Pushing Glass-Show and Tell

Show and Tell

"You are the perfect resident for the job!" Dan's sarcastic tone convinced James he was being picked because he could find no one else.

"I've never done something like this, Dan. I don't have any talk prepared."

"Piece of cake, James. Just show the kids some organs like a lung, a breast...oh yeah, show them a brain, they like that kind of stuff."

"But Dan-"

"Just wing it, Deetan."

"Wing it?"

"Improvise. Hey, these kids will think you're some pathology god. Only ones in the department who'll think that!"

The annual tour of Mrs. Jurist's third grade class was about to commence. Samantha Jurist was a former patient of the hospital, diagnosed and treated for breast cancer two years ago. In grateful appreciation for the work that the physicians performed for her, she was determined to share the miracles of modern medicine with her young students. Her tours shuttled through each of the hospital departments, ending in surgical pathology. A public service, the hospital administrators outlined for each department. A public nuisance, residents from each department confided to each other.

Twenty two children, all wearing their complimentary St. Louis Memorial Hospital tee-shirts, a size too large with shirt tails hanging to their thighs, were escorted through the double doors that led to surgical pathology. Around their necks were plastic stethoscopes. Mrs. Jurist proudly marched in front of them, dressed in a conservative blue blazer and matching skirt with a pastel pink blouse. It was attractively completed with a power blue scarf, an outfit much too warm for the oppressive summer heat, but a welcome sight amidst the endless white coats and green surgical scrubs. A younger woman, an aide, brought up the rear.

"That's her! I'll introduce you." Dan moved to meet the eager crowd. "Mrs. Jurist! How nice to see you again! I'm Dr. Daniel Rosenthal, we met last year."

"Dr. Rosenthal, of course! I never forget a face. Children, can you say hello to Dr. Rosenthal?"

"Hellooo Dr. Rosenthal." The young voices chimed in obedient unison.

"Dr. Rosenthal is a pathologist. Can you say pathologist?"

"Pa..tho..lee...gist."

"Hi kids, let me introduce you to another pathologist. This is Dr. Deetan. Can you say Dr. Deetan?"

Laughter erupted from the horde as they stumbled over the syllables. "Deeton...DeTUNE..Detin."

Dan shot James a mischievous glance. "They're all yours, Dr. DeTUNE. They're sponges, fill them with your knowledge!" James rolled his eyes as he turned to face the eager crowd.

"Hello Dr. Deetan, I'm Mrs. Samantha Jurist and this is my third grade class from Jackson Elementary School. This is my aide, Joanna Dewers."

"Mrs. Jurist...maam." James politely nodded in the direction of both women. "I, uh, thought we would start with the surgical pathology gross room."

"Don't you work with dead people? Do you get to see the bodies burned up?"

The questions started before James had even started toward the gross room.

"Children, Dr. Deetan will answer all your questions once we get inside the lab."

"No, no...it's quite all right, Mrs. Jurist." James confidently faced the impressionable minds. "We do work with dead people. Sometimes, the doctors don't know why patients are sick, why they die. They call us to do an autopsy and we open the body and examine all of the organs to see if we can find a cause of death." James felt a strange but welcome surge of confidence. For once, he was the authority, he was providing the answers. He was the doctor's doctor and he loved it.

"Can we see one?"

James smiled. "Maybe not today, but we could arrange something in the future." James lifted his hands in the air. "But, I have a surprise for you! I'm going to take you to the most important room in the hospital."

"The operating room!" Several of the children cried out in unison.

"Even better! " James was maneuvering the crowd through the narrow hall. In a second, the familiar sight of the gross room and the pungent aroma of formalin greeted him. "This, " James stated with a sweep of his arm, "is where medicine really happens in the hospital. This is the surgical pathology gross room."

"It stinks!" A chubby faced boy with red hair wrinkled his nose at James, diminishing James' enthusiasm.

"That's formalin, "James smiled and pinched his nose. "It does stink but you get used to it. We use the formalin to preserve the tissue. Look over here!"

James grabbed a large white bucket from the shelf. He was familiar with the contents since he had grossed it in yesterday but had not completed the entire dissection. Opening the lid, the pungent formalin fumes caused the entire crowd to stand back. "Pew! It burns!" Mrs. Jurist recoiled, surprised by the strength of the preservative.

James removed the organ from the formalin and placed it under running water. "Kids, let me wash this first to get rid of that smell, then I'll have you take a closer look." The children jockeyed for position as James dried the organ.

Be a little bit of a showman, he thought to himself. Keep them guessing! He placed the damp organ under a green surgical scrub towel and pulled the edge back one inch at a time.

"Who knows what this organ is?" James continued to pull the towel away until nearly the entire organ was exposed.

"Stomach?"

"Nope."

"Heart?"

"Getting warmer."

"It's a lung!" A skinny girl in the front row pointed at the collapsed organ.

"Correct!" James pointed to his chest. "We have two lungs that allow us to breathe. Sometimes people don't take care of their lungs and they get a disease like this." The lung was sliced along the long axis yielding several planes of sections resembling filets.

"Here kids, put on some gloves and feel this part of the lung." The children eagerly grabbed the powdered gloves from the box that James offered them. "I'm going to operate!" yelled one boy.

James rubbed the lung's cut surface. The porous appearance of the alveoli, the air exchanging sacs, stood out prominently, rather too prominently. Some were cystically dilated, a sign of emphysema. The usual pink-red surface of a fresh lung was now gray, the color rinsed out by the formalin fixation. Specks of black decorated the lung at irregular intervals, the telltale sign from a lifetime of living in a smog-ridden metropolitan city. James walked his fingers over the surface, feeling for the characteristic firmness of a pneumonia.

"Kids, feel this area. Feel how firm it is, compared to the rest of the lung?" Silent nods answered.

"This is a pneumonia. This patient was probably a smoker also. Do you see the large areas here?" James pointed the cystically dilated alveoli.

"This is called emphysema. You get this after many years of smoking and it destroys the lung cells." James looked at the children and frowned. "I hope none of you smoke cigarettes."

"Noooo!" The chorus chanted.

"So you're the one who tells the other doctors what kind of disease it is?" A skinny boy with horn-rimmed glasses resembling Harry Potter queried.

"Yes. I take small pieces of tissue and the next day, I examine it under the microscope and tell the surgeon what the disease is so they can continue to treat the patient. "

"Wow! So everyone is waiting for you to tell them the answer?"

James smiled. "That's correct. All diagnoses begin with the pathologist."

"Children, the pathologist is very important. The surgeon will remove the cancer but it is the pathologist who decides what kind of cancer it is." Mrs. Jurist was proud to clarify this fine point. Between the time of her initial biopsy and eventual mastectomy, she was a frequent visitor to the surgical pathology department, in fact, all of the hospital departments. She brought in reams of photocopied articles from pop health magazines as well as the internet. She would not leave until every question was answered. She intended to write a book about her experience to help other women cope with their disease.

"I hope to be a pathologist like you when I grow up." The rest of the children nodded, voicing their agreement.

These are very smart kids, James thought. They understand what pathologists do better than some of the employees of this hospital. Ha! Better than some of the doctors, even. Everyone should be given this tour, they would appreciate our skill, our knowledge, what we offer to the patient. We would-

"Bravo Dr. Deetan. Now why don't you tell them the real reason the lung was removed."

Haas! How long had she been there? He stared at her, unable to muster the courage to respond to her interrogation. Why are you doing this now? Why are you ruining my moment?

"Children, look at this lung." Haas ruthlessly snatched the lung from James hands and grabbed a metal probe. She stuck it into a lymph node adjacent to the main stem of the bronchus. "This...is why this patient had his lung removed." She grabbed a scalpel and sliced open an enlarged node. A firm white surface, cutting with a gritty sensation, was revealed. "This is a cancer that has spread from the lung to the lymph nodes. What you felt in the lung was a diffuse cancer that looked and felt like a pneumonia but was actually much more serious." Haas flashed James a sideways glance. "A common mistake amongst beginners."

James looked upon the group with envy. Couldn't he be an innocent child, eager to learn, instead of a whipping post for this sadist? She can't even let a benign presentation pass without using it as an opportunity to denigrate him. Why does she do this? What can she possibly gain from this?

The presentation continued for 20 more minutes but all joy and enthusiasm had evaporated. A quick review of the autopsy suite, a plunge into the anatomy of the brain, and a walk through of the clinical laboratories completed the tour. James plastered a brave smile on his face; his facial muscles ached.

"Dr. Deetan, I am certainly grateful for your very thorough tour of the pathology department. Children, what do we say to Dr. Deetan?"

"Thank you, Dr. Deetan!"

James waved to the crowd as they departed. He loved children, their innocence, their enthusiasm. Approach medicine with a child-like attitude, he often reminded himself. If only it were that easy. It's not the medicine that's difficult, it's the people that practice medicine! As he returned to his office, laughter emerged from Dan's office. He and two other residents were sharing a joke. He wanted to join in but he was never made to feel welcome at these impromptu bull sessions. He was tolerated but never accepted. He inched closer to the door, careful not to let them see his approach.

"Dee TUNE." Laughter erupted once again.

Wonderful! They were talking about me. Jokes at my expense. It would be so easy to walk into that office, stand up for myself. But what would that accomplish? Would they suddenly drop their negative expectations about me and accept me as one of their own? I would still be the FMG. The FMG who tries hard but never really has a chance, the also-ran.

James turned the corner and entered his office, closing the door, shutting out the gaiety. If he was going to be accepted, it would be on his terms, not theirs. He would master the material. He would bring honor to himself and his profession. There could be no other way.