Wednesday, October 31, 2012

At the end of October

I'm glad to say that I survived making yet another costume (pictures possibly to follow since our class went out as a group and mostly dressed up) and like every other year I've made a costume I have vowed NEVER AGAIN. Of course in about eleven and a half months, I'm sure it'll seem like an excellent idea to make a costume again.

I've also survived two and a half weeks of my three weeks at Duke surg path. The second go-round has been much less stressful than the first time since I've already seen a lot of the specimens before. It is still a learning curve. Right now I'm working on making sure my dictations clearly cover everything they need to cover. It is good practice to do free dictations to figure out the cadence and descriptions that work best. So I practice.

I've also been forcing myself to use the normal scalpel since they have had trouble getting the blades that I love and not everything needs a trimming knife. And it can't hurt to learn to be more flexible about the type of equipment I'm used to using since different locations stock different things (or, like my favorite scalpels, they might go on back order).

Sunday, October 28, 2012

Trying to find the best cupcake in Durham (Not related to pathology at all!)

Some classmates, the kids and I headed out to a food truck rodeo in downtown Durham. We tried some delicious hotdogs (mine was topped with lobster salad and shrimp, sooooo good), some Monuts Donuts, Italian Ice from some very dapper gentlemen, and I continued on in my quest to find the best cupcake in Durham. After one of my classmates texted me to see what the consensus was on the various ones we sampled today, I decided to go ahead and write it up with the disclaimer that it is just my opinion and yours may vary.

For brick and mortar stores we have: Daisy Cakes, Hummingbird Bakery, and The Cupcake Bar. The food trucks have been: Blue Ribbon Delights, Sweet Stacey Cakes, and Sweet Traditions by Leane. They are presented in the order in which I tried them and I usually didn't eat an entire cupcake for each flavor, most of the time it was a bite of someone else's or multiple flavors were purchased and split between people.

Hummingbird Bakery: (Pumpkin, red velvet, chocolate, malt chocolate, and their pride cupcake which was rainbow colored vanilla cake with vanilla icing) The flavors are good but nothing too exciting. The cake is good all by itself--dense and moist. The frosting is also dense but unpleasantly so, it is a solid block of buttercream about the same thickness as the cupcake itself. If the cupcake comes straight from the cool display case it is almost impossible to eat since it comes off the cake. The frosting doesn't form that sugar crust that I like, it stays solid and almost oily. For the most part I've discarded the frosting and eaten the cupcake plain. The one exception is their cream cheese frosting, which wasn't overwhelmingly cream cheese-y and a lot lighter in texture than their buttercream. They do always have a couple vegan options on hand, and having tried one it wasn't bad--it was a little drier than a normal cupcake but it tasted fine. They have other sweet treat options at the bakery that are much better than their cupcakes. 2/5 stars

Daisy Cakes: (Black and White, Red Velvet, and Chocolate Fix). At room temperature they are good, but it can suffer from the same problem as Hummingbird if it isn't warmish. But since they don't pile up three inches of icing like Hummingbird does, it isn't as much of a problem. It does tend to leave a slight oily feeling in your mouth after eating a cupcake from there though. None of the flavors stood out particularly well, the red velvet cake had cream cheese frosting but it wasn't as good as Hummingbird's. However, I will say that one of their non-cupcake options, their bread pudding, is phenomenal and eating it actually made me sad that I will leave Durham at some point in my life. It is a middle of the road cupcake experience but pretty easily accessible (they have both a brick and mortar store as well as their really cute Airstream food truck named Sugar). 3/5 stars for cupcakes, 5/5 for the bread pudding

The Cupcake Bar: (Apple Cider, Double Chocolate, Lemon, Mint Chocolate, some flavor I can't remember, and Margarita). It should also be noted that they sell shots of frosting individually, which is a wise business decision. Their frosting is fantastic, light and fluffy and it forms a slight crisp sugary crust. Soooo good. The cake is nicely fluffy; however, the cake in the chocolate cupcakes does not taste good at all. There was an almost chemical flavor that neither myself or my classmate could place in both the mint chocolate and the double chocolate. The mint chocolate one was especially unpleasant and I found the cake a little dry overall (for all flavors). That said, their Margarita cupcake (orange cake with lime frosting) tastes like Fruit Loops cereal, or at least my 20 year old memory of what Fruit Loops tastes like. It was really good, and I say that having been originally leery of a lime flavored icing. And they do make an effort to decorate each cupcake with some sort of additional candy garnish. 0/5 stars for any chocolate cake, 2.5/5 stars overall, 5/5 icing.

Sweet Stacey Cakes: (Plain Jane Chocolate, Coconut, and Working Man's Lunch, which involves a beer from Fullsteam Brewery, a local Durham establishment). Oh my goodness, sweet is the right word to have in the name of the bakery. I only had a taste of the Working Man's Lunch but the raspberry reduction paired well with the chocolate cake, and the icing was a great texture (I really am a sucker for a fluffy buttercream) but just so sugary sweet. The Plain Jane Chocolate was my absolute favorite from them, it was a good chocolate cupcake. The frosting was a strange green color but that might have been for Halloween? It was still really sweet though, good but after eating it I felt like I needed to brush my teeth. The Crazy for Coconut delivers on the coconut flavor, but... I didn't feel like finishing it. The cake part was nothing too exciting sort of a Duncan Hines yellow cake mix flavor with some shredded coconut thrown in, it tasted like something I could have made myself. I would like to try some of their other flavors though. 3/5 stars

Blue Ribbon Delights: (Strawberry Fudge, Strawberry Ciroc, Ultimate Candy Bar, and Fudge Sundae) They get bonus points for having more flavor options than anyone else (about a dozen overall, which is about twice what most folks have including the brick and mortar stores) but I was universally underwhelmed. I didn't try the Fudge Sundae one since my youngest son had picked that one out and he eats quickly, he seemed to enjoy it though. For me? There was an artificial taste I noticed in every single cupcake. The texture was okay but the flavor wasn't at all. 1/5 stars

Sweet Traditions by LeAne: (Peanut Butter Chocolate and Chocolate Chip Cookie Dough). These were hands down my absolute favorite. I had the peanut butter chocolate and my oldest child had the chocolate chip cookie dough. The peanut butter icing was delicious and light with good but not overwhelming flavor on a moist fluffy chocolate cake. They paired really well together, it was nicely balanced. The icing was on par with The Cupcake Bar's, formed that delicate crust that I love and was sweet without being excessively so. I only had a bite of the Chocolate Chip Cookie Dough but it was good with a core of cookie dough that my oldest son (age 8) thoroughly enjoyed. It was their first foray with their new truck, but I hope to see them again at future events since they have so many other flavors to try. It was the one cupcake truck that we saw today where after I left the rodeo I wished that I had picked up a few more to take home with us. They are dangerously good. 5/5 stars.

Thursday, October 25, 2012

And... I'm a masochist!

When we're at Duke North we can see the specimens that are triaged to be grossed the next day. If there is a particular specimen that we want to gross then we (with the permission of the PA we're working with that week) can put our name on it. I have been lining up a variety of interesting things for myself, some of which I've never done before. Some of which intimidate me but that I'm glad to have done.

Meanwhile, in my personal life I decided to sew a Halloween costume for myself. Which wouldn't be so bad if I could just do a simple costume like a normal person or if I'd given myself more than a week to do it. But... I can't. Instead we have 8 yards of rainbow colored fabric and no pattern. And I haven't sewn anything seriously for about a year and a half. It is colorful but miserable!

Monday, October 22, 2012

Wish list...

I think I've talked about it before but when we're at Duke North we have a board where we can write down the specimens that we'd like to have first dibs on if one happens to come in. I always have a hard time trying to figure out what to want since I feel like I'm consistently getting a good cross section of organs and disease processes.

I have jotted down a few things though. I'm not ambitious enough to be asking for a whipple just yet, but I wouldn't be opposed to an esophagogastrectomy coming across my table or a laryngectomy. Which might be more about the fact that some of my classmates have done those specimens and I don't want to feel like I'm lagging behind, or I'm not where I should be.

Thursday, October 18, 2012

Things to think about...

Where I used to work... it was roomy and I had windows
I'm back at Duke north surg path this week and feel like I've had a really productive week. But it started off at Durham Regional Hospital for a one day taste of what a regional hospital is like. It is a good idea to get a look at that sort of environment since it is very different from the other locations we see. Their main cancer cases are breast, colon, and prostate. They do also get some other routine surgical specimens like gallbladders, appendixes, placentas, etc. It is a very similar specimen-wise to where I worked so it felt familiar!

There are two PAs who work at that location and since I arrived right after they'd finished up the backlog that had built up over the weekend we had some time to sit down and just talk. They were kind enough to let me pick their brains about work environments and job hunting. It was a lot of food for thought.

One of them asked me if I would be bored working somewhere like a small regional hospital where I wouldn't routinely get things like transplant organs. They also brought up the stress that can come from being in a large, busy academic medical center. And they mentioned teaching, if it is something that would be a pro or a con in a job. There are a lot of things to think about.

Right now, I'm mostly interested in location. I really want to stay in the triangle area of NC if I can, other than that I can be happy in lots of different situations.

Sunday, October 14, 2012

Second week at the VA done

The VA is always a good rotation. It can be stressful on busy weeks, but it is similar to what a lot of us will experience once we start working. The work for the day needs to be finished up before we can leave, which happens earlier some days than others.

My second week was kind of rough, plagued by processor issues and several very time consuming specimens but it was good. We had the chief residents with us on this rotation and it was really interesting to have so many people there at slide sign out. There were also a couple medical students who visited for a few days, and they were such good sports about pitching in and helping out. I was able to walk them through doing a few smalls and one larger specimen. It was so neat to see some of the students we had classes with while they were rotating through, especially since I talked to one of them last year about her interest in pathology. We agreed, on our bus rides back to the parking garage, that when she's all done with her residency and is a fabulous pathologist and needs a PA that she will keep me in mind! ;)
Durham friends sampling deep fried girl scout cookies

It was a long week personally, as well, with soccer 3 nights, cubscouts one night and all day Saturday, and a trip to the fair with my Durham friends. Luckily my dad pitched in! The kids really are enjoying doing cubscouts with their grandfather, so I'm glad that they're getting some male bonding time in while we're all living together. It also freed up some time for me to go out with friends, which I might have overdone just a little bit this past week. I didn't do anything crazy, since I'm not a drinker, but it was a late night at the fair and a mini-trip for myself this weekend. Maybe I'm trying to get all my fun in before I'm on call again next weekend! I'm not anticipating being called in, but I don't like to make plans for anything on those weekends just in case. Except for pumpkin carving with the kids, we're doing that this weekend with their father since the kids were at cubscouts when all of the classmates got together for it. Hopefully it'll be cold enough that the pumpkins keep until Halloween!

Monday, October 8, 2012

What I did on my summer rotation

I thought it might be interesting for folks considering a pathologists' assistant program to see the types of specimens that I encountered and grossed during my first rotation (it was summer so it meant only one pass through Duke surgical pathology and the VA surgical pathology, and that we were brand new students so the complexity is not what it will be). This is not a comprehensive list, since I am not including specimen number counts and it doesn't include autopsy at all. Also, I'm not breaking it down by location to keep things vague since these are specimens that could be received on either rotation and I tend to overcompensate when it comes to not violating social media policies.

Summer rotation specimen list:

Radical mastectomies
Reduction mammoplasty
Sentinel lymph nodes/node dissections
Nephrectomy (partial and radical)
Prostatecomy (radical)
TURP (prostate chips)
Vas Deferens
Thyroidectomy for neoplasm
Liver wedges
Hepatectomy (total and partial)
Amputation specimens
Assorted orthopedic specimens
Colon resection (with and without anus, with and without appendix)
Gallbladder (routine and for suspicion of neoplasm)
Small bowel resections
Stoma takedown
Hysterectomy (for fibroids and neoplasm, simple and radical)
Ovaries (benign and neoplasm)
Placentas (singletons and multiples)
Pneumonectomies (native lungs for transplant patients and neoplasms)
Pneumonectomies (wedges/partial)
Assorted smaller specimens of varying types/complexity

It feels like a pretty solid start to my clinical year! The fall semester has already had some interesting specimens pop up, but I'll save those for later.

Thursday, October 4, 2012

Sad (link)

This post was so simple and so straightforward, it made me choke up a bit. I have seen the aftermath of a dissection, and some days I am so glad that I never have to meet the patients and know them.It makes it a lot easier to separate yourself from the person they used to be when you're working.