fucking hate it when the stuff everybody says "actually works" does actually work.
hate exercising and realizing i've let go of a lot of anxiety and anger because i've overturned my fight-or-flight response.
hate eating right and eating enough and eating 3 times a day and realizing i'm less anxious and i have more energy
hate journaling in my stupid notebook with my stupid bic ballpoint and realizing that i've actually started healing about something once i'm able to externalize it
hate forgiving myself hate complimenting myself more often hate treating myself with kindness hate taking a gratitude inventory hate having patience hate talking to myself gently
hate turning my little face up to the sun and taking deep breaths and looking at nature and grounding myself and realizing that i feel less burdened and more hopeful, more actually-here, that i am able to see the good sides of myself more clearly, that i am able to see not only how far i have to grow - but also how much growth i have already done & how much of my life i truly fill with light and laughter and love
horrible horrible horrible. hate it but i'm gonna do it tho
The postmortem examination deserves its honored place in pathology – and medicine as a whole
I read this article this week and I wanted to share it because I feel very strongly about the value of pathology as a profession and the struggles the profession as a whole and individual pathologists face. I also believe that autopsy/necropsy is a vital part of what we do as pathologists. As a warning, this post includes discussion of death, disease, and dissection of dead bodies. None of it is graphic, but make the best choice for yourself. These are also my opinions, and I don't know everything, so do with that what you will. This is going to be a long one, so my thoughts are all under the cut…
Two disclaimers: The letter linked above is a response to a previous editorial. Both are written by pathologists. Both are clearly written from a place of deep caring about pathology and a drive to see more medical professionals take up this vital specialty. I have deliberately chosen to link the rebuttal letter and not the original editorial because I feel very strongly that the editorial makes some controversial (and, in my mind, harmful) assertions about autopsy and as such it should not be read without the response. But I do think that there is value in reading both. Secondly, I am writing this from my perspective as a veterinary pathology resident. There are differences between human and veterinary pathology in how we are trained, the role we play in the health of our patients and the public, and what our day to day jobs look like. With this in mind, some of the misconceptions about pathology discussed in these pieces resonated with me, which is why I wanted to share my thoughts, and hopefully get some of you thinking about the same things.
I’m going to pull some key points and quotes from the articles to discuss but again, I highly recommend reading both pieces for yourself. This might be a long one folks, so settle in.
”There is a lack of understanding of our specialty among medical school classmates and eventual colleagues”
I 100% agree. Most of my classmates have next to no idea what I do with my day, or why I care so much about pathology. And this is reflected in the submissions I receive as well. I believe that a large part of why I receive so many cases with insufficient history or inappropriate samples for what the clinician needs. While I recognize that there is not the time in veterinary school to teach every element of every specialty (and I also have a lot of thoughts about the way we currently approach veterinary education in general), vet students get a much more “real-life” experience of the clinical specialties than they do of pathology. The clinical year pathology rotations at the school where I trained and the one where I now work and teach focus entirely on necropsy which, while extremely valuable in its own right, is only a very small proportion of what pathologists do on a daily basis. There are many pathologists who don’t do any necropsies in their role, and we do a disservice to all students by not accurately demonstrating what a pathologist actually does. For veterinarians, necropsy and sample collection are the only skills an anatomic pathologist might use that may also be used in the clinic. But in the same way that I benefit from understanding how the surgery which produces the sample I analyse is performed, I believe there is benefit in clinicians knowing the basics of what happens to that sample when it reaches the lab to generate the report they read.
“Pathology? Don’t you want to be a real doctor?”
This one… oof. I have so many thoughts because I have heard this so many times myself. I’ve been planning a separate post on this point alone, and some of those thoughts are in the point above, but I want to emphasize that pathologists are real doctors. Pathologists are essential to medical practice. We are expert diagnosticians, and that skill is vital to how doctors in other specialties function.
“An autopsy is not healthcare in any form”
The women of the response do an excellent job of rebutting this point, but I would like to emphasize how deeply I disagree with this. Autopsy is closure for a family. Autopsy is the last chance of a person or an animal to tell the story of what happened to them. Autopsy is education, autopsy is our protection against malpractice, autopsy is progress and solutions and knowledge. On the veterinary side, the necropsy of one animal can save the rest of the herd. Imaging can do a lot, but it is no substitute for holding an organ in your hand and being able to look at any piece of it under the microscope. Only necropsy can give you that.
This statement also feeds directly into the misconception that pathologists are not doctors because we do not directly “fix” anything. Diagnosis is essential and more emphasis on how what we do as pathologists influences treatment decisions would help in improving the perception of pathology held by the rest of the medical and veterinary professions.
“All physicians perform a prolonged autopsy during their freshman medical school anatomy class”
Prosection to learn anatomy is not autopsy/necropsy. The function and approach is different, and this is not an accurate representation of either the practice and intention of a true autopsy. The prosections performed by junior med and vet students are there to teach anatomy – the process is drawn out, performed on preserved cadavers, and focusses on minute detail. Autopsy/necropsy is a medical examination. There are specific questions to answer, and the approach is designed to fill that purpose. A student who has only experienced anatomy prosection has no true understanding of autopsy. The do not understand the care, the intention, the science of a necropsy performed by a pathologist. And the suggestion that anatomy dissection could or should be the only experience our medical and veterinary students have of autopsy/necropsy will only lead the profession further from a true understanding of what it is pathologists do and why we value necropsy so highly.
“The dismembering nature of the practice”… “It is dirty, malodorous, and dangerous. It carries infection risks for pathologists”
This is a medical exam, not dismemberment. Aspects of necropsy can be dirty, malodorous, dangerous, and carry an infection risk, but so does surgery. So does palliative care. So does pediatric medicine and large animal medicine and laboratory work. As medical professionals we cannot shy away from what is unpleasant to the detriment of the dignity and care of our patients and the progress of our science and our professions. Necropsy is not always a pleasant process, and not everyone will want to perform them, that is true. However, I personally found surgery distasteful and unpleasant, that does not mean I think we should stop performing it. With the appropriate safety measures in place, necropsy does not pose a significantly greater risk to those performing it than any other medical procedure. However, this is a reason why physicians and veterinarians should be the ones performing autopsies/necropsies, not lay people or unsupervised technicians. Our training in the recognition of disease allows us the unique capacity to read a history and quickly identify those cases that pose a greater risk, and require more specific PPE or safety measures. SOPs can help, but no checklist or protocol can outweigh deep medical knowledge for assessing and mitigating the risks of exposure to cadavers.
“Those rare physicians who want to perform autopsies can undertake a forensics fellowship – but, again, why must they be pathologists?”
Pathologists have the depth of understanding of how disease progresses and how gross and histologic changes correlate which is vital for interpreting the nuance and inter-relationships of the various changes you can see in a single body. No other professional is adequately prepared to interpret these findings, and it devalues the practice of autopsy to imply that this is merely a sample collection and recording exercise.
Overall, I strongly believe that autopsy/necropsy has intrinsic value to the practice of medicine, and should continue to be a part of the training of not just pathologists, but every medical and veterinary student. The path to improving the perception of pathologists and the work we do is not through eliminating anything which makes people uncomfortable, but through providing better education so that the purpose of what we do, and how it helps and supports the practice of medicine in every specialty is better understood by our non-pathologist colleagues. Pathologists deserve respect, and denigrating what we do from inside the profession does nothing but detract from that. What we do is valuable. What we do is vital. And we need to help others see that.
Microscopically, the mucosal lining of the rectum & colon exhibits many intestinal glands or crypts of Lieberkuhn (the flowers) that are lined with mucus secreting goblet cells (the petals).
Mucus collects in the lumen of the gland (center of flower) and is squeezed out when the muscular wall contracts to push the fecal material out.
As the feces move through the colon, water is reabsorbed making them drier to conserve the water. As a result, the mucus secreted from these crypts is super important in this region because it ensures that the tube is well lubricated to allow the dry feces to be passed along the colon easily without causing any damage (the mucus decreases friction).
If you slice up the colon or rectum in a way that ensures you cut through the mucosa parallel with its surface then your rectum looks much more like a field full of daisies with pretty goblet cell petals than a chute for passing along poop 💩
everytime there is a post about lucy liu, it showcases her absolutely shredding it in whatever she is doing. be it painting, gymnastics, javelin, anything! all of that and she still doesnt look a day over 25. keep killing it, ms liu
why did god make men last really short during sex while making women last really long during sex? the answer is easy sillies… man on man and woman on woman relationships were ALWAYS meant to be… man jerks off another man and they’re like this is it, it’s enough of an adventurous “sex” for AT LEAST a month…. us lads, we GET each other in EVERY way… while lesbians are out there beating each other’s meat for half an hour and they go to round 2 ten seconds later… they’re strong legends, that’s what they are… long story short, miss nature knows what’s up… so what’s up? mlm and wlw is the NATURAL way of living while a man/woman relationship is just a FORMAL communal way to help procreate gay legends
Ghostbusters 1984 was mediocre. Ghostbusters as a franchise isn’t and never has been particularly spectacular. It’s goofy trashy fun and that’s all it needs to be.
dailybridgerton
titsay
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