Mullberry Whine

poured out before bed

First Impressions

…(Paris Street, Rainy Day, 1877, Gustave Caillebotte)…

“I’m just so glad you get to learn from me, Ms. Mullberry!  I mean, what an awesome thing that I get to help out the next generation of doctors.  Oh, such a privilege!

She is absolutely beaming at me as the anesthesia resident places her IV, her perfectly coiffed permanent shimmering in the low light of the PACU.*  This is the happiest I’ve ever seen a pre-op patient, bar none.

“It’s a privilege to be on your care team, Mrs. Jones.  Thank you for the opportunity to learn from your health care,” I smile back at her.  “We’ll see you in the OR then, OK?  And Mr. Jones, we’ll be out to chat with you when we’ve finished up.  So nice to have met you both.”

I shake two warm hands, my day brightened by two warm souls, and head off to scrub in.

Mrs. Jones is still chattering warmly when the nurses wheel her in, grinning until she flies off to the land of MAC.**  What we see on hysteroscopy, though, is nothing to grin about.  Mrs. Jones’ deformed uterine cavity is nearly filled to capacity by a shaggy pink-white fluff with patches of black necrosis and hemorrhagic polyps – an abnormal finding for any woman, let alone a post-menopausal female whose endometrium should be thin, atrophic even.  Dr. J makes a whistling sound through his dentures as he begins to take pictures.  He sighs a little as he sets to the task of curettage, stripping great globs of ugly tissue from the uterine walls with quick, controlled strokes.

“It doesn’t look great,” he whispers at me with a sad wink.  “We’ll talk about it later.”

I wink reflexively and nod, knowing that our post-op discourse will be worlds different than the pre-op.

.

*PACU=Post-Anesthesia Care Unit

**MAC=monitored anesthesia care

Step 2 CK Throw Back, from Gyn-Onc

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10 comments on “First Impressions

  1. on thehomefrontandbeyondl
    October 26, 2012

    your posts are so honest, true to life, and grim yet have a great human-ness

    • mullberrywhine
      October 26, 2012

      Thank you very much. I just try to capture what I – and those I have opportunity to see – live.

  2. kindredspirit23
    October 26, 2012

    Isn’t that the way life is; yet there is a lesson to be learned everywhere and love and joy to be found even in the worst of things.
    Scott

  3. ahyesplans
    October 26, 2012

    The picture you chose is perfect for this story. It’s also one of my favorites- Caillebotte is an often overlooked impressionist. (the art history major in me said)

    • mullberrywhine
      October 26, 2012

      He’s just fabulous – I remember seeing the original in all it’s (giant!) glory in Chicago during a trip with friends in college. I loved it so that I bought a (ludicrously overpriced) card bearing it’s photo. Years later, it’s still on my bedside table, amongst other good (and also scalpingly overpriced) company. I was just waiting for the right story!
      On a side note, majoring in art history must have been wicked awesome. Certainly the sciences – not least of which, medicine – have an artistic beauty all their own, but to study art and history is to study humanity in a different and warm way… Said the microbiology/chemistry major. 🙂

  4. Dr. K
    October 26, 2012

    What kind of condition/disease would cause this so called “shaggy pink-white fluff with patches of black necrosis and hemorrhagic polyps” ? Granted I’m not a medical doctor but I’ve never heard of anything like. Can you expand on this Mrs. Mulberry?

    • mullberrywhine
      October 26, 2012

      Why certainly Dr. K!  

      The female endometrium – the layer of tissue within the uterine cavity – is a lovely, frilly, pinky-white carpet fluffing out to embrace any wayfaring fertilized egg that might happen upon that location – in that time of the monthly female cycle before it all goes to pot and menses begin, that is.  When a female stops menstruating after menopause, the monthly cycle of frilly growth and wicked menstrual sloughing ceases.  To see such a heaped and shaggy endometrium on hysteroscopy (a small scope inserted through the cervical canal into the uterus, here undertaken because Mrs. Jones had experienced new onset vaginal bleeding many years after menopause) in a post-menopausal female guarantees at least endometrial hyperplasia – a “growth gone hay-wire” precancerous state related to endometrial cancer in the same way colon polyps are related to colon cancer.  The hemorrhagic polyps and necrosis suggest at the very least dysplasia and atypia – abnormal cells which await just that one final set of mutations which allow them to become full blown cancer, capable of local invasion and/or distant metastasis.

      Sadly – but not surprisingly – the pathology on Mrs. Jones tissue samples came back as a highly aggressive endometrial carcinoma.

      • Dr. K
        October 26, 2012

        That is really sad. But knowing that she’s in your hands, at least she’ll have the overwhelming support and comfort we know as your bedside manner. I hope she stays strong!

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House Rules

Creative Commons License
Nothing under the table.
***
The views expressed on "Mullberry Whine" are NOT intended to diagnose or treat disease.
***
The med-ed related stories described here are based on real events. Details have been changed in accordance with HIPAA de-identification guidelines to protect confidentiality.
***
Mullberry Whine can be enjoyed daily; there is no unsafe quantity. Real wine, though, should be enjoyed in moderation. At-Risk Drinking for males under 65 is defined as >14 alcoholic beverages per week or >4/day, with >7 drinks a week or >3/day being the cut-off for females under 65 and for anyone, male or female, who has graced this planet for 65 years for more. Drink Mullberry Whine like there are no consequences. But drink alcohol responsibly. Your friends, your family, your health-care provider, and your liver - heck, ALL of the organs in your body - will thank you.
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