Exit 148

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.