Autopsy

Yesterday I had a strange new experience as a doctor. I have been taking care of a young (30s) man with spina bifida for the past 5 years. I had just seen him for a physical recently. A few minutes before leaving the clinic at the end of a busy day, I received a phone call from a pathologist. My patient, who I will call Steve, was found dead in his apartment. The cause of death was not known. An autopsy would be performed. I was stunned. I had just seen him a few days ago and things looked good. He had a chronic urinary infection, but with his neurogenic bladder and paraplegia, this was not new or unexpected. He was on prophylactic antibiotics for this. I asked when the autopsy was planned for and was told it would be done the following morning. Since I was not scheduled to work or be on call that day, I asked if I could attend. The autopsy was to be performed in another town.
Yesterday morning, I drove there and found the morgue. Present was the pathologist who would be doing the autopsy, the county coroner and a med tech. I was permitted to gown up and assist with the procedure.

It was a somewhat surreal experience to be standing before someone I had known and cared for for several years and had just examined a few days ago. He lay dead on the autopsy table. The autopsy proceeded in the usual fashion with a Y-shaped incision made on the chest. The ribs and clavicles were sawed to permit up to lift up the rib cage. Systematically, heart and lungs were removed and examined. Bowels were removed and examined. Liver and gall bladder were removed and examined. When we came to the urinary system, the cause of death became apparent. The right kidney was grossly enlarged with a large extra-renal pelvis. There was frank pus in the bladder. The cause of death was urosepsis. It was estimated that Steve had been dead for at least 24 hours before he was found in his apartment. Interestingly, a nurse from the clinic had called him in the morning to give him some normal lab results and his mother spoke to him at around 3 pm that afternoon. He must have died within 6 hours of that time. There was no warning. It is unusual for urosepsis to set in so rapidly with no symptoms manifesting even 6 hours before. Some element of mystery will always remain.

I called his mother from the morgue with Steve's splayed open body still on the table. She had come to his appointment with him as she usually did, just 4 days ago. I offered my condolescences. I said goodbye to Steve and walked away.

In one sense, it was interesting to see the very organs I had palpated, auscultated and percussed from the outside while he was alive. I was able to hold and touch the kidneys and lungs and other diseased organs. I was able to see his spinal fusion beneath the scars I had seen just 4 days ago. In another sense, it was sad -- I was looking at and in his corpse. As primary care providers we do not have to go to autopsies. I went because he was my patient and I wanted as much as anyone to know why he died and as my final act of care. Goodbye Steve. You died so young! I will miss you!

Camp Angel - Summer 2012

Fort

Camp Angel is a camp held twice a year (summer and winter) for children touched by cancer through a family member. Camp Angel 2012 was held at its usual summer location: Camp Luther, Three Lakes, WI (http://www.campluther.com/) from July 13 to 15, 2012. If you have never been to Camp Luther in beautiful Three Lakes, it is worth checking out the pictures of Camp Luther at their website. Especially beautiful and I think, unique are the actual camp sites where the campers spend their nights. 

Noah's Ark

Pioneer Village or Covered Wagons

Towers

51 kids showed up this year. They were divided into our usual 4 groups, the 14  littler girls (7-9 year olds) were in the Bunnies group and they stayed at the Pioneer Village or Covered Wagons. The 16 older girls (10 and 11 year olds) were in the Foxes group and stayed at the Treehouse. Similarly, the 9 littler boys (7-9 year olds) were in the Wolves Group and stayed in the Tower, while the 12 older boys (10 and 11 year olds) were in the Bears group and stayed at the Fort. The photos show pictures of the Covered Wagons, Treehouse, Tower and Fort camp sites where the groups stayed.

The campers arrived at about 3 pm in the afternoon on Friday, July 13. After some games of introduction, campers went to their respective camp sites to settle in. We had our usual Friday night dinner of delicious pizza. This year, something was different. We should have known, given it was Friday the 13^th. There was quite a storm during dinner and lightening cracked a tree that fell on a powerline pole and took the powerline down with it. One of our camp staff whose was driving in late was stranded on the other side of the blocked road. Also unable to get through to us was the local Harley Davidson Group. No one was hurt. We did lose power though. One enterprising biker was able to get through and he generously offered to present a show-and-tell to the kids. Practically every kid got their picture taken sitting on his bike! The camper retired to their camp site for the night where they slept…er…played and horsed around.

The downed power line

The next day, power was restored by around 7 am. After breakfast, in 2 separate groups, we took off for Eagle River where we went for a ride on the Pirate Ship (http://www.eagleriverpirates.com/index.html). 

Captain Steve was gracious as ever. We had a great time (aarrrhhh!!!). We came back hungry and ate a great lunch. After lunch and swimming tests, it was time to get out on the water. Kids swam, went tubing, swung from the rope into the water, fished (actually caught fish!). On shore, there was face painting, rock painting, crafts, painting driftwood and other fun activities. In the evening, DJ Dan brought his setup over and it was time to dance! This year, there were many requests for Justin Bieber. DJ Dan did not disappoint. Even though he did not have any to begin with, thanks to the internet and iTunes, kids were soon rocking to Bieber. Kids returned to their camp sites for bonfires, s’mores and (officially this did not happen) girls versus boys camp raids.

Beware the pirates!

Okay. So this is a medical blog. As the camp doctor, I treated small cuts and bruises. I did have to set and cast one displaced fracture for one little girl. Nothing serious. She came to me in tears with her broken walking stick. She left smiling with her stick bandages and set (almost) as good as new.

I treated some swimmers ear, upset stomachs, overheating, mild dehydration and the camp staple: homesickness. I also made sure everyone got their scheduled medications. I was a little uncomfortable given one little girl the medication that she was prescribed by her provider back home. Her medications included lithium (for bipolar disorder), Seroquel (for mood disorder), Depakote (for mood disorder) and something for sleep and ADHD. I am not a child psychiatrist. I felt sorry for this little girl being on such strong psych meds.

Free Style Four Squares: chicken feet, black magic and cherry bombs allowed!

Girl talk and ... hey, get off the roof!

Pirates of the Caribbean... okay, actually of Camp Angel

A sign in the pirate ship... hope the kids didn't notice!

Me and the First Mate

I LOVE Justin Bieber! Play more Justin Bieber!

Captain Steve made some mean tatooes...

Hanging on to the bobbing moon-thingie was loads of fun

Sliding into the lake

Our med and First-Aid room -- my kingdom

A view of the lake early in the morning

A shout-out to the awesome camp counselors we have. These young men and women, many of whom began coming as high school students and some of whom still come even though they’ve graduated college do a great job. They are aces at treating homesickness and worshipped by their campers. They carried them, played with them, colored T-shirts with them, and made the camps fun for these kids.

The camp is kept short – three days because most of these families have too much going on to spare their kids for longer. Reading through each child’s connection to cancer breaks your heart. There was one little boy at camp with his two sisters. 

He constantly acted up. Playing Four Squares, he would argue about the rules (black magic and chicken feet allowed/not allowed, we’re playing freestyle versus we’re playing four squares). Reading his notes, I realized that he and his three sisters had lost their dad about a month ago to cancer, and he was really close to him. What’s more, his death had been difficult. Childhood should be a happy time. Cancer does not respect that. Camp Angel brought smiles and laughter to broken hearts, even if just for a weekend. Every little bit helps. Hopefully, we created some sunshine memories in the dark cancer-winter  of these young lives. 

Tubing. Go faster!