Most tissue specimens for histopathological examination should be sent to the laboratory covered by at least 10 times their own volume of 10% formalin and should NOT be squeezed into small containers.

Pathology Specimen
Handling Histopathological specimens
The Royal Liverpool and Broadgreen University Hospitals

Simple enough instructions, straight out of the manual. Medicine, like the military, has clear rules. And like the military, clear rules get blurry in real life.

The holding area in an emergency department has fuzzy lines of responsibility. Often tucked away in a back corner, the holding area is where patients go while waiting for a bed. The ER doctor has pretty much done what she needs to do, and the admitting doctor has not yet quite taken over.

The first time I got called to the adult holding area, I got lost. I was called to resuscitate a baby.

I found a heavy young woman looking rather sad lying on the bed. The "patient" lay in a stainless steel emesis basin.

"It had a heartbeat. It's policy to call the pediatrician." The nurse was officious, and enjoying his role a tad too much.

"It's nonviable." I stated the obvious. The fetus' glistening chest pulsated with the rhythm of its beating heart. "I couldn't get a tube into it even if I wanted to--"

I am not sure the woman knew she had been pregnant. An obstetrical resident wandered in, muttering something about the specimen. I wrapped the fetus up in a towel, and offered it to the mother. She glanced at the fetus, and chose not to hold it.

I wasn't sure how far along the pregnancy had gone. A look at the crown-rump length put it at about 17 weeks. Tiny arms, tiny hands, tiny fingers, tiny nails. The eyelids, thankfully, were fused. I was annoyed at having been called.

A staff member fetched a plastic bucket of formalin. It sat on the stainless steel lid of a laundry basket in the room. I set the fetus on the lid as well, still wrapped in the towel.

It can take a while for a fetal heartbeat to stop. The creature was nonviable, but it was not dead.

What happened next can only happen in a world where argument replaces imagination, and efficiency replaces compassion.

Someone placed the fetus in the formalin. The fetus reacted.

"That's what the lab said I should do," a voice uttered. I shook my head and walked out.

The hospital administrator insisted that I fill out a death certificate. I refused. The fetus was nonviable, both by our technical limits and by legal definition. If neither the state nor I could recognize the fetus as human while still alive, it seemed perverse to recognize it as such when dead.

Still, it was alive. It was human. It reacted.

grain mill

Ye Maids who toiled so faithfully at the Mill
Now cease your work and from these toils be still;
Sleep now till dawn, and let the birds with glee
Sing to the ruddy morn from bush and tree;
For what your hands performed so long and true,
Ceres has charged the Water Nymphs to do..

Antipator of Thessalonica, 85 B.C. ¹

Grinding grain is hard work, still done by hand by much of the world. Hard kernels of wheat berries, barley, maize, or rice are ground into flour, the foundation for life in an agricultural society. Bread, booze, Fritos, Lucky Charms--all from ground grains.

On Sabbath, I grind wheat, a direct violation of the melachot. It is hard work. Muscles strain, but they know what to do. My mind is idle, and in the steady whir of burr on burr, my thoughts wander.

I use a Country Mills grain mill--a solid hand mill. It will last longer than me. The burrs need replacing every decade or so, but the rest of the machine will be fit for my grandchildren, should they choose to grind.

A small depression is growing deeper in the cement basement floor--my left foot rocks back and forth as I crank, and over time, the sole of my foot has made its own cradle. My son's bicycle rusts on my front porch--he has long outgrown it. When I get the time, I will figure out a way to rig his bicycle to my mill. I am not getting any younger, and my legs are stronger than my arms.

A wheat berry makes a fine crackle as it gets crunched between the plates of the hand mill. One stationary plate, one rotating plate. The noise sounds like the white noise background of an untuned radio. When I have drunk too much melomel, I imagine that the wheat berries make a noise beyond the crunching on the bran. There are worse things to imagine.

First my right arm, then my left. I can feel my biceps swell a bit from the work. The legs work, too, shifting my weight back and forth with each pass of the milling wheel. My breathing picks up. Oxygen in, carbon dioxide out. When the wheat berries were made in Montana, the wheat plant breathed in carbon dioxide, and using the sun's energy and water, created carbohydrates and oxygen. The sun's heat released again in the warmth of my breath, my churning muscles, the steel plates grinding the wheat.

Before the last few wheat berries pass through the millstone, I pick 2 or 3 to go into the garden. They are, after all, alive, until ground into flour. Conscious? No, but perhaps that's not the point. That's not the point at all.

¹ from Mill Folklore: "History or Hearsay," http://www.angelfire.com/folk/molinologist/folklore1.html