Life as a pathologist is very interesting. You are trained to look out for the abnormal. Normal is boring. But there are times when you are caught on the wrong foot. Here are two incidents which taught me to look beyond what textbooks teach you.
The first story is from a pathologist friend, who was sent a sample by a urologist. It was the specimen of a worm, 1.5 cm long, and the urologist said that it had been passed in urine. Apparently the patient said he had similar complaints in the past and now was passing blood in urine. The pathologists had never seen something like this in urine and took sections to study it under the microscope. They passed on the slides to the microbiologists who said they couldn’t identify it. When nothing worked, he sent the case to the Centres for Disease Control and Prevention (CDC) in Atlanta for the ultimate diagnosis.
As is the trend these days, my pathologist friend posted this case on an academic Whatsapp group to elicit opinions of expert pathologists. Opinions varied from fecal contamination of urine to round worms to Schistosomiasis (which is hardly seen in this country). In the middle of all this discussion, one smart alec friend, Nikita, jumped up to say: “It’s raining everywhere. This is just a stupid earthworm. Rule that out first in this monsoon season.”
Hell broke loose on the social media platform! Everyone was guffawing. But now everyone was eager to know the final report from CDC Atlanta. After several days of impatient waiting, the reports arrived today. And our smart friend Nikita was proved right! It was an earthworm which had accidentally contaminated the urine sample. We really don’t know what that slimy fella was doing in the sample. But I’m more concerned about the conversation that my pathologist friend would have had with his urologist!
The second story is from 1999. I had just passed my MD in Pathology, and joined as a lecturer. Like all novices I was all too eager to put my knowledge of theory into practice. One morning in the laboratory, my technician came up to me excitedly to show me a vial containing a urine sample. “Have you ever seen something like this?”, he said. I hadn’t. The sample was as white as milk.
Chyluria! I jumped up excitedly. Chyluria happens when there is obstruction of the lymphatics which redirects flow of lymph from the intestinal lymphatics to those in the kidney. Later these dilated lymphatics rupture into the urinary tract, which causes the contents to be seen in urine. This was something I had read about, but never seen.
I examined the sample under the microscope and I found the fat globules I was looking for. I pulled out my fat textbooks to revise the confirmatory test which I had never performed earlier. I was already imagining teaching the residents posted about this rare case.
And I was just about to get out of the lab to confirm my findings with a senior, when I stopped in my tracks. Shouldn’t I talk to the patient first? I found him waiting outside on the bench. An old man in his sixties dressed in a shabby shirt and dhoti with an umbrella in his hand. I tried to extract a history from him. There was nothing significant in what he was telling me. And then suddenly on impulse, I asked him, “Kaka, did you collect urine in a bottle of oil?”.
“Yes”, he nodded his head vigorously, “I washed a bottle of Parachute Coconut Hair Oil, and used it to collect the sample”!!! He had simply poured the sample from the bottle into the container given by the lab technician.
Poof! There went my rare case. What I called chyle was actually Parachute nariyal tel! I was back on terra firma.
Well, that’s just another day in the life of a pathologist. You are forever on the lookout for the rare and the exotic. And suddenly something like this happens which teaches you to look out for the mundane and ordinary first. Life is actually very boring. Perhaps, we make it exciting by imagining things!