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