollars. Noooooo.

What else... Oh! People have been sending me pictures! See???

My nudibranch from Monterey!

Grenada hash!

The Alps!!!

Soooo awesome. Great to have memories back.

Values

I want to tell you all a story about a dead man and a penny.

We received a man in the autopsy suite. This is in no way uncommon. One of the things we do, part of our list of things to check off as certainly as the weight of the heart and lungs, is to inventory anything we receive. Clothes, money, drugs, all on a checklist.

As we carefully removed the man's pants, we heard a sound, a clank on the floor, and we observed a single penny, the culmination of everything he had, and something we had missed in our initial exam.

"Get it!" my attending said sternly, and I chased the penny around the floor until I had it, detailed its worth on the sheet, and placed it carefully in a bag of personal effects so that the penny could be returned to be distributed as the deceased had seen fit. That penny rightfully belongs to the next of kin. If this man has a will, he can be burned, buried, or shot into space with his penny, and no rational individual would contest it. No moral person would contemplate stealing the penny, nor denying the ownership of said penny.

And I didn't contemplate stealing the penny, nor throwing it away, nor anything else. Because the penny belonged to the dead man.

I'm telling you this story to tell you another story. I received a page from a transcriptionist that lives around the corner from where I used to live. She told me she'd seen bulldozers by my old place. I left work (on time) to try and get access to the building for what must have been the eleventh time, since no one had called me, despite assuring me they would, but when I got there, everything had been reduced to a pile of rubble. The house is functionally gone, and the contents inside are buried under tons of bricks, lumbar, and debris, and what is visible has been crushed into the ground by a large machine.

I stood there in front of this silent but for a few profanities and saw a purple piece of fabric, and pulled, from the side of the lumbar, an intact blouse that was mine that had been untouched by fire, and had not been ruined by the water. It had been on my floor near my bed (I'm messy). Pulling a few nail-ridden boards out of the way, I saw the cane I had when I tore my plantar fascia, broken in half (because a bulldozer drove over it), but with every bit of plastic design on it unburned. This cane (which I didn't use) is notable because it had been leaning against the case of my solid top Takamine guitar, giving me reason to believe that my guitar was fully intact before being crushed under a building. I looked a bit further in and saw the splayed torn remains of a step 2 book.

There were things in there that were mine. That were driven over recklessly with no opportunity for me to access them because of the inconvenience of being on a second floor. Most of those things can be replaced. Many, I'm sure, were fully destroyed by the fire, including my back up drive, which contained all my pictures, and I'd fully come to terms with that. Some things cannot be replaced. They are memories and creations with emotional value. Now that the building has been reduced, anything that belonged to us now freely belongs to whoever risks looting the wreckage, including the owners of the bulldozer that brought it down.

I'd come to terms with the loss. I expected a complete loss after the fire due to seeing the skeleton of the building. I kept asking fire, police, anyone, if I would be allowed to see if I could recover anything, and I was treated like it was a crazy request that inconvenienced everyone, and ultimately, a futile one. My landlord was threatened with fines or imprisonment by the city of Charleston if he did not remove his arson-destroyed building from an area poorly served by police, and the eyesore was removed without much care to the people that lived inside of it.

It is reprehensible to steal from the dead. It is crucial to retain their memories so that their family and friends have items to remember that individual, or if nothing else, so that the individual's wishes can be enacted. And I'm all for that. But the contrast struck me. Why are the memories of the living in turn so valueless?

I apologize for having another dark entry so close to the last, and I am well aware that this is hardly why anyone would read this blog. I'm not wallowing in despair, I'm feeling happy most of the time, I'm moving on with my life, and I enjoyed the hell out of the Giants winning the Superbowl. This has been due *entirely* to help from friends and family, and I can say with certainty, *no* help to anyone representing the city or its offices. Well, the Giants thing more due to the Patriots' inability to catch a pass, but still.

I'm also in autopsy now, which is about half the hours and half the stress of surgical pathology, but is going to cause entries to take a pretty significant turn for the dark, and unfortunately, the still ambiguous. HIPAA applies to dead people too. Autopsy is also, already, giving me a raging case of weird insecurities and half-phobias.

A not case-related example: Back when I was doing a path rotation at Coney Island, I was looking through topics to present and came across vehicle vs pedestrian deaths and being a grisly lass, thought "perfect". Until I came to the chapter about dead people being found by the side of a road or interstate with a cause of death by a single blow to the head and no other injuries. Hypotheses collided... An extremely specific and weird gang initiation in which people leaned out of cars with baseball bats? Coconuts being dropped out of planes?

Or... buses and trucks have large side mirrors so they can visualize their blind spot, and if a stranded motorist is walking a little too close to the road, BAM! And the truck driver or bus driver may never know he hit anything.

"Neat", I thought morbidly. Until the next time a city bus pulled up to the stop and I jumped back like it was made of cockroaches and canned tuna. EVIL DEATH MIRROR.

The brief rule of autopsy is that absolutely everything *can* kill you. Some things like killing you more than others, popularly bullets, rapid decelerations, other cars, and bacon in your coronary arteries, but these are things we should already know to be paranoid about. If someone pulls a gun on me, I'm like "Uh oh, death possible", but thanks to the wonderful world of autopsy, I will eventually feel the same way about bus mirrors, bees, carnival rides, and hammocks.

Oh, and crabs. F- crabs, dude. If PETA had any idea, they'd be like "Animals are our friends. Except crabs. Eat them, wear them, torture them, but seriously... crabs are not your friends. F- crabs. PS, don't wear fur. Here's a picture of Pamela Anderson naked. Love PETA."

Wow, that was dark

See title. Goodness.

So, sorry about that last one folks. I contemplated deleting it and as I said at the intro to that post, didn't even initially post it, but then left it for the sake of honesty and completeness I suppose?

I asked my mom for her opinion, and it was like, med school/residency is the ups and downs, which is a point for leaving it up. Then I'm like, this is a very specific situation for which it's hard to imagine anyone looking for advice. Grenada's rock fever with study darkness with fulminant breakdown? Sure. That's at least half the student body and everyone that has a medical school related meltdown feels like they're alone in it and everyone else is succeeding. Same with residency. Normal stuff. We laugh about it now at work because we were all in various stages of it without knowing the others were suffering it. Doctors seem to be bred with a specific blend of arrogance and self doubt that starts a spiral of "I'm smart and med school/residency shouldn't be hard. I am struggling. Therefore, I am stupid and everyone around me is smart and ohmigod."

This peculiar blend of impotent rage I feel intermittently in this really specific situation? Not so much relatable. At least I hope not.

But enough of that. Tonight was really really good. We had a mini spontaneous surgical pathology girls' night bitch-a-thon, and it was a bunch of fun with great people that did, I admit, involve some poking fun of surgeons. Lighthearted, I assure you. My mom sent me a hard drive that I got today that has all of my diving pictures and California pictures and the like salvaged so I did not lose those, and that was really incredible. The response of you guys, as I've mentioned, has been fabulous, and it helps me quite a bit. Surgical pathology ends in three working days (but who's counting) and I'm pretty excited about it. While being the bread and butter stuff, it's really work intensive, so it'll be great to have a break working more normal hours. I am getting a lot more of the diagnoses and have a general idea of logic and workflow, which I've mentioned before.

Good stuff. I'm planning a trend of increasingly positive blog posts to follow, but right now, I'm crazy tired. Night all.

Good few days, bad few days

Okay, I wrote this yesterday night when I was in a *really* dark place, so I almost didn't post it, but figured it's honest, so I'd go ahead. I'm feeling better now, I am. It's almost the weekend; people are being nice to me, I pulled doctor-card on a surgeon and John Legend got properly replaced by Nina Simone, but DAMN, was I feeling nasty yesterday, so:

So here's the reverse.

Call it PMS. Call it delayed anger. Call it whatever, I'm feeling it. Maybe I'm just feeling tired, and I'm at the culmination of two months of surgical pathology...

I've been getting really nasty sleep lately, hence the 1 AM post, worse than usual. The week after the fire, it was nightmares and anxiety dreams, and I could pinpoint and be like "Yes, that dream I had where the insurance company repossessed the rental car and yelled at me was likely stress related to this situation" but lately it's just like "Wake up for no reason at 5 AM sucka!"

So I try to wind down again, and I miss lecture AGAIN and I wonder how my eval is going to go with all that crap missing, and I struggle to make it from new home in new car on time to at least get my duties done.

This morning, I got my first speeding ticket since I left for Grenada. My fault, of course. I overslept (again) because I couldn't sleep (again) and was racing to work (again) so I could make sure I was there for frozen sections and I got busted.

The whole where are you going in such a hurry, and I don't even really make eye contact with people or emote anymore because I DON'T CARE, so the second I hit "I'm a doctor and..." I get the instant cop-black-out, the "rich doctor", the "I'm the problem with health care" and nothing else I have to say matters like "my pager is going off" and "I'm in scrubs" and "This car costs less than yours" and "The address on my license is no longer valid because that address burned down" (he asked if my license info was accurate, and when I said 'no, it was burned', he got busy writing down... my old address.

Fine, ticket, whatever. My insurance company needs more money anyway. They just took a 13 thousand dollar loss.

I was following a car most of the way to work (before the ticket) with a bumper sticker that said "God doesn't believe in atheists". I haven't put similarly anti stickers on my car because A... I haven't had a car that's lasted more than 3 months, and B... people who put stickers like that on their cars are assholes and I'm trying not to be an asshole.

Things God believes in in Charleston:
-Shooting a 5 year old in the face
-Burning down three houses and killing a cat
-Letting an arsonist go free for NINE YEARS with dozens of fires
-More unsolved homicides than Dexter has to clean up in Miami

Things God doesn't believe in in Charleston:
-Me

Cool, we've nailed God's priorities. God doesn't have to like me. Lots of people don't like me. God seems to like the Patriots. I'm thinking of putting *that* sticker on my car, but I'm guessing someone would then cause yet *another* insurance hit on it if I did.

This whole asshole thing has been eating at me. When I got my new car, I went asshole mode because I was honestly so livid about having to shop again that I didn't care who I offended, and in doing so, managed to circumvent the type of people that would try to eke an extra two grand out of an arson victim.

It's a weird title to wear. As I left the parking garage today, having had a last minute surgeon dumb of specimens that kept me three hours late, I decided that in lieu of jumping off said parking garage, which crossed my mind, I would put in one song on my iphone... put it on repeat, and BLAST it. just freaking BLAST it.

That song turned out to be Stereo by John Legend. Is it a good song? I don't know. Probably kind of. Do I like it? I don't know. Does it have a really loud obnoxious baseline that you can jar the city with for no other reason than you're an asshole? Yes it does.

So I did that. No "I hope I'm not bothering anyone" or that crap, just one song, on repeat, for 25 minutes. Loud enough to hurt. Loud enough for people at home to have a brief moment of irritation and rage and assume that I'm a 16 year old ethnic kid outside, and I can say "I'm causing that feeling in you because now I'm the one with power and you're not, and I'm tired of being nice".

Amazing, that is. There's a truly almost zen moment where you can look at everyone else and go "Hmmm... nope, don't care".

That seems to lead to enlightenment or flipping out. I'm not sure which path I'm on

Our landlord is being fined by the city to tear down his eyesore. No one has contacted us. No one seems the least bit curious as to why we'd want to see if we had anything left. I found out our landlord is trying to tear it down by hand because of our local yellow journal. People are in the comments section saying "Just bulldoze it!!!" That's OUR STUFF, motherfuckers, why don't you go bulldoze your pets? Why don't you go bulldoze your face. John Legend in your house, how's that? Like the bassline on that?

It's just stuff! It's OUR stuff. Clothes and pictures and memories and niceties and handiness and long nights talking and playing Mario Kart stuff! Just stuff. Not just their stuff.

Did you have renter's insurance? NO. I did not have renter's insurance, so fuck me. This is the first question, which they might as well rephrase into "Is this your fault?

Wow, that sucks, well your parents' homeowners...
WHAT DID I JUST SAY?

"Mmep. Oh"

People are being different levels of helpful. There's pure help: "Hi, here's a hug/check/gift card. I'm sorry this happened. See ya" There's the Monday morning quarterbackers.. Gods are there... why didn't you get insurance? Why didn't you put your external hard drive in a safety deposit box? Why did you live in the ghetto? Why were you speeding? Why didn't you set your alarm sooner??

That voice already lives in my head. It's called "Crippling self doubt" and it's an old war buddy of mine that likes to sleep on the fold out. Crippling self doubt doesn't need your help. We go WAY back. Crippling self doubt has been with me from the start, and you have no hopes of taking his place, so you might as well just put yourself on Team Supportive and stop giving me advice that isn't advice. "You should have" isn't advice. It's superiority seeking.

I'm half contemplating hulking out at my court date, since now the arsonist and I both get one, but I don't want to go to jail because my toilet wine always lacks complexity but there's a huge part of me that says "Everything in my life has turned to shit since I moved to your town. Transport me somewhere safer, like back to Brooklyn."

But that's that, I suppose.

A good few days

I'm kind of cautious about characterizing my days, because there are some spectacularly good ones to spectacularly bad ones and it's not always easy to tell which they are.

This weekend, new Roomie made chili qualified as "f'ing amazing". I got my Xbox, which was my "thank goodness this was belated" Christmas gift, so we set up with work friends and played Just Dance 3 for an embarrassingly long time. Which was awesome. Last night, Rock Star contacted me to see if I wanted one of his guitars since my beloved Takamine solid top got turned into firewood, so I met him downtown for tea and now I have a guitar so I can start work on the "Ratboy blew up my economy car" blues. It's gonna have four chords, all of which are 7s, and start with "I woke up this morning". Wait for it to show up on Pandora soon.

I've been putting off and rehashing an HLA presentation for about two months now. Pathology is difficult and studious and such. Blood bank is confusing, immediately consequential, and has a lot of letters and numbers. HLA beats up blood bank every day and hangs it on a locker by its underwear.

So I had a five minute presentation that was killing me. I did a first version of it about a month ago, which was extraordinarily bad, and I didn't know any of the case details. I got last minute belled out of doing it, and then was hacking some stuff together (which also sucked) which then got burned up by the fire. This last one I did on an extended weekend sleep deprivathon that was more my MO in college.

Unless my colleagues are being really forgiving, which is likely, it didn't suck. Despite my rambling it on 4 hours of sleep. So then I had sign out, but my attending got detained at the main hospital for over an hour and I didn't have many cases anyway...

So I propped up a chair to put my legs on in the sign out room and threw my sweater over my face. The accessioner pops her head in at some point where I'm halfway to Edward Norton's house, and I startle up a bit and act... I dunno, normal?

Her comment? "You know these lights have a dimmer switch?" and dims them.

Guys, that is as close to authorized naptime as you can get without having a yoga mat on the floor.

So nap at work. Frigging awesome. And almost no real work to do in the afternoon so I could get caught up on my other stuff. It's going to get me back tomorrow though. I'm getting all the breast cases in the land.

What else... music at work is interesting because a lot of us listen to music while we're grossing because we can. I'm included in that. It gets weird when we need an attending to come help orient a specimen, but we don't turn the music off because I am not laying a greasy Hep C liver covered finger on my precious iPhone.

Leading to this:
Attending: Okay... the stitch is here, so... this.. yes, this is anterior
Shirley Manson: I'm waiting... I'm waiting.... I'm waiting
Attending: So if we whip this around like this, I'm thinking this is the uncinate process
Shirley Manson: I'm waiiiiiiiting. I'm waiiiting.
Attending: And we can dissect the pancreatic duct from this axis.
Shirley Manson: I'm waiiiiiiiiiiiiiting
Attending: She's waiting.

Greasy finger exceptions are for F*** You, White America, and ANYTHING by Tenacious D. Jack Black is killing me. An hour of Pearl Jam goes by but the second I need an attending, I start to hear the beginning of "Ya don't always haveta f*** her hard..." and I'm going "Excuse me! Hold on... gloves off... fast forward!" "What was that?" "Nothing!"

I do really like my new car guys. It's all RRRRRRRRRrrrrrrrrRRREEEEEEEEE when I take off in traffic.

Jean Grey is reborn as...

This is Phoenix. She's my new ride.

This is Dexter. He was my old ride. As you know.

Truth be told, though it kind of feels like I'm cheating on Dexter, I think I like Phoenix better. I thought I'd be fine with an automatic transmission, considering how absolutely adamant I was about not learning to drive a manual until I was in my 20s, but manuals are SO much fun to drive. Additionally, my go to car for a very long time was a 2001 Hyundai Accent that survived until my third year of medical school, though I didn't use it for any of my med school time. And it was a manual, and Phoenix is also a Hyundai Accent, albeit a 2010 model with more features, but the response is exactly like my old car only a little punchier. Also, lights and trunk latches and such.

But Dexter was my first. First new car ever, first financing ever, first total loss/gap insurance payoff.

Let me tell you, if you ever finance a car, get frigging gap insurance. I would have been paying a thousand extra dollars on a car I no longer own because a hoodrat burned it down.

Right, the fire... so... new update. Yes, it was in fact arson. Said arson was committed by a 14 year old boy who was attempting to fight the squatters next door for some giant I-don't-give-a-f*** reason, and when they didn't emerge (because they weren't there), he set their house on fire very deliberately, which subsequently spread to everything else.

As a doctor, I feel like I should understand environmental pressures, along with conduct disorder and other things that create this sort of... child. I know the inevitable progression to Antisocial Personality Disorder in adulthood and all sorts of organic biological nonsense. I get it.

Problem being? I don't care. I lack empathy for the unempathetic. Does that make sense? If you are schizophrenic, and the voices tell you that the girl on the subway is the devil threatening humanity and you murder her to save humanity, you certainly need to be locked up and heavily medicated, but to some extent, I understand that you meant well and you have a demonstrable chemical imbalance that is both putting crazy things into your head WHILE giving you a bonus lack of insight into your own condition. It isn't who you are, and before the disease took you in your teens or twenties, you had a whole other person you were before your dopamine levels went tits up. Got it. And I sympathize. I don't want to be on the subway with you, but I sympathize.

The axis II stuff, the personality disorders, it's harder. The person's bastardry is a part of who they are. When you take the schizophrenia away from a schizophrenic, they're a normal person. When you take the antisocial personality disorder away from a person, you're removing a key part of who they are, which is a jerk. When I did my psych rotation, I could deal with crackheads, gang members, and bipolarity but the antisocial personality disorder people were just GARGGGHHH. And the attempts to manipulate into their own worldview, double GARGGGHHH. I can't take it, and for some reason, the same function that allows me to forgive other behavior just doesn't extend to people who are incapable of being able to have a basic sense of empathy.

So I became a pathologist instead of a psychiatrist, because it's very difficult to treat your patients if you hate them.

The hearing was today. My colleagues, who have already been wonderful, made sure I was covered so I could go. I got a call on Friday from first the fire chief, and then the SC equivalent to the DA that started with "We have you listed as the owner of one of the cars that was damaged?" And I was like "Um... that's kind of an understatement", so I told her our side, and she emphasized that she wanted to see us at the hearing, and I forwarded her all the pictures I took of our home and Dexter, which seemed to make her happy. I thought it was just going to be my roommates and I but there were at least 15 victims of this nonsense, including our landlord, who at the end of all this was like "Oh, I owe you guys your security deposits", which was nice.

We can't name names, obviously. A juvenile hearing is a bit like a bail hearing, except no money in kiddie cases, so it's whether he can be under "house arrest" with his parents (no) or stay in juvie (yes). The fact that this was a possibility made me choke on my coffee, but turns out I should have had a little more faith in the state, because even his lawyer didn't put up any kind of a fight to get him out. I never saw him though; he waived his right to be at his hearing, but his parents were there, and refused to look at any of us. He's likely going to be locked up until the trial, and I'm guessing he's not going anywhere after that. The prosecution passed some of my pictures up to the judge.

I feel an odd sense of closure. I'm not sure whether I should blame general perceptions of the government on the media with the idea that if you're under 18, you can torch half a block and go home to your xbox, but I was actually impressed and feel like justice will be served and all without my having to put on Christian Bale's growly voice and patrol the streets. Which is good, because I can't fight for crap.

Friday was a really bad day for me. It started waking up from a nightmare, as many of the nights this last week have, and then I got lost on my new way to work, causing me to be 15 minutes late to lecture despite leaving well in time, had a bunch of stuff go down on complicated cases at work, and then my insurance company called to say my settlement would be minus a thousand dollars and my rental car was up on Wednesday. This was also the day I learned that the fire was arson. Honestly, before that I felt strangely fine. Nightmare ridden and dyspeptic, since doctors are the kings and queens of somatization, but fine. Friday, the combination of the end of the comfort zone of driving around in a rented Chevy Impala and the new information that this was a motivated attack gave me a full dose of rage-a-hol, which was hard to try to keep under wraps, especially with everyone at the hospital being so wonderful.

And it's gotta be confusing to them.
Day 1: Hey colleague! Funny story, my house burned down, still need a roommate?
Day 2: Thanks for the pick up from the airport! Red wine and Incredible Hulk? Hooray! Look at this awesome bed!
Day 3: Wow, coworkers, this support is amazing! How am I doing? Fine. Nope, haven't seen the house.
Day 4: Yup, saw the house. Nah, figured from the pictures nothing was left anyway. I got a computer and can watch Dexter again!
Day 5-6: Springing Dexter from the junkyard! Wow, look how damaged he is!
Day 7-9: Doop doop, surge path, hmm, not so bad! I'm having fun! I feel like I'm getting it this time around!
Day 10: (*&(*&)(*&@(*&(*!! ******* BURNED MY HOUSE DOWN RAWRRRRRRRR

Friday night, I saw female former-roommate for the first time since the fire, and we drank margaritas and her boyfriend gave me the third season of Arrested Development, because he's awesome at gift-giving and likes to demonstrate it. Seeing them helped a lot. Saturday, I decided to turn my misanthropic bend to the positive of using it to intimidate car dealers since the Wednesday of rental car expiration is not a good day to car shop, nor is it ever a good idea to do your shopping on a day that you're desperate.

So I went to a few dealerships, and test drove a few cars. The dealership where I bought Phoenix had a 2009 Nissan Versa with a hatchback and a stick shift, which was kind of my final opportunity to revitalize Dexter and remake him in an image I actually initially wanted, but were too expensive and not available, respectively. It was even black. But the response was a little sluggish and no features, including no auxillary jack, which is a dumb thing that is critically important to me since five minutes without my iphone causes me to cry uncontrollably and chew my elbows.

I had finally settled on Phoenix as "a car I like and I'm tired of dealerships", which had a price on the window that was hilarious, particularly since someone mentioned in front of me having trouble moving it off the lot because no one wants manual transmission anymore. Dealer fail 101. States he "might be able to come down a little on it".

I'm usually a people pleaser. I don't to offend people or have them be mad at me, which to people selling anything, puts me in a sort of Girl with the Dragon Tattoo position (how's that for graphic imagery?). Fortunately, Friday left me in a state of pissed-offery and the fire taught me to spurn strong attachments to any material item, PLUS I hate shopping and was being forced to do this again, so I rode into Saturday with a rampaging chip on my shoulder. Which is a plus if you're buying a car. Which seemed to carry across, such that he was like "So, you're not from Charleston?" since Charleston is billed as a polite city. I pulled the Brooklyn card, neglecting to mention that I lived in high-gentrification Brooklyn for two years and moved there when I was 29 so it gives me absolutely no objective excuse to be an asshole. I can even fake the accent. I can also fake a Caribbean accent, but it's harder to sell people on. And it's not like my home state of California is known for having manners.

I also don't think I was a lot of fun for them. They kept doing that "Excited about getting a new car???" thing, and I was like "Not really."

I also fortunately have the Kelley Blue Book application on my phone. So I'm idly tapping away on it while he's talking (HIGHLY RUDE) about the car's features. Because I'm entering them one by one. So he finishes, and I turn the phone around and slide it over to him because its "excellent" condition for the same car with the same mileage is 1500 dollars less.

I frigging love technology.

We don't need no water... wait, yes we do

F*** indeed, neighbor.

Went to the scene today and chatted with some of the neighbors, including, I believe, the one that took this video, so we have some record of stuff.

Long story short, absolutely nothing left. I was captivated by the sound of the broken glass and tinder crunching under my new boots. My closet, I was told, fell outward, which sparked a brief hope of finding my bedbug costume, and one of my displaced neighbors, Superman, as we all call him, started climbing through the collapsed stuff to pick through the things that looked like clothes. Half of a pair of jeans, I think.

Lots of people were driving by to loiter, and I didn't really mind that, because it's probably what I would do. I gawked at the house on Rutledge that burned earlier this year. I took some pictures of my place just for the hell of it, not because I think I really need to document anything. But one of the landlords from across the street saw me and the neighbor and were like "do you live nearby?" and I'm like "I'm the third roommate". "Ohh... Was yours the red car? It was a trooper." "No, mine was the black nissan." "Oh... It exploded." "I know." "Do you have a place to go?" "Yup."

I went to the hospital today, one, because one of my attendings kept insisting that I do so, and two, because in an amazing show of foresight, I kept some of my insurance paperwork there, and the degree of support and concern was amazing and humbling. I've only been at my residency for six months but everyone rallied. I got hugs and offers and even though I immediately called a friend needing a roommate as soon as I heard, people were all "Where is she staying" and eager to make sure I wasn't sleeping in a Red Cross shelter. Despite everything, I feel really lucky.

I think that's one of the keys in a residency program too. Not "Who will hug me if my house and car burn down" because that is an oddly specific question to ask at the pre-interview dinner, but just how close knit a program is makes a huge difference in overall happiness. Our department has happy hours, parties, and an open door policy that nurtures an environment where someone could come home from vacation with nothing and find everything she could hope for, to get back on her feet, within her program's walls.

Family has also been absolutely amazing. Getting the news was surreal, and occurred around the small cousins, and it's difficult to know how to react in any appropriate fashion since presumably singing four letter words in the major and minor scales is not recommended for the TV-Y crew. I was helped out, taken shopping, given clothes, and perhaps really importantly, distracted so I couldn't dwell on it.

I'm safe and sound tonight back in Charleston. Things are moving along; I'm trying to release my car to the insurance company and get a lease agreement moving along. Good times.

Eulogy for Dexter

I realized I didn't post a picture of Dex in his prime of life, so here's one of his death. He's behind the mini cooper, who is also totaled.

He was a nice car. He delivered me to Maryland without murdering me and synced my ipod really well. He died in a blaze of glory that was dripped from my house, which was undergoing its own blaze of glory. RIP Dexter. Flights of angels, and the like.

A funny thing happened while I was in Houston...

My house burned down. And the car out front.

As ya do. As they say.

I'm not entirely sure what the proper response is. I'm trying for the dark humor. The "fire sale". The "blackened fish tacos". Everything I own is gone. My new car is gone. The roommate's dog, whom I love, is safe. No one is hurt. But there is decent coverage on all of Charleston's news outlets, that show my home, and everything I own, save the suitcases I have in Houston, up in flames. My neighbors talking about how hard it is on them, because the firefighters evacuated them before saving *their* homes. Not mine. There's only so much they can do. By the news report, I'm the "fifth person", after the Red Cross helped four, who is "out of town", as the news reporter says, "thank goodness". As do I.

I have family. I have friends. I have a general worthlessness to the things I owned. A Wii my mom got me. A regifted futon. An Ikea dresser I got in New York. A computer that was already on the fritz. A brand new car that was engulfed in the front. But I have friends, I have family. I have a job and a place to stay. I have a roommate's big sloppy dog that's not dead. I have... I don't know... a fresh start? It's not a fresh start. It's a charred start that hurts when I think of the emotional losses. The med school diploma. The pictures from Prague. The episodes of hell, Dexter, the show that named my car, who's dripping melted plastic in a parking garage downtown. My external hard drive. I had a flashing minute, before I left for Houston, where I thought "I should put that in my file drawer at the hospital" before I thought "nahhhh, what could happen". The blackmail photos of my roommate and my friends in New York. It's done.

I'm in Houston. I'm not sure what the response is. I'm not sure how I should feel about the arsonist speculation (which I don't really believe) and they claims to my insurance company. I'm moving in with someone I really like. But I feel odd; I feel disconnected. I feel like never going back to pick through the condemned wreckage to see if I can find the necklace I bought in Venezuela, the luck dragon my boyfriend and I got in Chinatown when I was hammered, that I used as a puppet to order tickets to a midnight showing of the Dark Crystal, the few bills of Costa Rican money, my checks that couldn't spell "Union Street" correctly.

Is stuff important? I don't know. I've moved so many times. I frequently joke that every time I move, I want to pile up everything I own and light it on fire, and now that job's been done for me. When I talked to the claims guy for my car, he says "Is your address still on Nunan Street?" and I say "Not anymore" because it's not. The CAT-AT in our living room, the life sized Anakin Skywalker that scared the shit out of the roommate. The fridge with the door that would never close. I'm moved with a suitcase to a nice apartment in West Ashley with a new, different dog and a new roommate and a new life in the same city.

I packed a bunch of my clothes to Houston because I had to check a bottle of port for Christmas. More than I would normally. Dress clothes. An electric blanket.

I don't have scrubs. Those stupid throwaway pieces of cloth the hospital provides us, but we have to return them to the machine to get them back and mine are burned.

But stay tuned for us on the news. We're top billing. They don't know our names or the dog's name, or if the cat I never liked is alive. But they know about the smoke that actually changed the city skyline for a while, the neighbors that were so horrified by our loss, the possibility of the Arsonist At Large, or if you're me, more probably, the Squatters That Were Cooking.

Can I just stay in Houston?

Another month of surg path down

Why are there so many Christmas trees around?

Oh right, the holidays... so today was the last day of work; I raced home, swinging by Charleston Beer Exchange to buy my roommate a "thank you for ferrying me to the airport at the break of day" six pack hand picked by a man with a moustache that said he was up to the job, then home to do the *absolute* worst packing job I've ever done in my life, and now, en route to bed as I wash my last shirt.

Warning to cousins: I may end up wearing bathing suit bottoms and a winter jacket. Not a good packing day for me.

This month has been an interesting one. As I've mentioned, I'm feeling more "getting the hang of it" in surg path. This is partially related to learning how all the systems work and what's supposed to go to what, which is a far greater contributor to competence than... you know... knowing what's under the microscope.

There's a certain logic that's emerging that seems absolutely obvious now most of the time but just wasn't when I started. Example...

My first month on, I had a uterus with potential endometrial cancer. I asked for help and was told to submit as much of the endometrium as possible, since obviously, that's where the cancer is.

So I proudly scraped every bit I could find off to make sure there was no spot unsampled. Bring on sign out... "Do you have any sections showing the depth of penetration into the myometrium?"

"Huh?"

"The most important prognostic criterion?"

"Uh... I scraped it off."

"You SCRAPED it OFF?"

(Puppy frown)

Fortunately, the beleaguered attending was able to salvage some unmutilated sample from the specimen, but not a proud day for me. Looking back, I have no idea what possessed me to think that would be a good idea. I wrote some of it down in my notebook so that I never go fully butt wild on a noob because I'm already realizing how much of an idiot I was a whole three months ago. By the time I'm in fourth year, it's going to be insane.

Part of my increasing, let's say "comfort", with my current lot in life is only now realizing that other people are going through *exactly* the same thing I went through.

Ishie, having mastered the art of "track down the screwed up slides" is charging through the halls between the resident on yesterday and the histo lab, is stopped by colleague who looks close to tears.

Colleague: "Um... do you know anything about... um... pancreas?"

Ishie: "Ah... my archnemesis. Not really. Sucks macro; sucks micro, gotta go".

Ishie sees colleague later, who is on hour 4 of read out or what I like to call "staring impotently into a scope until someone either helps you or you panic and then stop caring".

Ishie: "How'd it go?"

Colleague: "I hate pancreas."

Ishie peers in scope... "Breast, eh?"

Colleague: "I have four more... is it bad... I feel like I just don't care."

Ishie: "Diagnostic inertia."

Colleague: "This isn't cancer. What is that?"

Ishie: "I'd probably hedge my bets and call it sclerosing adenosis. It's probably wrong, but shows you were paying attention."

Female voice from dictaphone: "...Goodbye."

Colleague: "No!! You bitch!"

--------------------

While grossing placentas, which is tedious.

Ishie: "Dammit."

Different colleague: "What?"

Ishie: "This umbilical cord inserts but then, it's membrane bound all the way to the edge, and I don't remember what that's called."

Different colleage: "Where's the actual insertion point?"

Ishie: "Central. What should I call it?"

Different colleague: "Central."

--------------

Other colleague: "This is case SP-76-7872, patient's name is Jane Doe. Preop diagnosis of missed abortion. Specimen A is received in formalin in a container labeled with the patient's name, medical record number, and... wait a minute" (presses rewind)

Dictaphone: "Please scan the bar code."

Other colleague scans bar code: "beep"

Other colleague: "GODS. This is case SP-76-7872, patient's name is Jane Doe." (presses rewind)

Dictaphone: "Please scan the bar code."

Other colleague: "I'm going to break this phone."

I have done every single one of these things. It makes me feel peaceful. It also makes me feel good to be the go to girl among first years for prostate. It's a weird source of pride but there you have it. I'm good at prostates. I looked at so many at Brooklyn Hospital that it just stuck, so now I can scan away on forty slides feeling downright zen despite getting twisted into indecisive convulsions at trying to phrase "This guy has a giant icky infected boil in his arm" into pathology speech.

But enough with that! No more surge path this month or this year, and I'm off to see my family! I haven't seen any of them since I took my step 2 CS and my uncle ironed my white coat for me while my aunt took me shopping and my cousins took me drinking. I'm full of awesome sauce for it.

Happy Holidays everyone!!! May your ovaries all stay manageable sizes!!!!

A Caribbean M.D. is Weird Enough for Me.

See what I did there?

If I had to use one word to sum up what medicine feels like, it would be "Imposter".

Things are weird. Not bad weird. Just weird weird. Sometimes good weird.

I'm not sure if I'm a hipster or a yuppie or just desperately trying to pretend to be one or the other. I scathingly referred to my new brew as "Nut Brown Budweiser", which seems to put me in the hipster category, but I spent the evening at an Aquarium party for who knows what while eating different select cheeses and staring at fish, which seems like the latter. I did that while wearing a seemingly ironic dead alligator purse, which seems hipstery, until it's known that I only did it because it's the ONLY purse I have that can double as an evening purse, and then we're just back at imposter.

My point being, when I think "I'm a doctor", I don't think this:

Hi, I'm a turtle. I have nothing to do with pathology

I'm not sure why this party was being thrown. It was supposed to be impressing something on someone, but I don't think that someone was us. So we drank Chardonnay and watched albino alligators and sea turtles and ate brie, and attempted to do the electric slide, while I fidgeted and adjusted the dress I borrowed from my roommate, pretended to be deliberately avant garde with my eBay dead alligator purse, and made that level of polite conversation you see in movies about social functions like this one. If this had been a movie, you would have seen me through a fisheye lens prattling at the protagonist about sales on purses at Kohl's because the media has taught me that this makes good conversation, and to be fair to them, it totally does.

While a bald eagle squawks in front of the whole purse/shoe conversation because... pathology?

I'm okay with it though. It keeps me in wine and free meals until Christmas.

We had a fancy pants party last week as well, though this one had a more discernible motive and involved our department, but still, everyone climbed into the Charleston finery, went out to a posh venue and sipped champagne and ate sushi and danced the macarena or whatever else uncoordinated white people such as myself do. Of course, then all the residents bailed and went to a dive bar (the hipster is strong with these ones, Obi Wan), but still.

If I were back in Blood Bank, this would be a more natural progression of "nice clothes with a white coat and reviewing charts and occasional (gasp) seeing patients, and feeling all real-doctory and stuff, but I'm not. I'm in surgical pathology again. I live in comfy oversized scrubs that I rank according to how much formalin-soaked uterus juice they have on them on any given day. I run place to place; my pager goes off constantly.

Weirdly still, I'm starting to learn the whole way of it. For visiting newbies, (hi!) this is a marked deviation from my previous coping methodology which was sobbing hysterically into an open specimen until someone helped me.

I'm at 70 hours this week for the first time. And I haven't cried once.

Yesterday, I grossed. I've been getting faster and more efficient at it, so worked through my sheets as quickly as was possible and got it all on my run. This grossing day included some particularly juicy ovaries and placentas that sprayed blood, formalin, and unspeakable evil all over the place. But then... I have one attending whom I really like a lot but I feel like I've been letting her down a bit lately. Mainly because she's been following up cases that are in my custody while I've been attempting to score at least five hours of sleep a night. This is the same attending that's an amazing neuropathologist and has been trying to teach her knowledge to us. It becomes apparent to her through a few lectures that not a single damn person in our residency program has read the damn chapter(me included!) and she's beginning to get pissed.

So we end up with bonus unknown slides. This is essentially the pop quiz of pathology and consists of looking at tissue under a microscope while said image is projected onto a big screen and you have to describe the tissue and get the diagnosis (or something approximating it) while your colleagues stare at you, and the nice ones try to cough answers. Tres stresful. So I want to go home last night but I'm like "I can't even fake neuro, so I'm going to look at these unknowns", and try to cheat by pulling the patient numbers, which are obscured, which just serves to make me study. Two hours later, I realize I've been punked into reading the chapter I was attempting to cheat to avoid reading.

Morning came. 7:30 I'm there for frozen sections. Get a little breakfast. Go to neuro unknown conference. First two neuro cases go... for the second, I'm called up to drive the microscope. I do. My pager goes off after I get as far as "Uhh..." and I'm off to the frozen room. OR 8 needs frozens because their surgeon doesn't understand what frozens are for. I freeze lymph nodes in that time period, because I enjoy destroying diagnostically important tissue that doesn't freeze well. I go back to conference. Five minutes passes, during which I proudly have all my late night-compiled notes in front of me so I can act all gangsta about knowing that the nastiness in that person's skull is from their gonads. Beep goes the pager. Back to the frozen room.

The frozen room is where surgeons bombard you with spare scraps of their patients and expect you, in 20 minutes, to tell them what's wrong. This leads to conflict.

Some surgeons just call you to harass you. Some send an entourage of residents and fellows to come down and troll for blood. If they sense your weakness, you get overwhelmed and apologize profusely for the delay. If you sense *their* weakness for violating your territory, you adopt killer attitude and throw them out.

This used to be prime Ishie-cry territory, but I went with it. Describe the specimen, print the slides, freeze the piece, make the slides, run it to the attending. Rinse and repeat.

I get a tumor bank. No problem. I'm inking stuff and cutting into necrotic horrible looking tumor while the PA cuts other frozens in the background. I got this. I'm smearing awfulness onto a petri dish and dumping a piece of something else in cytogenetics material and running each to its proper place. It's good.

The morning hell cycle ends and I run to my mailbox, which is full of "special stains". My pager goes off three more times because the stuff I need deboned is coming out. Slowly and inconsistently. I grab those. All the stuff I grossed the day before starts coming out.

My attendings from the previous week all want something. Do you have the mesh? The mandible?" The Ki-67? Do you have the new levels? What did you think?

Meanwhile, I'm like... I spent 14 hours in a plastic shirt chopping uterus. Unless what you're talking to me about relates to being in a plastic shirt cutting uterus, I'm less than useful to you.

But I get it. I gather my old cases, start dictating addendums, and start making house calls. "Dr. S. I have the two decal slides that show infiltrating ductal carcinoma and I dictated them but..." etc. Then it's multi-houred "Benign Reactive Lymphoid Hyperplasia" (tonsils) time. I get those out. Throw in some transected fallopian tubes. A positive for cancer biopsy. A Vulvar lesion, grade 3. I dictate it off and keep going. I find myself minus one endometrium, and I wind up elbow deep in uterine fragments, wondering if I should be more worried about there being uterus on my upper arm or the carcinogens said uterus has been sitting in. I turf some stuff; I read up on the immunostains. I chat with the histologist, who calls me doctor.

I get it. Or, I'm finally starting to get it. This whole cycle, and I'm okay with it, hard as it is.

But then I'm running home to change into a cocktail dress so I can look at a bald eagle while eating homemade mac and cheese and drinking wine. Weird.

Meanwhile, stuff heard in the grossing room:

"Dammit, it looks like someone slaughtered a goat at my station."

"Wow! That looks like a honeybaked ham! Jamie!! Doesn't that look like a honeybaked ham?" "That's disgusting."

"Yo, Anna, you happen to see my dead twins around?" "Ah, the Carson kids. They're downstairs."

(after cranking at the cryostat) "Marster! Dinner is prepared!"

"Check it out; it's Godzilla's ovary."

My attending: "More blue." "More blue?" "Don't use the timer. Use the Force."

"Wanna see my carotid body?"

"I'm comfortable enough with my masculinity to wear a pink shirt, but to let another man run his hands all over me? No way. Let me see that uterus."

"Oh my god, I absolutely LOVE Florence and the Machine. Her voice is ama... SHIT, this ovary just exploded on me.

"There's a frozen from OR5." "Tell him to go away. Tell him Tyler went away. Tyler not here. Tell him the gate's closed."

"Can I put my butt warts on your run?"

You want me to tell what to whom?

"I bivalved the uterus. The endometrium looks normal."

"All right, let me come see. Okay, you're calling the OR."

"... what?"

"Call them and tell them."

(Deep breath) "Okay." (picks up phone)

"Wait! What are you going to say?"

"Uhhh... I... this is pathology."

"Do you have a name?"

"Yes."

"Do you have a degree?"

"Yes."

"So use it! Women, we always do this. You're DOCTOR Sancho and you have his results. Now what are you going to say?"

"Um... this is Dr. Sancho from pathology. The... uterus..."

"I examined the corpus and..."

"The endometrium appears benign. There are no polyps or lesions visible."

"Okay."

(Picks up phone) "Hello! This is Dr. Sancho from pathology. I examined the uterine corpus and the endometrium appears benign."

"Oh! This is his nurse. I'll put you on with Dr. ScarySurgeon."

"Hello? This is Dr. ScarySurgeon. You're on speakerphone."

"Meep."

Meanwhile:

Accessioner: "Ooh, that's Dr. ScarySurgeon? Tell him to call ahead on his frozens. I can't, but you can."
Ishie: "I'm a first year. He'll beat me up and take my lunch money."
Accessioner: "You have lunch money?"
Ishie: Dammit.

The elusive monkey

But just when you thought I had a big long blog post prepared for you, I'm back on surgical pathology! Mwa ha ha ha ha. And still without a home computer. I'm looking at a hard drive wipe, but I'm also looking at a device so buggy that it won't avoid the fatal errors for the two days it would take to do a full back up onto my external. Le Sigh.

I'm also left with the quandary of having that Dr. Horrible link come up as one of the first things I see, because I could probably watch Slipping and Bad Horse on repeat for as long as it would take me to fix my home computer.

But instead I'll say, I went to Costa Rica! Woo hoo!! After fruitless years as an anthropology major with an advisor who was a big primatology guy, as well as two years in Grenada and a trip to the Philippines, I'm finally gonna see some frigging monkeys!

Dammit. It's like they know. We went to this one beach where I overheard a guide say to a group "You need to be careful about leaving belongings on the beach. The monkeys will open your bags and rummage through them."

Monkeys are actually a *problem* in this country. But for me? No monkeys.

However, as I was walking through a particularly scenic rainforest, this guy nearly fell on me:

They're not graceful animals.

They also kind of look like Chewbacca and an orangutan had a drunken, regret filled night in Las Vegas. And died the result green.

I heard a cracking noise above me, and something crashed down out of the trees. When I saw it was a sloth, I had a brief insane moment where I whipped my camera out and was like "I need to get this picture before it gets away". Then I took like 25 pictures because... sloth.

We also stayed in a place that looked like this:

And I did this:

So I'm thinking f- the monkeys.

Anyway, I'm late to bed but the short of it is:
Costa Rica= awesome
Blood bank rotation= awesome
Having a week of Xmas vacation over surge path= awesome
Having additional source of income= awesome
Getting to go to Houston for the holidays to see extended family for the first time in forever= awesome
Seeing mom in Maryland over Thanksgiving and learning fun-facts about the Amish= awesome
Being back in surge path= This time will be totally different! What's that ominous music?
Dad back in hospital for Thanksgiving= unawesome

Pending... pending... Thanksgiving loading

Hiya guys, lots of stuff lately conspiring to keep me from you. My dad's in the hospital again, my computer's internet has been completely disabled by ZeroAccess and Combofix can't seem to restore it, I'm sick, and I've been in Costa Rica, but now I'm in Maryland with my mom. And then there's the whole doctor thing.

Happy Thanksgiving/murder a hypertrophic chicken day. Specific updates to follow at some point.

Happy Pre-Halloween!

I'm stuck inside doing a PowerPoint presentation for Halloween, so figured I'd share some Joss Whedon vaguely Halloweenish action with you guys, since it distracts me from having to screw with fonts.

Enjoy.