Speaker 1: Mother Knows Death Presents External Exams with Nicole and Jimmy.
Speaker 2: Hi, everyone, welcome the Mother Knows Death. On this week's
Speaker 2: External Exam, we will be talking with one of my
Speaker 2: best friends. Her name is Christy Salapata Salapata, and we're
Speaker 2: just this is how our friend Ken used to say
Speaker 2: her last name. He used to call her Salapata and
Speaker 2: we missed him. He was an investigator at the medical
Speaker 2: Exammer's office while we were in school, and we loved him,
Speaker 2: and unfortunately he had two heart transplants and ended up
Speaker 2: dying before he was forty years old, and it was
Speaker 2: really sad.
Speaker 3: So, yeah, he was a good dude.
Speaker 2: Yeah he was. So. I first met Christy in two
Speaker 2: thousand and seven in PA schools, and the reason we're
Speaker 2: interviewing her today is because she's a PA like me,
Speaker 2: but she specializes in pediatric pathology, which we have to
Speaker 2: ask her why because I just don't understand why she's
Speaker 2: interested in it. So we're going to talk about it.
Speaker 2: And let's so let's talk about first when we met
Speaker 2: when we were in PA school two thousand and seven, right, two.
Speaker 3: Thousand and seven, we met actually before starting because remember
Speaker 3: you reached out to a couple of us and we
Speaker 3: wound up going out to what was it lunch or
Speaker 3: dinner or something like that. Oh yeah, and that place
Speaker 3: is no longer there.
Speaker 2: That was Oh yeah, that place was this swing that's right.
Speaker 3: Yeah.
Speaker 2: Yeah. So before we started PA school, our program director
Speaker 2: had sent an email out to us welcoming all the
Speaker 2: new kids in the class or the adults I guess
Speaker 2: you would say, and we all reached out to each
Speaker 2: other so we could meet each other because it's it's
Speaker 2: kind of cool when you're starting a program like this
Speaker 2: that's so specific and you want to meet everyone that
Speaker 2: you're going to school with because you're like, how is
Speaker 2: everybody like into this same zech field as me? So
Speaker 2: that really, I would say, like when I met Christy
Speaker 2: and the other girls in my class, we were such
Speaker 2: a tight knit group of people, and that's when I
Speaker 2: really like made a best friend for real, Like, and
Speaker 2: it wasn't until I was like, what was I twenty
Speaker 2: six or twenty seven years old when I started school,
Speaker 2: So but that like we've been kind of inseparable since then.
Speaker 3: That's when the love affair began.
Speaker 2: Yes, So let's talk. She she's a little bit of
Speaker 2: a wild one, so we're gonna have to real her.
Speaker 2: So one funny story that that I do have is
Speaker 2: so when so Christy used to live in the city
Speaker 2: and I lived in Jersey. So I would drive over
Speaker 2: from Jersey every single day and pick up Christie because
Speaker 2: we were rotating in West Philly at similar like different places,
Speaker 2: but a lot of the hospitals were in the same area.
Speaker 2: And I was at Children's Hospital at the time and
Speaker 2: you were at the m a yes, vice versa. Yeah,
Speaker 2: it was. It was something like that. And so I'm
Speaker 2: going to pick up Christy in the morning, and all
Speaker 2: my way to pick her up, I stopped at Wawa
Speaker 2: to get coffee, like I did every day, And that
Speaker 2: was when I met Gabe, actually, right, So I'd meet
Speaker 2: Gabe in wah Wah in the morning and I sat
Speaker 2: there and talked to him for like a couple hours
Speaker 2: out front of Wahwah the day I met him, and
Speaker 2: I just totally didn't call Christy, didn't tell her, like I.
Speaker 3: Wasn't picking up for school. Nothing.
Speaker 2: Yeah, So it was really it was just really funny.
Speaker 2: So like she missed school that day, she just couldn't
Speaker 2: get there, Like it was just all this stuff, and
Speaker 2: I called her and it's just like I met the
Speaker 2: love of my life. Like, I'm just gonna like you
Speaker 2: have to miss school today because I and she she understood,
Speaker 2: you know, that's what a good friend does.
Speaker 3: Yeah, at first I was upset because my abandonment issues
Speaker 3: came up, and then once she told me that, I
Speaker 3: was like, Okay, this is way better. I'm like totally acceptable.
Speaker 2: Yeah, so it was really cool that she's like part
Speaker 2: of our story like that. So before we talk about
Speaker 2: what you do now is PA, let's talk about what
Speaker 2: were you you decided to go to Obviously, so when
Speaker 2: you go to PA school to master's program, so you
Speaker 2: already have to kind of have a college degree before
Speaker 2: you even start PA school. So what what did you do?
Speaker 2: What did you go to college for? Initially?
Speaker 3: So initially I went for biology, just did a standard
Speaker 3: biology degree because you know, in high school, nobody tells you, hey,
Speaker 3: with this degree in college, you can do X, Y
Speaker 3: or Z. No offense to guidance counselors back then, but
Speaker 3: you were either a doctor or a researcher, and that
Speaker 3: was it. So I knew I loved science. I kind
Speaker 3: of liked math, but I was like I don't know
Speaker 3: what you do with math other than be a math teacher.
Speaker 3: You're a teacher, And I was like, now I'm good.
Speaker 3: So I wound up deciding biology was the way I
Speaker 3: wanted to go because I was interested in like animals,
Speaker 3: and I was interested in the human body. And that's
Speaker 3: how I wound up with a biodegree.
Speaker 2: And what So, how old were you when you graduated,
Speaker 2: like twenty two or you went right from college? Right?
Speaker 3: Yeah? Yeah? Or from first high school? Yeah? For undergrad
Speaker 3: I don't know. That was a long time ago, nineteen
Speaker 3: ninety nine. I think I graduated high school.
Speaker 2: So when you so, when you graduated from college, were
Speaker 2: you able to get a job?
Speaker 3: So well, that's so that's an interesting story and actually
Speaker 3: ropes into like how I wound up here. But so
Speaker 3: I was an undergrad. I was like, I don't want
Speaker 3: to be a doctor, and I really wasn't into research,
Speaker 3: but I found a fascination with genetics, and it was
Speaker 3: more so aside from the obvious, you know, learning how
Speaker 3: genetics actually works and plays a role in diversity for
Speaker 3: human the gene pool, I wound up also being intrigued
Speaker 3: by dys morphology, which should have been my first clue
Speaker 3: that this was like the calling something abnormal is what
Speaker 3: struck my interest versus just the typical day.
Speaker 2: Okay, so that's how you started kind of finding out
Speaker 2: about pathology and stuff.
Speaker 3: Well kind of. But when I was like, hmmm, I'd
Speaker 3: say around like third grade age, I was watching PBS
Speaker 3: and there was a doctor once again, a doctor on TV,
Speaker 3: and she was showing slides these pink and purple images,
Speaker 3: and I was kind of fascinated by what she was
Speaker 3: talking about, and she was a pathologist, and that's when
Speaker 3: it all started.
Speaker 2: Oh really, that's that's cool that you did, like got
Speaker 2: into that so early because people asked me.
Speaker 3: That, Ye when I was like nine or ten. It's
Speaker 3: really cool that I was into weird, freakishly weird things
Speaker 3: and diseases. Cool.
Speaker 2: So you're undergrad So once you graduated college and you
Speaker 2: so you started working in a genetics lab, right, So.
Speaker 3: No, what happened was I didn't want to do research
Speaker 3: I knew I did in undergrad. We did an internship
Speaker 3: and it was fun. I worked you know, with like
Speaker 3: Western blots and I was working on that and just
Speaker 3: wasn't my thing, Like there was too much like it
Speaker 3: was too boring for me. No offense to researchers, but
Speaker 3: it was just too boring for me. So genetics I
Speaker 3: wound up discovering genetic counseling field and that's when I
Speaker 3: started to apply to grad school for genetic counseling. And
Speaker 3: then on that interview basically said I also have an
Speaker 3: interest in forensics, and they were kind of like, well,
Speaker 3: do you have any experience in genetic counseling. I said no.
Speaker 3: I was like, I just think it's really cool what
Speaker 3: they do. So on that interview, needless to say, I
Speaker 3: didn't get into that program, but they set me up
Speaker 3: with a job my first job out of college, which
Speaker 3: was working with genetic counselors, which is where I found
Speaker 3: out genetic counseling wasn't for me. It was interesting in
Speaker 3: the fact that they were basically offering support to these
Speaker 3: families that had new diagnoses in what their kids had
Speaker 3: as far as like a genetic disorder or syndrome. And
Speaker 3: then that was like the extent of what I liked.
Speaker 3: I wound up going to clinics seeing the patients, finding
Speaker 3: out a little bit more about the dys morphologies and
Speaker 3: like what problems arise in the life of these shows Ldren.
Speaker 3: But I was creeping up to pathology to go check
Speaker 3: out the lab, and I think that's when it was
Speaker 3: very clear.
Speaker 2: I was going to say that like the whole time
Speaker 2: where you like, I want to see what these genetic
Speaker 2: disorders look like. I don't want to read about it,
Speaker 2: Like what does this look like? You're saying all these
Speaker 2: different things, like remember you had that one song for like,
Speaker 2: oh god, it.
Speaker 3: Was that for Edwards it was Edwards and Pitaw we
Speaker 3: were doing it was like Rocker Bottom feet and then
Speaker 3: I can't remember the rest and I've been trying to
Speaker 3: remember it.
Speaker 2: But that helped us. When we were taking our tests
Speaker 2: and stuff, I.
Speaker 3: Was like small jall and I'm like, what else was it?
Speaker 2: Yeah, exactly, that's funny. So so then, so how did
Speaker 2: you find out about our field? Because like this is
Speaker 2: kind of there was internet, but it was kind of
Speaker 2: It wasn't great.
Speaker 3: That was the problem at the time. You couldn't find
Speaker 3: out about anything other than, like I said, being a doctor,
Speaker 3: a nurse, or doing research. So while I was in
Speaker 3: genetics and I saw this, anytime the doctor had something
Speaker 3: that had to go up to pathology, I was like
Speaker 3: volunteering left and right. It was like anything to just
Speaker 3: go up there and see what was going on. So
Speaker 3: I started thinking, you know what, I need to get
Speaker 3: back in a lab setting because it was more of
Speaker 3: like a secretary's type of position I was in. Although
Speaker 3: it taught me a lot and exposed to me, exposed
Speaker 3: me to a lot, it definitely wasn't where I wanted
Speaker 3: to be. So I wound up going back and working
Speaker 3: at my undergrad as their lab assistant, and there I
Speaker 3: was doing like setting up chem labs, biolabs, et cetera.
Speaker 3: During that time, they must have saw that I was
Speaker 3: getting bored and decided to have me teach anatomy lab
Speaker 3: in microbiology lab to the nursing students. Oh that's fun,
Speaker 3: which was a lot of fun. And then met one
Speaker 3: of the professors said to me, you know, I know
Speaker 3: you're itching to get out and you're looking for something
Speaker 3: to do. But I know this woman who works at
Speaker 3: a hospital and she does adutopsies and she does organism.
Speaker 3: He's like, I think that's something you would really like.
Speaker 3: Well he said that, and I almost fell on the floor.
Speaker 3: I was like, my dream job. Yeah, I just like,
Speaker 3: no one tells you that this field is out there.
Speaker 3: So after that I started looking into the field the program.
Speaker 3: He told me her title Pathologists Assistant, and I was like,
Speaker 3: this is it, this is what I want to do.
Speaker 3: I was like, I didn't want to be a pathologist.
Speaker 3: They look at slides all day on bored I'm not
Speaker 3: going to enjoy that. I want to get in there, eviscerate,
Speaker 3: to sect and cut shit up.
Speaker 2: Exactly that. And that's actually part of the theme of
Speaker 2: my lecture for crime con is just like, because you know,
Speaker 2: I always get that question, you know, why don't why
Speaker 2: aren't you a doctor? And you're just like, there's a
Speaker 2: little bit more to it than just to just that, right,
Speaker 2: So you start PA school and that's how we met.
Speaker 2: And another thing I wanted to add is that when
Speaker 2: our PA program at Drexel started two years before we did,
Speaker 2: so it was we were the third class of a
Speaker 2: new program. So when we were looking into the field
Speaker 2: of pathology, because I already worked in psychology, so I
Speaker 2: knew a little bit about it because we had PA's
Speaker 2: working at the hospital, but there was no program for
Speaker 2: it in Philly. And then the word started getting out
Speaker 2: around it and we were I believe our program wasn't
Speaker 2: even accredited when we started, or or at least when
Speaker 2: we signed up.
Speaker 3: Yeah, I think so it was kind of risky to go.
Speaker 2: Into a program that's not accredited because basically they wouldn't
Speaker 2: let we wouldn't be eligible to take the PA exam
Speaker 2: if it didn't become accredited. And that's happened before. It
Speaker 2: happened at Hanuman with the with some of the programs
Speaker 2: back in the day. So and then we would just
Speaker 2: basically pay for that whole college degree and they'd say
Speaker 2: you can't take the test and you'd be screwed. So
Speaker 2: so we start PA School and so PA School is
Speaker 2: a master's program and it's two years. The first year
Speaker 2: is was the classroom work and that.
Speaker 3: Was just blood, sweat and tears, but it was it.
Speaker 2: Was fun though, Like we got through it and it
Speaker 2: was fun. And then the land we we had such
Speaker 2: a good group of God, there was what six of
Speaker 2: us that were just kind of very close in seven
Speaker 2: well so yeah, including ourselves, yes, six other people, but yeah,
Speaker 2: we and we still we still talk, were actually trying
Speaker 2: to get together for like old Lady Reinga at this point. Yeah,
Speaker 2: but so, yeah, we had a good time and everything,
Speaker 2: and then the second So the second year we do
Speaker 2: our internship, which we just basically have to rotate at
Speaker 2: different hospitals and morgues in order to get the certain
Speaker 2: requirements that we need for graduation. So we had to
Speaker 2: do autopsy rotation, surgical pathology rotation, forensic rotation, and children's
Speaker 2: hospital rotation, and so all of us had to do
Speaker 2: just to And it's also good because it kind of
Speaker 2: gives you a feel for like what you would like.
Speaker 3: As a PA, right and seversity of this.
Speaker 2: Yeah, and some labs that you work in have a
Speaker 2: mixture of it, but other ones are, like you could
Speaker 2: get a specific autopsy job, a specific children's job, specific
Speaker 2: search path job. So when I went to Children's hospital,
Speaker 2: I loved the pas there. I had a blast. They
Speaker 2: were really really fun, But I hated the pathology part
Speaker 2: of it. I thought it was very tedious and sad,
Speaker 2: and just like I just I didn't like it. So
Speaker 2: you you went and you loved it, Like what why?
Speaker 3: So it's funny because I was thinking about that answer
Speaker 3: to that question because I don't necessarily think, like when
Speaker 3: I came into the field, I was like, ooh, let
Speaker 3: me do pediatrics, this is what I want to do.
Speaker 3: And then I think over time just seeing how quote
Speaker 3: unquote tedious, how detail oriented, how how much was involved
Speaker 3: with a pediatric specimen or even the autopsy. It just
Speaker 3: took another level of expertise to be in the field,
Speaker 3: and I think that's what drew me to it. First.
Speaker 3: I'd like to say, the people that we rotated with
Speaker 3: at the pediatric hospital amazing pas, and I think that
Speaker 3: also helped with it. Yeah, I mean I.
Speaker 2: Could see you would want to work with them because
Speaker 2: they were so much fun. But like if they offered
Speaker 2: me a job, I'd be like, no, I'm not like, like, yes,
Speaker 2: we did an autopsy one time on like a sixteen
Speaker 2: week fetus and it was it took from like nine
Speaker 2: in the morning until four at night on one fetus.
Speaker 2: But in there now, I always say this though, like
Speaker 2: if I ever had a miscarriage, or if I had
Speaker 2: a child, God forbid that ever died, there's no other
Speaker 2: people in the world that you want in charge of
Speaker 2: them besides a pediatric PA, because because they do put
Speaker 2: so much attention and they know how important it is
Speaker 2: not only to give you answers as to why your
Speaker 2: child died, but also if you're deciding to get pregnant
Speaker 2: again or something like that, that they can figure out
Speaker 2: if you have some kind of underlying genetic thing that
Speaker 2: you're passing on and that this might happen again in
Speaker 2: another pregnancy. So your job is super important. And I
Speaker 2: think that a lot of times as pas, we don't
Speaker 2: get this like recognition of doing because we don't ever
Speaker 2: have family saying like thank you so much and stuff.
Speaker 2: You just you have to be a person that's confident
Speaker 2: and don't need the recognition all the time, but know
Speaker 2: that you're doing something good.
Speaker 3: Right absolutely, And I think that's true, Like you know,
Speaker 3: even just trying to even when I teach students right now,
Speaker 3: or just thinking about what I do on a day
Speaker 3: to day basis, I take for granted how much we
Speaker 3: actually know, and I take for granted how much we
Speaker 3: actually do because it's just something I do. It's not
Speaker 3: something I think about. And like you said, there's no
Speaker 3: recognition really outside of maybe your department, and sometimes depending
Speaker 3: where you work, that's not always something you get. You'll
Speaker 3: always get feedback, but yeah, you kind of lose touch
Speaker 3: with that. And interestingly enough thinking about it, you know
Speaker 3: you go through these autopsies on these children, and it
Speaker 3: kind of goes hand in hand in genetic counseling. I
Speaker 3: never made the association, but in genetic counseling, that's what
Speaker 3: you're doing. You're aiding some kind of guidance and help
Speaker 3: to the family with their new diagnosis of their child.
Speaker 3: And on the flip side, if the child passes, you're
Speaker 3: now adding that new perspective or giving them some kind
Speaker 3: of insight on what happened, which then leads to possible
Speaker 3: genetic counseling after the death of their firstborn or one
Speaker 3: of their children.
Speaker 2: Yeah, and just and you even noticed that with adults
Speaker 2: like you, when you explain to families really in depth,
Speaker 2: like what happened, it helps bring a such of closer
Speaker 2: to these people that at least they could understand what
Speaker 2: happened rather than just like not knowing. And even if
Speaker 2: you lose a child like that, like imagine having surviving
Speaker 2: children and just always being scared that something's going to happen.
Speaker 2: And just or sometimes you could have an autopsy on
Speaker 2: a child and then find out that they do have
Speaker 2: this underlying health condition that like they could test the
Speaker 2: other kids for and prevent it. Maybe, and there's just
Speaker 2: a lot that you do that you don't really most
Speaker 2: people don't even realize that you have this job, right,
Speaker 2: it's just like this hidden thing in the least.
Speaker 3: Or if you say, hey, I'm a pathologist assistant, they're like, oh,
Speaker 3: in autopsy and that's about as far as it goes
Speaker 3: with some people, and they're like, oh, it's just like
Speaker 3: on TV. And I'm like, yeah, every day, go high heels,
Speaker 3: make up address, I'm like completely to the nines, ready
Speaker 3: to do it, and then covered in blood by the
Speaker 3: end of the day. Perfect.
Speaker 2: I get that, Okay. So when we graduated, so this
Speaker 2: is one of the disadvantages of being a PA because
Speaker 2: we were in Philadelphia, and how many of us ended
Speaker 2: up graduating eight maybe we ten or yeah, like nine
Speaker 2: sticks enough just from one person a lot just from
Speaker 2: one year. And there's definitely not nine PA openings in
Speaker 2: the Philadelphia area a year. So what happens is when
Speaker 2: we a couple of us already had jobs prior to graduation,
Speaker 2: but like you and LP and stuff, that they had
Speaker 2: to move after we graduated to get a job, because
Speaker 2: you don't want to just wait around and like pray
Speaker 2: that something opens. If you know you want to work.
Speaker 3: You have student loan debts.
Speaker 2: Yeah exactly. Back in the day, Yeah exactly. So you
Speaker 2: moved to Tennessee and you didn't get a job at
Speaker 2: a children's hospital, but you did do some children's so yeah.
Speaker 3: So when I so initially how I started off with
Speaker 3: the whole entire moving out of the area. I lived
Speaker 3: in Philadelphia my entire life, So I was like, all right,
Speaker 3: this is a point where I can actually go somewhere,
Speaker 3: afford to live somewhere, and start a whole new career,
Speaker 3: maybe a whole new life. So I applied out of state, specifically,
Speaker 3: I didn't even apply anywhere in Philadelphia, and wound up
Speaker 3: in ten See in a number one trauma hospital that
Speaker 3: also had a children's hospital attached to it, so I
Speaker 3: could get the best of both worlds. Because being a
Speaker 3: new graduate, I didn't want to lose anything that I
Speaker 3: learned in school. And I feel me personally, I just
Speaker 3: feel that when you first come out, that's when your
Speaker 3: knowledge is the strongest, so you want to solidify as
Speaker 3: much as you can. And I'm a hands on visual person,
Speaker 3: so I wanted to be able to be exposed to
Speaker 3: everything I possibly could and that's how I wound up there.
Speaker 3: I taught residents when I was there, which was even better,
Speaker 3: which was intimidating at first until I realized how much
Speaker 3: I actually knew and how easy it was to do that,
Speaker 3: And it just solidified everything from school that was in
Speaker 3: the back of my mind that I never put two
Speaker 3: and two because you're just trying to get through the program,
Speaker 3: trying to get through your rotations, learn everything you can,
Speaker 3: so it really solidified everything for me.
Speaker 2: I find that with pathology residents too, that even though
Speaker 2: they're technically doctors, they don't they don't really learn stuff
Speaker 2: the way that we learn stuff in path as far
Speaker 2: as pathology, especially like gross findings and what to look
Speaker 2: at like when you're actually that's like my macroscopic like
Speaker 2: what things look like with your eyes. They just don't
Speaker 2: really they're not taught that, and they're not taught their
Speaker 2: purpose of being right, like you have to prove why
Speaker 2: the surgeon took this out kind of thing. So I
Speaker 2: think that we offer like a really good role for
Speaker 2: them because if they're learning off another pathologist, they're just
Speaker 2: not going to get that.
Speaker 3: I feel like, and I think, like I was just saying,
Speaker 3: you know, you're just trying to get through everything. And
Speaker 3: like being a pathology resident, you're now specializing pathology, coming
Speaker 3: with the background that every other clinician has, So how
Speaker 3: do you tailor it down to the specific field that
Speaker 3: you're in, Like how do you actually get that focus?
Speaker 3: And I think that's where we come in and we
Speaker 3: can offer that to them because we are that focus.
Speaker 3: We're like pigeonholed into that area that that's what we're
Speaker 3: going to do.
Speaker 2: Yeah, And I think that any good pathologists and even
Speaker 2: surgeons when they come down to the lab, they recognize
Speaker 2: that we are like the go to person for sure.
Speaker 3: For sure. So I used to actually joke around when
Speaker 3: they would come down for frozens and you know, we'd
Speaker 3: have a piece of tissue that was maybe like a
Speaker 3: centimeter and they'd give me like a millimeter and say
Speaker 3: can you freeze that? And I'm like, I'm good, but
Speaker 3: like you're pushing it.
Speaker 2: Here, Yeah, exactly. I remember because Andrea, when she's another
Speaker 2: one of our friends, as she used to be like
Speaker 2: the main frozen pa. It's like the top surgeons at
Speaker 2: the hospital would come in and be like, where's Andrea.
Speaker 2: Like they'd have a panic attack. If she was off
Speaker 2: you know what I mean true, which was which was
Speaker 2: like really really cool. So so you work at this
Speaker 2: hospital in Tennessee, did you see when you were there?
Speaker 2: So since it was in like a trauma center, did
Speaker 2: you see anything like cool while you were working there?
Speaker 3: Absolutely? So the one one defining factor that pediatrics we
Speaker 3: are all the difference between piatrics an adult. Pediatrics were
Speaker 3: one hundred percent on top of things that's a kid.
Speaker 3: We were really interested in their health. As adults, we
Speaker 3: neglect ourselves, deny things, and kind of just let things
Speaker 3: stew and stimmer. And so when it came to cancer
Speaker 3: cases there you would get I remember I had like
Speaker 3: a lot of genital warts that was like two feet
Speaker 3: long by one foot wide, and I was like what
Speaker 3: the I was like, who like a pimple? And I'm
Speaker 3: like freaking out, how did this happen? Or you know?
Speaker 3: Another one was a melanoma that was solid probably a
Speaker 3: good like six inches by six inches and about three
Speaker 3: inches thick on a mon's pubis.
Speaker 2: Like I was like favorite anatomical part.
Speaker 3: I could go inside, I could go down the rabbit hole,
Speaker 3: but we'll just scarred around it anyway. So you know,
Speaker 3: like seeing this, I'm like, an ingrown hair would freak
Speaker 3: me out. Let alone, this whole hire a huge mass.
Speaker 3: It was just always crazy things that I would see.
Speaker 2: There's always this sense of I think when you work
Speaker 2: in pathology, you don't realize that people. I mean, obviously,
Speaker 2: in America people have access to healthcare, but some of
Speaker 2: them don't have insurance and they're scared of the cost
Speaker 2: of it. So that's what's different than other countries that
Speaker 2: don't have access to healthcare, because sometimes you could say, oh,
Speaker 2: the closest hospital was six hours away, and they just
Speaker 2: they're poor and they can't do it. But here there's
Speaker 2: a hospital everywhere. The problem is is that you have
Speaker 2: the healthcare issue and then you have just people, which
Speaker 2: I feel like is more common, or just straight up
Speaker 2: like they're in denial and they just they just ignore things.
Speaker 2: And it's really mind blowing some of the stuff that
Speaker 2: you see that you're like, how are people so checked
Speaker 2: out that they don't they don't they think this is
Speaker 2: going to go away or or you know, it's it's
Speaker 2: just crazy. So so you're working in Tennessee and then
Speaker 2: a job comes up at the children's hospital, and then
Speaker 2: you decided to kind of leave all that and go
Speaker 2: work in a children's hospital.
Speaker 3: Actually, I was back in the adult world before that.
Speaker 2: Yeah, that was the other Okay, sorry, while I was
Speaker 2: down I can't keep track of your timeline jobs. Okay,
Speaker 2: so you want to, I know, like you wanted to
Speaker 2: come back like your parents essentially.
Speaker 3: Yeah, So what wind wound up happening was when I
Speaker 3: was down there working on the adult side, things got
Speaker 3: a little chaotic. They wound up trying to keep me
Speaker 3: a little bit longer and pushed me off to the
Speaker 3: peed side, which they managed to keep me a little
Speaker 3: bit longer, and I got exposure to more pediatric specimens
Speaker 3: being there, and then I wanted to come back in
Speaker 3: the area. I was kind of missing home, missing my friends,
Speaker 3: and came back to this area. I worked back in
Speaker 3: the adult side of pathology and loved it once again.
Speaker 3: Saw crazy things like pelvic exonerations and you know, you
Speaker 3: have an organ block that somebody had colon cancer, and
Speaker 3: all of a sudden, you don't only have a colon
Speaker 3: because they're like, oh, I couldn't pee a little, and
Speaker 3: well here's your colon, here's your bladder, here's your kidney,
Speaker 3: and oh, there's your uterus. Cool, Like, how'd that happen?
Speaker 2: You know? I actually think that that there I heard
Speaker 2: they're really not doing those anything anymore because they they
Speaker 2: found I know, I know, but I've had some too
Speaker 2: in my earlier years, but I think that they found
Speaker 2: that the outcome is no different. So like why put
Speaker 2: someone through all that? Yeah, because one of our friends
Speaker 2: mom had more recently had one for like metastatic melanoma,
Speaker 2: and it's like the the recovery from that, It's like
Speaker 2: if you only are going to have five more months
Speaker 2: to live, Like, why would you ever want to get
Speaker 2: someone through that? Imagine not being able to pee, poop, Yeah,
Speaker 2: I mean that would I guess eventually they rework whatever,
Speaker 2: they give you a new bladder, whatever, but it's not
Speaker 2: it's major functions that you have to do multiple times
Speaker 2: a day or a week, and you just it's just
Speaker 2: crazy to even think about healing from that. So, so
Speaker 2: you worked in the adult world and then this job.
Speaker 2: I know that, like you were holding out for this job,
Speaker 2: like you were waiting.
Speaker 3: I was, in a sense, but what actually wound up
Speaker 3: So yeah, what wound up happening was they had a
Speaker 3: per diem position at a local Children's hospital and I
Speaker 3: was like, I could use the extra money. I can
Speaker 3: use some extra time, I said, and it'll get me
Speaker 3: once again back in the field. So I was like, oh,
Speaker 3: I'll call up and see what the perdiem deal is.
Speaker 3: And at that point when I inquired, they said what
Speaker 3: if it were a full time position? And I was like,
Speaker 3: I just I just moved and back and I just
Speaker 3: got this job and they're really happy with me here,
Speaker 3: and I'm happy here and now I'm gonna jump ship. Whoops.
Speaker 3: So I wound up considering it and then took the
Speaker 3: job and then started another I think I was there
Speaker 3: about four or five years in pedes again and learned
Speaker 3: a lot, know a lot to a fault, and that's
Speaker 3: when I wound up back in peds. After that, went
Speaker 3: back to the adult side for a little bit and
Speaker 3: back in pedes again. So clearly the universe wants me
Speaker 3: in pediatric pathology, despite me trying to jump ship every
Speaker 3: once in a while. But here I am.
Speaker 2: So it's it is. It is a very different world
Speaker 2: than than regular pathology because it's it's slower, it's a
Speaker 2: lot slower, and it's a lot more tedious. So that
Speaker 2: could be good because some days it's just like a
Speaker 2: little bit more not like a high strung kind of environment,
Speaker 2: whereas working in the surgical lab, especially with frozens and stuff,
Speaker 2: could be like a high stress situation. Absolutely, so I
Speaker 2: could see the pros and cons of of wanting those jobs.
Speaker 2: But so I guess, so I have a couple of
Speaker 2: questions as far as pediatric stuff goes, because all the
Speaker 2: hospitals that I've ever worked with, we dealt with miscarriages
Speaker 2: and stuff, and a fetus full the whole entire term
Speaker 2: of a fetus, as well as like infants. But past
Speaker 2: that we've we don't we don't typically do children in
Speaker 2: the normal.
Speaker 3: Hospitals or anything. You don't ye like.
Speaker 2: They just exactly like you'll get an appendix and stuff
Speaker 2: from little kids all the time, but when it's something
Speaker 2: like like a cancer especially, it's like they send them all.
Speaker 2: And I guess in our area we have a major
Speaker 2: children's hospital, So like, why you're not why you've not
Speaker 2: messed with that? So what like if you get surgical
Speaker 2: specimens in the children's hospital, Like, what are the most
Speaker 2: common things that you get?
Speaker 3: So some of the most commons that we get, just
Speaker 3: like you would learn in school. The most commons would
Speaker 3: be the kidney tumor, which is known as a Wilm's tumor. Okay,
Speaker 3: and then we also get like osteo sarks, which your
Speaker 3: bone resections, which they're kind of my favorite best men
Speaker 3: kind of So.
Speaker 2: Do they take like if where's the most common location
Speaker 2: for osteosarchs.
Speaker 3: Yeah, So they're usually in the long bones, and they're
Speaker 3: usually at the growth plate down towards like the end.
Speaker 3: So you'll see them in your humorous, which is your
Speaker 3: shoulder or part of your shoulder, your upper arm, and
Speaker 3: then your femur, which is your thigh. You can also
Speaker 3: have them in the ribs, and you can also have
Speaker 3: them in the pelvis, but mainly the long bones are
Speaker 3: where we see them in. I've had a couple in
Speaker 3: the humorous and I've had several in a femur.
Speaker 2: So, if you get an osteosark from a femur, do
Speaker 2: you do they give the kid an amputation or like
Speaker 2: how do you receive that?
Speaker 3: So they try to do if they can, they will
Speaker 3: do a limb sparing, so if it's in the distal portion,
Speaker 3: they'll keep the proximal portion that's where it attaches to
Speaker 3: the pelvis in your hip joint, and so they'll keep
Speaker 3: that portion, only take the distal portion, put a prosthetic in.
Speaker 2: Oh that's interesting.
Speaker 3: Yeah, so they can also do it where they spare
Speaker 3: the skin. It just depends on when we found delesion.
Speaker 3: And typically they present as just pain, there's sudden pain,
Speaker 3: they're swelling, some kind of discomfort. Kid goes in has
Speaker 3: some imaging done.
Speaker 2: This is what was my biggest fear when, like I've
Speaker 2: talked to, I did a mystery diagnosis a couple of
Speaker 2: years ago that my youngest was diagnosed with something called
Speaker 2: non infectious osteo chronic non infectious osteomi latest And it
Speaker 2: started off with like the distal femur like knee pain,
Speaker 2: and then we went and got the X ray and
Speaker 2: then they called me and they said you have to
Speaker 2: come back right now, and I automatically was like, oh
Speaker 2: my god, this kid's got cancer in her knee. Like
Speaker 2: I flipped out, And thank god it didn't end up
Speaker 2: being that, but like that location and that presentation is.
Speaker 3: Just Yeah, the serious downfall of our field is knowing
Speaker 3: knowing way.
Speaker 2: Too way too much exactly, so so you get these
Speaker 2: specimens that have that have tumor, so sometimes you get
Speaker 2: but like amputations and things like that.
Speaker 3: Right, so we'll get like, for instance, with the osteosark,
Speaker 3: we'll get a piece of the femur, or we'll get
Speaker 3: the whole femur, depending what it is. An adult hospital practice,
Speaker 3: what I've come to know is that you wind up
Speaker 3: shaving off all of the soft tissue from the bone,
Speaker 3: so there's muscles surrounding the bone that you'll get their skin,
Speaker 3: So you shave all of that, have to keep orientation
Speaker 3: in case they have to go back if there's a
Speaker 3: positive margin, et cetera, and then put it all back
Speaker 3: together and make it make sense in your gross in
Speaker 3: your pictures, et cetera. Whereas at least the children's hospitals
Speaker 3: I've worked at, we wind up actually taking the specimen
Speaker 3: soft tissue and bone, freezing it all together while it's fresh,
Speaker 3: then fixing it. So let me go back a little
Speaker 3: bit after it's fresh. We wind up cutting it completely
Speaker 3: frozen in a saw, which gives us beautiful sections that
Speaker 3: show the actual relationship between the soft tissue and the bone.
Speaker 3: Use like a band saw, like a band saw, just
Speaker 3: like a butcher does.
Speaker 2: Yeah, so that's interesting. Too, because a lot of people
Speaker 2: don't realize that we have to not only like be
Speaker 2: experts in all this kind of stuff, but have to
Speaker 2: use power tools.
Speaker 3: Wood shop would have came in handy along the wall.
Speaker 2: Yeah, and so that the oscillating saw is a little
Speaker 2: bit less scary. That's the kind of saw they would
Speaker 2: use to cut off a kid's cast or something. So
Speaker 2: if you're using it, it hits your hand or your
Speaker 2: your soft tissue, like it's more of like a friction burn,
Speaker 2: but it won't like cut your finger off, whereas like
Speaker 2: a bandsaw could cut your finger off. It's a real
Speaker 2: it's a really sharp saw, and obviously if it could
Speaker 2: cut bone and soft tissue that's frozen.
Speaker 3: Yeah, and these are huge. You're talking about a band
Speaker 3: saw being about I guess it's like two feet of
Speaker 3: reciprocating blade or actually Yeah, And one of the institutions
Speaker 3: I worked at we cut ephemeral head, which is a
Speaker 3: whole whopping like three inches in diameter. Yeah, and it
Speaker 3: would have to go through this machine and there you're
Speaker 3: you're holding it with tools and gripping it on for
Speaker 3: dear life as you're trying not to cut yourself or
Speaker 3: have what I had, in one instance have the femeral
Speaker 3: head go and hit oh my god, hit the wall
Speaker 3: behind me and give me a heart attack. And you know,
Speaker 3: it's a lot.
Speaker 2: So we had this one at one of the hospitals
Speaker 2: I worked at, because we got a lot of these
Speaker 2: like jaw re sections. It was the kind of I
Speaker 2: don't even think it was made for human tissue. It
Speaker 2: was like a tile cutting saw. It was like a
Speaker 2: very little bandsaw that had like water dripping off of it.
Speaker 2: It was crazy, but because we had like little tiny
Speaker 2: jaws to stick through, I know what I mean. But
Speaker 2: so okay, So you also get like, are these are
Speaker 2: children's hospitals considered like trauma units too, or like how
Speaker 2: would that work?
Speaker 3: There are? But I you know, for us, for trauma,
Speaker 3: it's usually same thing. Even when I was at the
Speaker 3: other place that was a number one trauma, it's usually
Speaker 3: some kind of lawnmower accident or fingers got crushed by
Speaker 3: you know, a hammer or something. Kids being kids. To say,
Speaker 3: I hate to say that sometimes, but that's usually what
Speaker 3: it is. It's not so much as what you would
Speaker 3: have in an adult hospital.
Speaker 2: And what about like do you get foreign bodies and
Speaker 2: stuff from kids, and.
Speaker 3: Like we do. It's usually those little round magnetic balls.
Speaker 3: Do not buy them for any of your kids. Yeah,
Speaker 3: they always seem to come down and we get like
Speaker 3: a chain of like twelve of them, and it's like cool.
Speaker 2: Really dangerous. Like we did a high profile death this
Speaker 2: section for toys at Christmas time, and that was one
Speaker 2: of them that kept coming up in the literature too. Yeah,
Speaker 2: because they like make the segments of bowls stick together,
Speaker 2: Oh my gosh.
Speaker 3: And they look like those little what were they those
Speaker 3: little candies that were round balls that were like filled
Speaker 3: with chocolate with the stickles or yeah, that's what they
Speaker 3: look like. So if I was a kid, I'd be like,
Speaker 3: oh cool, let me eat one and not think anything
Speaker 3: of it until I'm like having poop and problems and
Speaker 3: all of a sudden, I'm like not feeling good parent nightmare.
Speaker 3: That batteries, the little watch batteries are the little you.
Speaker 2: Know there are bad because kid e roade and they
Speaker 2: could cause like perforations and stuff. Oh my god, yeah
Speaker 2: we we. I think that actually when I was writing
Speaker 2: that up this Christmas that there was this band on them.
Speaker 2: For a while, they weren't allowed to be sold and
Speaker 2: now they're like on Amazon again again. Yeah, and parents
Speaker 2: just don't. It's another one that's dangerous is those orby beads.
Speaker 2: You know what they are. They're like these little plastic
Speaker 2: beads and when you put them in water, they like
Speaker 2: swell up. So they're like the kids, Yeah, they liked it.
Speaker 2: It's like this sensory right, but like, which is fine
Speaker 2: for my age kids, but little kids if they eat
Speaker 2: the balls when they're little, they like expand in their
Speaker 2: gi track and cause obstruction. Yeah, and there's a kid
Speaker 2: that actually died from it. And it said that the
Speaker 2: mom had bought them at Target and there wasn't a warning.
Speaker 2: There was a warning label that said that there was
Speaker 2: a choking risk, but it didn't say there was a
Speaker 2: risk for ingestion and obstruction. And she's trying to like
Speaker 2: say something about that, which I don't know personally, like
Speaker 2: the kid was not, Like, I'm like, you shouldn't have
Speaker 2: had it near your nine month old kid, I don't care.
Speaker 3: Float some blueberries and water and do their sensory activity
Speaker 3: with peas or something exactly.
Speaker 2: This episode is brought to you by my book Nicole
Speaker 2: and Jemmy's Anatomy Do you have my book yet. If not,
Speaker 2: you better get it because it's really awesome. It is
Speaker 2: an A through Z journey of the human body and
Speaker 2: everything that could go wrong with it. Get it now
Speaker 2: at thedorramodern dot com slash book So when you get
Speaker 2: autopsies now. So one of the cool things that I
Speaker 2: didn't realize being in the children's hospital was that you said,
Speaker 2: from time to time you do autopsies on adults. Can
Speaker 2: you explain, like why you would ever do that?
Speaker 3: So sometimes we have cases where clearly not every disease
Speaker 3: is curable. We're still working towards cures. We're doing research,
Speaker 3: which is another aspect of the job. But you have
Speaker 3: these patients who could be eighteen twenty five still with
Speaker 3: either residual tumor or still struggling even with a late diagnosis. Actually,
Speaker 3: there was a case that we had a late diagnosis.
Speaker 3: By the time they found out this patient had the diagnosis,
Speaker 3: they did the patient, it was a male that died
Speaker 3: maybe a couple days after that. And so sometimes it's
Speaker 3: a late diagnosis of a quote unquote childhood tumor that
Speaker 3: you wouldn't normally see in an adult hospital. So we
Speaker 3: might have a reference from an outside hospital to take
Speaker 3: this patient on, although they might be in their twenties.
Speaker 3: You also have I had a case where eighteen years
Speaker 3: old had one of the forms of cancer I can't
Speaker 3: remember which it was, signed his autopsy consent to donate
Speaker 3: his tissue for research because he had a significant size tumor.
Speaker 3: And I think at that point, whatever the staging was,
Speaker 3: he knew he wasn't gonna last very long. And that
Speaker 3: was that was an overwhelming, like humbling experience right there,
Speaker 3: because I couldn't imagine being in a position to sign
Speaker 3: my own autopsy consent and being eighteen doing that.
Speaker 2: Yeah, it's like, it's it's so cool that people that
Speaker 2: are like that enlightened and mature correct to think, because
Speaker 2: that is the only way for us to you know.
Speaker 2: It's more so I feel those so sent the dead
Speaker 2: teach the living. It's just like the only way to
Speaker 2: really do that. And like, even talking recently about OJ
Speaker 2: dying right and him not like it's just so fucking selfish, right,
Speaker 2: Like I'm just like this guy who there's all this
Speaker 2: suspicion that he might have like CTE from all the
Speaker 2: trauma of playing football all those years, that that could
Speaker 2: have maybe contributed to him snapping and doing what he
Speaker 2: did and stuff like you would think, okay, well, like
Speaker 2: I'll donate my brain to science just to see because
Speaker 2: that would even help like future football players and stuff.
Speaker 2: It's just like, why, you're just gonna incinerate it and
Speaker 2: be buried and it doesn't help anybody. But I love
Speaker 2: hearing stories like that of people that are just like listed,
Speaker 2: my time on Earth is gone, and people do it
Speaker 2: with their families. So me and Crisper are like really
Speaker 2: huge proponents of the organ donation. Sure, so so getting
Speaker 2: to that, like you said that, that was like a
Speaker 2: humbling experience for you. Do you feel like sadness towards
Speaker 2: some of your cases?
Speaker 3: For sure? When I first got back into pediatrics, there
Speaker 3: was I think a thirteen year old who was having
Speaker 3: a work up on he was having some kind of
Speaker 3: neurological dysfunction and they were working on it, working on it,
Speaker 3: and unfortunately they didn't find out what happened before he expired.
Speaker 3: And that was one of the first case I had,
Speaker 3: and I read just like, I can't imagine one being
Speaker 3: the parent in that position that you know something's wrong
Speaker 3: with your child. The clinicians are trying really hard to
Speaker 3: figure out what's going on, and you're almost there, you're
Speaker 3: working towards it, and then all of a sudden they
Speaker 3: just die and there's no longer that opportunity there. So
Speaker 3: I can't imagine it from that aspect. And then standing
Speaker 3: there and you're like, wow, this thirteen year old, how
Speaker 3: many people has this kids touched their lives? You know, encountered,
Speaker 3: he's made friends in school, he's you know, adult family,
Speaker 3: his peer group. Gone. Yeah, like there one day, gone
Speaker 3: the next, no warning. Yeah.
Speaker 2: I hear about that sometimes with kids, just on the
Speaker 2: news that we cover all the time about kids that
Speaker 2: get hit by a car or just anything, and then
Speaker 2: they'll say, like they'll just put this brief thing out
Speaker 2: like oh, there's grief counseling at the school, and you're
Speaker 2: just like, yeah, that's it's so hard, especially for children
Speaker 2: to like grasp that and just being a parent, like
Speaker 2: I can't even like wrap my head around them. Like
Speaker 2: it's just and it's weird. Like I feel like I
Speaker 2: feel like when I do an autopsy on like a fetus,
Speaker 2: I do. I do feel bad for the parents, but
Speaker 2: I try not to like sit there and want to cry.
Speaker 2: Because like I want to get the job done and stuff.
Speaker 2: But I definitely have had times, especially rotating at the
Speaker 2: Children's Hospital, that I like, even how long ago did
Speaker 2: we graduate thirteen years ago or whatever? Like long ago exactly?
Speaker 2: I just like, no, it's been longer than that we graduated. Jesus,
Speaker 2: I just gave up.
Speaker 3: Good thing.
Speaker 2: You weren't a math man. But anyway, right, I'm like,
Speaker 2: is aren't we encroaching like fifteen years So anyway, regardless,
Speaker 2: I just totally forgot what I was talking about.
Speaker 3: But still the whole patient interaction, yeah, everything and the
Speaker 3: human aspect of it. So basically you're focusing on a
Speaker 3: task getting it done.
Speaker 2: Yeah, but oh, that's what I was going to say. So,
Speaker 2: so Children's Hospital, like I remember the kids that I
Speaker 2: autopsy still, like, I'll just never like the big kids,
Speaker 2: like the teenagers and stuff and the eight year olds
Speaker 2: and stuff like, because because they have parents. They all
Speaker 2: have parents, and you just can't help but think that.
Speaker 3: Right, absolutely, well, And that's another There's been a couple
Speaker 3: of times that I, you know, first off, when we
Speaker 3: do our job, we need to be informed. We're not
Speaker 3: clinicians on the floor with them. We don't get the
Speaker 3: interaction that nurses do with the patient, but we still
Speaker 3: have to go back to the chart review it, figure
Speaker 3: out what's important and what we have to focus on
Speaker 3: for the autopsy and for the case. So reading the
Speaker 3: chart you get into very like personal notes from like
Speaker 3: social work and everything. And then it really brings the
Speaker 3: human element in which not that I want to think
Speaker 3: about it focus on it because I have a job
Speaker 3: to but it definitely makes you step back for a
Speaker 3: minute and makes you really like think, wow, this is terrible,
Speaker 3: and then once again you have to pick yourself back
Speaker 3: up and get to your purpose.
Speaker 2: I'm even like that with the Saint Jude commercials, like
Speaker 2: I can't. I just can't watch them. I just I'm like,
Speaker 2: take all my money. I get what you're doing, Like
Speaker 2: just like I'll write you a check. I just can't.
Speaker 2: Like it's it's so heartbreaking, like it'll be a parent
Speaker 2: just saying because you know, my kids, my my younger kid. Anyway,
Speaker 2: Lil Lucia still believes in Santa claus Es. Like it's like,
Speaker 2: how do you talk to a child about something so
Speaker 2: heavy like cancer or any kind of like a like
Speaker 2: life ending situation.
Speaker 3: It's just.
Speaker 2: Like I just it just breaks my heart so much
Speaker 2: to even think about it that it's just better to
Speaker 2: like be disconnected a little bit.
Speaker 3: Absolutely. So that's that's the one thing I don't really
Speaker 3: love about the job is having to actually dive deep
Speaker 3: in the chart. But you know, after the fact, when
Speaker 3: you I had a case, actually they did I think
Speaker 3: she the patient was I think she had a brain
Speaker 3: tumor and wound up donating her brain to research. So
Speaker 3: here I did this case. Then on the weekend there
Speaker 3: was like some kind of fundraising walk for the research
Speaker 3: for brain tumors, and I wound up meeting this person,
Speaker 3: this patient's parents at the walk, and I was like,
Speaker 3: this is this is a little much like you don't
Speaker 3: know what to say, And then how do you walk
Speaker 3: up to them and say, Hi, I did your daughter's autopsy,
Speaker 3: Like you just don't like you're just kind of exactly.
Speaker 2: Oh hi, Hi Wait. We literally Annette and I literally
Speaker 2: had the same exact thing happen. We were working in
Speaker 2: the lab and we get this frozen section on it.
Speaker 2: Odd but a colon tumor, which is not normally something.
Speaker 2: So a frozen section is when they send a specimen
Speaker 2: down while the patient's still open on the table and
Speaker 2: we have to examine it. And usually that's only done
Speaker 2: in the case where like the surgeon needs to know
Speaker 2: right away what something is in order to direct the
Speaker 2: course of his surgery or his or her surgery. But
Speaker 2: in this case, they sent it down to us because
Speaker 2: it was so weird. It was a nineteen year old,
Speaker 2: and they sent it down to us because they were
Speaker 2: removing this colon because this girl, this nineteen year old,
Speaker 2: had an obstruction, and they just couldn't believe it because
Speaker 2: on imaging it looked like it was cancer. So they
Speaker 2: sent it down to us and said open it up
Speaker 2: and just look at it. And then so we cut
Speaker 2: it and just by looking at it on frozen section,
Speaker 2: it was like already perforated through the wall. It was bad.
Speaker 2: It was like at least the stage three at that point,
Speaker 2: right nineteen. And we were like so upset and and
Speaker 2: I so we go downstairs to the coffee shop at
Speaker 2: lunch time and we hear this mom on the phone
Speaker 2: like behind us, like talking about, oh, she's in surgery
Speaker 2: right now, it's probably nothing like and I was like,
Speaker 2: oh my god, Like it was it was just so
Speaker 2: like you just wanted to throw up, you know, because
Speaker 2: I'm like, this is this poor lady is having like
Speaker 2: this last moment of not finding out how bad this
Speaker 2: can be. And of course the disadvantage to our job
Speaker 2: is like we we have no idea what happened to
Speaker 2: that girl, like did she live?
Speaker 3: Did she die?
Speaker 2: Like we don't. We hear nothing else. That's the end
Speaker 2: of the story.
Speaker 3: And then on the flip side of it, for me,
Speaker 3: it's always, you know, I always stand there and my
Speaker 3: face I can't hold anything. My mouth will hold it back.
Speaker 3: My face says everything that my mouth will not. And
Speaker 3: you know, I had a one of my mom's friends.
Speaker 3: My mom calls me and she's like she got diagnosed
Speaker 3: with stage four inflammatory breast cancer. And I was like,
Speaker 3: oh God, like this woman's gonna die. That was like
Speaker 3: my first reaction to it. And I stood there and
Speaker 3: I was like.
Speaker 2: I see you're good because I just like when my
Speaker 2: mom was like, oh, Nanny, hows this is my grandmom
Speaker 2: has gallbladder cancer. I was just like, you ver prepare
Speaker 2: she's going to die from this. And my mom was
Speaker 2: like no, like they told us that there, and I
Speaker 2: was like, Mom, like I just can't keep my mouth shut.
Speaker 2: Like I just can't.
Speaker 3: Like I was like, just tell her to spend a
Speaker 3: lot of time with their kids and her husband. It's
Speaker 3: really important.
Speaker 2: I was like, I know, I know, I just I
Speaker 2: feel so terrible, but I don't like and this this
Speaker 2: is like a good reminder with my grandmom and stuff.
Speaker 2: It's like she got diagnosed with with gallbladder cancer and
Speaker 2: that was that was whatever. But when they went in
Speaker 2: to do the gallbladder resection to take out the around
Speaker 2: her liver where the tumor was still at, and they
Speaker 2: opened her up and saw it was seated in her
Speaker 2: peritoneal cavity, I was just like, why are they even
Speaker 2: giving any one hope that she's going to survive this?
Speaker 2: Like biliary cancers are nasty as it is stage four
Speaker 2: and and like they were though when my aunts were
Speaker 2: going and my mom were going to the appointments with
Speaker 2: with my grandmom, they were like, well, we'll give her chemo,
Speaker 2: and like they they were giving them hope for And
Speaker 2: I was trying to be realistic with my mom and
Speaker 2: saying like, don't have hope here, Like she'll live another
Speaker 2: couple of months maybe, but like this is going to
Speaker 2: be the end for you know, and I don't. I
Speaker 2: didn't think that was cool, honestly, no, but maybe it
Speaker 2: feels better for the patients that don't know anything, right,
Speaker 2: I don't.
Speaker 3: Well, And I think that's another aspect of it, like
Speaker 3: you want to give them hope because you want them
Speaker 3: to actually fight or enjoy what's left. But at the
Speaker 3: same time, it's kind of like I want to be
Speaker 3: honest with you the truth. Yes, I hate that position.
Speaker 2: Yeah, it's just like, don't ask me if you have anything.
Speaker 3: Exactly, if anything's wrong with you. I don't know. I'm
Speaker 3: an idiots asking on college exactly, phone in college. It's
Speaker 3: not us. We're going to tell you the dark side
Speaker 3: of the story.
Speaker 2: Right. So when you so you have autopsies on kids,
Speaker 2: like what is there like a most you know how
Speaker 2: with adults it's like heart disease is a big wan
Speaker 2: obesity related things like.
Speaker 3: Usually like lifestyle with adults, I feel.
Speaker 2: Like, yeah, like what is it with kids? Like genetic things?
Speaker 3: So for sure it's genetics that's a component anomaies, malformations,
Speaker 3: anything that's once again dysmorphic syndromes can have a boatload
Speaker 3: going on with them. Most commonly we wind up seeing
Speaker 3: heart defects, the general heart defects which go into the
Speaker 3: syndromes as well. Also, we've had cases where they're just
Speaker 3: not compatible with life because of a genetic disorder, genetic syndrome.
Speaker 2: Have you ever seen conjoined twins?
Speaker 3: So I had a case. It was a fetus and
Speaker 3: it was an aborted fetus where they shared basically the
Speaker 3: same Torso had two sets of arms, two sets of legs,
Speaker 3: and we're joining. I think it was torso brain, so
Speaker 3: I guess the spinal cord and brain. They shared two
Speaker 3: faces and the body was like shared. Oh wow, that's yeah,
Speaker 3: it's super It was probably.
Speaker 2: How many weeks was to say it was maybe twelve?
Speaker 3: Maybe it was. It was yeah, an itty bitty that's interesting.
Speaker 3: It was super cool to be able to experience that
Speaker 3: because it's not something that you see often, let alone
Speaker 3: have an autopsy on.
Speaker 2: I know it's like and it's like, I always get
Speaker 2: shipped for saying that things are cool. It's like, obviously
Speaker 2: it's not cool for this interest, but from a from
Speaker 2: a pathologic perspective, it's cool for us in the lab
Speaker 2: to see special weeks. We just talked about in the
Speaker 2: news recently. Laurie and George Chappelle. You know the twins
Speaker 2: twins from reading. Yeah, they just passed away. They were
Speaker 2: sixty to the oldest living twins. And then we were
Speaker 2: talking about Abigail and Brittany, the younger twins, because one
Speaker 2: of them just got married. So we were talking about like,
Speaker 2: well how does that work? Like really interesting? Right? Stop?
Speaker 2: Have you have you ever seen citis and versus? I
Speaker 2: don't know if I've ever asked you that. I think
Speaker 2: that so I think when we were in school, like
Speaker 2: one of the students rotating there solid.
Speaker 3: Possibly, I don't remember. I don't think.
Speaker 2: I like, it's like all my bucket list, but I
Speaker 2: just think I'll never see it.
Speaker 3: There's some things that I just don't remember. And that's
Speaker 3: probably I know.
Speaker 2: That's so. Citis and versus is when all the organs
Speaker 2: are flipped, like mirror flipped, so like your heart would
Speaker 2: be on the different side than than it is normally in.
Speaker 3: Your liver as opposed to the rights to the left,
Speaker 3: and you know there's mal rotation and all this other craziness.
Speaker 2: Yeah, it's just it's just crazy. Like you could say,
Speaker 2: throughout your career, even if you've done hundreds of autopsies.
Speaker 2: It's just like sometimes you just see like like one
Speaker 2: time I found a horseshoe kidney, like once, you know,
Speaker 2: like just one time. You see I've seen I found
Speaker 2: mechels actually twice, but like just different things like that
Speaker 2: or that's another like fun yeah, right, that you would
Speaker 2: get that. I love those. I love like congenital anomalies
Speaker 2: that are like not really like life threats. Well I
Speaker 2: guess that could be life threatening, but not like not really.
Speaker 3: Yeah.
Speaker 2: Like I just wrote a case for the Gross Room
Speaker 2: about a baby that was born with a tail, so
Speaker 2: it's pretty Yeah, I'll send it to you.
Speaker 3: Yeah.
Speaker 2: I always like we always like talk about this stuff.
Speaker 2: This is what we do. Like she'll come over and
Speaker 2: we talk about men shopping and men shopping.
Speaker 3: Fetal anomalies, the Coffee Show.
Speaker 2: So so this is interesting when you were talking about
Speaker 2: like lifestyle changes, because I think in adult pathology, like
Speaker 2: most so many of the cases, it's like related to smoking,
Speaker 2: related to drinking, alcohol, related to obesity, just all these things,
Speaker 2: even work exposures, just like all these things that people
Speaker 2: are environmental or just bring on, even viral things like
Speaker 2: HPV or hepatitis C. So with little kids. I guess
Speaker 2: you don't really see that kind of stuff. Right.
Speaker 3: We may see like as far as like infection goes sepsis,
Speaker 3: if there's some kind of issue that happens there, but
Speaker 3: usually it's not lifestyle changes that are in our demographic,
Speaker 3: at least the demographic I've been exposed to. Yeah, I
Speaker 3: don't want to say that it doesn't happen in other
Speaker 3: children's hospitals, but with us, it's usually there's some kind
Speaker 3: of tumor or congenital heart disease.
Speaker 2: Yeah, we had a lot a fair number of miscarriages
Speaker 2: from parents and placentas in the hospital from people that
Speaker 2: were using drugs, but nothing really specific that sticks out
Speaker 2: to me that you could say, oh, yeah, that person
Speaker 2: was on math and that's why this baby was like
Speaker 2: this or whatever.
Speaker 3: Right, there's definitely changes within the placenta or even sometimes
Speaker 3: some of the heart defects come from drug use. Yeah,
Speaker 3: that's so, you know, that's one aspect of it. But
Speaker 3: it's not like I'm sitting there and saying, Okay, this
Speaker 3: this patient has an ASD or a VSD, which is
Speaker 3: basically a hole in the upper or lower portion of
Speaker 3: the heart. Oh, somebody must have used drugs, Like, there's
Speaker 3: a million reasons why that could have happened. Exactly necessarily
Speaker 3: always jumped to lifestyle, although it could be Yeah that's'
Speaker 3: and I think there actually was somebody that I think
Speaker 3: they're I don't even know how we came to figure
Speaker 3: that out, but I think they had high levels of
Speaker 3: THHC or something to that effect, and I think we
Speaker 3: might have actually ran something.
Speaker 2: It does nothing bad to you, Okay, just stick with
Speaker 2: stick with the story, stick with the script.
Speaker 3: It's all about cancer.
Speaker 1: Lifestyle is wonderful, Yeah, exactly, all right, So so this
Speaker 1: is this is this is really interesting to me actually
Speaker 1: because so working in surgical pathology, I started whatever it
Speaker 1: was fifteen twenty.
Speaker 2: Years ago whatever. I noticed that there was a change
Speaker 2: in some specimens we were getting, and then there was
Speaker 2: a there. You know, you're working there for five years
Speaker 2: and then all of a sudden you start getting like
Speaker 2: sleeve gastrectomies, and then you would get one a week,
Speaker 2: and then it turned into five a day. Yeah. Right,
Speaker 2: do you have any kind of specimens like that that like,
Speaker 2: now that you've been working in the field so long,
Speaker 2: you're seeing like this is a more popular surgery versus so.
Speaker 3: Definitely a lot of sleeve gas directomies have been happening,
Speaker 3: and I'd say in the last like year or two
Speaker 3: they've picked up.
Speaker 2: So a sleeve gas tractomy is when they reduce the
Speaker 2: size of the stomach for it to try to I
Speaker 2: guess it would be for childhood obesity. How, I mean,
Speaker 2: what age are you getting these things?
Speaker 3: Usually teens as where yeah, somewhere in the teenage. And
Speaker 3: same thing for the other specimen that we wind up
Speaker 3: getting or usually breast reductions. Oh really yeah, And I
Speaker 3: don't know if it's just because of our demographic.
Speaker 2: But it's interesting because I always say, like, as much
Speaker 2: as I don't like children's hospitals, that the best part
Speaker 2: would be that you don't get breast because I hate breast.
Speaker 2: I just hate them as.
Speaker 3: Breast for tumors a whole other story.
Speaker 1: Yeah.
Speaker 2: Yeah, the reductions are easier, I mean, but you still
Speaker 2: have to look at them in case, absolutely.
Speaker 3: Just in case, because you know, there's like a fiber autonoma.
Speaker 3: It could be it's benign, but just.
Speaker 2: In case, yeah, exactly. You can't just like throw that
Speaker 2: in the trash like you would have pass or something
Speaker 2: like that. So what what are some of the differences. Like,
Speaker 2: so when we do an autopsy, it will take like
Speaker 2: I mean, you could get it done in like an
Speaker 2: hour or two really fast. So why why does an
Speaker 2: autopsy on a fetus take eight hours?
Speaker 3: So well, let's start with so for a fetus, so
Speaker 3: there's perinatal, right, which is the fetus, which is before
Speaker 3: birth they die or surrounding birth they die, and that's
Speaker 3: usually the one that takes forever. Like you mentioned, what
Speaker 3: was it a sixteen week er? It was an all
Speaker 3: day affair.
Speaker 2: Facing Remember you guys used to have that laptop that
Speaker 2: like was like, okay, look, probe the bio duct, then
Speaker 2: move on, and then we.
Speaker 3: Had the whole entire like yeah, we had the whole
Speaker 3: template and like exactly what.
Speaker 2: The bile duct in an adult is so small in
Speaker 2: a fetus, It's like what did you have to use,
Speaker 2: like it like a sewing pin to probe it?
Speaker 3: Like I can't. And that's like that's ultimately what it
Speaker 3: comes down to. You're dealing with a body that's you know,
Speaker 3: three inches long, and so the cavity is only maybe
Speaker 3: like two inches and you're like, okay, where do I start?
Speaker 3: And then sometimes there's findings that they have questioned. The
Speaker 3: clinicians have questions about and you're like, uh, what the
Speaker 3: ultrasound or something, and I'm confirming what, Like, how can
Speaker 3: I even possibly you know, there's grain of salt is
Speaker 3: what I'm looking for. And it gets a little bit
Speaker 3: tough at that point. But then we have like a
Speaker 3: dissecting scope and then an enlarged image on a screen,
Speaker 3: and then that's a whole other ballpark, because how in
Speaker 3: the heck to you sit there under a microscope do
Speaker 3: an autopsy, watch a screen and make it all happen
Speaker 3: where you don't ruin anything before you can actually confirm
Speaker 3: or deny that something was or wasn't there. So starting there,
Speaker 3: it's one. They're small, so we have to slow down
Speaker 3: a little bit because trying to make that happen is
Speaker 3: difficult technically difficult. Then you also run into they might
Speaker 3: have had imaging, and we want to prove that the
Speaker 3: imaging was correct. We also will find things that necessarily
Speaker 3: weren't found on imaging in the autopsy, so we have
Speaker 3: to slow down. Knowing normal is where we start. Knowing
Speaker 3: abnormal is where we specialize. So you have congenital anomalies
Speaker 3: malformations like I was talking about the congenital heart defects.
Speaker 3: You wind up opening a heart in an adult you're
Speaker 3: looking for an infarct.
Speaker 2: Yeah, you're not going to find a hole in a
Speaker 2: heart in a sixty year old person. Right. The general
Speaker 2: consensus is like, if you live to be old like you,
Speaker 2: you don't have any generator correct or anything that really
Speaker 2: killed you like that.
Speaker 3: And if you have one, it's so small it never
Speaker 3: affected you ye the way it would if it were
Speaker 3: a large t effects. So you wind up like having
Speaker 3: to slow down, having to look at what should be
Speaker 3: there compared to what isn't there, And there is variability
Speaker 3: in what should be there, which is a whole other
Speaker 3: other thing. So you really have to slow down and
Speaker 3: just take a minute and go system by system and
Speaker 3: orientation and anatomy at its finest, like you wind up
Speaker 3: being more specialized in it because now you're looking for
Speaker 3: things that like you were saying, if you're an adult,
Speaker 3: you're sixty, you've lived your life. Nobody's really concerned if
Speaker 3: you had a small hole in your heart that you
Speaker 3: lived with. But when you're a fetus and you're syndromic, well,
Speaker 3: this is a clue as to why this fetus died.
Speaker 3: This is a clue to what we're now counseling these
Speaker 3: parents towards, like for future pregnancies. So you basically slow
Speaker 3: down plush. You might get a placenta with a perinatal autopsy,
Speaker 3: then you have to do the whole entire examination of
Speaker 3: that and it's very important which you always don't get
Speaker 3: the placenta, do they do.
Speaker 2: People deliver at the children's hospital?
Speaker 3: So yes, So for high risk case, that's when we
Speaker 3: have a delivery at the hospital. And I believe both
Speaker 3: institutions that I've worked for do have a labor and
Speaker 3: delivery unit. So these high risk case they pair with
Speaker 3: an adult hospital, they come in deliver the baby. Babies
Speaker 3: delivered at the children's hospital then sent to the oors
Speaker 3: to have whatever surgery something you know the asd VSD
Speaker 3: repair or even something like a correctation of the order
Speaker 3: where it's a narrowing of that lumen. They'll take out
Speaker 3: that little snippet, put a little patch in this way
Speaker 3: it's a normal flow of blood.
Speaker 2: Would they send that snippet to you guys to get.
Speaker 3: So we get them and they're just basically a little
Speaker 3: piece of vestil a one cassette. Easy, just confirm, Hey,
Speaker 3: this lumin is narrow, it's smaller than where what started.
Speaker 3: You know, there's a spot that goes to like maybe
Speaker 3: pinpoint or like a zero point one centimeter and then
Speaker 3: the rest of it's like zero point five. So clearly,
Speaker 3: like when you have blood flow, that's going to be
Speaker 3: a problem, just like it would be with a funnel, Like, yeah,
Speaker 3: it'll going to slow down.
Speaker 2: Right, that's interesting. All right, So I'm glad that we
Speaker 2: could talk to Crisper about this pediatric pathology because I
Speaker 2: talk a lot about surgical pathology and autopsy, but like
Speaker 2: I just tend to keep my head.
Speaker 3: I can have a mini series on pediatric Yeah exactly.
Speaker 2: But regardless of like all this stuff that we can
Speaker 2: do at our job, I feel like one of the
Speaker 2: things that we talk about all the time is the
Speaker 2: limitations of being a PA. So when we go to
Speaker 2: school to be a pathologists assistant, it's kind of like
Speaker 2: you can get a job in the lab or you
Speaker 2: can get a job in the morgue. But like that's
Speaker 2: kind of it, right, there's no other thing, which for
Speaker 2: us it's fine because we love pathology and like whatever
Speaker 2: I'll be fine with that, but some people sorry, yeah exactly.
Speaker 2: But it's like some people go all the way through
Speaker 2: school and then they say like, oh, I would I
Speaker 2: would like to work in dermatology, and then you're like, oh, well,
Speaker 2: guess what, Like your degree means nothing and you need
Speaker 2: to go back to school to do this. And so
Speaker 2: the reason that I'm bringing this up is like, do
Speaker 2: you do you ever find yourself like you think that
Speaker 2: you're going to do this the rest of your life.
Speaker 2: I mean I know that you're like approaching retirement like now,
Speaker 2: It's like, no, it's so crazy because I remember we
Speaker 2: were taught like when we when even ten years ago,
Speaker 2: like I would be talking a Gabe about like, oh,
Speaker 2: retiring or whatever, and now I'm like, oh my god,
Speaker 2: he's eligible to retire this year. It's just completely crazy.
Speaker 2: And I mean we're just getting older, not that that's
Speaker 2: going to happen anytime soon, but like for the next
Speaker 2: twenty years, are you do you yourself doing this or would.
Speaker 3: You like one hundred percent? To be honest, like, this
Speaker 3: was something I think I was even asked early on
Speaker 3: or maybe even just talking to one of the students.
Speaker 3: It was it's for me one hundred percent. This is
Speaker 3: what I've always wanted to do. I absolutely love the field.
Speaker 3: If I didn't need to rely on money to survive
Speaker 3: in this lovely world, I would do it for free,
Speaker 3: Like I would hands down go in and enjoy my
Speaker 3: life doing.
Speaker 2: This like maybe just not every day, just maybe not every.
Speaker 3: Day, making make it like a little bit of a
Speaker 3: per diem or like a weekend gig. But for for
Speaker 3: sure I joke about, like, you know, being eighty and
Speaker 3: doing an autopsy and pretty much suspend me from the
Speaker 3: ceiling and just let me do my business.
Speaker 2: You know.
Speaker 3: Here, I got to go to the gym, keep my
Speaker 3: mobility up so I can at eighty not have to
Speaker 3: worry about retiring when I can't.
Speaker 4: Afford anything, Yeah, exactly, and living off of so sah,
Speaker 4: I can't imagine you like doing anything else, honestly, And
Speaker 4: that that's like not one bit.
Speaker 2: She She's a typical all we all are like this,
Speaker 2: this like anti a little bit anti social, like fit
Speaker 2: in the world just fine, but like they're good at
Speaker 2: our craft kind of thing. Well, thanks so much for
Speaker 2: being here today. This was very good. It was it
Speaker 2: was good for me to hear all this stuff. Because
Speaker 2: I certainly stay away from pediatrics as much as I can.
Speaker 2: I think I think a big bit reason is because
Speaker 2: I'm a mom and I have little kids. I just
Speaker 2: out of slight, out of mine kind of thing. But
Speaker 2: it's great that there's people like you that that do
Speaker 2: this and don't cry over your workstation and just like
Speaker 2: get it done. So thanks for being here.
Speaker 3: I cry in private.
Speaker 2: I'm glad you guys get got to meet one of
Speaker 2: my best friends. She's here all the time and we're
Speaker 2: hanging out and.
Speaker 3: It's been great talking smack yep.
Speaker 2: Thanks guys, Thank you for listening to Mother nos Death.
Speaker 2: As a reminder, my training is as a pathologist's assistant.
Speaker 2: I have a master's level education and specialize in anatomy
Speaker 2: and pathology education. I am not a doctor and I
Speaker 2: have not diagnosed or treated anyone dead or alive without
Speaker 2: the assistance of a licensed medical doctor. This show, my website,
Speaker 2: and social media accounts are designed to educate and inform
Speaker 2: people based on my experience working in pathology, so they
Speaker 2: can make healthier decisions regarding their life and well being.
Speaker 2: Always remember that science is changing every day, and the
Speaker 2: opinions expressed in this episode are based on my knowledge
Speaker 2: of those subjects at the time of publication. If you
Speaker 2: are having a medical problem, have a medical question, or
Speaker 2: having a medical emergency, please contact your physician or visit
Speaker 2: an urgent care center, emergency room, or hospital. Please rate, review,
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