Lindz had the best post in my Bloglines today, and her subject matter, in a roundabout way, inspired to tell you about this part of my job.

One day a week, I am an honorary member of the surgical pathology department. I help with what are called “frozen section” specimens, the kind that require a rapid, intra-operative diagnosis so the surgeons know how to proceed with the operation. The bulk of these are cancer cases, in which the surgeons are looking for margins – basically trying to find out how close they are to the edge of your cancer without taking out anything you could still use. We do a lot of biopsies to see if anything is cancerous in the first place – lymph nodes, chunks of curious growths and so on, in order to make sure that as long as they’re in there, the surgeons get what they need to get the first time.

I got to carry a couple of prostates today. Not my most interesting specimens though, but that’s how Lindz’s post  came into play and made me think about those, and the fact that sometimes it’s a little weird that I might be walking out of the OR suite with something in my hand that you didn’t quite expect to lose.

Most people know when they go in for a procedure that the surgeon is going to remove lymph nodes, a liver lesion, an ovary, a ureter. I got all of those today. When i take the specimens out of the OR to the lab, I sign off on the Tissue Exam Request and check out what the procedure is. Today those prostatectomies were both expected (one was even being televised; more on that in a bit) but there have been times when the patient’s record indicates that she is just having an ovarian tumor removed and I end up walking out of the room with an entire ovary and a uterus because there were a few surprises in there.

I get called several times in succession for some cases, depending on whether the patient had a good margin and the operation can end, or if they had a poor margin and more tissue has to go up for tests. And sometimes the docs just open a patient up and say “Well. Holy cow. THAT didn’t show up on the film we took two weeks ago,” and hand me half a kidney, five lymph nodes, and a left ureter.

The ickiest (and yes, that is a professional medical term) case I’ve ever worked pathology for was a below-the-knee amputation on a patient who had bone cancer. I took half a leg to the lab so the pathologists could figure out in a matter of minutes whether I would need to go back and get more. I didn’t. I think the patient and I would both have been very upset if I’d had to make a return trip.

I’ve worked around blood and guts (guts really IS a medical term, and a type of suture) for several years now, and I like to watch cases and see what’s going on. Since I never go onto the sterile field, I watch the laparoscopy cameras overhead when I get to the suites early, before the specimens are ready. I’ve watched a heart stop beating and start up again after an artificial aortic valve was implanted. Today I almost smacked into a cameraman when I went to pick up a prostate in the room where a local news station was filming Dr. B using a robot to perform the entire operation. It looked like he was playing a video game until one of the residents turned around and handed the nurse a piece of the patient.

Pathology isn’t so bad, really. After a thousand anatomy book diagrams and photos, after dozens of looks inside open incisions where everything is intact, it’s kind of interesting to hold a little plastic cup and see nothing but a lymph node inside. So that’s what that looks like, I tell myself. And this thing, this is what pops out those annoying little eggs every month. It’s so tiny!

I know what my legs look like, though, and I’ll keep those on. Ick.