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June 13, 2018 Nonfiction

Breaking Up With Pathology

Sara Greenslit

Breaking Up With Pathology photo

At first, it seemed like a poet’s dream day job. A job of watching, then describing. Thin slices of tissue, stained, then viewed under the microscope, structures and colors and shapes and anomalies differentiated and ascribed with precise diction. I had gotten an MFA in poetry, then went back to school to be a veterinarian, something I wanted since I was a kid.

Anatomic pathology was crammed with tiny, gorgeous corners of tissue, and you could only see these intricacies by pausing, siting down, and focusing on a slide. Find the thing, describe it, and then place it in its cataloged family. It was exacting and comforting, how each thing was named, categorized. There was almost a word for everything, and I liked how precise vocabulary contained what seemed impossibly diverse.

The other half of an anatomic pathologist’s tasks was more difficult for me. I had a strong stomach, but it was still too much sensory input. It involves the dismemberment of a whole animal down to respective samples of each of the organs. Known as gross pathology, as in large, but to me, also the dreadful other. Weigh the heart, cut through the skull and remove the brain, slice and tag pieces of lung, lymph node, stomach, liver, intestine, kidney, bladder, spleen, pancreas and adrenal gland, measure any free fluids in cavities, on and on.

The first cuts were always the worst—the large swipe under each of the hind and forelegs on the belly side to allow easier access to the viscera—the axial and femoral veins, once opened, oozed coagulated and black blood. I would look at the pet, then pause, not ready to set forth, to this land of loss. Then a sharp blade through the skin and sinew, the skinning away. Their bodies were cold, stiff, blood often dripping from fluid pooled in the lungs after death, out of nostrils and mouths onto the large stainless steel tables. Sometimes there was a horse, a cow, a llama, a parrot. In the background, occasionally someone was sharpening a knife—swipe, swipe, swipe against a metal rod. I called it the Creepy Christmas: once opened, you never knew what you’d find.

If you were skilled, you could get the pluck out in one piece—tongue, esophagus, heart and lungs. Animals like birds and reptiles have no diaphragms, and their smaller bodies made the de-plucking more satisfying—cleaner, compact, cuts made with a scalpel blade or a tissue scissors, organs falling free from their evolutionary and visceral attachments. Slicing around a hedgehog’s diaphragm was simpler and easier, due to size, than a 90 pound Rottweiler’s, or for that matter, a one-ton breeding bull’s, its belly bloated. Offal = awful. The smaller the animal, the less chance you’d run into a deluge of overflowing fluids.

One writes down lesion descriptions as you work through the necropsy. The paper itself gets stained with blood and feces and fat and small remnants of various organs, yet it neatly states things like 1 multilobulated, white, 3x2.5x2.1cm mesenteric lymph node, affixed to the antimesenteric edge of 3 jejunal loops; 2 round, 2x7x13mm and 2x4x5mm, smooth-edged, flat, red lesions on the caudal aspect of the left lateral cerebellar surface; diffuse, multifocal, pinpoint to 3cm reddish, black, cavitated, round, smooth lesions to liver capsule. First, you describe. Later, give your list of differentials, your reasons behind the lesions.

To make the cuts, to get the diagnosis that so many want to finally know, you had to put the student in the forefront, that perpetually alert and engaged cousin of your whole self, and shelve emotion. Don’t overreact to the reek, the continual arrival of the dead on carts and in bags. Don’t think of those who lost the adored. Don’t think of the individual in front of you. Don’t think of the dizziness, your fatigue at standing for hours on a concrete floor.

I loved the listing of words, the adjectives, the uses of all your senses. A professor held up a gloved fingertip covered in green goo, his other hand holding a knife—Smell this! We resisted, we leaned away. 

•••

During first year histopathology lab, I spent weekends going through hundreds of slides to differentiate heart from colon from kidney. It was back-lit and bright down there, tissues stained pink and black and blue. The spiraling myocardium fibers contract the heart muscle; a goblet cell makes mucus to protect the intestines; the renal glomerulus filters blood, creating urine. We learned the details of the details: the layers of the stomach wall, the white pulp vs. red pulp of the spleen, the pathway of filtering fluids through the liver, through a lymph node. It was a new world, and I was entranced. 

Then the summer between first and second year of vet school, vertigo swooped in and stayed. I fell backward when I walked. I couldn’t wear a backpack or stand up straight—I felt like someone was pulling me from behind my shoulder blades. The room spun when I took notes from the overhead lecture slides. Words bleared on the page, my eyes lagged behind my typing or writing hand. Aphasia reared and I couldn’t find the right words or I wrote them down wrong. I was so very tired, my brain constantly sorting through disjointed stimuli. I wanted to sleep, the only time I wasn’t dizzy.

My mother constantly worried I would drop out of school, but I reassured her, No. No, I had worked too hard to get here, going back to school at 33. I had left a job in copywriting, smothered by rising, smoldering panic. I hated my cubicle, I hated the wasted hours. Vet school was my choice out.

The neurologists ruled out multiple sclerosis and brain tumors, stroke and Meniere’s, otoliths, dehydration, as well as infectious, inflammatory and degenerative diseases. All diagnoses funneled into idiopathic vertigo, or We Don’t Know Why. I was told my symptoms would not progress, that I would not die. I would have to find a way to adjust.

•••

The fine eye movement needed to use a microscope sent me off into spin and nausea. The act of zooming in on fine detail, the complexity hidden until it was magnified and in focus—something I no longer could do, something I had been smitten with since elementary school. I had set up my own science kit at home, and the scope used a mirror to reflect sun into the vision field. The lake water was disordered and dense with innumerable creatures, oblivious and amazing, and an onion skin was almost filigree. I did not want to give this up.

But my tilting brain said, No, find something else to love. You can’t walk without touching the wall, but you can rally to push through vet school since you have invested so much time and effort for the final prize: DVM after your name. But you cannot survive the 80-hour weeks of an internship and then three years of residency, all while spiraling and seasick. It was sudden and severe, my illness, and my aim in becoming a specialist was erased. I was headed to general practice, something I did not want—too wide a reach of knowledge and too much client-time for an introvert. I hoped to narrow my professional focus, to be better at one thing, but now I was skittering toward the land of knowing everything a little, but not very well. 

There were other hidden losses to quitting path. I fit in with the word-obsessed, quirky folks. I felt comfort in attending rounds twice a day, the same small group, morning and evening. At the start of the day, the path professors and the ocular path fellow would work through stacks of slides that never got boring. We sat around a multi-headed scope, crammed at the eyepieces like members at a too small boardroom table. We only looked at eyes, each globe sliced vertically through its midpoint, the circular route repeated each time: let’s drive from cornea to anterior chamber to iris to drainage angle to lens, swoop along the ten layers of retina and choroid, stop at the optic nerve. Repeat along the symmetric half, note what’s irregular, what’s not. And at the end of the day, we’d all go to gross path rounds—see what surprises had been unearthed, the challenge of who was right in the end. We’d laugh, we’d nod.

I didn’t want to lose this group of people, this comfort. I also wanted a space away from the chaos of the hospital, where things were understandably often emotional and steeped with exhaustion. I wanted my own desk in my own room, like a writer.

•••

But the true breakup was due in the end to gross path, the tissue as organs in front of you, not the microscopic. Vertigo took my ability to saunter and linger through the microscopic. Gross path, with its panoply of fetor, took my stomach and will. In the end, I could not imagine myself after graduation, working as pathologist, stuck in viscous rank.

So how does one fall away from loving words in this matter’s manner, even the diseased? It came upon like a flash, a No, I cannot. All it took was a moment during second year pathology lab, during the reproductive section—a pyometra, a cow’s uterus filled with pus. The uterus was on a tray, splayed flat in its natural T- shape, but swollen, distended, flaccid. And when poked, its surface bounced back like a loosely filled water balloon. The cervix was clamped shut so that the purulent material stayed in the organ, but the stench was there, the kind I later learned with greater detail fourth year during necropsy rotation, a rotted intimacy that gets in your hair and your skin, that you cannot shower off. Yes, the waft of formalin was everywhere, and that smell follows you, too.

Almost every vet student loves pus—loves to lance an abscess, squeeze the pustule on the chin of a cat with acne. Expulsion and cleansing are satisfying. We prided ourselves on who could tolerate the repulsive the most.

But this did not stop the gasps, the exclamations, the sheer declarations of grotesqueries during necropsy. Give a student an intra-abdominal, walled-off abscess in a bull, which once opened, leaks putrid, mint-grey material, gallons of it, from a watery thickness to jello, and you will not be hungry for dinner. Luckily I was not assigned to this case—no one wanted to crawl into the carcass. Once inside, that person had work her way outward, through the gristle and havoc. And then throw the bits not needed into many industrial grey garbage cans on wheels. You wear brown coveralls, knee-high barn boots, a long apron, protective eyewear, gloves. You put your hair up the best you can. But it’s never enough. Something somewhere always seeps, leaches, oozes, sticks.

You keep working despite the stress of national boards coming up, of hearing others getting job offers or applying for the internship match program. Sharpen your knife, incise a golden retriever’s peritoneum, subsume your jealousies, your hefty anxieties about the future.

Necropsy rounds for the hospital cases were in a cemented, small amphitheater, each weekday at 4:30. Vet folks stood in tiered rows as students held up trays of organs and animal bits, described and diagnosed. You waited, in your stained apron, sharp tools in hand. Afterward, you hosed the blood and loose bits down the drain, packed your specimens in tupperwares of formaldehyde. From the outside, we must have looked like a small gathering of lunatics. It was a gory asylum, and I was glad when my required two weeks were done.

I grinded through vet school towards one thing, thinking I could specialize, but then I got something off the map, a derailment by illness. Nothing seemed clear ahead. The not-knowing, the ambiguity admixed with bewilderment, this stayed.

These words will echo out of my mouth to future clients: We don’t know why your pet got sick, we don’t have a name for the illness, and sometimes even pathologists can’t find the answer. Getting vertigo, it was my first rough lesson on learning to say, I don’t know, over and over.

image: Tara Wray


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