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Pillow Talk

“You know Haas did the autopsy on her own miscarriage.”

“Get out of here!” Carlos de Jesus frowns in disbelief at Dan Rosenthal’s comment.

Unfazed, Dan continues between bites of his sandwich. “She didn’t trust any of the residents with the job so she brought the fetus in, sent everyone out of the morgue, and did the autopsy herself.”

“Whoa..how could anyone be that ice cold and do that on their own child?” James is mortified.

“A child? It’s a macerated fetus…a stillborn.” Dan interjects a pathological description for a miscarriage.

James glares at Dan. “It is a child. It doesn’t matter whether the child is a fetus at conception, 2 months in the womb, or a term infant.”

“Here come the skin docs. Late today…must have been a conference.” Dan abruptly changes the topic pointing to a group of residents entering the dining room as an uncomfortable silence came over the table.

“Yeah…wonder what happened? Carlos jumps in, feigning interest and also hoping the conversation would change topic.

There are two groups of residents in the physician’s dining room at the beginning of the lunch hour, the pathologists and dermatologists. Dermatologists always chose a table inside the dining room hidden from the harmful solar rays while pathologists gravitate to the outside patio, usually in the direct sunlight, seemingly oblivious to the accumulating skin cancer risk.

“Guys, you look like you’re having fun!” Deanna Berkowitz places her tray on the table and sits down next to Rosenthal. A faint whiff of jasmine perfume floats past James’ nose announcing her arrival.

“Father Deetan is giving us a sermon on the sanctity of life.” Dan’s voice dripped of sarcasm as he airily pronounces sanctity. James is expressionless, knowing that he should not have let his emotions get the better of him. Dan always knew how to prick at James’ most sensitive issues.

“So I hoped you learned something Dan, it’s about time someone gave you a talk about life!” Deanna winks at James.

“Ah, Dr. Berkowitz! I know far more about life than you could ever begin to imagine.”

Deanna smiles, “If you mean life as having a comprehensive collection of jazz CDs, I would say you have achieved enlightenment. By the way, how does your wife put up with you? Karen hates jazz.”

A broad smile breaks across Dan’s face. “I have other talents that keep Karen interested in me.”

“I don’t think we want to go there!” Carlos laughs.

“Seriously,” Dan continues, ignoring the comment, “She told me last night that I was a sex god!”

Laughter erupts from the table followed by a severe coughing fit by Deanna as she chokes on her drink. Finally clearing her throat, she bows in Dan’s direction.“The next time I come across road kill, I’ll be sure to offer up a sacrifice to you.”

Deanna Berkowitz’s shoulder length chestnut brown hair playfully dances in the light breeze that caresses the patio. In the sunlight, it is several shades lighter compared to the usual illumination under the fluorescent lights of the hospital. Her brown eyes are a window into an adventurous spirit, flashing a mischievous look to all who caught her gaze. Conspicuously well groomed with a smile never more than a few seconds away from her expression. Her beauty is obvious to all but it is her poise that commands immediate attention. She could size up an entire roomful of people with a single glance. She first arrived to the United States from Brazil as a young adult for college. The daughter of a diplomat, her father was determined she receive a rich and diversified education through boarding schools in Switzerland and England. She matriculated at Princeton, majoring in history, and obtained her medical degree from Johns Hopkins. She is a fourth year resident and acknowledged as one of the stars of the department.

When James first met her, he was taken by her confidence and gregarious nature. Deanna, in turn, respected James’ earnest desire to become a pathologist. She made it a point to frequently stop by his desk and offer encouragement. Little notes signed with DB and a smile were often stuck on his microscope. She was single and although James longed to ask her out, he was intimidated by the throng of male residents from throughout the hospital who managed to accidentally find themselves outside her office.

“So why are you late Deanna?” Carlos was finishing his last french fry.

“Nomura and I were presenting at the dermatology grand rounds.”

“Did you present my pyoderma gangrenosum case?”

“Yup, the patient was there so it was quite impressive to see the size of his lesion. He also had ulcerative colitis with a recent colonoscopy biopsy surveillance revealing a high grade dysplasia at several sites, so he may end up with a total colectomy. Very sad…I think the patient knew what was in store for him. You know, I can present at tumor board, chest conference, breast conference, neuropathology….but I can never get used to these dermatology grand rounds, when you actually meet and see the patients. I didn’t think I would be doing this in pathology.”

James is surprised. “Deanna, you are such a people person!”

“That’s just it…I am too empathetic. I get too involved. In medical school, I would get overly emotional if my patients didn’t recover or if complications set in. I try to remain detached but it’s asking me to be something less than what I am. In psychiatry, they videotaped our interviews with our patients. I unconsciously would hold the patient’s hand if they broke down and cried. Not a good thing. But I love medicine and people so I felt pathology would be an excellent way to use my skills to help people. It's funny...in college, I took one of those psychological evaluations which supposedly help guide you in your career choice. Not surprisingly, I would have made a good minister but not a good psychologist.”

“Father Deetan and Mother Superior Berkowitz! Imagine that, a Jewish nun!” Dan is off and running.

Deanna sighs and flicks a stray bread crumb at Dan’s direction. “Rosenthal, purgatory welcomes true believers like yourself! Carlos, how is the cytology service?”

“Saving lives everyday!” Carlos De Jesus grins as he pumps the air with his fist. “You know, Deanna, if you are bothered by seeing patients how do you manage when you are on cytology?”

“What do you mean?”

“I mean, when you are on the fine needle aspiration service, you are seeing patients with probable cancers in their thyroid, breasts, chest wall….and you have to aspirate these tumors, all the while talking to them, knowing that you are probably going to be giving them a death sentence. You smear the aspiration on a slide, stain the slides, and proceed to look under the microscope. Where else in medicine can you render a definitive diagnosis in less than 5 minutes?”

Deanna nods in agreement. “You’re right. Sometimes, I dismiss these thoughts when I see these patients and perform these procedures. We all need to maintain some emotional distance from our patients or else we can never adequately perform our jobs. All physicians do this but I am sure that all physicians experience some degree of empathy for certain patients. I don’t think compassion and excellence as a physician are mutually exclusive. I know I speak the obvious but sometimes this message gets lost in the frenetic pace of our lives.”

“Don’t forget the bone marrow biopsies,” James quickly adds.

“Especially the bone marrow biopsies!” Carlos shouts. “The patients certainly don’t enjoy you sticking that Jamshidi needle in their butt. The hematologists always turf these patients to us when they don’t get paid by the patient’s insurance carrier. I think they do it so their patients won’t be upset with them.”

“I don’t enjoy doing it either. I always try to put in perspective with the overall care of the patient. Ironic, isn’t it? So many patients and even some of our clinical colleagues are totally clueless regarding how much direct patient care pathologists actually have. The patients think their surgeon or hematologist is making the diagnosis but we are the ones meticulously going through their tissues with our microscope and finding that elusive cancer cell or giving the patient the reassuring news that no cancer remains.”

Everyone nods with Deanna’s comment. It reminds James of his initial encounter with the highly esteemed pathologists in the Philippines. He wondered why American pathologists were not afforded the same level of respect. The brief lull in the conversation is broken by Carlos who glances at the clock. “I guess its time for pillow talk.”

Deanna shakes her head dismissively. “Must you reduce all your observations to a sexual encounter?”

“What?” feigning surprise. “We just had this intense discussion and now we need to wind down, spend that obligatory five minutes comforting our woman.”

“I don’t need comfort or pillow talk…and even if I did, five minutes wouldn’t even begin to do it for me. How did you come up with that figure? Is your pillow talk time calculated from a 150% increase over the time you actually spend with your ladies?”

“No, it is calculated from how soon I need to get out of there before my girlfriend finds me missing!”

“Carlos as a newly crowned sex god, I agree wholeheartedly!” Dan slaps Carlos’ outstretched hand. “It’s a guy thing, Deanna, right James?”

James blushes as the question is directed his way. He never felt as comfortable as his colleagues when discussing issues of sex, even less so in Deanna’s presence.

“Oh, sorry James. I forgot priests were celibate.”

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