letter jan 08 2012

Dear everyone,

This is my first update in over a month, what with the holidays, the Mexican vacation, etc. We had a great time in Mexico (or as much of great as I will allow myself to have). The trip there and back was without any complications, which is always a big bonus (I take that back, Nicola had some trouble on the way through security in Chicago because she had failed to sign her new passport). We all appreciated the warm weather, scuba diving (the boys saw a sea turtle), playing tennis, lazing on the lounge chair, disco naps, singing in Temania, and discussing Frankenstein. If you haven’t read it, it really is a much better book than you think it is, and not at all like the movies. Many of the issues Mary Shelley is concerned about are still unanswered today. I look forward to hearing about the choices for next year, rumored to be graphic novels.

One of the highlights of the Mexican trip is always access to free, unlimited alcohol (or, it would be if the drinks were composed of unwatered spirits). After watching the adults imbibe, Lucas created a drink he named’ The Vampire’, composed of Campari and tomato juice. I have since made one and I don’t recommend it. I think it could be good with actual fresh squeezed tomatoes (after all, Campari and orange is a pretty good drink), but not with store-bought, rehydrated, corn syrup adulterated tomato drink.

Nicola started back at school pretty much the day we got back. She seemed happy about her first quarter in college. Her grades were good, and she enjoys the company of her housemates. Her thespian activities seem to be on the upswing this quarter. Jasper got back his EXPLORE test scores, and he did pretty well. I guess he will be allowed to enroll at Hinsdale Central and graduate, if he and Lucas can take a break from playing the latest Zelda game, which is been running pretty constantly since they got it a few weeks ago.

A week off feels like forever when I get back to work. I finally got an answer on a weird pediatric tumor that has been sitting around for over three months. This was a large skin-based lesion on a newborn. We looked at it at Christ, and thought it was some weird congenital vascular lesion. We sent it to Lutheran, where our practice has some good soft tissue people, and a skin specialist. They weren’t sure what it was either. I sent the case on to a pediatric vascular pathologist at the Medical College of Wisconsin in Milwaukee; she did a lot of special tests and held on to the case for over two months. I finally demanded that she send it back, which she did. Her diagnosis was “soft tissue neoplasm with uncertain malignant potential”. This being pretty unsatisfying, I sent the case to another expert in Boston at the Brigham and Women’s hospital. He only held the case for two weeks, but he had pretty much the same diagnosis. Neither had ever seen anything quite like it. So, I signed the case out with their comments. Probably, the kid is fine.

People were asking me more questions about pathology than usual at this vacation, so I thought I would write a paragraph on it. Other than Radiology, pathology is in charge of pretty much every test done in the hospital if it isn’t directly performed on you by a physician (like a nerve conduction study by a neurologist, or a colonoscopy by the gastroenterologist). So every time blood is drawn, you pee in a cup, a biopsy is taken, someone swabs your mouth for strep throat - - that material goes to pathology. We are in charge of microbiology, blood chemistry, urinalysis, blood banking, immunology, and of course anatomic pathology (AP). AP is the part of pathology that examines tissues, and is further divided into specialties such as autopsy, surgical pathology, cytopathology (cytopathologists actually see patients. They stick needles into lesions and examine the exfoliated cells for malignancy. They also do Pap smears.), dermatopathology, and neuropathology.

So when the surgeon takes out you entire colon, or just a little biopsy, that tissue comes to me. It gets processed over a couple of days, a process where the tissue is fixed in formaldehyde, dehydrated, embedded in wax, and cut into really thin slices (8 microns (1 micron is one millionth of a meter)). The slices are stuck on a glass slide and stained with dyes, almost like Easter egg dyes. Then I look at the cells with a microscope. My part of the job would appeal to anyone with strong visual skills who likes to categorize stuff: an art historian, a birdwatcher, a stamp collector - - any of these people would be very good as an anatomic pathologist. I look at these slides all day, and I try to decide if they represent what family they belong to, and whether they are good or bad. Just like an art historian would say “of this is a painting from the Dutch school of 1640” or “this is a fake Rembrandt”, so I say ‘this is brain tumor is an intermediate grade astrocytoma”.

We have seen the new Sherlock Holmes movie which I enjoyed. I don’t recall the first one that well, so I guess my viewing pleasure was not diminished by comparison. We also rented a Jackie Chan Chinese movie (I don’t think it was ever released in the US) called Little Big Soldier. It takes place in 220 BC when the different Chinese proto-states are vying for control of the empire (that the Qin eventually won). Chan plays a reluctant soldier of the Liang state that captures a general of the Wei, and their adventures as Chan tries to deliver the general up to his home force for a reward. The movie was a bit confusing in the beginning, but a lot of fun, with good acrobatic sequences and an interesting point.

The Steelers play this afternoon!...They lost in overtime. Cindy is taking solace in her Husky animal hat, a Christmas gift from the kids http://www.amazon.com/Husky-Animal-Hat-with-Mittens/dp/B004852AKG/ref=sr_1_4?ie=UTF8&qid=1326071936&sr=8-4

Love, H.