Knives, A Puff Of Smoke, and Me. What Could Go Wrong?

John Belushi would have made an excellent neuropathologist!

John Belushi would have made an excellent neuropathologist!

(Rated SG for Slightly Gross)

Do you remember Friday afternoons when you were a kid in school? The teacher’s voice would drone on and on. The minute hand on the wall clock would move slower and slower. Time would freeze.

You kept staring out the window, at the shining sun, at the park at the end of the block. You couldn’t wait to get outside and play some ball. Or snow was on the other side of the glass — and you were looking forward to an evening with friends at Alpine Mountain to practice some downhill ski runs. In any case, it sure was rough waiting those last few minutes.

No matter how bad you thought you had it on those long-past Friday afternoons, you most likely have nothing to compare to my Fridays in the early 1980s when I was a Resident in Pathology at a teaching hospital just outside Chicago. Because every Friday, at precisely 3:30, was brain-cutting time! 

No, that’s not a clever nickname for some devilish oral Q and A the attendings would throw at us, nor was it a dastardly written exam. On Friday afternoons we would literally slice our way through the previous week’s autopsy brains.

I’ve written about autopsies before. But not the secret of brain-cutting. A brain removed at autopsy is a squishy mess. It’s the consistency of that disgusting lemon Jello mold that has been sitting under the hot sun since 11 am at your 4th of July picnic. Trying to examine it fresh is brain salad surgery.

So to prevent brain meltdown at autopsy, the fresh brain is carefully dissected from the cranial cavity (we won’t discuss how you open that up,) wrapped in gauze, and suspended on a network of strings in a large bucket of formalin for at least a week. Put THAT on your bucket list.

But eventually, we had to look at those brains.  So every Friday afternoons Dr. D, our visiting samurai neuropathologist, would join the residents in the autopsy suite. One by one the brains from the previous week’s post-mortems, now solid enough to be cut, would be set before him. Though each had been soaking in running water for several hours in preparation for his attention, the formalin odor was still overpowering to the assembled residents. But the miasma didn’t seem to bother the Master.

Brandishing a long, glistening, and oh-so-sharp two-foot-long stainless steel knife he would approach each brain and go chop-chop-chop. He would then bow slightly and present us with thin slices of sashimied brain laid out in precise rows on a cafeteria tray. With the tip of his blade, he would point out the abnormalities–the tumors, the infarcts, the paleness of the substantia nigra in Parkinson’s Disease. He guided me through the pink blush of increased vessels in Moyamoya Disease, a rare vascular disease whose name — “puff of smoke” in Japanese —  memorialized the appearance of increased blood vessels in an angiogram.

Dr. D had seen it all and explained it all.

Our residents may not have been happy to be in that autopsy suite late on a Friday afternoon. Maybe the good neuropathologist didn’t want to be there either. So many other places we all could have been. But no matter how much we hated it, we learned our neuropathology — at the point of a sword.

But it is a shame that I never did learn how to ski!

Use your very functional brain–VOTE!

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