September is wrapping up

I made myself promises about October. The most important one is that I have to start reviewing Robbins regularly so I don't lose the information I learned last year. We do have other classroom instruction happening right now but it isn't nearly as much as last year, so there really isn't a good excuse to not keep up on studying.

The second thing I have planned for October is rewriting my resume. I haven't had to apply for a job since early 2008, so I'm a little rusty on that front! Not that I've applied for a lot of jobs in my life... I had one in the early 2000s for *four years before I went back to finish my undergraduate degree and then just the one grossing job after I graduated. I also worked at Kaplan as an MCAT instructor when I was grossing so I guess technically I've had three experiences with applying for jobs, interviewing and all of that.

Meanwhile, I'm heading back to the VA this week for surg path! I feel like it has been ages since I was last on surg path but it really hasn't been that long, time just gets distorted with being on rotations and having the weeks divided up with different activities. I hope I remember everything from the summer semester in case I get called out during slide sign out!

*I moved three times, got married, and had my oldest son during that job! It was a very eventful four years.

The coolest thing I saw last week...

So Friday wrapped up my week in imaging, which was mostly getting the opportunity to see how tests I've heard of before were actually performed. It was neat, especially with some of the FISH stuff where they are working on being able to detect extremely low percentages of positive cells. But, by far, the coolest thing I saw was the process that allows them to count circulating tumor cells (CTCs) from patients with tumor metastasis.

It is one of those things I've never heard of before, and I don't think I'm alone in that. The patients come in approximately every six weeks and their levels of CTCs are counted. It allows their doctors to see how the patient is responding to treatment very quickly and to be able to track the extent of metastatic disease in the blood. They can even directly visualize tumor microemboli, as in they can count the number of cells in a microemboli. It was such a cool technology and I was able to see some sample data that really showed how effective it was in practice. I sat with the tech who has been the one to get the process up and running at Duke (it isn't a wide spread technology yet, there is one at Duke and then the next closest one is in Tennessee) with the results of a test up on the screen in front of us and he did his count of cells with me, quizzing me on which cells I thought were positive, negative, or borderline. It was a lot of fun.

It is a quick entry, I just wanted to get that down while I was thinking about it (I still have three things from autopsy I haven't written!). Some days technology just amazes me, I'm so lucky to be able to see things like this.

It was the tail end of the summer... (the video has nothing to do with pathology but the song makes me happy)

Or technically the beginning of the autumn but the south holds onto its summers longer than most places. We are in that flux of fall where the mornings have a chill to them while the afternoons burn all of that away and we're left walking around holding hoodies that seemed like a good idea eight hours and -20 degrees ago.

I talked to my sister last night and she's settling into a new home in a new state and will start a new job on Monday. Then today I see that Forrest has been offered and accepted a position in his home state. And I'm happy for them, but at the same time so jealous.

I asked our course director today how early is too early to apply for jobs and she reminded me that last year one of our students had accepted a job offer in October (which is coming up quickly!). Every year there are one or two students who have a job before Thanksgiving, and having talked with a few of my classmates about it, we're all already keeping an eye out for openings in the places we are most interested in.

California and New York almost always have a few openings (I got a letter in the mail yesterday from a hospital in San Fransisco about a job, I'm assuming they spammed the AAPA mailing list), but if you have a more specific place that you'd like to work it may take a while for there to be a position there so you have to be proactive about keeping an eye out.

I think the married students in my year will be the first to start seriously applying since it takes longer to find jobs for two people than it does just one. Of course, by now half of us are married and having to take a spouse's job prospects into consideration. So we'll see.

For me, I want to go ahead and have an idea of where we'll be a year from now. There are houses to sell back in SC, a husband who needs to find a future employer, and research about a new area that would have to be done to ensure good schools and recreation options for the kids. I told myself that I would at least wait until October before beginning to apply because before that just felt so ridiculously far out. It is asking a lot from an employer to wait ten months for an employee and I am very aware of that.

And part of me is just sad about the prospect of moving away from here. I was trying to explain that to my sister last night. I have never lived anywhere long enough to put down roots but I feel like I know Durham better after just fourteen months than I did the city I lived in before for three and a half years. The kids and I are part of the community of our little town, we recognize people from school and sports at cubscouts meetings or at stores or at playgrounds. I've never had a hometown but this place feels like home and I'm going to be heart broken to move away.

First years and bowels

I'm so happy for the first years since today was their histology exam, which signals the end of Molecules and Cells (I can't believe it has only been a year since I was in that position!). They will have a day off before jumping into the Normal Body unit on Thursday (first day of gross anatomy is Friday! I helped outfit folks with scrubs and pointed at the bucket o' dissection tools with the admonition to only touch it with gloves). Hopefully some of them will come out for the massive PA dinner tomorrow night that one of the autopsy PAs organized at a local pizza place and socialize a bit (I do feel a bit guilty about not having had a dinner party since they started classes but the whole kids in cubscouts and soccer has eaten up a lot of my down time.).

FISH, I figured it was more appropriate than pictures of bowel

So (and I fully admit that this is a horrible segue), I was running the bowel during an autopsy which involves taking the small bowel and colon that the autopsy techs have helpfully removed and opening it up so that the entire length can be examined (for polyps, ulcerations, diverticulosis, tumors, strictures, etc any disease process that might be present there). And I realized that it was one of those activities that most people just wouldn't want to do, yet there I was not only doing it but having cheerfully volunteered for the task (after double checking to make sure the scissors in that autopsy suite were sharp, because that really makes that job easier). Not to say that it is a fun task necessarily but one of those that I had done once or twice and wanted more practice with and it isn't something that anyone is really going to fight you to do. "No, no, I want the bowel, you had it last time!" isn't a phrase you hear often, or possibly ever.

I'm glad that I had weekend call coming off of an autopsy rotation, I felt pretty confident in what I was doing. Hopefully it'll all still seem as familiar next time I'm on call since I'll be in the middle of a surg path rotation. I feel like it will. It helps so much that while we're rotating, we are doing it mostly through the same locations. It means that we're not wasting the start of every rotation figuring out where this gross room keeps its supplies, how they like to have their prostates sections, being trained on whatever form of dictation software they use, or learning what they want in their dictations (although I'm still learning that for Duke surg path! It might be a long process, but hopefully it doesn't tax the patience of the staff PAs too much.). After the summer semester we've been at all of main rotation sites so the rest of the year is less disorienting.

Well, except for me this week since I'm on imaging! I've been with the molecular pathology department this week, which means flow, immunopathology, FISH, etc. It was always something that we sent off to another lab when I was working (except for immuno stains) so I've never actually seen what happens when they run the various tests until now. There is a big difference between knowing what a test is and seeing it, very useful and I might even understand some of the slides during grand rounds a little better now.

I'm a slacker!

I have a list of things I've mentally set aside to blog about but I've been... I don't even know if busy is the right word. The kids are now in cub scouts, which combined with soccer eats up a lot of my weeknights! Plus I've been browsing (not seriously studying though...) Robbins so I don't forget everything I learned last year. And I've been enjoying the calm after last year.

This past weekend I saw a concert Friday night with friends, went to an event at The Cookery, went to a Modernist Home Tour in Durham (including the Knights House, built for a Duke University President. It was awesome!), had sushi with classmates (but skipped drinks in Chapel Hill because I'm old and boring), went to a classmate's house early Sunday to try to make cheese again (it is getting better!) which ran until we had to leave to go see a friend's band play (well, technically longer than that. My best friend in Durham had to babysit our cheese curds for us while we were at the show but luckily the house and the band's show were only about a block away from each other!), and after that me, my Durham friends and my classmate went for the best pizza in the triangle. I love this town.

It was a fantastic weekend, exhausting but fantastic. I couldn't do it too often because it did involve a lot of not seeing the kids (except for driving back home to make dinner/shower/change/sleep in between activities) and not as much sleeping as I'd like, but it was still fun.

I wrapped up a relatively quiet week in autopsy on Friday. It was good though, the cases we did have weren't rushed and it meant plenty of time for teaching. That's useful since I'll be on call this weekend and will need to be able to do things! But I'll leave the real entry for later, right now you just get a placeholder saying that I am alive, well, and happily rotating. Second year is completely amazing.

More autopsies!

And when I say more autopsies, I mean more opportunities for autopsies since it is hit or miss with autopsy service. But at least I'm on autopsy service for the next two weeks and will have my first on-call weekend at the end of my two weeks (just the way the schedule worked out this go around) so I should hopefully have lots of chances.  Plus, the other student on autopsy rotation is at the AAPA conference this week so there should be even more work to go around.

Speaking of the conference, it'll be interesting to hear how the speakers are and how the poster presentations go. Plus the students are being housed four to a room so I'm sure our students will be able to tell us more what some of the other programs are like, it is hard not to be nosey!

Very excited to try this out!

Meanwhile it is nice to be back around that part of campus on a regular basis. I feel like I didn't spend much time in the PA room while I was at north and it was weird not to see everyone! And I think by my next rotation through north we'll be having classes during lunch several times a week plus grand rounds so it shouldn't be like that again. I think without the class it didn't seem to make sense to use a third of our lunch break going back and forth to the clinics, so I just hung out at the hospital with the folks I was on rotation with there.

One of whom is super awesome and came to a class with me on cheese making, and who will be helping me use the book my best friend in Durham got me for my birthday last week. They're both enablers! Cheese making supplies are on their way to me via priority mail as I type this. I will have to figure out the ripening situation as well since I don't have a handy cave or basement or other similar cool temperature regulated place to store cheese as they mature.

Hey look, down time!

I wrapped up week three at Duke North last Friday, which was also the day our summer portfolio was due. It was strange to go over the list of specimens I've grossed... the number of complex specimens really adds up over even just a few short weeks at a busy tertiary treatment center.

Anyway, it was good and I liked surg path but I am looking forward to heading back to autopsy next week. My first stint was a quiet week for the department so I feel a little behind in autopsy (not to say that we didn't have any at all, just that I haven't had the chance to do any evisceration personally. Observing is useful, but I'm a hands on learner.).

We're off this week which is nice. I think I prefer the shorter summer break and more scattered breaks throughout this year. It gives us a chance to recharge... and having gone through each of the major rotations sites to have some time for introspection. I continue on in my belief that second year is so much more satisfying than first year (classroom lectures cannot begin to compare to clinical rotations... although I do acknowledge the usefulness of the foundation of medical knowledge laid down in that first year!).

My husband and I spent a long weekend in Atlanta meeting up with friends from all over the country. I actually ran into both a histotech that works here at Duke and a lady I went to a biotech summer camp with in 1995, which was weird but amazing that we still recognized each other! It was a fantastic (if exhausting!) time. My husband and I used the car ride back to pick up our children from my parents to write a wishlist of things we'd like for wherever it is we end up moving after I take a job. We also ruled out which states we are definitely not considering as a future home (sorry Alaska! You are a beautiful state but are just too far away from the continental US), and which ones top the list (NC and MN, with CO up there too for some reason. Some places we know nothing about, we just like the idea of them!).

Today is my birthday, and since there's nothing to study for (unlike last year!) I have spent it cooking Filipino food. Round one is finished and delivered to the autopsy folks and Duke surg path. Round two will start up again shortly but I'm taking a little bit of a break first. That batch of lumpia and pancit will be fed to local friends who have been awesome enough to make me chocolate cake and macarons.