Tuesday 3 March 2015

The Pathologist. Pt.1.& Pt 2.*****************************


           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 get close enough to the corpse to do the autopsy.  Unusual in those days
            "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.
             I spent the next couple of days in the lab, learning to do tests that a computer does nowadays, in a fraction of the time.
           
      

Autopsy Time.

         Two days later, I showed up in the hospital morgue bright and early, for an eight am autopsy.  I made sure to be there a few minutes early, so that Jim and I  could make sure that everything would be laid out just the way Dr. McMurray liked it.  Eight o'clock came and went, without sign or sight of Dr. McMurray.  I was getting a little nervous. 
            "She's late," I said, "I just hope everything is okay."
            "Ah, don't be worrying," Jim said optimistically, "everything will be just fine."
            "I hope so, I'd hate to be left to do this on my own."
            Jim grinned that leprachaun smile that the Irish sometimes have.
   "Ah sure if the worst came to the worst, you and I could do it ourselves.  I've been hanging around these post-mortems and helping out long enough to be able to do them myself."
            There was a knock at the door, immediately a the secretary poked her head around it.
            "I'm afraid you fellows are going to have to do the post-mortems on your own.  Dr. McMurray was admitted to the hospital in the small hours of the morning in labor, so I don't think she's going to be in to help you out today."
            With that the door slammed closed and she was gone. I almost panicked, then I re-called Churchill's war time credo. 'keep calm and carry on!' and  I determined to try to do just that.  And, after all, the patient was dead before I got to him.
            "We'll have to find another pathologist right away, Jim."
            "There's no other pathologist available.  There's a critical shortage of pathologists in Dublin right now." Jim laughed.  "How do you think you, a first year intern, got the job in the first place.  That job usually goes to a senior house officer, who's specializing in pathology.  They knew Dr.McMurray was going to be having a baby soon and I suppose they thought that having you was better than nothing." Jim answered unceremoniously.
            That certainly sounded more realistic than my previously held belief that they had just conjured up a position to slot me into, to help me out. What a fool I was, they were helping themselves out, albeit with a grossly under-qualified candidate.
            "Anyway Doc, don't worry, I'll show you how to do a post-mortem.   Sure, who do you think taught Dr. McMurray to do them?" he asked modestly.  "She was just at your stage when she first came down here to learn how to do autopsies.  And there's one piece of good news, the house officer who does or helps with an autopsy gets a fee of five pounds and five shillings.  Not many junior interns get a deal like that.  They usually give me a pound for my help," he added, meaningfully. 
            "Don't worry about that, Jim.  If you can get me through that, I'll give you twenty-five shillings.  Do you really think we could do the complete job ourselves?"
            "Sure I'd teach you to do an autopsy on my old Granny for twenty - five bob!" he laughed.
            "So, if we're going to get out of here tonight we'd better get started," I said.
            "Yep, Doc, now you've got to decide if you want to do it Dr. McMurray's way or the quick way!" Jim said.
            "Well, what's the difference?" I asked..
            "It's like this Doc, in the long run it doesn't make any difference.  In either case, the stiff, er, I mean the corpse, ends up nicely put together and is sewn up neatly, all ready for the undertaker. But one method takes two hours and Dr. McMurray's method takes four or more hours.  It's up to you."
            "Now wait a minute, what's the point of taking four hours when you can do the procedure in two hours?  Dr. McMurray is a very practical doctor, why would she opt to spend four hours doing a procedure that could be done in two hours?" I asked.
            Jim shrugged his shoulders.
           "I asked her the very same thing myself.  What's the difference, Doc, I asked her.  'Ah Jim,' she answered, 'the difference is the human dignity and respect that every human being is entitled to.'   That's where we differed and I told her so.  You got it wrong, Doc,  Jesus Christ himself is looking after the immortal soul and its dignity, all you're looking after is an auld corpse!"
          So we agreed to disagree, and she was the doctor and all I was, was a morgue porter, so of course, we did it her way.  But we had some grand discussions.  Which way do you want to do it, Doc?"
            I knew that everything took at least twice as long as anticipated and sometimes three times, so I had no difficulty in making the decision.
            "I want to do it the fast way."
            He answered without hesitation.
            "I can see we're going to work just fine together. Now Doc, you just pick up this scalpel and make a long incision, starting right up here at the sternal notch and extending down to the xiphi-sternal joint."
            I picked up the scalpel.

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