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!