Rotations, Autopsies, and a bit of a social life.

January has been such a fantastic month so far! Rotations continue to be great, and I'm looking forward to another day of surgical grossing at Duke North. I am getting used to their format for dictations but more practice is always welcome!

Last week we finally got to see some autopsies, including one where we got to see a second year student do the evisceration. That is what I'll be doing this time next year, so exciting! We also got to see the autopsy technicians (dieners) do some evisceration and it is impressive how quickly they get everything done.

I mentioned before that Duke does a modified Letulle autopsy, removing the colon and then doing the rest of the organs en masse. I am used to Virchow autopsies, which is all done one organ at a time and doesn't require the prosector to visualize body placement/orientation. The en bloc method makes it much easier to examine the entire organ system at once and minimizes the time the body is open and exposed. I like being able to see the different styles.

Grave Digger at Monster Jam! Photo credit to April :)

In other news, we had a three day weekend for MLK and it was so relaxing! My class (and my husband!) went to Greensboro for Monster Jam! And since we were there, I finally got to take advantage of a friend's generosity and treated everyone to sushi courtesy of him. It was a really fun time.

Sunday I went to visit my favorite med students and one of my classmates and I took over their apartment and everyone made Filipino food together. Then we took a break where I went home and cooked American food for my family, and then I went to the movies with a couple friends (War Horse, which was okay but not as good as the company).

Yesterday was my dad's birthday, so the kids and I got him a card, some money, made his favorite dinner and baked a cake while I studied off and on for my autopsy procedure quiz and ignored the giant pile of laundry I didn't fold this weekend (I will do it tonight... probably).

Why am I in school?

Being on rotations I've gotten to talk to some of the second years that I haven't really had much interaction with up until now. Two different ones have asked me why I'm going through a PA program when I was grossing before. And I guess, looking at it from the outside, I can understand the question. I do think, though, that they will understand why I made the choice after they have worked out in the industry for a while.

Beyond what I'm learning in classes, I'm getting an opportunity to see a greater variety of specimens than I will ever see again. The thing about Duke is that it is a major medical center and there are surgeries and procedures commonly done there that rarely happen in other places. Just from an intellectual standpoint, it is a great place to be.

Not only that, after graduation I will have my masters and be eligible to sit for the board exam, which makes me much more marketable. Also, before I could only gross specimens that a pathologist had signed off on me for, which doesn't mean as much to a future employer than a solid year of documented rotations and dedicated training. Not to mention that board certified PAs earn significantly more money than a grossing tech, which helps offset the tuition investment.

And... I'm really enjoying the experience. Seriously, even with the horrific test anxiety and stress of being back in school after four years out of it and living apart from my husband, I enjoy it. It has given me a lot of perspective about the specimen types I've worked with and I know that Body and Disease is going to even more applicable. Plus, we're going to have microbiology and it has always been my favorite subject! I have great *classmates (yes, yes, I know I've mentioned it once or twice before, but they are!) and we have med students who have been amazingly inclusive. I walked from the parking garage this morning with one, got hugged by others who spied me in the food court at lunch and was joined for lunch by one of my absolute favorite med students. Our program directors are accessible and responsive, and while I'm not entirely sure how the TBL intensive spring semester will be the idea of it is interesting.

*No seriously, they do amazing things like share outlines they've made, send out information about resources, and are just great to work with in groups and on rotations.

Ugly side of medicine.

Today started with autopsy sign out, it wasn't on the schedule but as a class we are usually early enough to have significant time in the student room before we're due to be somewhere so we just tagged along when we heard it was happening. Just from conversation with one of the autopsy PAs it reminded me of some of the cadavers and specimens I have seen.

For many people, it is hard to imagine walking around with part of their body mummified or rotting off but for other people it is their normal life. I don't know how long you have to wear your clothes before they fuse to your body, but I've seen it at least once and heard of it from others often enough to know it happens more than someone outside of the medical field would believe.

Where I worked before some specimens made it into legendary status for their odd location, appearance or sheer size. I will never forget the enormous pedunculated skin tag that we dubbed the "back potato" for its shape, color and size. It was massive and I couldn't figure out how you could sit or wear normal clothes while carrying around something so large, and it had to be growing for ages.

Large crusted skin lesions, hoof-like toenails, gangrene going black, sloughing... things allowed to fester for years and years. It could be a matter of not having health insurance, a neglected geriatric patient or that deep seated human belief that if you ignore it long enough it might go away (ignoring the evidence of past experience, of course).

It can be heartbreaking to imagine living your life like that, especially for the elderly patients who aren't necessarily the one making the decision to go for medical care or not. For that, I am actually grateful that in pathology we won't have to see the patients whose specimens we receive and that the autopsy patients are beyond pain.

Intersession Week 1

Tabs from our binder--awesome topics to cover this month!

It all started on Monday with getting to see all of my classmates again and play catch up on everyone's holiday break. We had an orientation to the schedule for the month and received the not unsubstantial binder containing lecture materials.

We had classes on neuroanatomy, medical ethics, lab safety, medical terminology (which is more fun than it sounds), autopsy and surgical pathology at Duke, as well as neuroanatomy lab. And, as I mentioned a bit in my last post we've been split into two groups for autopsy and surgical pathology rotations. It is fine, because our class is pretty close as a whole there have been no complaints about who is in which group. And being split up makes it fun to come back together and hear about what the other group got to do that day.

I really cannot being to say how excited/happy/jubilant I am about the rotations? Sadly there wasn't an autopsy Thursday afternoon (the one time my group has been on that particular rotation) but I'm holding out hope for tomorrow afternoon (and if we don't have one then it is extra time to read the neuroanatomy text, which is useful too). I am really interested to see an autopsy here because they do a modified Letulle (en mass organ removal) for their evisceration, while my experiences up until this point have been with Virchow (organ by organ removal).

Trimming knives

The surgical pathology rotations are pretty great so far. It is fun to be grossing (even just a little bit!) again! I tried to be good on Friday and use the scalpel instead of the trimming knife so I can be more proficient with using it. 95% of the time I've used the type of scalpel I posted in the last blog entry. Occasionally I used a regular scalpel with a #22 blade, so I have to get used to handling a regular scalpel with a much longer cutting surface than that. Trimming knives are fantastic and sharp but it would be ridiculous to try to cut up a little skin shave with one or bisect a little GI biopsy. I am sure that by the end of the month I will be much more comfortable using the tools available to me here, it is (like most things!) a matter of practice.

Also, if I can add another thing about how Duke is different from my previous experience? There is just so much more going on in the surg path department! Frozen sections are happening all the time; there are PAs, PA students, and pathology residents doing fixed tissues; and there are techs moving around through all of this as well. It is definitely a bustling environment! At my last job there were three of us in a brand new facility (built around the middle of my time there) with yards of open space between the grossing tables. It is fascinating to be somewhere where the pacing is so different and every where you look someone is doing something interesting.

Quickest blog post ever!

I love this style of scalpel <3

I will write more when I am less engaged in other things, but my class has been split into two groups for January and my group had surgical path rotation today. I got to gross my first specimen at Duke! It was exciting and made me realize just how very much I've missed grossing. It was good. It is funny though since so many things are different! It must be like this when a PA moves from one job to another... the basic tools are the same (scalpel, forceps, cassettes) but everything is not what you are used to and you have to let go of the way you have always done things. I am used to yellow cassettes being derm cases but those are stat cases at Duke, pinkish purple being GEs but those are surgicals at Duke, and green being surgicals which may or may not be small biopsies at Duke (it was a long day with a lot of information so forgive me for not remembering offhand). There are other little things like measuring with the top of the ruler instead of the bottom and using a different type of scalpel.

Tomorrow we have a neuroanatomy lab and my group is assigned to autopsy. I'm not hoping that a bunch of people die so that my January is more interesting, but I am hoping that if people are going to die anyway that they do it the days when I am on autopsy rotation.


Meanwhile I'm having a dinner party tomorrow night. I might have seriously underestimated the amount of work involved. I thought it would be fun to try making something I've never cooked before with my classmates and an assortment of med students as guinea pigs. I made a roux last night, I thought I had burned it but it turned out it was actually a pretty good brick roux. Unfortunately I didn't think to google what it was supposed to look like until after I let it cool down into an unappealing sludge in the bottom of my dutch oven. So tonight is my second attempt at making gumbo.

And I've gone insane with the whole cheese plate thing again. I don't think it is normal to have a monthly cheese budget... but I enjoy it so much.

Anyway, I have to go rearrange my living room furniture, make a chicken and andouille gumbo, slice lots of bread, and cut up even more vegetables. I promise to write a real blog entry detailing the awesomeness of this week so far this weekend!