Inspissated

Today I wrote a necropsy report using the word "inspissated." It's a word that I didn't even know existed before vet school. But I have a job where using cool words like that is a regular occurrence.

The necropsy/autopsy is a very old medical tool. There are some fairly strict rules for how to go about it, and it would be easy to dismiss these rules as a bit old fashioned. Our understanding of the pathology of disease at the molecular level has exploded in the past few decades. But here we are, still examining animal remains with our eyes and fingers (and noses--I've made some interesting diagnoses based on characteristic odors). And while in plenty of cases I will request additional diagnostics such as PCR (polymerase chain reaction) for a specific virus--a tool that was only developed in the early 1980s--I can often reach a conclusion in my necropsy cases based only on gross findings (in this case, gross means obtained by visual examination).

So in no particular order, here are some of my recent cases which required no additional testing:

• heat prostration in dogs (5 cases in September alone)
• a dog whose chest was pierced by small caliber bullet or sharp object (nicked a large vessel, dog died of shock due to loss of blood, although the lungs were also collapsed which probably didn't help this pup); I found the 2mm entry wound because I always do a complete physical examination of the exterior of my cases before I begin the necropsy, and I was able to follow the damaged tissue trail into the chest
• pyometra (bacterial infection in the uterus) in an unspayed female pitbull (backyard breeder)
• chronic, severe footpad dermatitis in some commercial broiler breeder hens and roosters (the pus in the abscesses in their feet became inspissated)
• a dog whose chest and abdomen were filled with blood due to a very large, ruptured hemangiosarcoma on its spleen (dog also died of shock due to sudden loss of blood; I estimated the volume of blood inside its abdomen alone to be 3 L, which was over half the blood in its body)
• a middle-aged male Boxer with progressive neurological signs--when the case came in, I predicted a mass in its brain and I was right: it was an aggressive oligodendroglioma (Boxers are considered textbook models for brain tumors)
• two backyard laying hens (different owners) with astonishingly advanced ovarian/oviductal carcinoma
• a goat with anemia that had horrible intestinal parasites--anemic small ruminants have Haemonchus in their abomasums (one of the forestomach compartments) until proven otherwise, and there was no proving otherwise in this case
• a dog that died suddenly--it had so many whipworms in its cecum that I called it a "Trichuris burrito"--whipworms are common intestinal parasites but are easily controlled with modern parasiticide products which this dog had not received
• a cat with a SINGLE heartworm in its right atrium and horrific heart disease (one heartworm is enough to kill a cat)
• a calf that had been banded improperly so that the testicles were pushed back inside and an infection developed at the site where the band was placed; the band and empty scrotum fell off but the infection ascended into the abdomen, and ultimately the calf died of bacterial sepsis (I only figured this out when I found the infected testicles inside his abdomen; all evidence of the scrotal sac and band were gone; it was a bit of an awkward moment when I called the producer and asked, "Um, did you castrate this animal? Because I found both testes inside it..."

All of these cases were from the past 5-6 weeks, and they are a fraction of my actual case load. Since I started in July, I have performed 89 solo necropsies. That's actually more than 89 individual animals since the commercial poultry producers usually submit between 10 and 30 birds.

I always try to approach a case with some differentials in mind, and I do this to help focus my attention on particular organs or tissues. Before I do the necropsy, I read the submission form and whatever history I am provided. I might call the producer or referring veterinarian to get more history. I often look at papers or pull a textbook off the shelf and skim a chapter or two. And when I perform the necropsy, I follow the old fashioned rules--be thorough, be systematic. Look at everything. You might decide it is normal but you still need to look at it.

Sometimes following the old fashioned rules are all you need to close a case.

Just Look At This Dude!

Look at this bug trying to pass himself off as some dried up pine needles hanging off the wires. He's been there all day.

Inappropriate

Taken out of context, nearly every conversation that I have at work makes me sound like a psychopath or totally unhinged. Either way, when added to the general funk that hangs about my person on most necropsy days, I am now mostly unfit for normal adult society.

During our first night in Archie's agility class, I was asked by the teenaged daughter of one of the women if I saw mostly dogs. She thought I was a small animal clinician. I told her, "Oh, no, I work with all species, as long as they are dead." Which in the nanosecond between thought and words leaving my mouth seemed like a funny joke. In reality, neither the girl nor her mother spoke to me again that night. (I've since mended things with the mother.)

The director of the lab mentioned the fancy photography table out on the necropsy floor. He wanted to know if I wanted to use it. I told him, "I have indeed been stepping up our game on photographs but I've been having quite a bit of success with rinsing the tissues and posing them on a clean cutting board." And he just nodded like this was a normal thing to say.

A woman brought in a gecko for a necropsy around 3pm on Friday. That's kind of late in the day--everyone is thinking about heading home, what they will make for dinner, what they will be doing for the weekend. But in my limited experience with reptiles and amphibians, I know they autolyse extremely quickly. The gecko would have melted into a puddle of gecko goo if I left it until Monday. So I grabbed it from Receiving and went skipping down to necropsy to get set up. One of the lab techs from bacteriology saw me and said, "Wow, so much energy for Friday afternoon." And I replied with considerable enthusiasm while brandishing the small, already rather smelly box at her, "I get to necropsy this gecko!" She nodded slowly, eyes widening, and said, "Oh" while walking away more quickly than necessary.

I've had considerable success at arriving at some sort of diagnosis for most of my cases to date. But I had a case with a cat last week that completely stumped me. The director asked me about my conclusions for the cat, and I said, "Well, the only problem I could find is that she's dead." He's starting to get used to me, but that reply even stopped him for a couple of seconds.

To a much greater degree than most human medicine practitioners (with the exception of certain specialists), veterinarians directly confront death on a daily basis. Compassion fatigue is a very real problem in vet med. Suicide rates for veterinarians exceed those of human medicine doctors. Clinicians have to euthanize animals every single day. Every. Single. Day. In a busy emergency clinic, they will be performing several euthanasias per day. They have to deal with grieving owners, who may be in shock, may be enraged, may be distraught with grief. It's a heavy burden. Finding the middle path between becoming emotionally upset yourself and not having any emotional reaction at all is very hard.

I am somewhat shielded from that. I do not have to euthanize animals, but I do deal with upset and grieving owners and with upset and grieving fellow veterinarians who had to euthanize the animal they are submitting to the lab. And my own job is to then perform very invasive actions on the remains of the animals. It is always jarring to me to see someone's beloved pet lying on the metal table, still with an IV catheter in place covered with vet wrap.

The way I deal with my personal emotions is to take a couple of minutes and carefully examine the exterior of every animal. I run my hands over every inch of them. Of course that is just good pathology practice, but it also gives me time to think about the life each animal had. Was it cared for? Was it loved? It's a way for me to honor that animal, and thank them for letting us try to learn what happened to them. Nobody I work with knows that I do this.

My inappropriate comments are a release valve that let me blow off emotional steam. But they are not intentionally disrespectful. Vet school is so immersive that it is hard to remember that the black humor so common in our profession is usually not appropriate outside of those settings. Now that I'm out in the real world more often, it's hard to be mindful of how others perceive my job.