November 9, 2011

Macroscopic Pathology Lab (11/7/11)

Filed under: Med School and the MSTP — sanguinemare @ 3:24 pm
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Suppressing gag reflex for 2 hours – not. fun.

After getting lost in a rat maze of underground halls, I step into the demonstration room.  5/7 of us are already there, along with the girl leading our lab.  The room is filled with the rank smell of formalin and decaying organs, and buckets full of fluids and various organ parts line the tables and shelves of the small room.  On the demo table are 7 trays, like the ones you use to serve food, only the insides have towels wrapped around a netted bag containing organs of the recently deceased.  One student asks how long the organs are kept.  The answer was a couple weeks, and then they are stored in the jars for a few months until the case is closed, and then they are disposed of.

We are told to “play” with our organs for a while, and then the girl leading the lab would go over all the cases.  Honestly, as first years, none of us really know what we are doing or looking at, besides what we could vaguely recognize from the pictures from the few online lab we had gotten so far.  But we do as we are told.

Upon reading the notes from the examiner, I find that my specimens come from an inmate who had emphesema before he passed away.  I unwrap the towel and try to figure out what organ I have on hand while simultaneously trying to hold my breath at the sudden blast of noxious air.  Lung? Heart?  What is this random slice here?  Why is the kidney sliced up so much on one side like pre-cut slices of thick deli meat?  Oh, she’s talking to another student about how they cut so much through the heart and the chambers that even she can’t really orient herself on what part she’s looking at.  Now I don’t feel so bad about not recognizing the heart at first, despite having seen a pig’s heart in 5th grade.

Going through my organs, I really can’t tell much of what’s going on.  The most I can see is that the lungs are slightly paler than other people’s, and sponge-like.  There are also gaping holes where abscesses were, with an especially large one in one lower lobe.  I really have no clue what most of the other items are, besides a long smooth strip that reminds me of stomach lining in Chinese food, some kidneys, and testes, and the mess of what I presume is a thoroughly cut-up heart.

The lab leader begins going through the cases one by one.  She sees half of us hanging back a bit, and others sometimes recoiling backwards when she fishes out the next organ.  “Oh, does the formalin bother you?” she asks.  “Yeah, some people have problems with it, for some reason.  It doesn’t really bother me.  Maybe it’s just because I’m used to it.” The rest of us send furtive glances of silent, wry agreement.  I don’t know about the others, but I was trying hard not to pass out for most of the two hours, feeling more and more light-headed as the lab went on. 

 On the upside, we did see a few interesting things.  We had a few “nutmeg livers”, which we learned in class today (2 days later) about how it’s called that because the red spots and bumpy appearance of the liver looks like the inside of a nutmeg.  I found out that the gall bladder turns a brilliant green after fixation due to the bile acids – it’s really quite a pretty color, like green grass – the only nice-looking color in the whole bunch.  One guy had a huge stone in his tray’s kidney.  It had approximately the size, shape, and color of a dried date, although slightly pricklier on the surface and much harder.  Considering that the size of the kidney was only a bit larger than a fist, it was quite a significant portion of the organ.  We also saw lots of thrombi (clots), and plaques in people’s aortas (which is what that strip of yellow, stomach-lining looking thing was).  We also saw evidence of fatty liver (which turns the color tan-ish compared to the normal blue-ish color), and had it compared to pate or foie gras by the lab leader… apparently pathologists really like comparing things to food.

My case had the obvious signs of emphysema as mentioned above, and slight diveriticulitis of the colon (some pockets were we saw fecal matter was still trapped in in the gut), and a spleen that was dark red, congested (full of material), and twice the size it should be.  One person also had a liver that had a ton of metastases from cancer (lots of white spots all over). 

So, some interesting things.  But definitely not enough to make up for the smell and grossness, at least not for me.  Thank goodness we only have to do this once.  I can’t believe I’m saying this, but even anatomy lab was better.  Maybe it’s the fact that formaldehyde smells marginally better than formalin.  Maybe it’s the fact that bodies sprayed down with formaldehyde (or maybe the fact that most of what we’ve looked at in anatomy so far are muscles, nerves and vessels, which) tend to be drier and firmer, rather than squishy, slippery, and gushy with putrid masses.  I can now say that I have definitely rule out my nebulous consideration of going into forensic pathology.


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