Dec 17, 2011

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?"

1 comment:

Anonymous said...

More blue! Don't use the timer. Use the Force.