As the year ends...

I'm curious to see what the final number tallies are for the year at Duke surg path, autopsy, and the VA. We used to do an unofficial betting pool where I worked before (and I'm sure they still do) for the various specimen types to see where they would end up. Always nice to see the business growing from year to year, especially for the veterinary practice which went up significantly in the time I worked there.

I'm hoping, in the new year, that there will be a spate of job openings scattered around the US. There are always positions available in California and New York and one or two in Texas. But otherwise it is hit or miss as to where there is an opening. Right now, we're being selective about where we want to end up so I'm just keeping an eye on openings for the ones that are interesting in the areas we wouldn't mind living.

The spring semester will be interesting. We'll be seeing the first years in January and even having a class with them, which will be a good chance to actually interact with them. And one of the autopsy PAs is having us all over for a party sometime in January (oh, I just winced because I've been meaning to, but haven't actually, have a dinner party for... months now), also good.

I'm having a very relaxing break. I've gone to the movies, taken kids on so many outings (tomorrow, we're going to explore more parks in Durham), traveled a bit around North Carolina, walked the dog, cooked a little, and slept a lot. My husband has been in town so we've had a decent chunk of time spent together as a nuclear family, but it'll be hard tomorrow when he goes back to work in South Carolina (and takes my dog).

December was busy...

And I have been awful about blogging.



Christmas preparations and catching up on two rotations worth of autopsy reports really limited my free time.

I found that I like writing clinical histories, but I feel less sure of myself when writing up the PAD. It is much easier when there is a readily identifiable cause of death and much more tedious when there is not... I'm sure it is one of those things that gets easier with practice. I'm still intimidated by doing the microscopic part of the diagnosis, but it isn't something they throw us into without any help. I will find out in mid-January when I go back to autopsy.

My week at Duke before the break was pretty good. I had a nice variety of complex specimens and felt pretty good about my comfort level with them.

But that is all done now and I've been enjoying a nice Christmas week. My mom has been living with us for two weeks, which meant that 5 out of 7 of the people in my immediate family were in Hillsborough so we had Christmas here this year. My husband came up last Friday and my sister just started a new job this year and as the newest employee ended up being the one to cover Christmas (the downside of being an OB/GYN is that you can't exactly schedule when doctors are needed) so we had to make do with phone calls and mailing presents in advance. It was strange before the break when people asked me if I was going home for Christmas and I pointed out that I basically live here now... It is different for other people who have extended families and roots elsewhere, but for me Durham (well technically Hillsborough) is home.

I spent some of the start of my break in Asheville visiting friends and wandering downtown, then my husband and I went on a post-Christmas mini-trip for two to Raleigh. It was nice to have quiet time and the freedom to wander around downtown and explore. We hit up the Edward Munch exhibit at the art museum and my husband found a new favorite bar, The Raleigh Times, which had an extensive beer menu, extremely friendly bartenders, and an interesting interior layout (they have a history of the building on their website). We have plans to go back to the art museum with the children at some point, and maybe check out the state history museum as well. As close as Raleigh actually is, we're spoiled and it seems like such a chore to drive the extra 20 minutes when Durham is so close and there are so many things to do here.

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. 

One door closes... (not pathology related, sorry)

Buy this house, buy it!

On Friday I was absent from autopsy and I traveled to the town where my parents have lived for twenty years to be there for my mother. She retired from the Department of Social Services, a veteran of many, many years of government services. She did a stint in child protective services, years in medicaid, a stretch in adult protective services that included working from home for hours each night in addition to the full days put in at the office, and ended as a worker in AFDC. I can't think of a time in recent memory where we have gone out in the town near her home where we didn't run into someone she'd helped on their way to a better life.

On her first day of retirement she wanted to close out her career with a party for all of the people she'd worked with over the years. She invited other retirees, long time coworkers, and her best friends to join her for a night of music and food. It was a lovely party, well attended and extremely well provisioned (it is cultural!). My sister flew in from Tennessee, my husband drove up from Columbia, and I brought the rest of the family down from North Carolina.

My parents have their house up for sale (and our first house is also up for sale, if anyone wants to move to upstate SC and would like a house or two!). My mother will take a few weeks off to visit a family friend in a pleasant location and then start splitting her time between North and South Carolina until the house sells. And then my parents will officially be homeless (except for a third house that they own in another town in upstate SC) and living with me and the kids.

I dropped my sister off at the airport on Sunday morning and I realized at that moment that it was the last time that we would all be together in their home. I should feel more nostalgic about it, but the house has been renovated enough since the last time I lived there that it doesn't feel familiar. It makes it so much easier to move somewhere else.

My husband is hilarious (don't tell him that I admitted that)

I'm on google chat with my husband discussing the sorts of things you think about when you're job hunting, like having to come up with (if asked during an interview) my strengths and weaknesses. He replies with the following:

Weakness: I am too awesome

Strength: I am very modest

Things that can be unpleasant

One thing I've noticed is that I really do tend to do things that I find unpleasant. For instance, I will almost always volunteer to run the bowel when I'm on autopsy (of course that usually makes the person that I'm on service with volunteer to do it the next time) because I think that repeated exposure will desensitize me to the experience. And, I'd like to think that I'm getting faster at it!

I do the same thing with products of conception. Some of my classmates have had moments that were emotionally difficult when handling POCs with identifiable fetal parts, and I'm not completely immune to it. Some people react to their discomfort with seeing a POC by being vocal about their squeamishness (not necessarily at Duke, we received them were I worked before as well), which is another reason why I volunteer to handle those specimens. I know that with my language and actions I'm not doing anything that I wouldn't be comfortable with the parents seeing. The staff PAs stress to the students and residents to not say anything in the dictation that would be upsetting to the parents, and I think it is just a good practice to keep their sensibilities in mind.

And finally, the interview process. Surprisingly, I like interviews. I don't tend to get nervous about them, possibly because I moved around so much as a child and I'm comfortable meeting strangers. Now afterwards I might think back on how things could have been phrased better or information that I wish I had put forth, etc. But during the actual process I'm usually fine. What I am not particularly looking forward to is salary negotiation. It isn't just the number, it is factoring in continuing education allowance, hours, weekend and holiday call, relocation expenses, cost of living, corporate culture, bonuses, and a lot of other things. No one else in our class has gone through the process yet, so we're all still feeling our way through it. We have interview and application resources that we're reading through but there is a huge difference between reading up on it and actually doing it.

Job Hunting

When I walked into the PA student room on Monday I saw two of my classmates working on their resumes. It seems like all of a sudden November hit and we all decided it was time to get serious about job hunting.

I wonder where I'll be living this time next year!

I have written a resume and had it reviewed by a few friends that I trust. I feel pretty good about it and I hope that it serves me well. And while I'm not particularly big on self promotion, I will be available for hire and will be able to start working July 2013!

My husband and I had a chance to talk about employment and our future this weekend. I know that it is prudent to start my job hunt sooner rather than later because he will also need to find a job, which is why I've seriously started looking. I would love to stay in Durham, but I know because we all stay in town for our clinical rotations it is one of the few places in the US where there isn't a shortage of PAs. So, I'm keeping my options open. My parents are leaving the country and neither my husband or I have roots anywhere in the US so we're viewing this as an adventure. We will see where the job market takes us.

Rotated through and now back to autopsy

Friday was my last day doing surgical specimens for a while. It was a good five weeks and I feel a lot more comfortable at Duke surg path. I know that I still have a ways to go on getting my dictations where I want them to be but I did get a lot more positive feedback on them on them this go-round.

We have case assessments where the pathologist who reads out the case can comment on our dictations and sections on the cases that we select for assessment. And it can be disheartening some times when the staff PA looks over the blocks being submitted and praises the sections but the assessment comes back with the pathologist not liking them... or having one pathologist wanting larger sections and another wanting smaller ones. That is all part of the learning process. It isn't easy or fun to get feedback (unless it is 100% enthusiastic and positive, because who doesn't love that?) but it is helpful.The good thing about being able to handle constructive criticism and apply it is that it means that there should be improvement. Learning to tailor your sections to the pathologist reading them is a very important professional skill!

Still, I really enjoyed my time on surg path. I felt like things were starting to become more comfortable and familiar at Duke. And I was able to answer the questions the staff PAs put to me about the disease processes going on in the specimens I was grossing and what sections needed to be submitted, etc. It was nice to feel confident about that.

Meanwhile, as of this morning I am back on autopsy for two weeks. Oh autopsy! You never know what the work load is going to be, but I like it a lot - more than I thought I would before I started the program.  The one thing I miss equipment-wise is a scale that you can wheel the gurney on to get the patient weight. But other than that, it is great. Everyone that works there has been working there for years and teaching for ages so they're very focused on us as students. Plus, most of the organs are relatively normal (which is not something you get too often in surg path) and it helps reinforce anatomy information. During this rotation I'd like to get evisceration down, which everyone seems supportive about so hopefully we'll have some cases that are good for teaching (ie: there's not a recent thoracic or abdominal surgery in the patients that would require a more experience hand for evisceration, etc).

In completely unrelated news, the first years had their first gross anatomy practical this morning. Oh goodness, I remember being in their position last year... it hits at the end of a solid month where there was a test in a different subject every Monday. Hopefully they're all recovering from all the studying but having a relaxing night. It is one of those situations where it feels like it has been forever since we were doing that and no time at all.

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).

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.

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!

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.

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.

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!

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.

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.

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.

Things I can't talk about but wish I could!

If a group of PA students are walking down the hall and one of the autopsy techs sticks his head out of the door to the autopsy suite and says, "Do you guys want to come see a cool case?" the answer is always going to be yes. If a resident is triaging a segment of colon so fresh that it is still peristalsing on the cutting board and invites me over to look, then I'm there.

And I'd love to be able to tell everyone about the specimens we see and everything we do, but I can't because of the social media policy. It is just the way things are. No one would want to stumble across a detailed description of their loved one's (or their own!) organ/illness/body part, so no specific details with associated dates.

I will say that the number of complex specimens that Duke North handles daily is probably about what we would have seen in two weeks where I worked before. It is a completely different environment, but really amazing about being able to ensure that each student gets a wide variety of complex specimens.

I might have mentioned before that there is a white board where each student or resident can jot down their wishlist specimens. I've got a few things written down, but I don't have much because I've had a decent sampling of different specimens during this rotation (hepatectomies, pneumonectomies, mastectomies, prostatectomies, etc). And I'm not bold enough to put whipple down on my wishlist yet, but maybe for the next rotation!

It makes me realize how much I have genuinely missed grossing during our didactic year. I love cutting things up into uniform 2-3 mm slices and laying them out (prostatectomies and thyroidectomies are awesome for that). And it is always nice when a passing staff PA glances over at my sections and compliments them.

In completely unrelated news, our first years had their first Molecules and Cells exam today (I hope they all did well!). I can't believe that it was only this time last year that we were in their shoes...




 

A PA blog

One of my classmates sent me a link a few days ago to a pathologist's assistant's blog. If you are interested in the profession then it is well worth checking out. She is a working PA and has lots of pictures of specimens that come across her grossing table (ah, the advantage of not working under a social media policy that prohibits such things).

Figuring things out...

We use different programs for different things. As long as we are signed in with VPN we can access the programs that have patient history and autopsy information. The one we don't have on our laptops is the one that allows us to view and edit our dictations. There is one work station in the PA student room where we can access it, but unfortunately there are three students trying to use the one terminal all at the same time.

Each morning we have to turn in our edited dictations from the day before, but since we had classes or conferences every morning but Friday last week that meant getting on campus in time for everyone to get their stuff done by 8 am... I've been shooting for being in the room by 7:15, some days were more successful than others.

Even still, I feel rushed because I am aware that there are other people waiting to use the program. I tried going back in one night around 7 pm, hoping that the dictation would be transcribed. There was one available. I asked and apparently the microscopic dictation gets prioritized, which makes sense. I might give it another try one day this week to see if it is useful to go in at night instead of jockeying for position first thing in the morning.

We were also told that we could use some of the computers in surg path, but it is a tight space until they move into the new location next year. I just worry about being in someone's way since those are the same computers they use for accessioning and looking up patient history.

I'm sure, eventually I'll get it figured out and I'll be more used to using the software so it won't take as long. Plus, this week has a lot fewer morning conferences so it won't be so bad! 

Photography class, first rotation at Duke North, and an awesome weekend!

We had our first digital photography class. I'm a little intimidated by the cameras we'll be using... I've never manually had to adjust anything. When I was grossing before I only ever had to use the MacroPath system that we had set up there, which did everything automatically and actually took really sharp pictures. It will be good to have the training though since it is a skill that can be used in regular life (I might actually manage to get good pictures of my offspring out of this!).

After class those of us at Duke North this week headed over. It took me a while to get oriented! I've been dictating the VA way for two weeks which is a bit different from Duke but by the third or forth case I was beginning dictations without having to think about it. Tomorrow morning I'll have to show up early and proofread my dictations so hopefully they're not too bad!

I did end up at a grossing station next to one of the residents I was on autopsy with. He's so nice. The problem being that chatting with the friendly resident is probably not helpful in terms of productivity and focus! Of course, one day he might need to employ a pathologist assistant so having a good working relationship can't hurt, right?

A long drive, but the scenery was gorgeous

I'm a little exhausted though! Friday was a long day involving a lot of walking from the VA to Duke and then back again, and we were still grossing at 5:15 when the resident found out that we had the first year's welcome party and kicked me and the other PA student out. I felt so guilty leaving her, but she kept insisting and only had ten or so smalls left... I still feel bad! It was a bit of a rush to get home, showered, changed and back to Durham for the party in time but I made it. We were there for a couple hours and I ended up adjourning with almost everyone else to a bar downtown. I had plans to meet with friends that night but their dinner ended up running late so I had more time than I thought I would. I didn't meet up with my friends until after ten and ended up just crashing at their house rather than drive back to my apartment at 2 am.

Then I woke up really early and got on the road to Asheville to meet my husband (and best friend, mine not his). The drive should have taken just under 4 hours but instead it was closer to five and a half. Then the husband and I ditched one car and headed up to the Tennessee/Virginia border to see my favorite band ever! It was the first time my husband has seen them with me and he grudgingly admitted that they are, in fact, a phenomenal live band. It was amazing to be out under the stars with him while they played. Of course, we didn't get back to Asheville until 1 am and into bed until 2 am. Then we had to get up super early and head back to our respective towns. I think I'm still a little sleep deprived to be honest, but it was such a great great weekend.

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.

First years start tomorrow!

The class of 2014 starts orientation tomorrow morning! We met all but one of them for dinner tonight, which means that at least we can put names to faces. It helps.

Poor first years though, our class has a... boisterous dynamic, which can be overwhelming. I'm sure they'll get used to it in a few weeks. Plus, once they get to know each other/us/etc it'll be be easier.

I should head to bed soon since we're getting a chance to redo our official student photos tomorrow and I don't want to look exhausted in mine.

Pet peeve...

The container should be bigger than what you put in it! :)

This is universal and not confined to any one institution or medical facility, but I have a pet peeve.

I'm not sure why, but when submitting things for pathology the person putting it in the container feels like it is necessary to put the specimen in as small a container as possible... as though there is a formalin shortage and we must conserve every precious drop. Or that they'll be charged more if they use a slightly larger jar or chastised for wasting resources...

I have routinely seen specimens before where they were shoved into jars so small that the entire specimen was molded into the shape of the container (where I worked before, not here!) and the tissue pushed out almost all of the formalin. It is particularly annoying with fatty specimens, which tend to be the larger ones anyway.

It isn't a competition, no one is judging anyone for using a bigger jar. Please, by all means, use the bigger jar. I like to see a specimen floating freely in ample amounts of formalin (or at least more formalin than specimen in a container... five times as much tissue as fixative is not a recipe for success!) when I open a container, not be greeted by a jar where I can look at the jar and see the subcutaneous tissue smashed up against the walls.

Sorry for the rant folks...

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. 

An anniversary and having a moment

This past weekend marked a year since my last day at work! I miss the people I used to work with, but glad to be moving forward professionally.

On Sunday the kids and I met my husband in Charlotte to celebrate my oldest child turning 8. It was hard when we were hugging goodbye to let go of my husband. He'll be coming to Durham this weekend so we can celebrate his birthday, but it is getting harder and harder to live apart. I don't know if it is the fact it has been a year or if it is because we were able to spend so much time together in July and I got used to living with him again... or the fact we were apart on our ten year wedding anniversary. That part of this whole going to graduate school experience has been the most difficult.

But hating it doesn't change that it is my reality so I should suck it up and keep going, which is how we've traditionally dealt with unpleasant things we can't change.

There was a strange moment when we were eating dinner together on Sunday when we were figuring out if we'd make Carowinds theme park the oldest child's birthday tradition (this is the second year in a row he's gone since it took him to age 7 to be tall enough to ride the fun rides)... It hit us that next year I'd have a job somewhere and we may have picked up and moved across the country by the time my son was 9. Exciting but scary!

Different mindset

I started my first surg path rotation today (it went well!) but... I got in early this morning and looked over what was there before my classmate arrived. I figured I'd knock out the small stuff really quickly so we could concentrate on the bigger stuff. Which is what I would have done at work... but this is not work and getting the smalls out of the way would mean stealing educational experience from my classmate...

And then later when we were going over the larger specimens there was one type I'd done before at my old job so I said I would take it since I was comfortable with it. Except... that would have been less helpful when it comes to learning new things so my classmate took that specimen and I took something I'd never done before.

The goal of these rotations is not the same as working. We still need everything grossed and on the processors but so that everyone's had a chance to do their share and that we've all gotten to do specimens that we haven't done before. I need to remember that. I'm just used to where I used to work where we also wanted to get everything done as fast as possible since we had sort of a set schedule for when processors needed to be loaded (and also because we couldn't leave at the end of the night until everything was done). To that end, everyone grabbed what they were good with and did them.

Evisceration and adventures in histology

This morning we had a conference with some of the autopsy staff where we had a presentation on evisceration. One of the PAs made us cinnamon rolls. As we all sat around munching on breakfast and watching slides on how to properly remove the chest plate (and hearing about how to deal with a heart that is adhesed to it if the patient has had bypass surgery), I realized that the level of squeamishness of the people in the room was ridiculously low. This is probably a good thing given the profession we are training for.

The autopsy staff PAs are also pretty accommodating about student guided learning. If we want to practice a given skill, then we can (I want to see if I can get the brain out by myself, for instance. I feel like I can do that so I'd like to try it and see how it goes). If we want to focus on a particular organ block then we can or if we need someone to walk us through removing the bowel one more time, then they're there. Not that I've removed a bowel yet. That was more of a resident thing since they were getting ready to be on their own for weekend call. But the next time I'm there I should be able to do the evisceration with assistance (for the summer rotations I started out in the middle of the two weeks of autopsy, so I'll have my second week after I go through the VA and Duke surg path).

Random internet picture of a cryostat

Moving on to today's rotation, I practiced frozen sections which I haven't done in ages and didn't feel very secure about. However, using the microtome on Monday made it easier to use the cryostat. The tissue was also well frozen and not very fatty, which I'm sure helped immensely. The histology lab manager mounted one block for me and showed me how to use the machine. Then he left and I practiced a bit before mounting a second specimen on my own and making my slides. They turned out much better than I thought they would, so that is a relief!

Also I went through my now stained and cover-slipped slides from Monday to pick out the ones for grading and see which ones needed recuts. I had a couple that I redid and will stain in the morning after conference. The histology manager looked over my special stains and said they were all just fine so that's good! I just have to finish up the written portion of the rotation (which is not going as quickly as I would like) and I should be all set to turn everything in on Friday.

So far, so good with regards to rotation. Next week is the VA though, which is more surg path and a grab bag of specimens so we will see how that goes!

Autopsy, special cuttings, and histology

Paraffin tissue blocks (not mine though!)

In deference to the Duke social media policy I will continue with my (maddening to some, apparently) tendency towards vagueness.

Duke's autopsy service is pretty busy, some cases come from outside hospitals and some from Duke itself. Autopsies happen and I will be present for some of them (some as the person eviscerating, some assisting a resident or staff PA, and some as the lead prosector). We have three diener's (known collectively as "The guys") who do most of the eviscerations, prep work, lung inflation, and clean up. It is very helpful to have such experienced techs, especially considering how much time the autopsy services spends training residents, med students, and PA students.

I like autopsy, in general (although the smell can be very noticeable at times)...the schedule can be irregular though. In addition to the actual autopsies, which can start any time between 8 am and 1:30 pm, there are the slide sign outs (going over the slides with the attendings). Some sign outs have more of a set schedule, but other times it is when the residents have had a chance to look over their slides and can grab an attending. There are also the special cuttings (brain, eyes, and sometimes heart if there is a reason for it) which may or may not have a regular schedule (brain definitely does) and may or may not be mandatory (eyes aren't). It just makes me worry that I'm going to miss something. But the autopsy PAs are fantastic and the residents I was with last week were so great to work with, so it was a really amazing first rotation.

This week is histology! They set aside sample tissue during preceptor week and I took my blocks down for processing on Friday. I embedded them this morning (with a break to go to a special cutting) and spent the afternoon cutting slides. I've embedded before, but this was my first time making slides. Oh my goodness, I would be the worst histotech ever! Or at least the slowest. And paraffin shavings get everywhere! The rest of the week will be spent doing special stains and studying the histology textbook.

Congratulations to the class of 2012

Yesterday the members of the class of 2012 presented their senior seminar cases. I learned some things and enjoyed seeing everyone looking very professional and prepared. Public speaking is never fun but they all did a good job with it.


Folks are getting ready to move, start new jobs, and maybe even start thinking about taking the certification exam. It is an exciting time for them and I really do wish them well!

It has been an interesting two weeks watching them get ready to leave while still trying to pass on helpful information to our class as we start rotations. It was great to get to go on rotations with them, especially the ones who have gone out of their way this year to advise and encourage our class.

It doesn't seem real that they're done and my class is definitely the second years, but the PA room is half empty and awaiting the incoming class so it must be!

In which I discuss my love of scalpels!

Pathco Scalpels are my favorite!

During preceptor week I had one rotation at Duke North. My instructor for the day was
a second year I've never had a chance to work with before and it was a good experience (she was instructive without being overbearing which is always nice when you're in a new situation!). But... I may have frightened her with how excited I got over finding a pathco doubled edged scalpel at Duke surg path. I was so happy to see that one of the PAs that now works there has had a few of these ordered (the PA in charge of the lab had offered to order a few for the current second years to use after they saw some at the conference last year but no one really wanted to use them). It might be that the double edged scalpel seems less safe, but you get used to it pretty quickly and it is convenient to be able to flip it over and have a new, sharp cutting surface.

Sakura Tissue Tek Trimming Knives (I like the flat ones!)

I love this style of scalpel. I prefer it with the blade a little angled, but I couldn't find any pictures of that. This is what I've mostly worked with and it feels familiar and natural to gross with it. My sections are much, much better with it than with the other style. I'm not saying that I only ever use this one or that there isn't a place for the other style (since I do like them on autopsy or when having to cut smalls) but it felt so good to have a favorite tool available. And it is the type of scalpel I had in mind when I named the blog since it is what I've always used!

I went to the movies with one of my best friends in Durham, who happens to be one of the few people I know in the area from outside of school, and my enthusiasm for discussing how awesome scalpels and trimming knives are may have worried him. Just a little. I think, since my best friend is a nurse, my sister is a doctor, and most of my other friends are either from school (undergrad or Duke) or have been hearing about the awesome (if messiness) of my job for the past four years, I forget that there are people for whom waxing poetic about the handiness of a sharp blade is unsettling!

Rotations begun, timing, residents, incoming students

I'm starting off with a week of autopsy! Duke is on track to do over 400 autopsies this year so it gives us a good chance to practice our evisceration skills. I also have brain cutting one day a week with the neuropathologist that taught us in January and who was also our pathology course director in our Body and Disease unit. She's fantastic but I'm so worried that she's going to ask me an anatomy question and I won't remember. Hopefully I'll be able to name any structures she questions me on! 

So autopsy starts at 8:30 and that is a little later than last year, but since the residents have to be there and they have conferences almost every morning getting there at 8 left people standing around waiting. Also, I'm thinking ahead to when my children go back to school. I shouldn't have a problem getting to any of the rotations by the time they start, but the mornings we have conferences (which is variable each week) it would be impossible since I can't drop the kids off at school before a certain time. Luckily I have my dad, so I'm going to be leaning on him more this year to help get the kids to school.

While we are out on our first rotations, the first year residents are out on theirs. I think they started last week so they have a little bit of a head start on us but we're all learning together. It is another set of names to learn but we have sheets posted everywhere with the picture and name of this year's residents. There are also sheets with our pictures posted everywhere, which is always strange to see (Oh look! It's my face looking back at me...again). We'll have a new sheet coming out soon since the incoming first years are having their pictures done in a few weeks.

I'm excited for the incoming students! And I should email them tonight for the casual get to know you dinner thing the students do before orientation actually starts. It makes being social at the official party easier when you at least know your classmate's names!

Keeping a log...

As second years (yay second year!) we are supposed to keep a portfolio of specimens that we gross for a couple reasons such as being able to tell future employers what we've done, ensuring that we're not missing out on any particular specimen type, etc. My first day of preceptor week was at the VA (my second day will be there too!) and I know that I grossed things... but neglected to write down how many of what. Tomorrow I will do better with that!

At some point I tried to figure out ballpark numbers of specimens that I did in my previous job. "A lot" probably isn't a very useful unit of measurement. I know that the last full year I worked we did around twenty nine thousand accessions. Approximately five or six thousand GI (and I know that about a third of them had multiple sites, so figure between seven to nine thousand actual specimens in a given year). Skins and small surgicals were each around nine and half thousand accessions (say eleven or twelve thousand individual specimens for each type) and large surgicals that the techs did were maybe five thousand (mostly not multiples but maybe six thousand actual speciments). There were only two of us for the first year and a half that I worked (although during that time I did mostly GIs, some small surgicals, and almost all of the large surgicals), and then three of us for the last two years I worked when we started added more derms, larger smalls and larges. So... "a lot" seems to sum it up. It sounds weird to say that I've done thousands of anything, but realistically I've done thousands of GIs, thousands of skins, thousands of small surgicals (so many cervical biopsies, tonsils, etc).

But! Those specimens weren't officially supervised educational specimens so while I've done them and I should hope they count in my favor when it comes time to interview (although most positions do mention that they welcome new graduates!), they won't be part of my tally this year. I hope I get a decent number of specimens documented though since I'd feel silly just having a list that says I've only done a handful of something common.

Orientation today!

This week is preceptor week, but before that starts in earnest we have orientation! More chapters will be added to our PA student manual and we will find out more specifically what we will be doing day to day.

We're transitioning from the predominantly classroom first year to the predominantly clinical second year, but not really feeling like we're really almost second years yet. Of course our second years are still here but they are all thinking about taking the certification exam, moving and starting their new jobs. I can't believe that will be us in a year! I can't believe they were us this time last year... they seemed like old pros by the time we arrived in August!

It is an exciting period. We'll bid farewell to our second year's, welcome our incoming first years, some of us will start work study positions (I won't have one, in large part due to not knowing what the children's schedule will be with sports and how much I will see them just with rotations, etc), and we'll try to make our way through our first experience in each of our rotations.

I still really need to practice frozen sections... I'm sure that'll happen this week sometime.

Also, my laptop has another virus... I've lost count. I really wish I could have had a Mac, but at least the incoming students seem to have been given the choice. Hopefully it means fewer visits to the IT department for them. 

Oh goodness, a real vacation...

My husband's middle sister, her fiance, their daughter, and his mother have all come to visit the US from Sweden. They arrived on the 29th and will be visiting us through July 12th. Since we knew I was going to be off this week and they were coming all this way we decided to plan a family vacation at the beach. And, because I haven't been able to see much of my family the past year (not entirely due to my school obligations, a lot of it was because the kid's school breaks didn't sync up with mine) we invited them along too.

The beach house!

We opted for Nags Head, NC which is in a part of the state known as the Outer Banks. It is a lovely place for a family vacation. On the one side we have calm shallow bays where we can take the kids and not have to worry since you can wade out hundreds of yards without it getting deep, on the other side there is blue sparkly ocean with waves and deep sea fishing. It is commercial enough that there are shops, restaurants and stores but not so much that everything is choked with gift shops. Honestly, my husband might already be planning our next trip here before we even finish with this one, we've liked it so much.

It has been almost a whole week with one or two trips a day to the beach and we've managed to make it without anyone really getting sunburned. We've gone through sooooo much sunscreen. Sunscreen and food! But luckily we're in a great beach house with a well equipped kitchen which has helped immensely. Plus we have balconies, wild rabbits, and a hot tub (that we haven't used because it is July in the South, but I keep thinking I should at least try it!).

I have had a great time decompressing and relaxing. Vacations are nice... I should take them more often.

But on Monday we go back to the real world of rotations! Even that doesn't start until the afternoon since it is just an orientation day! Starting rotations will make the reality of being done with the didactic year more concrete. And it means that there's less than a month until the incoming class arrives!

First year done!!

We had our cumulative final this morning. I spent yesterday studying (with a two hour break around dinner time to see a friend and grab something to eat) and woke up around 6 this morning to go back over the most important things. I feel like I did well... for the most part the answer I was thinking of was one of the options I had to choose from, which I feel like is generally a good sign.

I still feel like laying down and having a good cry though. Just to purge some of the stress from the last week. Not that it has even been that horrifically bad... It always gets built up worse in my mind than it actually is. 

I called my husband on the way back to my car and gave him the report. He said congratulations and then dropped a bit of a bomb on me. Apparently the screening medical procedure my mom had done a few weeks ago had yielded a positive result and she'd gotten the results last week. And everyone in my family decided, what with everything else going on, that they wouldn't tell me until after my exams were over.

Which, while it shocked me, was probably the best course of action... especially considering that our Monday exam covered relevant material and crying makes studying harder. The good news is that as far as prognoses go, she has a really, really good one. Hearing medical news is a lot easier when you know what all the words mean and have a solid understanding of what is going on. And finding out about everything later meant that by today my sister already had a copy of the pathology report, and my mom and dad have had follow up appointments and a plan is already in place.

On not saying goodbye...

It belatedly dawned on me that our last interaction with the full class of med students was last Wednesday (and I was only there briefly). Their final exam is Friday so events are planned, but since my class elected to have our exam on Wednesday most of us will be scattered across North America by that point.

I studied this morning until around 10:30 with a handful of medical students. It wasn't until one was leaving to take her test that I realized I wouldn't be seeing her much anymore and I like seeing her! Facebook makes it easier to keep in some kind of touch with people and I'm sure there will be chances to get together socially, but it won't be the five days a week, seeing each other in class and hallways set up we have now. I will definitely miss them, their class was more welcoming and inclusive than I had any reason to believe they would be. And Duke School of Medicine's class of 2015 will always hold a spot in my heart (except for the folks who always streamed lectures, because it is startling how even after a year in class together I can still see some of them and think, who is that guy?! ;D ).

Two down, two to go

This book has taken over my life

The pathology small group final was not what I expected from either the practice test or what the second years said about last year's test. I was expecting histology questions where they would be in groups of three or so related questions, which is more what they had in the past. But our questions weren't organized like that, we just had stand alone questions which made it harder since we had to keep mentally shifting between different organs, tissues and diseases. A classmate described the test as "demoralizing" but I think at this point we're so close to the end we just have to keep pushing through to the next test.

I'm not a huge fan of the fact that our next two tests start at 9 am again. One of the things I've really liked about body and disease has been that our tests have been at noon and we have the morning before the exam to review what we need to.  Tomorrow's test not so much. I don't think I'm going to forget everything tonight while I'm sleeping, but there's always that chance! So I'm going to review the major things tonight right before bed, go to bed early and try to be in the study room by 7:30. The test is open from 9 to 1 pm so I don't have to start right at 9, which helps. 

On Wednesday, with our cumulative final, we don't have that flexibility. It should still be okay, I think. Not having the kids helps a lot as well since I will have all day Tuesday to review and it will be quiet. I've been trying to, in any downtime the past two weeks, go over more Robbin's review questions. I have no idea how much of it I am retaining... I hope a lot!

Just a few more days. First year is so, so close to being over.