Tuesday, 10 February 2015

The Pathologist.

           It is hard to believe that the time I am writing about was almost a half century ago.  Tempus, as they say, surely does fugit.   For reasons related to health I was out of sync with my graduating class and was desperately looking for an internship job.  
            When I  showed up at Dr Pickles, the medical director's (They used to be doctors in  those days!)  office on Monday morning I was greeted by a pleasant smile .
            "I have good news for you," he said to me  "Although all the regular internship positions have been filled, there's a vacancy in pathology, that normally would have to be filled by a second year pathology resident.  He cancelled out at the last minute, so we can offer that position to you for four months and that will bring you into sync with the regular rotations.  It will be quite a valuable experience as well as allowing you to earn some money "
            I was relieved to have a job, but a little apprehensive about my ability to do justice to a position normally occupied by a person with two years more experience than I had.
            "Thank you, sir, but do you think I'll be able to manage it satisfactorily?"
            "Oh don't worry about that.  You'll be working directly under the supervision of Dr. McMurray, and she'll give you all the supervision you'll need.  It will be a wonderful educational experience because there are no more senior residents between  you and your consultant.  You'll get the opportunity to do things that a junior rarely gets near."
             Monday at eight-thirty I arrived at Dr. McMurray's office, ready to start work.
            "Good morning," the pleasant -faced middle-aged secretary smiled.  Then, in a slightly remonstrative way, added, "Dr. McMurray is down in the morgue doing an autopsy.  She said that you're to go down there right away.  She starts at eight sharp, you know.  Don't worry  though, I'm sure she will take into consideration that it's just your first day."
            "Gee, I'm sorry, I thought we started at nine."I answered apologetically.
            "Just take the elevator at the end of the corridor down to the basement and turn left.  You'll see a big gray double door in front of you.  Walk right in."
          I followed the directions and saw the door..  I turned the handle and walked in.  Standing at the operating table was a woman clad in operating room attire, a scalpel in her hand and so pregnant that she could barely reach the corpse.
            "I glad you could make it," she said irritably. "now get yourself gowned and gloved.  I need a hand."
            "I'm sorry, Doctor, I thought we started at nine.  I should have checked with you.  It won't happen again."
            As I slipped off my jacket and tie and secured the rubber apron that protected from neck to ankle I felt like a butcher about to butcher a carcass.  I pulled on a white gown, tied it up at the back and stepped up to the mortuary slab.
            "Okay," said Dr. McMurray, "step up here and get another suture around the esophagus, above the one I've already secured, I can barely stretch that far, with this in front of me," she said pointing to her swollen belly.
           I leaned forward, slightly nauseated from the pervasive  smell  of  formaldehyde and still a little shaken from what was the rather bizarre picture of a very pregnant woman doing an autopsy.
            "Okay, cut right here, between the two sutures, then dissect away from the posterior thoracic and abdominal wall right down to the duodenum, and then cut between the lower two ligatures that I had secured earlier.  That way we can get the whole segment of bowel out, without spilling gastric content all over the peritoneal cavity.  Unless, of course, you puncture the bowel wall.  And, by the way, don't get a fright when Jim starts the saw going.  She introduced me to the autopsy room orderly.
              Jim was the operating room orderly.  He nodded his head at me and smiled.
              "Ah, you'll get used to all this stuff quickly enough, doctor.  Just don't mind the noise."  He added this as he continued a transverse scalp incision and then pulled the apron of scalp forward to cover the face and got busy with an electric bone saw.
            Meanwhile, I continued the dissection carefully, anxious to avoid the humiliation of perforating the bowel, let alone the miasmic odors that would follow.  The loud vibrations of the saw cutting through bone provided the background for the next half-hour, and the effluvium of bone dust was added to the other odors.  Meanwhile Dr. McMurray carried on dissecting and supervising me at the same time.  Following the gross dissection, Dr. McMurray showed me how to section the removed organs and place the specimens in formalin for later histological microscopic examination.  We were all finished before noon.
            "Do we have another to do this afternoon ?" I asked.
             Dr. McMurray laughed.
            "We don't kill all our patents, you know.  I've assigned you to Tom Morgan, the chief laboratory technician.  A good pathologist has to be able to do and to supervise everything a technician can do."
             I thought it would be imprudent to mention that I had no interest in becoming a pathologist.
           My first solo  (almost) autopsy will follow later.

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