Saturday, August 4, 2012

Retrospective Part Three

Note:  Many writers compose thoughts when they are not thinking.  I am one.  I am part of the cadre of writers who write when they do not really intend to write.  Thus I begin the third installment of Retrospective.  Please refer to this link to catch up on the story:

Ultrasound and Evolution: a Personal retrospective ( Part 2)

I Remember flying home on Brannif airlines after skiing in A-Bason with a nice lady who was a great skier that did not seduce me, or give me bath salts.  Bath salts were not known in the 70's.  A zombie was only in a movie.  My goal was to meet with the hospital administrator to explain my issues.  I had trepidations.  I was not trained to be a sonographer.  I failed.....

We met and I explained that I had no idea how to perform a sonogram.  "You did attend three days of instruction?"  He said.  "Of course"!  I replied.  I did not skip out.  He called the chief of Staff.

COS asked if I had any hands-on.


Why not?

No machines.... (Nervous)  this CME event provided no hands-on.

Shuffling of feet...

"You will make yourself known to the Pathologist." (Drum roll)

Notes that here my stomach dropped to my Valves of Houston (look that one up medical students). Hodor

"A Pathologist deals with dead things." I said.

I met with the pathologist and we agreed to a structured regiment of anatomical training.  I was dealt a hand which included autopsies and sonograms.  Specifically, I would take a corpse out of the fridge, and work it on to a gurney, then dress it with white muslin for decorum.  I would then wheedle it up the elevator to my lab much to the guffaws of my fellows (they called me Doctor Frankenstein) whence I would perform a sonogram on the corpse and make notes and Polaroids of my findings. I used a "Sharpy" magic marker to point to interesting areas.  My notes in hand, I would wheel that corpse back down to the morgue and call the pathologist on the phone (Real phone) and announce I had performed the sonogram much to the delight of administration.  This was before HIPPA of course.

The pathologist always arrived with a touch of bourbon in her breath, but she was a relentless task master.  "What did you see?"

"A mass on the superior pole of the right kidney"

"Then poke it!" she said while she was running the bowel under the vent-a-hood.

"Use the scalpel.  that thing with the green plastic handle"!

OK.... (poke)...poke poke

"What is the contents of the mass?"

Yellow fluid.  Yeccch.   

Grats.... a renal cyst...

Moments later after we had taken the liver to the dissection table.....

The first time she showed me the common bile duct I was floored.  The CBD is connected to the gall bladder, a source of many ED visits.

Gall bladder disease is rampant in the USA and many modern countries. Gall bladder surgeries are a staple of a general surgeons pay-check.  I will post a separate article on gall bladder disease.

The CBD is only 3 mm wide in normal patients.  Pancreatic duct?  LOL.  I could not see Wirsungs duct when she showed it to me.  I have an admiration for pathologists.  They see things many people are not aware of.  We went on to examine the pancreas (Looks like a pork tenderloin to me), the liver, the spleen, and some fun stuff with ruptured aortic aneurysms.  Wonderful stuff for people in search of anatomical knowledge.  A look into the abdominal cavity of a human is a wonderful look at what God creates.  So pretty, compact, and elegant. 

Weeks went by.  My pathologist friend revealed to me many secrets to include the anatomical relationships of the organs of the abdomen, chest and cranium.  I will never forget finding my first gallstones.They looked like smurfs.  She laughed and said "These are very common".  Little did I know how correct she was.  She said "Fast food is a scourge, and is making people very sick."  This was back in the 70's.  How true her predictions were.

Next installment: the Heart.

Gizz note:  this blog is a labor of love, and is always a work in progress

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