May 19, 2010

My First Visit to the Morgue

This morning was my first visit to the morgue. Every Wednesday morning at 7:30am the neuropathologist cuts and teaches about all the brains that they are investigating that week. It was actually incredibly clean, bright, and people were altogether in light moods. I'm not sure what I was expecting - zombies?

Today's case was apparently exceptional in the degree of injury:

59 year old man who had died a few days ago after presenting more than a week ago with "confusion, ataxia (feeling off balance), and problems with his vision". He came back in a few days ago to the ER because his daughter could not wake him up. He died later that day. He had a history of alcoholism, liver disease, and diabetes (the last two often stem from the first)

The other pathologist had already done the full body autopsy and found very clear arteries (which apparently is very typical of alcoholics, strange protective effect that can actually be achieved with MUCH LESS alcohol), as well as endocarditis of the mitral valve. Endocarditis is basically inflammation of a heart valve. In this case, it seems to have been caused by an infection of staph aureus which had also entered into his CSF (spinal fluid).

After slicing through the entire brain carefully, the neuropathologist went through the most effected slices. There were several emboli in the brain (emboli = blood clot) probably caused by the heart not working correctly, blood getting backed up, and those clots moving to the brain.

There were emboli in the cerebellum (controls movement), frontal cortex, specifically in the area that adjusts motion as well as the area that controls your eye movement, the temporal lobe (in an area processing what touch means), and in the occipital lobe (which is mostly dedicated to the visual system).

Then we went around and each said one neurological disease process that can be caused, either directly or indirectly, by alcoholism. We got to 38 before I had to run to class, including:

traumatic brain injury from falling (contusions/concussions/hemorrhages),
encephalopathy (increased pressure inside the skull pushing down on the brain),
vitamin deficiencies (B12, and B1; which can cause confusion, delirium, problems with eye movements, problems with the spine),
delirium tremens (tremors or shakes that won't stop),
and hyperglycemia (too much sugar in your blood; which causes all sorts of problems on its own)

This variety of illnesses is why when someone who is an alocoholic comes in in crisis you give them an "alcoholic's cocktail" (different from an alcoholic cocktail) consisting of: a benzodiazepeine (to prevent DTs), thiamine (to proactively treat any B1 aka thiamine deficiency), and glucose (because alcohol prevents your liver from actually being able to use any glucose, and alcoholics are often not eating anything else). This is also known as a "banana bag" because it looks pretty yellow. A clear IV bag should never be given to an alcoholic, because it's missing at least the thiamine!

As we're going around, my fellow first year med student and I are in awe - that all these more advanced students can rattle off these disease processes on cue, but even more so that we understand almost all of what they're saying. The best part about things like this is that as we walked into class this morning to learn about tremors, we paid WAY more attention.

(completely unrelated)

"a woman is like a tea bag, you cannot tell how strong she is until you see her in hot water" - eleanor roosevelt

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