“You’re the perfect resident for the job.”
“I’ve never done anything like this, Dan. I don’t have a talk prepared. I’ve been a resident for a month.”
“Piece of cake,” Dan said. “Show ’em a lung, a breast—oh, and a brain. Kids love brains.”
“Dan—”
“Wing it, Deetan.”
“Wing it?”
“Improvise. They’ll think you’re a pathology god.” He grinned. “Only people in the department who’ll ever think that.”
The annual tour from Mrs. Jurist’s third-grade class spilled through the double doors a few minutes later: twenty-two kids in oversized St. Louis Memorial tee shirts, plastic stethoscopes clacking against their chests. Mrs. Samantha Jurist marched at the front—navy blazer, pastel blouse, powder-blue scarf—her aide, Joanna Dewers, shepherding stragglers in the back.
“That’s her,” Dan said. “Let’s go.”
“Mrs. Jurist! Welcome back,” Dan called. “I’m Dr. Rosenthal—we met last year.”
“Of course.” She turned to the kids. “Say hello to Dr. Rosenthal.”
“Hellooo, Dr. Rosenthal,” they chimed.
“Dr. Rosenthal is a pathologist. Can you say pathologist?”
“Pa…tho…lee…gist.”
“And this is Dr. Deetan,” Dan said, shooting me—James—a mischievous look. “Can you say Dr. Deetan?”
The names tumbled into laughter. “Dee-ton… De-TUNE… De-tin.”
“They’re all yours, Dr. DeTUNE,” Dan said under his breath. “Sponges. Fill ’em up.”
“Hello, I’m Dr. Deetan,” James said, nodding to Mrs. Jurist and Joanna. “We’ll start in the surgical pathology gross room.”
“Do you work with dead people?” a kid blurted. “Do you see bodies cut up?”
“Children,” Mrs. Jurist warned, “we’ll save questions for inside.”
“It’s all right,” James said. He faced the kids. “Sometimes doctors don’t know why patients are sick or why they die. We perform an autopsy to examine all the organs and figure out the cause.”
“Can we see one?” a boy asked, eyes huge.
“Maybe not today,” James smiled. “But I have a surprise. I’m taking you to the most important room in the hospital.”
“The operating room!” several shouted.
“Even better.”
He led them down the narrow hall into the gross room, where the air met them with a slap of formalin. A red-haired boy pinched his nose. “It stinks.”
“That’s formalin,” James said, doing the same. “It preserves tissue. You get used to it. Look here.”
He set a white bucket on the counter, popped the lid, and let the fumes roll. “Phew!” Mrs. Jurist stepped back, surprised by the burn.
James lifted a lung into the sink and rinsed until the reek softened, then carried the organ to the table and draped it with a green towel. “Gloves on,” he said, handing out powdered pairs. The kids snapped fingers into latex with solemn concentration.
“Who knows this organ?” James peeled back the cloth an inch at a time.
“Stomach?”
“Nope.”
“Heart?”
“Getting warmer.”
“Lung!” A bespectacled girl in front pointed at the collapsed, gray tissue.
“Correct.” He tapped his chest. “Two of them, to breathe. Sometimes people don’t take care of their lungs.”
He opened the lung through long planes of section. The cut surface was porous, some areas cystically dilated; the usual healthy pink had gone gray under fixation. Fine black specks peppered the parenchyma.
“Feel this area,” he said, guiding small gloved hands. “It’s firmer than the rest, right? That’s pneumonia. These big holes”—he traced the dilated alveoli—“are emphysema. Years of smoking can destroy the air sacs.”
“I hope none of you smoke,” he added, mock-stern.
“Nooo!” they chorused.
“So you tell other doctors what the disease is?” a skinny boy with horn-rimmed glasses asked.
“Yes. We take small pieces of tissue, process them, and examine them under the microscope. Then we tell the treating doctors what we see so they can plan treatment.”
“Wow. So everyone is waiting for you?”
He smiled. “A lot of the time, yes. All diagnoses begin with the pathologist.”
“That’s right,” Mrs. Jurist said, proud. “The surgeon removes the tumor, but the pathologist decides what kind of tumor it is.” She would know—two years out from a breast cancer diagnosis, she had haunted every corridor of the hospital with photocopied articles and questions no one could dodge.
“I want to be a pathologist when I grow up,” someone said, and heads bobbed in agreement.
Very smart kids, James thought. Smarter than some people in this hospital. If everyone saw this room, they’d understand—
“Bravo, Dr. Deetan. Now tell them the real reason this lung was removed.”
Haas.
James hadn’t seen her in the doorway. He felt his throat tighten. Don’t ruin this.
“Children, look here,” Haas said, lifting the lung from his hands with a metal probe and precise fingers. She pressed the probe into a firm node near the mainstem bronchus. “This is why the lung was removed.”
She drew a scalpel, opened the enlarged node. The cut surface was white and gritty.
“Cancer that has spread to the lymph nodes. The firmness Dr. Deetan showed you isn’t just infection. It’s diffuse tumor that can look like pneumonia to beginners.” She flicked a sideways glance at James. “A common mistake.”
The room cooled. James’s enthusiasm bled out like rinse water down the sink.
They went on—autopsy suite, a quick tour of the brain, a walk-through of the clinical labs—but the lightness had gone. His cheeks ached from keeping a smile in place.
“Dr. Deetan, thank you for such a thorough tour,” Mrs. Jurist said at last. “Children, what do we say?”
“Thank you, Dr. Deetan!”
He waved as they filed out. He loved children—their curiosity, their lack of pretense. Approach medicine the same way, he told himself. If only it were that easy. Medicine wasn’t difficult. People were.
Laughter floated from Dan’s office as James turned the corner. He slowed, hoping not to be seen.
“Dee-TUNE!” someone called, and the room erupted again.
Great. More kidding. He slipped into the residents’ office and shut the door, cutting off the noise.
“Good job with the kids.”
He hadn’t noticed anyone else there. Deanna.
“Thanks,” he said. “Would’ve been perfect if Haas hadn’t shown up.”
“Some attendings are…more challenging,” she said. “We’ve all been there.”
“Not you. You’re amazing.” Too much. Recover. “I mean—your cases always look so—”
“James,” she said, amused, “I’m not that far from where you are. I struggled too.” She studied his face. “Want to go over the unknowns before tomorrow’s conference?”
“Do you have time?”
“Now’s good,” she said, laughing—brown hair catching a hint of jasmine as she moved. She pulled the tray of unknown slides and set one on the double-headed scope. “Start us off. What do you see?”
He hesitated. One month in, he still sometimes had to guess the organ. “Heart?”
Deanna looked up, surprised. “I’m impressed. Most new residents guess skeletal muscle. Yes—heart. Where’s the action?”
James took a breath. “Lymphocytes around fibers. Some enlarged, vacuolated myocytes. Could be viral myocarditis… but these swollen cells—spider cells? Cardiac rhabdomyoma?”
Her eyebrows shot up. “You know spider cells?”
“In Dr. Carter’s lab. One project looked at benign cardiac tumors, including rhabdomyomas, and any associations with other malignancies. I did the microscopic descriptions.”
“James, you know more about this than I do.”
“It’s just Carter’s lab,” he said. “I’ve read a lot, but I can’t put it together like you or Dan.”
“You’re selling yourself short.” She slid on the next slide. “What about this one?”
He squinted. “Not sure which organ.”
“That’s because it isn’t,” she said, grinning. “Tapeworm. Trick question.”
“I only know tumors,” James laughed. “Carter never showed me infections.”
“Then,” Deanna said, nudging the tray closer, “I guess I’ll have to spend more time with you.”
James smiled. “I guess you will.”
Next Chapter: Chapter 4-Pathology Rounds
