Dr. Jim's WebLog

'Twas ternship, and the frantic fleas
did bix and bumble in the trach'.
All bovey were the Ohbeegees,
and uteri did quake.

"Beware the radical neck, my son,
the 'terns that call, the studs that vex.
Beware the Open Lung, and shun
the Hemonc-ish Marrow Techs!"

He took his 'BP' blade in hand,
long time the tumrous nodes he sought,
till wondered he, on a quick D and C,
"Can I ever escape to the pot?"

And as in formalish fumes he pared,
the Radical Neck with Margins Galore
came whuffling in from its Oto-Lair!
He burbled, "Not one more!"

One two! One two! and through and through,
the BP blade went snicker snack.
He froze and dyed, and with the slide,
he came galumphing back.

"And has thou carved the Radical Neck?
Come to my scope, my beamish boy!
A tum'rous node? A canc'rous fleck?
No! Margins free! Oh Joy!"

'Twas ternship, and the frantic fleas
did bix and bumble in the trach'.
All bovey were the Ohbeegees,
and uteri did quake.

James M. Small MD PhD
in honor of his Pathology residency mentor, Thomas V. Colby MD, 1987.

I think my kids shall never see,
a sight as horrid as a bee,
unless they spy upon their pants
a pair of tiny carnivorous ants.

A moth upon the ceiling flits,
sending Becca into fits;
the fits are only exceeded by
those engendered by a fly.

Sarah begs for me to hide her
from the visage of a spider,
or better yet, oh Father Brave,
send that ogre to his grave.

Katie shrieks, "A bug! A BUG!"
"Dad, come quick, I need a hug!"

The world is full of wondrous things
with jointed legs and lacelike wings
so full of life and animated...
my children with them exterminated.

Jim Small 6/17/90

There are 10 kinds of people: those who know Binary and those who don't.

On making a cell model
Jim Small, ninth-grade, 1969.

I. Visualization:
Some days ago, our sadistic biology teacher, Mr. Richard Bly, gave us a challenging assignment. He called the class to order and said, "by March the fourth, you will have built a three-dimensional model of a cell. It will contain the following: a nucleus, a nucleolus, Golgi bodies, etc...."

I sat smugly, visualizing a gleaming plastic sphere that I would bring in -- amazing everyone with its beauty and accuracy. I thought of how I would use red kidney beans for the mitochondria, green marbles for the chloroplasts, clear marbles for the vacuoles, beads on a wire for the centriole, and most brilliant of all, marbles inside a separately poured nucleus, to simulate the nucleolus. My genius astounded me. I had a sure A!

II. Construction:
I gave my mother a shopping list and she gulped a little and got me the things I needed. On Saturday morning, bright and early, I began the construction of my sure A. I filed a hole in my second ping-pong ball. (The first had died as the result of an operation with a dull saw.) I deftly bored the hole in the top (?) And mixed the first of the plastic, my thoughts were all cheerful and optimistic. I mixed a catalyst and some purple dye, for authenticity, and poured it in the hole. And waited. And waited. I had the marble, and even some little steel springs for chromosomes. I just had to get it perfect. I am still waiting.

Next morning, it was still gooey, and the whole house smelled awful. After having taken the ingredients in my own room (my mother insisted,) I poured the first layer of plastic into my big, round glass mold. I had even figured out, in my brilliance, that it had to be poured in layers so that all the things that I was going to put in would be distributed throughout the ball, instead of lying in a heap at the bottom. I put in just a pinch of blue-green glitter for ribosomes, and several kidney beans, mitochondria. Then I dropped in a few green marbles, and clear marbles for vacuoles. Saran wrap seemed like a likely addition for the endoplasmic reticulum. It was gorgeous I congratulated myself I stood back as far as I could, and admired to taking a deep breath of fume with a little air in it.
Panic struck as I realized a little late that I had not a working nucleus. With blinding speed, I filed a hole in our remaining ping pong ball. This time I took out the bottom. Realizing that I wanted a transparent nucleus that was not all gooey, I left most of the dye out, and added lots of catalyst. This one had to harden, and fast. Then in mounting panic, I poured some more layers into the rapidly hardening cell. It was over half full already, and my nucleus wasn't hard. It was getting very hot, though, and sticky. Finally the nucleus hardened enough so that I could get the ping-pong ball off of it. I peeled while I reflected on how clever I was. It wouldn't fit in the hole in the glass mold. I swore. I pushed. I finally hammered it through and it fell with a plop into the half solid mass below. Since I had wasted some of the plastic, it didn't quite fill the mold. When reason returned, I inductively reasoned that I could fix it if I put in seven or eight more chloroplasts, and lots of vacuoles and everything else that I hadn't put in yet. It still has a flat top.

Then catalytic action took over my cell. Superheated air tried vainly to escape from the folds of Saran wrap. Steam exploded from boiling beans. A hissing noise came from the mold. The internal pressure mounted. I worried. I visualized a terrible explosion and pieces of half cured plastic dripping from my walls and ceiling. I waited and watched. The internal pressure mounted. A strange odor wafted through the already polluted air in my room. Baked beans? The cell suddenly cracked and lines appeared in all directions.

My dad came in, took one look, and ran for towels to put around the hissing, boiling, cracking "cell", opened a window, and ordered everyone out of the room.

One hour later. To our amazement, it didn't explode. I am still trying to think of an explanation for the cracks. Perhaps some horrible disease?

Next time I'll bring a shoebox.

This is advice given to a young woman who felt too ashamed to come back to faith; she had become a prostitute, and her uncle found her and came to bring her home.

“It is not new to fall; what is wrong is to lie down when you have fallen. Remember where you stood before you fell. The devil once mocked you, but now he will know that you can rise stronger than before….Do not draw back from the mercy of God.”

What is amazing about this timeless quote is that it happened fifteen hundred years ago. It is the story of St. Mary of Edessa.

"Minor surgery is surgery done on somebody else."

--J. Small

"A woman does not choose abortion as she would choose a Porsche or an ice cream cone, but as an animal caught in a trap chooses to gnaw its own leg off."


Matthewes-Green, Frederica. Real Choices: Listening to Women;
Looking for Abortion Alternatives, Conciliar Press, July 1997.

Another idea: A single woman with an unwanted pregnancy is in pain. She faces the following alternatives:
1. Have an abortion. She will likely never forget the day.
2. Give up the baby for adoption. She will look at every child she sees from then on and will wonder.
3. Keep the child and likely be economically marginalized, in poverty for life.

What a "choice" modern women have! And modern men unfortunately are happy to shove this choice on her.

Psalm 103 2,5

Praise the Lord, o my soul, and forget not all his benefits...
who satisfies your desires with good things so that your youth is renewed like the Eagle's!

The Expectation of Gratitude

Luke 17:11, NIV.
Now on his way to Jerusalem, Jesus traveled along the border between Samaria and Galilee. 12As he was going into a village, ten men who had leprosy[a]met him. They stood at a distance 13and called out in a loud voice, "Jesus, Master, have pity on us!"
14When he saw them, he said, "Go, show yourselves to the priests." And as they went, they were cleansed.
15One of them, when he saw he was healed, came back, praising God in a loud voice. 16He threw himself at Jesus' feet and thanked him—and he was a Samaritan.
17Jesus asked, "Were not all ten cleansed? Where are the other nine? 18Was no one found to return and give praise to God except this foreigner?" 19Then he said to him, "Rise and go; your faith has made you well."

A 49 year old woman came in for biopsy of an ovarian cyst. The gynecologist sent me a portion for frozen section. I overcalled it as a malignancy, and she had a hysterectomy. The next day I realized my mistake and called the doc, who said that he would go tell the patient the good news. “She will be thrilled—she doesn’t have cancer!”

The way she showed me how thrilled she was, was to file suit for excessive surgery due to my error.


Most of us came to medicine to help others. We work long hours, gave much of our youth to studies rather than parties, sacrifice time with our own families. Of course we mostly do get paid well, but on the other hand we are on call and get called at all hours.

Is it too much to expect gratitude in return? Can’t we expect that people will understand how hard we work, how hard we try, how much we sacrifice, how much we worry over their conditions? Isn’t it wrong and unjust of people to not at least thank us?

And what do we often get? Complaints about bills. Complaints about waiting too long in the office. Complaints that recovery is taking too long. And of course complaints filed in court.

As I’ve matured, the realization has dawned that it is unwise to rely on expectations of undying gratitude and thanks from our patients. While gratitude and generosity are the absolute requirements for a happy and joyful life, for some reason many people choose ingratitude, thoughtlessness, or greed. Their choice is beyond my control, and should not dictate my satisfaction with my chosen calling as a pathologist. The scripture for the day reminds me that gratitude is a gift, not an obligation.

Luke 17 is a great story for young doctors and medical students. It teaches that even Jesus himself, performing miraculous cures that nobody else could have done, received only 10% gratitude. In fact, as I look back, I’ll bet my record is better than 10%. Our reward is doing a good job, taking the best care of people who have trusted their lives and health to our care and skills. The few times they come back to thank us are not their obligation, but a grand, generous, and unexpected gift from them to us, to be savored, enjoyed, and appreciated.

Lord, you of all of us most understand ingratitude from those you love. Your people constantly turn from your open arms and defy your loving instruction. We know you want to make us like you, like your Son. Teach us to serve without expectation, to excel in our work with your sons and daughters, to help them in their sufferings, and to rest content whether they think to thank us or not. Amen.

Badges? We don't need no stinking badges!

This Long Island boy got all the Merit Badges. Incredible.

I got an award for service to the College of American Pathologists. What a great ceremony. Here is a link to the press release.

Might as well link the other press release, too, on the Missions Ministries clinic we do each February.