• Jena Martin MD

Unrecognizable


When he went in, it was summer. Unambiguously summer. Above average hot, sticky and humid. The kind of weather that feels like it will go on forever.


He went in 2 days before I did. When he went in, he’d had trouble finding words. An electrical surge through his brain brought him in to the Emergency Department and then in a step wise fashion, inexorably, to the neurosurgeon, who intends to drill into his skull and remove the problem. The patient can’t find the words, but his condition needs a name and that’s where I come in.


When I drive in, the wind is blowing. It is an announcement that breaks the spell - summer is ending. The chill in the air is unfamiliar, although I know it all too well. Every year I engage in this same denial. Back so soon, I think. My old nemesis - winter. I duck into the hospital and shiver. I move fast, setting my things at the desk, reviewing the scans and his last few days. The prequel.


When the OR tech brings me several tiny gelatinous white and red pieces of tissue smeared on a piece of white shiny gauze, I am ready.


I unfold the gauze and use a scalpel blade to poke through the brain tissue. I take a small piece, like this size [ o ] and set it on one end of a glass slide. I set another slide on top and watch as the brain flattens and spreads out between the glass. I gently pull the slides apart, smearing the arborizing brain tissue onto both surfaces. I dip the slides sequentially through a series of dyes and drying chemicals, lay them on a tray, and carry them to the microscope I have already turned on in the office across the lab.


I adjust my eyes, look through the light as it passes through the cells and then enter a different world. Our world, but smaller. Our world, but at the resolution that keeps us honest.


My office is quiet, but the quiet under the microscope is not peaceful. It is a horror show. The cells are, as we like to say, ugly. Large, different from each other, irregularly shaped. The proper word is 'pleomorphic'. I spot a dividing cell caught in the act, but it's one that has forgotten how to properly duplicate itself. Its chromosomes are awkwardly arranged, a mockery of orderly cell division. We call these mitotic figures "bizarre".


For a flash I am gripped by the terror of unfamiliarity. I need to recognize these monsters and I need to do it immediately. I identify one cell, and then my eyes and mind flit to the next possibility. I glare at each cell as my stomach churns. Is it a brain tumor, a metastasis, an infection? It feels as though I’ve forgotten the names of everyone in my house.


Finally, after 4 minutes that felt like 40, I can confidently name it, this thing that has taken names from him and will take his life. I’ve confronted the unfamiliar under the microscope, but when I lift my eyes from the microscope, my world is still recognizable.


I get to leave the hospital soon after, back into summer set off the boil. Just a few more days of life at body temperature.


When he comes out, it will be cold and rainy. Suddenly unrecognizable.


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