Don't bother going into Kroger or Wal-Mart here in Little Rock. There's still plenty of panic buying and hoarding going on. I am baffled at their failure to limit the number of "essential" items that someone can buy. All paper goods, most cleaning supplies, eggs, all forms of milk, canned goods, pasta, vitamins and supplements and OTC medications--rows and rows of empty shelves. However, Whole Foods and Trader Joe's still seem to have a decent supply of food, particularly fresh food. Need deodorant? Too bad. Need a nice head of cauliflower? Trader Joe's has big ones for a decent price.
It's interesting how the word "essential" has taken on new, even sinister meanings. In its unavailability, toilet paper has become essential. My job is essential. I am the only person along my street that still goes to work every day. No teleworking is possible for people who do lab-based work. My schedule hasn't really changed all that much. It feels strange to be going through normal daily routines when nobody else around me is doing the same.
At the lab, the number of necropsy and tissue biopsy submissions has dropped off quite a bit. We didn't have a single new small animal necropsy case last week. Still plenty of goats, chickens, and calves, though. Veterinary clinics are generally deemed essential businesses (there's that word again) even in areas where there are more stringent business closure actions than here in Arkansas. But they have to limit the procedures they can perform either by decree or because they have limited PPE and have to ration it out for the critical life-saving procedures.
We wear N95 masks when we do necropsies. We now have to ration them by wearing them for several days in a row. Even so, we are at much lower risk than human health care providers who have to re-use their masks. Sure, our exposure risks include some bacteria and viruses that can kill us, but those cases are rare, relatively predicable (we can identify those high-risk cases early), and we can further mitigate risks by moving the necropsies into a fume hood (if it's a small animal). Nurses and doctors are definitively being exposed to a virus that can kill them--their risk skyrockets with increased exposure. It's a bad situation for them.
Our lab has donated swabs and masks to the Department of Health. And it looks like some state employees who have experience in running PCRs are going to be seconded to the Department of Health. Their regular job may not be essential but their knowledge is.
Stay home if you can. Wear gloves when you have to buy gas. Limit your trips into the grocery store--and wear gloves in there too. No nitrile exam gloves? Use winter gloves and wash them. Alcohol in a spray bottle makes an excellent, clothing-friendly disinfectant. Don't panic. Check on your neighbors. Be polite.
Sunday, March 29, 2020
Saturday, January 25, 2020
Phone Call
While I don't regularly have to work after-hours or nights or weekends, there are exceptions. On Christmas Eve, I did a necropsy on a police K9. On MLK Day, my colleague and I did a necropsy on a racehorse that collapsed on the track that morning. These are high-profile cases that require us to provide a fairly immediate response. All after-hours cases come in via a dedicated phone that my colleague and I swap between us every few weeks. Right now, I have that phone. Last night, it rang at 2:17am.
I was asleep but jerked awake right away. I fumbled around a bit, and managed to answer the phone in time. It was a guy who told me that his dog had just died. He wanted us to do a necropsy so he could find out what happened.
I always try to manage expectations for these companion animal owners, because necropsies are not magic. Our track record is very good, but we don't always find a cause of death in every case. And for this kind of case, we wouldn't be doing the necropsy until Monday. We briefly talked about a few logistics (we have a dock cooler where companion animals can be dropped off after-hours).
But it turned out that what this guy really wanted was to talk to somebody about his dog. I was that somebody.
So I took a deep breath, sat up and rearranged my pillow and blankets. I spent about 20 minutes on the phone with this guy, talking about sharing our lives with dogs. Talking about seeing our dogs get old. Talking about grief. My eyes kept drifting across my pack--Archie curled up under the covers at my feet, Azza under her own blanket at the other end of the bed, Mimi tucked up next to me, belly in the air, and the cat curled up next to her. I kept this guy on the phone to make sure he heard the words he needed to hear.
Don't misread this. This story isn't about me. It's about being a caring human being. Life lessons.
I was asleep but jerked awake right away. I fumbled around a bit, and managed to answer the phone in time. It was a guy who told me that his dog had just died. He wanted us to do a necropsy so he could find out what happened.
I always try to manage expectations for these companion animal owners, because necropsies are not magic. Our track record is very good, but we don't always find a cause of death in every case. And for this kind of case, we wouldn't be doing the necropsy until Monday. We briefly talked about a few logistics (we have a dock cooler where companion animals can be dropped off after-hours).
But it turned out that what this guy really wanted was to talk to somebody about his dog. I was that somebody.
So I took a deep breath, sat up and rearranged my pillow and blankets. I spent about 20 minutes on the phone with this guy, talking about sharing our lives with dogs. Talking about seeing our dogs get old. Talking about grief. My eyes kept drifting across my pack--Archie curled up under the covers at my feet, Azza under her own blanket at the other end of the bed, Mimi tucked up next to me, belly in the air, and the cat curled up next to her. I kept this guy on the phone to make sure he heard the words he needed to hear.
Don't misread this. This story isn't about me. It's about being a caring human being. Life lessons.
Sunday, January 19, 2020
A Love Letter To My Colleague
I've had a couple of long posts simmering in my brain for quite some time, and I thought I'd give one of them an airing. This post is about my colleague, JX. And no, I'm not really in love with him, but this is definitely a love letter.
JX and his wife, both Han Chinese from Xinjiang (that fact alone prompted me to write more than 1000 words on the current political situation in Xinjiang, which I subsequently deleted, as it's not the point of this post), have been in the US for close to 10+ years. He's got a good applied veterinary job with the state, she's got a good research job with the enormous medical research university here. Between them, they hold many degrees and accreditations.
Now I've got to loop in some old hair-raising tales from our lab. For years, the board-certified veterinary pathologists were stabbing each other in the back. They would sit on cases like they personally owned all data and test results. They would claw and scratch anyone who even dared to ask about the status of a case. They would literally close their office doors and refuse to communicate with lab techs, submitting veterinarians, farm managers, and especially co-workers. Cases would drag on for months.
My colleague JX was hired into this quagmire with the expectation that he would handle all veterinarian-submitted cases that didn't involve tissue or a body. And that's what he did for several years, until that toxic workplace imploded on itself.
I was told by the current lab director that the first time my colleague JX went onto the necropsy floor, the board-certified pathologists wasted no time showing up in the director's office to complain about the "contamination."
And here we are, at the heart of this post. Racism, egotism, white privilege. It all makes me sick to my stomach.
When the implosion occurred, and the racist, egoistic, privileged pathologists quit en masse, my colleague JX was left to hold down the fort in necropsy for months until I showed up in July of last year. Talk about trial by fire. He was certainly qualified but had limited necropsy experience to that point. JX was thrown into the deep end of the pool...and he excelled. He rose to the occasion, and he learned what he needed to learn despite the lack of supervision, guidance, and mentorship.
When I arrived, I met a seasoned gross pathologist, a solid veterinary diagnostician. He freely and generously offered his opinion...but only when asked. He acknowledged that our lab section was in desperate need of supervision...but he didn't want to be the person in charge. When I was made supervisor of our section, he told me, "I have your back. I will support all decisions that you make." How awesome is that? Any supervisor ever would be over the moon to hear that from a high-level report.
And here's the thing. JX might not be in charge, but I don't make very many decisions without consulting with him first. He and I talk about our active cases every day--we discuss what our differentials are, what ancillary tests we might want to run, what results have come in and how they are to be interpreted, and what is important and what is just of "academic" interest. Our discussion are loud, lively, and often involve citing references to each other. Our lab director told me privately that he often has no idea what we are arguing about most of the time, but that he loves overhearing us. In fact, JX and I work so closely that we do necropsies together, and even trade cases between ourselves. This drives Receiving crazy as they want to know "who has this case" but I tell them, JX and I will sort that out later.
JX took in a racehorse today. He texted me to let me know. I replied, "When do you want to do the necropsy?"--it's his case, after all. It's a holiday on Monday and the lab is officially closed and our techs are not available. He said, "Your thinking?" and I replied, "Insured. We shouldn't wait. Tomorrow morning?". He replied, "9am". Perfect. He's in charge, I will be his tech, and it will be a fantastic morning in necropsy with my colleague.
I've had plenty of colleagues and mentors in my checkered career(s). But JX stands out. Professional. No drama. Amazing powers of observation (he found a PDA in a calf, super rare). Thorough but level-headed, so he isn't obsessive. He is kind. He is perfectly happy to indulge in black humor. He thinks outside of the box. He is willing to take risks. But he does not want to be in charge. And here I am, bossy-pants, ready to tell everyone what to do. Match made in heaven.
This is a love letter to my colleague. JX, because of you, I am a better veterinarian, a better gross pathologist, and a better manager.
JX and his wife, both Han Chinese from Xinjiang (that fact alone prompted me to write more than 1000 words on the current political situation in Xinjiang, which I subsequently deleted, as it's not the point of this post), have been in the US for close to 10+ years. He's got a good applied veterinary job with the state, she's got a good research job with the enormous medical research university here. Between them, they hold many degrees and accreditations.
Now I've got to loop in some old hair-raising tales from our lab. For years, the board-certified veterinary pathologists were stabbing each other in the back. They would sit on cases like they personally owned all data and test results. They would claw and scratch anyone who even dared to ask about the status of a case. They would literally close their office doors and refuse to communicate with lab techs, submitting veterinarians, farm managers, and especially co-workers. Cases would drag on for months.
My colleague JX was hired into this quagmire with the expectation that he would handle all veterinarian-submitted cases that didn't involve tissue or a body. And that's what he did for several years, until that toxic workplace imploded on itself.
I was told by the current lab director that the first time my colleague JX went onto the necropsy floor, the board-certified pathologists wasted no time showing up in the director's office to complain about the "contamination."
And here we are, at the heart of this post. Racism, egotism, white privilege. It all makes me sick to my stomach.
When the implosion occurred, and the racist, egoistic, privileged pathologists quit en masse, my colleague JX was left to hold down the fort in necropsy for months until I showed up in July of last year. Talk about trial by fire. He was certainly qualified but had limited necropsy experience to that point. JX was thrown into the deep end of the pool...and he excelled. He rose to the occasion, and he learned what he needed to learn despite the lack of supervision, guidance, and mentorship.
When I arrived, I met a seasoned gross pathologist, a solid veterinary diagnostician. He freely and generously offered his opinion...but only when asked. He acknowledged that our lab section was in desperate need of supervision...but he didn't want to be the person in charge. When I was made supervisor of our section, he told me, "I have your back. I will support all decisions that you make." How awesome is that? Any supervisor ever would be over the moon to hear that from a high-level report.
And here's the thing. JX might not be in charge, but I don't make very many decisions without consulting with him first. He and I talk about our active cases every day--we discuss what our differentials are, what ancillary tests we might want to run, what results have come in and how they are to be interpreted, and what is important and what is just of "academic" interest. Our discussion are loud, lively, and often involve citing references to each other. Our lab director told me privately that he often has no idea what we are arguing about most of the time, but that he loves overhearing us. In fact, JX and I work so closely that we do necropsies together, and even trade cases between ourselves. This drives Receiving crazy as they want to know "who has this case" but I tell them, JX and I will sort that out later.
JX took in a racehorse today. He texted me to let me know. I replied, "When do you want to do the necropsy?"--it's his case, after all. It's a holiday on Monday and the lab is officially closed and our techs are not available. He said, "Your thinking?" and I replied, "Insured. We shouldn't wait. Tomorrow morning?". He replied, "9am". Perfect. He's in charge, I will be his tech, and it will be a fantastic morning in necropsy with my colleague.
I've had plenty of colleagues and mentors in my checkered career(s). But JX stands out. Professional. No drama. Amazing powers of observation (he found a PDA in a calf, super rare). Thorough but level-headed, so he isn't obsessive. He is kind. He is perfectly happy to indulge in black humor. He thinks outside of the box. He is willing to take risks. But he does not want to be in charge. And here I am, bossy-pants, ready to tell everyone what to do. Match made in heaven.
This is a love letter to my colleague. JX, because of you, I am a better veterinarian, a better gross pathologist, and a better manager.
Saturday, January 04, 2020
Some Unusual Production Animal Necropsy Cases
This is the season for beef cows to be calving and sheeps to be lambing, so we are seeing a spike in those animals coming into the lab for necropsy. As a result, I've had four very interesting cases in the past couple of weeks. It's a good thing my professional interests in reproductive pathologies has expanded to include neonatal pathologies!
In case 1, a four-day old beef calf was brought in. Like nearly all of these cases, it was "fine the night before, dead the next morning." The calf had compelling evidence of infection with the bacterium Clostridium. Clostridium species are anaerobic, and live in the soil, so they are everywhere. You already know about two common Clostridium species because they cause botulism and tetanus, diseases that affect both humans and animals. In cattle, other species cause necrosis of skeletal muscle tissue, with a preference for muscle around the thigh and hip joint so the disease is referred to as "black leg." The bacteria also have a preference for heart muscle. In addition to making black patches in muscle, these bacteria produce gas that makes tissues "bubbly" (emphysematous is the doctor word), and they cause gelatinization of fat. Clostridium infections also have a very distinctive "sewer" smell that is usually strong enough to defeat face masks. A lot of the other clinical signs of Clostridial disease are caused by circulation of endotoxins that the bacteria secrete.
So this calf was infected with Clostridium but it wasn't clear at first why. Yes, it died from the clostridial infection and the endotoxemia, but there had to be some precipitating event. Neonatal calves don't have a fully functional rumen yet, and when they nurse, milk bypasses the rumen and goes straight into the abomasum, the glandular chamber of ruminant forestomachs. This calf had huge, greasy, white chunks filling its abomasum, which was itself larger than it should have been. Abomasal bloat has been linked to overgrowth of ... yes, Clostridium bacteria. And Clostridium bacteria have yet another special talent--they cause agglutination of milk proteins. We cultured the same species of Clostridium from the abomasal fluid, from affected skeletal muscle, and from heart muscle. Even though the dam had been vaccinated for Clostridium, a sequence of unfortunate events cascaded through this calf to cause its death.
In case 2, another 2 to 3 day old beef calf was brought in (actually, on the same day as the calf in case 1). This calf had nearly identical clostridial lesions in skeletal muscle and its heart. However, there was no evidence that this calf had ever nursed. The diagnosis in this case was something called failure of passive transfer. When neonatal mammals don't get colostrum from their dams, they become susceptible to many viral and bacterial diseases. This calf never got any antibodies from its dam. Although the first case makes it clear that colostrum is not the only factor for survival (necessary but not sufficient), a complete lack of it is nearly always fatal for these neonates. If it hadn't been Clostridium, it would have been some other virus or bacteria that would have killed this calf.
In case 3, a 10 day old beef calf was brought in. Good necropsy technique means you conduct it in a systematic manner, and try to do it the same way every time, no matter what species you are working on. The actual order of things can vary somewhat, but most pathologists lay the animal on its side, open the abdomen, remove one half of the rib cage, then fully examine all thoracic structures (more or less the lungs, heart, esophagus, trachea, larynx, oral cavity). When we opened the abdomen, it was obvious that the problem was somewhere in there, but I stuck to the program and examined the thorax first. No lesions at all. Everything looked fine.
When you work on the abdomen, you often remove the liver and spleen and kidneys on their own, then examine the intestinal tract from one end to the other. In this calf, the forestomachs looked okay but the small intestines were necrotic and bloody. I was gently tugging on the entire intestinal tract to pull it out to examine it in more detail when suddenly the colon just popped out. I stood there holding a blind sac in my hand for several seconds before it registered what I was seeing. Normally, the colon attaches to the rectum, and normally, you shouldn't be able to "pull out" the colon. This colon did not connect to anything. Normal colons are fairly muscular organs, but this one was distended and flabby. Then I noticed that the muscles lining the pelvic inlet were green and covered with shaggy bits of fibrin. And then I noticed that the two sets of anal sphincter muscles (one is skeletal muscle, the other is smooth muscle) were completely missing. There was no anus or rectum in this animal. There was a hole in the skin below the tail, so on my initial physical exam it looked normal from the outside.
This was an extremely rare and severe case of the congenital abnormality called atresia ani. This abnormality can vary from mild forms in which the anal opening is absent but all of the other organs are present (this can be corrected surgically if it is identified early) to cases like this one in which the colon doesn't reach all the way to the rectum/anus. This case was even more severe because of the additional absence of anal sphincter muscles.
Because the animal couldn't defecate, the intestines became necrotic. Bacteria and dead cell contents leaked out (there may also have been a small rupture, hard to tell when the tissues are so altered), causing septic peritonitis. Circulation of dead cell contents caused septicemia and shock and death. I shared details of this case with a few colleagues and was told that I may never see this rare abnormality in my career again.
The fourth case was a pregnant ewe. Like the calves, she was "fine the day before, dead this morning." I spoke to the owner when he dropped her off, and I learned that she was late term and that he didn't have very good management practices. Sheep and goats that aren't dewormed regularly get a nasty abomasal worm called Haemonchus that makes them anemic and can kill both young and adult animals if not treated. Haemonchus was high on my differential list--present until proven otherwise. But sheep and goats are also quite susceptible to something called pregnancy toxemia, especially if they have multiple fetuses.
This ewe was small, 120 pounds, and extremely overconditioned (fat). A quick physical exam eliminated anemia even before we opened her up. Now Haemonchus was off the list (and in fact, we found no parasites in her intestinal tract). She had three nearly full-term fetuses, all about the same size and without gross defects or evidence of early death. No evidence of viral or bacterial placental infections. Her uterus was enormous, and had squashed her rumen up next to her spine and forward towards her lungs. The papillae that line her rumen were hard and shrunken. Her liver was huge and yellow. All of this, sadly, pointed to pregnancy toxemia.
It affects ewes who are either super skinny or super fat when they are in late gestation, and who have multiple fetuses. The energy demands of those fetuses cause the ewe to first use up her liver glycogen stores, then to begin to use her body fat stores to keep the fetuses alive. In the case of the skinny ewe, there is no body fat and she dies. In the case of the fat ewe, the amount of fat sent to the liver overwhelms it completely, and she begins to pump out ketone bodies and develops rumen acidosis. The papillae respond to the rumen acidosis by becoming keratinized. The liver cells become stuffed with fat and stop working. And she dies.
Pregnancy toxemia is preventable but it requires fairly close monitoring of the ewes before and during pregnancy, and adjustment of their diet to keep them in good condition before they become pregnant. It's also important to identify ewes who have multiple fetuses, usually via ultrasound, so they can be separated and fed separately.
These were not my only cases in the past two weeks (the intake of dog and cat cases is fairly regular), but I thought it was cool that all four of these production animal cases came in so close together. I also appreciated these cases because they really stretched my diagnostic skills.
In case 1, a four-day old beef calf was brought in. Like nearly all of these cases, it was "fine the night before, dead the next morning." The calf had compelling evidence of infection with the bacterium Clostridium. Clostridium species are anaerobic, and live in the soil, so they are everywhere. You already know about two common Clostridium species because they cause botulism and tetanus, diseases that affect both humans and animals. In cattle, other species cause necrosis of skeletal muscle tissue, with a preference for muscle around the thigh and hip joint so the disease is referred to as "black leg." The bacteria also have a preference for heart muscle. In addition to making black patches in muscle, these bacteria produce gas that makes tissues "bubbly" (emphysematous is the doctor word), and they cause gelatinization of fat. Clostridium infections also have a very distinctive "sewer" smell that is usually strong enough to defeat face masks. A lot of the other clinical signs of Clostridial disease are caused by circulation of endotoxins that the bacteria secrete.
So this calf was infected with Clostridium but it wasn't clear at first why. Yes, it died from the clostridial infection and the endotoxemia, but there had to be some precipitating event. Neonatal calves don't have a fully functional rumen yet, and when they nurse, milk bypasses the rumen and goes straight into the abomasum, the glandular chamber of ruminant forestomachs. This calf had huge, greasy, white chunks filling its abomasum, which was itself larger than it should have been. Abomasal bloat has been linked to overgrowth of ... yes, Clostridium bacteria. And Clostridium bacteria have yet another special talent--they cause agglutination of milk proteins. We cultured the same species of Clostridium from the abomasal fluid, from affected skeletal muscle, and from heart muscle. Even though the dam had been vaccinated for Clostridium, a sequence of unfortunate events cascaded through this calf to cause its death.
In case 2, another 2 to 3 day old beef calf was brought in (actually, on the same day as the calf in case 1). This calf had nearly identical clostridial lesions in skeletal muscle and its heart. However, there was no evidence that this calf had ever nursed. The diagnosis in this case was something called failure of passive transfer. When neonatal mammals don't get colostrum from their dams, they become susceptible to many viral and bacterial diseases. This calf never got any antibodies from its dam. Although the first case makes it clear that colostrum is not the only factor for survival (necessary but not sufficient), a complete lack of it is nearly always fatal for these neonates. If it hadn't been Clostridium, it would have been some other virus or bacteria that would have killed this calf.
In case 3, a 10 day old beef calf was brought in. Good necropsy technique means you conduct it in a systematic manner, and try to do it the same way every time, no matter what species you are working on. The actual order of things can vary somewhat, but most pathologists lay the animal on its side, open the abdomen, remove one half of the rib cage, then fully examine all thoracic structures (more or less the lungs, heart, esophagus, trachea, larynx, oral cavity). When we opened the abdomen, it was obvious that the problem was somewhere in there, but I stuck to the program and examined the thorax first. No lesions at all. Everything looked fine.
When you work on the abdomen, you often remove the liver and spleen and kidneys on their own, then examine the intestinal tract from one end to the other. In this calf, the forestomachs looked okay but the small intestines were necrotic and bloody. I was gently tugging on the entire intestinal tract to pull it out to examine it in more detail when suddenly the colon just popped out. I stood there holding a blind sac in my hand for several seconds before it registered what I was seeing. Normally, the colon attaches to the rectum, and normally, you shouldn't be able to "pull out" the colon. This colon did not connect to anything. Normal colons are fairly muscular organs, but this one was distended and flabby. Then I noticed that the muscles lining the pelvic inlet were green and covered with shaggy bits of fibrin. And then I noticed that the two sets of anal sphincter muscles (one is skeletal muscle, the other is smooth muscle) were completely missing. There was no anus or rectum in this animal. There was a hole in the skin below the tail, so on my initial physical exam it looked normal from the outside.
This was an extremely rare and severe case of the congenital abnormality called atresia ani. This abnormality can vary from mild forms in which the anal opening is absent but all of the other organs are present (this can be corrected surgically if it is identified early) to cases like this one in which the colon doesn't reach all the way to the rectum/anus. This case was even more severe because of the additional absence of anal sphincter muscles.
Because the animal couldn't defecate, the intestines became necrotic. Bacteria and dead cell contents leaked out (there may also have been a small rupture, hard to tell when the tissues are so altered), causing septic peritonitis. Circulation of dead cell contents caused septicemia and shock and death. I shared details of this case with a few colleagues and was told that I may never see this rare abnormality in my career again.
The fourth case was a pregnant ewe. Like the calves, she was "fine the day before, dead this morning." I spoke to the owner when he dropped her off, and I learned that she was late term and that he didn't have very good management practices. Sheep and goats that aren't dewormed regularly get a nasty abomasal worm called Haemonchus that makes them anemic and can kill both young and adult animals if not treated. Haemonchus was high on my differential list--present until proven otherwise. But sheep and goats are also quite susceptible to something called pregnancy toxemia, especially if they have multiple fetuses.
This ewe was small, 120 pounds, and extremely overconditioned (fat). A quick physical exam eliminated anemia even before we opened her up. Now Haemonchus was off the list (and in fact, we found no parasites in her intestinal tract). She had three nearly full-term fetuses, all about the same size and without gross defects or evidence of early death. No evidence of viral or bacterial placental infections. Her uterus was enormous, and had squashed her rumen up next to her spine and forward towards her lungs. The papillae that line her rumen were hard and shrunken. Her liver was huge and yellow. All of this, sadly, pointed to pregnancy toxemia.
It affects ewes who are either super skinny or super fat when they are in late gestation, and who have multiple fetuses. The energy demands of those fetuses cause the ewe to first use up her liver glycogen stores, then to begin to use her body fat stores to keep the fetuses alive. In the case of the skinny ewe, there is no body fat and she dies. In the case of the fat ewe, the amount of fat sent to the liver overwhelms it completely, and she begins to pump out ketone bodies and develops rumen acidosis. The papillae respond to the rumen acidosis by becoming keratinized. The liver cells become stuffed with fat and stop working. And she dies.
Pregnancy toxemia is preventable but it requires fairly close monitoring of the ewes before and during pregnancy, and adjustment of their diet to keep them in good condition before they become pregnant. It's also important to identify ewes who have multiple fetuses, usually via ultrasound, so they can be separated and fed separately.
These were not my only cases in the past two weeks (the intake of dog and cat cases is fairly regular), but I thought it was cool that all four of these production animal cases came in so close together. I also appreciated these cases because they really stretched my diagnostic skills.
Thursday, December 26, 2019
Being A Team Player
My closest colleague at work is a Chinese guy. He has a BSVM from a Chinese university, which is educationally equivalent to a DVM. He has not completed the (difficult and expensive) program that would certify him to practice as a DVM in the U.S. But he has the same job title as me, and in the 18-month gap when they were looking to fill my position that also included the 6 or so months that they had to wait for me to finish vet school, he conducted nearly all of the non-poultry necropsies that came through the lab. And for the last three months of that period, he had to do the poultry necropsies too. (For the record, he doesn't like working with birds, which is fine by me as I really like doing avian necropsies.)
Since I started working in July, I have completed over 150 necropsies in multiple species. I split each week's cases with my colleague. Using those numbers, by my back-of-the-envelope-calculation, he likely handled over 500 necropsies during the period that he was on his own. This gave him an incredible breadth and depth of experience, and a deep understanding of pathology of disease.
I find working with him to be quite enjoyable. He's got a dry sense of humor and a keen eye for detail. He and I have different styles on the necropsy floor (one time he put the entire head of a cat in formalin for reasons I still haven't been able to discern), but our styles are compatible so we work very well together. We discuss our active cases every day. We trade cases. We ask each other to look over necropsy reports before they get sent out. We argue about differentials (the director is particularly amused by this as we can get rather excited and loud). We cite papers at each other. We call the other one down to necropsy if we have a particularly interesting finding. I was able to ramp up my own performance very quickly by relying on him for advice, which he shared freely. He is professional, courteous, smart, thinks outside the box, and is happy to indulge in black humor when we need to blow off steam. What's not to like about having a colleague like that?
All of this is an introduction to what I really wanted to rant about. I have learned that my predecessors did not regard my colleague in the same way that I do. When one of the pathologists took him on the necropsy floor to teach him the basics, the other two pathologists ran to the director clutching their pearls, aghast and appalled, complaining that he was transgressing a sacred space. It's of a piece with those two refusing to share any details of their cases with anyone else. I also suspect microaggressive racism lurking around the edges of their behavior, but that is only my opinion. In short, my colleague was dismissed, overlooked, and treated quite unprofessionally.
In contrast, I have come to rely on my colleague. And the feeling is mutual! He tells me often how much he enjoys working with me, that he and I make a great team, that he has my back as I take over as supervisor of our section of the lab. He has no interest in being a visible leader himself, but without a doubt he leads by his actions.
The director has told me several times about a police K9 case from a few years ago that was handled quite poorly by one of the aforementioned pearl-clutchers. I don't have all the details but the necropsy wasn't done promptly, the necropsied body was kept for months instead of being released, and the report was treated like it contained state secrets. The mishandling and delays resulted in bad publicity for the lab.
Yesterday, on Christmas Eve, around noon, I got a call from the police chief of a small Arkansas town about 75 miles from Little Rock. A police K9 had been found dead and they wanted to bring him in for a necropsy. I don't typically have to work nights or weekends or holidays, but there are a few rare exceptions, and police K9s are one. The chief and I worked out details of timing. And the very next person that I called was my colleague. "I know you are on vacation, and it's a holiday on top of that, but I need your help," I told him. He said, "Absolutely, we are a team. When do I need to be there?" My second call was to the director to assure him that we had this case well in hand.
I ran the necropsy and my colleague acted as my tech, fetching things, taking pictures, managing my necropsy table. The gross findings were definitive, and we were able to determine a cause of death, document it properly, and get the two police officers back on their way home in about an hour. The director will be over the moon. As I drove home, I reflected on how much I have learned from my colleague in the past few months. Our job is unusual and can be physically and emotionally difficult at times. We are going to be more successful if we work together.
I am ashamed that my colleague was treated so poorly in the past, and even though I know that it wasn't my fault or my doing, and that I can't make up for years of poor treatment, I am reaping the benefits of choosing to treat him with the respect and professionalism that he is due.
Since I started working in July, I have completed over 150 necropsies in multiple species. I split each week's cases with my colleague. Using those numbers, by my back-of-the-envelope-calculation, he likely handled over 500 necropsies during the period that he was on his own. This gave him an incredible breadth and depth of experience, and a deep understanding of pathology of disease.
I find working with him to be quite enjoyable. He's got a dry sense of humor and a keen eye for detail. He and I have different styles on the necropsy floor (one time he put the entire head of a cat in formalin for reasons I still haven't been able to discern), but our styles are compatible so we work very well together. We discuss our active cases every day. We trade cases. We ask each other to look over necropsy reports before they get sent out. We argue about differentials (the director is particularly amused by this as we can get rather excited and loud). We cite papers at each other. We call the other one down to necropsy if we have a particularly interesting finding. I was able to ramp up my own performance very quickly by relying on him for advice, which he shared freely. He is professional, courteous, smart, thinks outside the box, and is happy to indulge in black humor when we need to blow off steam. What's not to like about having a colleague like that?
All of this is an introduction to what I really wanted to rant about. I have learned that my predecessors did not regard my colleague in the same way that I do. When one of the pathologists took him on the necropsy floor to teach him the basics, the other two pathologists ran to the director clutching their pearls, aghast and appalled, complaining that he was transgressing a sacred space. It's of a piece with those two refusing to share any details of their cases with anyone else. I also suspect microaggressive racism lurking around the edges of their behavior, but that is only my opinion. In short, my colleague was dismissed, overlooked, and treated quite unprofessionally.
In contrast, I have come to rely on my colleague. And the feeling is mutual! He tells me often how much he enjoys working with me, that he and I make a great team, that he has my back as I take over as supervisor of our section of the lab. He has no interest in being a visible leader himself, but without a doubt he leads by his actions.
The director has told me several times about a police K9 case from a few years ago that was handled quite poorly by one of the aforementioned pearl-clutchers. I don't have all the details but the necropsy wasn't done promptly, the necropsied body was kept for months instead of being released, and the report was treated like it contained state secrets. The mishandling and delays resulted in bad publicity for the lab.
Yesterday, on Christmas Eve, around noon, I got a call from the police chief of a small Arkansas town about 75 miles from Little Rock. A police K9 had been found dead and they wanted to bring him in for a necropsy. I don't typically have to work nights or weekends or holidays, but there are a few rare exceptions, and police K9s are one. The chief and I worked out details of timing. And the very next person that I called was my colleague. "I know you are on vacation, and it's a holiday on top of that, but I need your help," I told him. He said, "Absolutely, we are a team. When do I need to be there?" My second call was to the director to assure him that we had this case well in hand.
I ran the necropsy and my colleague acted as my tech, fetching things, taking pictures, managing my necropsy table. The gross findings were definitive, and we were able to determine a cause of death, document it properly, and get the two police officers back on their way home in about an hour. The director will be over the moon. As I drove home, I reflected on how much I have learned from my colleague in the past few months. Our job is unusual and can be physically and emotionally difficult at times. We are going to be more successful if we work together.
I am ashamed that my colleague was treated so poorly in the past, and even though I know that it wasn't my fault or my doing, and that I can't make up for years of poor treatment, I am reaping the benefits of choosing to treat him with the respect and professionalism that he is due.
Wednesday, December 25, 2019
Orange Basil Lentil Salad
I haven't posted a recipe in quite a while. This is a salad that I've now made twice, with good repeatability. The first time I came up with it, I took it to a party where it was complimented by all. No leftovers either. Yes, it was a bit risky to take a dish I literally created on the spot to a party, but I'm pretty confident in my cooking skills. I made it again last night for my Xmas Eve dinner. Total prep time is about an hour if you take time to drink a glass or two of pinot gris while you are puttering about in the kitchen.
Lentils, 1 to 2 cups dried
Fresh basil, lots
Red onion
Feta cheese crumbles, 6 oz or so (one small container)
Navel orange (one or two depending on size)
Dried cranberries, about 1/2 to 2/3 cup
Fresh greens (arugula, spinach, mixed greens, etc)
Olive oil
Honey
Apple cider vinegar (optional)
Black pepper, fresh ground
Rinse the lentils in a strainer. Cook 1 to 2 cups of lentils on low to medium heat (simmer, don't boil). Don't worry about having extra water as you can drain that off. Use French green lentils if you want to be fancy. Set the lentils aside to cool. When cool, put 1 to 2 cups cooked lentils, drained, in a large salad bowl. The lentils don't take long at all to cook. You can make them ahead of time if you want.
Finely slice a red onion and caramelize with some olive oil. This will take about 20 minutes on low to medium heat. Stir often. Set aside to cool. When cool to the touch, add to the large salad bowl.
Put the feta cheese into the large salad bowl.
Add a large handful of dried cranberries to the large salad bowl.
Finely dice a very large handful of fresh basil leaves. Put 1/3 of the leaves in a measuring cup and put the rest in the large salad bowl.
Note that the order in which you add things to the salad bowl is not actually all that important. Don't add the lentils and onions until they are cool though.
I find this recipe only needs 1 large navel orange but you could use two if you wanted. You might want to increase honey and basil if you use two oranges. Cut the navel orange into quarters and peel two of the quarters and divide into sections. Slice the sections into 1 cm-long pieces and add to the large salad bowl. Squeeze the juice out of the other two quarters into the measuring cup.
To the measuring cup, add some olive oil, a tablespoon of honey, and lots of fresh ground black pepper. If you want the dressing to have more of a bite, add 1/2 tablespoon of apple cider vinegar. Otherwise, it will be fairly sweet. Stir very well to dissolve the honey and mix the oil and orange juice.
Add your greens to the salad bowl. Fill that bowl up! Give the dressing another good stir and pour over the top. Gently mix everything well. Enjoy!
Lentils, 1 to 2 cups dried
Fresh basil, lots
Red onion
Feta cheese crumbles, 6 oz or so (one small container)
Navel orange (one or two depending on size)
Dried cranberries, about 1/2 to 2/3 cup
Fresh greens (arugula, spinach, mixed greens, etc)
Olive oil
Honey
Apple cider vinegar (optional)
Black pepper, fresh ground
Rinse the lentils in a strainer. Cook 1 to 2 cups of lentils on low to medium heat (simmer, don't boil). Don't worry about having extra water as you can drain that off. Use French green lentils if you want to be fancy. Set the lentils aside to cool. When cool, put 1 to 2 cups cooked lentils, drained, in a large salad bowl. The lentils don't take long at all to cook. You can make them ahead of time if you want.
Finely slice a red onion and caramelize with some olive oil. This will take about 20 minutes on low to medium heat. Stir often. Set aside to cool. When cool to the touch, add to the large salad bowl.
Put the feta cheese into the large salad bowl.
Add a large handful of dried cranberries to the large salad bowl.
Finely dice a very large handful of fresh basil leaves. Put 1/3 of the leaves in a measuring cup and put the rest in the large salad bowl.
Note that the order in which you add things to the salad bowl is not actually all that important. Don't add the lentils and onions until they are cool though.
 |
| I like feta cheese and used an entire small container. Feel free to exercise more restraint. |
I find this recipe only needs 1 large navel orange but you could use two if you wanted. You might want to increase honey and basil if you use two oranges. Cut the navel orange into quarters and peel two of the quarters and divide into sections. Slice the sections into 1 cm-long pieces and add to the large salad bowl. Squeeze the juice out of the other two quarters into the measuring cup.
To the measuring cup, add some olive oil, a tablespoon of honey, and lots of fresh ground black pepper. If you want the dressing to have more of a bite, add 1/2 tablespoon of apple cider vinegar. Otherwise, it will be fairly sweet. Stir very well to dissolve the honey and mix the oil and orange juice.
Add your greens to the salad bowl. Fill that bowl up! Give the dressing another good stir and pour over the top. Gently mix everything well. Enjoy!
Sunday, December 22, 2019
"You mean they are calling to talk to you about patients that are still living?"
Even though I'm a brand new veterinarian and shiny new gross pathologist, I've got more than two decades of experience as a scientific professional behind me. As a result, I just assumed that I should be doing certain things in my own workflows. For example, I always call the referring veterinarian when I finish a necropsy, usually even before I write my report, and let them know my preliminary findings. Sometimes I don't have a veterinarian contact, so I talk to the poultry house manager or the owner of the beef cow. But the important point is that within a few hours of submitting animal remains for necropsy, our stakeholders get a brief report directly from me. I also started calling vets who submit biopsies, mostly to let them know they sent us an alien baby tissue sample in a woefully inadequate amount of formalin and it would take us a few more days to properly fix the tissue before we could cut it in.
Since making these phone calls seemed to be reasonable and minimally professional, and really didn't take much time at all, you can imagine how astonished I was to learn that the previous holders of my particular job never did these things. Never. Necropsy cases might be open for weeks, and the results never discussed with anyone. One previous pathologist put a sign on his closed office door (the office that I occupy now) stating that he was not to be disturbed for any reason. He never answered his phone either.
My office door is always open. The super nice but very large microscope that I use was deliberately positioned on the desk so that it formed an imposing physical barrier facing the door. I moved it to a small desk on the other side of the room. The light from the windows can be a bit bright sometimes, but I felt that was a small price to pay for getting rid of the physical wall that was between me and everyone else.
I'd been happily rolling along for several months, picking up the phone just about every day to talk to our referring vets, who are located all over the state (I had to put up some maps of counties and cities in Arkansas so I could figure out where these folks were located). Since I assumed this was basic professional courtesy, I was unprepared when one of those vets, who works in a three-vet, mixed animal practice that sends us a ton of necropsy cases, told me that I was a "breath of fresh air" and that I couldn't ever leave the lab. She called me a "treasure." Not much can leave me speechless but I found myself stammering out a reply. And in fact, this happened more than once. Nobody else called me a treasure, but several vets told me that they were extremely appreciative of my efforts to reach out to them about their cases.
Shortly after that, I noticed that vets were calling me. And they were calling to... chat. They would describe some puzzling case they were working on in their clinic then ask my opinion on this or that diagnosis or treatment, often prompting me to look at the phone handset and think, wow, they think I know what I'm doing here. But my geological science background made me very comfortable with exploring a problem with multiple hypotheses that may be overlapping or even mutually exclusive. I can do that with vet med problems too. I am not a naturally glib person, but I love to gab about science, and I always learn new things when I talk to fellow scientists. It seems that my veterinarian colleagues out there in clinics across the state like to gab too, and have decided that I'm either a resource with decent suggestions, or at least a good listener.
I relayed this to the lab director, and he paused then somewhat incredulously said, "You mean to tell me that the vets are calling to talk to you about patients that are still living?" I paused, surprised, and said, "Yes, I think that's exactly what I'm telling you." And he said, "Nobody in your role in this lab has ever accomplished this."
Accomplished simply because I chose to be an engaged professional.
Since making these phone calls seemed to be reasonable and minimally professional, and really didn't take much time at all, you can imagine how astonished I was to learn that the previous holders of my particular job never did these things. Never. Necropsy cases might be open for weeks, and the results never discussed with anyone. One previous pathologist put a sign on his closed office door (the office that I occupy now) stating that he was not to be disturbed for any reason. He never answered his phone either.
My office door is always open. The super nice but very large microscope that I use was deliberately positioned on the desk so that it formed an imposing physical barrier facing the door. I moved it to a small desk on the other side of the room. The light from the windows can be a bit bright sometimes, but I felt that was a small price to pay for getting rid of the physical wall that was between me and everyone else.
I'd been happily rolling along for several months, picking up the phone just about every day to talk to our referring vets, who are located all over the state (I had to put up some maps of counties and cities in Arkansas so I could figure out where these folks were located). Since I assumed this was basic professional courtesy, I was unprepared when one of those vets, who works in a three-vet, mixed animal practice that sends us a ton of necropsy cases, told me that I was a "breath of fresh air" and that I couldn't ever leave the lab. She called me a "treasure." Not much can leave me speechless but I found myself stammering out a reply. And in fact, this happened more than once. Nobody else called me a treasure, but several vets told me that they were extremely appreciative of my efforts to reach out to them about their cases.
Shortly after that, I noticed that vets were calling me. And they were calling to... chat. They would describe some puzzling case they were working on in their clinic then ask my opinion on this or that diagnosis or treatment, often prompting me to look at the phone handset and think, wow, they think I know what I'm doing here. But my geological science background made me very comfortable with exploring a problem with multiple hypotheses that may be overlapping or even mutually exclusive. I can do that with vet med problems too. I am not a naturally glib person, but I love to gab about science, and I always learn new things when I talk to fellow scientists. It seems that my veterinarian colleagues out there in clinics across the state like to gab too, and have decided that I'm either a resource with decent suggestions, or at least a good listener.
I relayed this to the lab director, and he paused then somewhat incredulously said, "You mean to tell me that the vets are calling to talk to you about patients that are still living?" I paused, surprised, and said, "Yes, I think that's exactly what I'm telling you." And he said, "Nobody in your role in this lab has ever accomplished this."
Accomplished simply because I chose to be an engaged professional.
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