Three day weekend time!

They've already messed up my reservation!

I'm taking off all day tomorrow. It is my congratulations you got a masters degree day off, just a month later. It worked out having that day that I could schedule at will (or so I reminded myself when I was rotating while everyone else was off enjoying time with their family!). The kids will have their last day of school and I'll be picking up a uhaul to load up everything to go back to SC. It will be a working weekend but I'm still so grateful to have the extra day to get everything done.

It has been a relatively quiet week at the VA, one of the techs mentioned that the surgical residents had their boards so there were fewer procedures scheduled. Our resident is there for her first trip to the VA and it is funny to be the one that knows how to do everything, to be unfazed by frozens, or processors. After almost a year, I feel like I know where most of the supplies are kept even..er, except for the forceps which disappeared again. Where do the good ones always go?

Last week the other student on autopsy and I made eight formalin buckets with blocks full of various tissues. They'll sit in a cabinet in the autopsy suite for a while but sooner than they think they will belong to the first years (soon to be second years). Each one will rotate through histology as part of their first summer block just like we all did last year. So soon, and it will mean that I'll have finished the program! Yikes! Exciting and scary!

Slowing down (maybe?)

Last week at the VA was intense... a lot of that was a matter of timing. The techs were short staffed so things weren't getting accessioned until after slide sign out (which ends at 3) which meant the morning was spent grossing larges triaged from the day before and triaging things for the end of the afternoon/next day and the afternoon was spent scrambling to get things grossed. Add in frozens scattered throughout the day and never having more than 20 minutes to get lunch, it made for a very full week.

Yesterday was spent wrapping up specimens triaged on Friday and doing smalls. I had one really interesting case today that I'm looking forward to see the slides on and a few other bigger specimens, plus an assortment of smalls. It was much better having the smalls throughout the day instead of just all at once right at the end of the day. Soooo much better.

Last week and this week, I've had a first year student come through on Tuesday afternoon for slide sign out and some time in the gross room. I've been trying to let them do things that might be slightly more appealing than straight forward small biopsies. Hopefully they've appreciated it. It would have been good to have a BKA or something to let them work on but I had to take the specimens that were available. Still, they got their hands on a couple larger specimens (even if it was just to triage) and got a chance to practice dictating without a template. Both were super great about pitching in and getting work done, which makes a difference when things are busy!

The downside to the busy week is that I didn't do any of the half dozen autopsy reports from the cases I had the week before this rotation started. I know that I need to do them, and sooner rather than later, but at this point I'm considering it an accomplishment that the kids were fed and laundry got washed last week.

The upside to the busy week is that I had some delightful options for feedback forms, and at the VA you get them back! One of my classmates sent me a text asking how I was doing on feedback forms, so I figured it out. I sent out two to three a day the entire time I was at North, and out of literally dozens of forms I got back about five back. A lot of it is just that the physical forms get misplaced, or received with every intention of being filled out and forgotten. At the VA they basically fill out the forms as they are received, so much more effective!

In other news, I've decided not to close myself off from job opportunities in the Southeast. They'd be weekend commutable to SC (and think of all the frequent flyer miles) and realistically, there isn't a job in Columbia and isn't likely to be one any time soon (years would be the timeline here). So... we'll see what happens.

Meanwhile, it is surprising to be contacted about an interview for a position that I applied to four
months ago and had pretty much forgotten about. But, considering the location in the west it would be a waste of everyone's time to do anything other than politely decline.

Oh well, life will work out like it is supposed to. It always does! I'm excited about buying the house, closing is in a month and I feel really good about it for the family. It feels like the kind of house the kids can grow up in, and I hope it makes up for the instability of the last two years. They will be moving down after they're out of school at the beginning of June to give them enough time to make friends in the neighborhood and get used to the new environment. It will give me time to get the apartment all packed up as well. I like moving with a long lead time and not feeling rushed.

Productive week on autopsy

Last week was bustling, and I was on weekend call having switched ages ago with a classmate. It put me on call not with my normal partner, but rather my PA student BFF who'd I'd actually spent the week already on autopsy rotation with. So much togetherness! I also had a resident that I haven't worked with since July but really like (just one of those people that you meet and think, we should really be friends) and another resident that I'd only been with on one or two cases.

It was great! It is amazing how little it feels like work to be doing things with such happy fun people to be around. Even though it was my busiest week on autopsy ever and sometimes the gross sign out ran later in the day, I really enjoyed it. I also feel like I have a pretty good grasp of prosection now (except I need to practice heart cutting) and if left alone with a cadaver I could do it start to finish. I do struggle with never wanting to eviscerate. After cutting myself at the MEs officer I really don't want that to happen again. I know Duke is different and the way we eviscerate is a lot safer (ie: much less cutting while actually in the body cavity) we have patient history, etc, but... I'm still so reticent to do it. I need to get over that. I do. I think mostly it is a matter of forcing myself to just do it and face the fear. I know how to do it, I just don't want to.

This week I'm at the VA. It is a little different because it is just one PA student and one resident,

Durham VA

instead of two PA students. We do have medical students with us for a couple days so it doesn't feel as quiet. So far it has been pretty good. I had a couple large cases yesterday and lots of small biopsies. Nothing overwhelming and the resident helped out on smalls and mashed fat with me looking for lymph nodes. Slide sign out was good, and having medical students around means you get some interesting questions.

My ankle is absolutely killing me though. It really hurts after almost a month and a half of being nearly normal. I think it is the result of standing for autopsies for a week straight, not having the weekend to recover, and then being at the VA. Until you go without them for a while, you sometimes forget just how incredibly helpful those anti-fatigue mats are. Duke North has them, otherwise that rotation would have been miserable. I think I'm going to try sitting down and grossing as much as possible while here at the VA. I just feel less productive sitting down (although things still get grossed so it could be a psychological thing!).

So overdue for an update...

I'm winding down three weeks at the VA. It has been a productive few weeks, and I've had lots of chances to do frozens. It is always interesting when I've been away from the VA and haven't been doing them... It is inevitable that my first case after being away is one where the surgeon walks it down to the gross room and sits there waiting for the frozen to be done. Ah, stressful! But it is fine. After being back in the swing of things for a while, I feel comfortable that I can churn out some decent sections.

Plus, it is a useful rotation to be on for a while. I get to see the slides that my sections get turned into and pick up bits of knowledge from the attending pathologists and residents--and we're there with one of the nicest residents (most of our residents are pretty awesome, but she is just really exceptionally pleasant). The VA is a lot more like a regular hospital than Duke is, so it is good to get a mix of smalls and complex specimens instead of the high concentration of complex specimens that you get at a major academic medical center. 

Christmas trees make me happy!

Today was the Christmas party for the clinical labs and there was an enormous amount of food brought in. We snagged some on our way to our lunch time lecture, which was our penultimate class for this course. It has been one of those long weeks where we've had a morning class every morning and a lunch time lecture each day (except Monday). There's been a lot of going from the Duke clinics to the VA back to the clinics and then back to the VA. We take this walkway between the clinics on the way through Duke North when going between the clinics and the VA across the street that is lined with windows. One side looks out over the new center for medical education, the other is the Duke Medical Pavilion--both of which are under construction. Every day, every week, we can see it change. I like the idea of it... things have grown and evolved during our time at Duke and will be in their semi-final state by the time my class graduates (I say semi-final because it seems that hospitals are always changing, but I think they will be happy with the way things stand for a while after this construction wraps up. Although... I'm sure there's someone somewhere in the organization that is already projecting the needs of the hospital system for the next decade that's drafting a whole new set of blue prints for future classes to watch be erected.).

The Christmas party did take me off guard though. This year has just gone zipping past! Our fall semester is going to be wrapping up in just over a week. I feel like I've gotten to gross everything that I've wanted to do, which leaves the spring for refining those skills.

Second year is just so different from first year. I don't get to see our first years much unless I'm on autopsy, but I hope that they're doing well. They have another few days before their exams, but they are coming up quickly! And then they will get to be on rotations with us in January, everyone is looking forward to it. It will be good for them as well to get some hands on experience. January was really a high light of my first year and I think that is a pretty universal opinion. 

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:

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

An atypical day in the life...

It started at 8 with an interesting talk on genetic analysis using microarrays, mostly I took away how you can tell when when someone is the result of consanguineous breeding (this bit is normal!).

Then we milled around a bit and some of us retook our official school photos.... I'm wondering if I should have left well enough alone but what's done is done. After that we were officially introduced to the incoming class and chatted a bit with them, possibly giving useful advice (one hopes anyway!).

Then back upstairs to mill some more. Members of our class began planning efficient student tours for tomorrow and more events were added to the social calender one of my classmates had put together. I added two events, a cheese class at Reliable Cheese (I haven't been there in a month! But I'm poor until student loans are dispersed again, so I'll have to wait.) and a drag show at a local bar (where my classmates might actually get to meet some of my non-classmate Durham friends). The milling didn't last long because the first years kept being efficiently processed through various things at Duke, and we joined them for lunch from Foster's Market. More chatting ensued and we tried our best to answer questions/remember what was useful when we were starting out.

Lunch ended and I headed across the street to the VA with the other student on that rotation this week. We knew there were large specimens waiting on us since we'd triaged them the day before. Slide sign out was pretty brief and we started grossing around 2:30.... We finished four long hours later. That includes our resident taking over the third station to knock out the smalls and triage a large specimen for tomorrow. We realized that if tomorrow goes as long as today did, we'll still be at the VA grossing when the official welcome party for the first years starts.

The worst part is when we were walking back to the parking garage and realized that neither one of us had loaded the decal specimens on the processor... So back to the VA we went to correct that mistake. Moral was not the highest after that, but thankfully I'm on rotation with someone with a good sense of humor and we were still laughing at the end of the day!

It is amazing though, to be the person grossing the large specimens. We'll be faster once we've had more experience.

Alopecia lecture and a VA week end wrap up

Part of second year is attending the pathology lectures along with the residents. Yesterday's lecture was given by one of the dermatopathologists and it was really good! She lectured on alopecia and it finally makes sense why, where I used to work, we would bisect the punches for alopecia and embed the two halves differently. Plus, I was really pleased to see how much of the skin anatomy I remembered from way back in October. It is funny sometimes to realize just how much we learned in the past year and how much of it has been retained.

This week has been my first real surg path rotation and I'm at the VA where there are three staff pathologists and a forth year pathology resident. The PA students do the majority of the grossing at the VA, which is nice. It is lower pressure than Duke surg path and the workload is about what you would get a normal (not a research/academic) hospital, so a variety of smalls, frozens, and some larger specimens (colon, lung, amputations, etc) with a widely variable work load. I like it as a reintroduction to doing surgical grossing on a regular basis.

The residents are helpful and mindful that they're the first person we're likely to seek out for questions, which is nice. The one who was on rotation in July apparently sat in the gross room and did his slide sign out at the microscope we use for frozen section evaluation just so he could be on hand if someone had questions. He was a great person to have there for the first few weeks of rotations! Our resident now has been very conscientious about checking with us regularly to see if we have questions and stressing how we can come ask her anything we need, but other than yesterday we haven't had to have too much hands-on assistance so yay us! For an early rotation I feel pretty good.

And it is interesting to be the one doing the types of specimens we always had to have a pathologist or a PA do when I was a gross tech (mastectomies, larger amputations, colon resections, etc). It is a mental shift to realize that I'm allowed to do them... I'm actually encouraged to do them! It is exciting and I'm so glad to be in my second year and grossing again.