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.