The Doctor's Doctor Talks To You
In a dark room in the hospital, everyone is waiting to hear your diagnosis. Your internist has a list of ideas, as does the radiologist. All the physicians and nursing specialists gather around a table at the weekly tumor conference, presenting their best guesses. They're waiting for the final answer - from me.
The first was in residency. A patient who’d had nearly his entire colon removed wanted to look at it. So I got the colon specimen from storage, where it was kept in preservative-filled sealed plastic bags, and met him in the laboratory. He was recovering from surgery two days earlier and was in a wheelchair pushed by his girlfriend. He was young, seemingly too young for such a radical surgery, but that’s why it was performed – to prevent him from getting a colon cancer later in life. He had been diagnosed with a pre-disposition to develop cancer, called Familial Polyposis. His colon was studded with small bulbous growths and none of them were yet cancer. I showed him the colon, already yellow-grey and hard from the chemical fixation, pushing on the plastic bag to reveal the growths peeking out of the normal colon folds. And that was it. He didn't ask many questions, just wanted to see it for himself. I’d want to see my colon too, if I’d had it removed at age 24.
The second time was after I started my job at a community hospital, with a young woman who’d had a Desmoid tumor removed. This process is like an over active scar that grows down and out, subtly infiltrating into her abdominal wall. Like many other patient’s with desmoid tumors, hers occurred after pregnancy. She too was wheeled into my office, a day after surgery, to peer into the microscope and get a look at the process that had caused her so much grief. We looked at the cells together, but it's hard to look through a microscope if you're not used to it. **
I hope to provide my unique perspective as a pathologist, but offer no medical advice. By sharing my knowledge with you, I hope you’ll enjoy reading your inside stories, have fun with the gross stuff of humanity, and feel more empowered at the hospital.
A note: I was trained to diagnose all disease, but in practice I focus on the skin, with a variety of other surgical pathology specimens included.
** It’s hard to point to what’s wrong on the slide of a desmoid tumor, also called a fibromatosis. It’s nearly entirely pink, and composed of sheaths of cells that all look the same. There’s no top or bottom, and the infiltration is difficult to demonstrate if you’re not used to discerning amongst shades of pink.
A typical colon involved by a familial polyposis syndrome. The numerous brown and mushroom shaped growths all have pre cancerous potential.