The year that was, and the year that will be.

2013 was chock full of exciting and wondrous things, and a few things I'd rather never have happen again. I will forget to mention great swathes of things that mattered, I'm sure, but that is par for the course. The things that seemed so horrible at the time (I'm looking at you laptop crash!) have faded from the forefront of memory, as most unpleasant things tend to do.

It was an accident prone sort of year, between ending up on crutches and having my car totaled (and still feeling the ill effects of that, to be honest) I spent more time in doctor's offices than any other time in my life (excluding the years I actually worked in a doctor's office). But I'm still grateful that nothing worse came of it, and the kids were not with me when the accident happened.


Educationally, I received a master's degree and finished the PA program. It isn't a small thing for anyone, but considering my past it meant more than I had imagined. I still felt a bit silly in the black robe, but participating in the ceremony is something I'm glad I did for my family. The certification exam is still hanging over my head, but that is something that belongs to 2014.

Employment-wise, it was an interesting year. My husband's promotion determined where I'd be searching for a job, but it is something that he earned and something he worked very hard for. It did mean that I've become a labor department statistic (ie: the under employed), but considering the job market in my state (largely non-existent) I'm fortunate to have found something that allows me to actually live at home and work as a PA. And I couldn't have imagined a nicer place to start out working though, honestly. My boss is really great! The pathologists are nice too, but not as fun to hang out with!

Moving back to where I lived before would have been easier if we'd stayed in the same house, but... for the children's sake we uprooted ourselves and found a homey house in the best school district we could find. We're firmly ensconced on the other side of town from where we were before, which meant condensing the old house, the NC apartment, and whatever we inherited from my parents into the new house. So much moving! On the upside, we now have two extremely well seasoned cast iron pans (and so many magic bullet cups). Ah, but I loved house hunting. I always do. For the potential of the places, and the dreams of lives that may be lived there. I even tagged along when my best friends in Durham were looking for houses, I couldn't help myself.

July was miserable for all the goodbyes. School ended and most of us scattered, leaving behind the teachers, PAs, residents, pathologists, techs and everyone else that had been so important during our time there. And then I had to say goodbye to Durham itself, and all the places I'd come to know and like. It was a sad month, my best friend (since 1996!) moved far, far away and then I had to leave my other best friend there in NC while I moved far away. In a lifetime of moving and meeting strangers, there are three who have become my closest and best friends. One had to move away, one I had to leave behind, and the third I finally got to live with again after being apart for two years. The latter helped offset the former two. Getting to be all together as a family, and living with my dog again is good.

Things that I've never experienced before happened... for instance I was mentioned in the dedication of a book (I'm actually in a book circa 2000, but as one of dozens of people)! And we had a housewarming party, where forty people crammed into my kitchen while ignoring the entire rest of the ground floor. Oh! And I've started baking, which seems a small thing but it is something I've always been intimidated by but after the previously blogged about pie making weekend (inspired by a conversation at work one day), I've gotten more adventurous!

And as this has gotten quite long, I'll wrap it up. 2014 will be here soon! Let's hope it is a good one.

And I've studied sporadically at best...

I need to dig out my sealed transcripts so I can sign up for the certification exam. Having a date will help with motivation, I think. November was good for studying, December has been very Christmasy with some interspersed studying.

On the upside, Christmas is now over and we had a lovely time. My family all came to visit for a few days and it was really nice, probably the least stressful Christmas we've ever had. We tried to model things on my husband's Swedish Christmas traditions and it went over well.

I worked Christmas Eve and the day after, which is about what you expect in the medical field. Things slow down but it doesn't stop because people like to get things done while their deductibles are already met. At least I didn't have to work Christmas Day, which my sister's had to do several times in the past.

December has been busy...

I don't know if traveling over Thanksgiving just put us behind, but December has felt like a month of catch up. My husband is working some evenings and some weekends, so I'm trying to pick up the household slack while studying and getting ready for Christmas and working. Somedays I just want to hang out in a blanket fort, reading something fictional and fun.

But work is still going well. Lots of babies being born apparently, but relatively slow on colons. Things come in waves with no rhyme or reason.

My student AAPA membership expires at the end of the month, so I should probably look into renewing that.

Scrubs...

My husband took advantage of some black Friday-esque sales at Brooks Brothers while we were driving back from our holiday trip to DC (since we don't have a store locally, it made sense to stop when we saw one). And it made me really grateful that I wear scrubs to work. I put a lot less thought into what I'm wearing on a given day to the hospital...light blue scrubs every day. They are hospital issue, which makes sense for the type of job I have. In a position where you could be soiled with chemicals and/or bodily fluids, it is comforting to know that non-contaminated clothing is as close as the break room.

Plus as a new grad, it was nice not to have to buy a new work wardrobe...

Schedule...

I haven't signed up to take the exam, but I have a mental deadline for myself. I want to be done with my first pass through Robbins by the end of the month. In December, I'll actually see about registering to take the test for sometime in January. And I'll have the month of December to go back through Robbins and make outlines (I do love outlines) for major diseases/topics, etc.

In the meantime, we're going on a road trip to DC for Thanksgiving with the kids because it makes much more sense to do this now that we live three hours further away from DC instead of when we were in Durham. We meant to but never had the time! It will be good, a family trip before my parents move away, lots of pictures and memories of being together.

Today is my last work day for the week, which makes it a ridiculously short one. At least the rest of the week is relatively quiet so I don't have to feel bad about leaving a lot of work for my boss to do. That is the thing about working in medicine...you can't just leave the work to pile up while you're not there, someone has to do it. It isn't a good profession for people who like to call in for sick days because there always has to be someone there covering for you.

But, days off are nice sometimes and is travel, even if it is just around where you live. It is nice to have a break in routine and play tourist somewhere... even if I will be studying in the backseat while someone else drives us there.

Typhoon Haiyan (Not related to pathology)

You can't work in medicine without knowing some Filipinos. We come over as doctors, as lab workers, and nurses. We are ubiquitous throughout American hospitals, and almost all of us still have family members back home.

I appreciate that my hospital system sent out emails expressing their support of Filipino employees and that coworkers asked after my family members. It took several days for my aunts and cousins to be able to contact relatives in the Philippines but outside of the effected area. Thankfully everyone is fine, and other than some roof damage, my mother's childhood home survived the storm. Also, my grandparents' house has a well of sorts so they have water, which is a big concern for survivors. 

A lot of people have not been so lucky and it is heart breaking to hear the news reports of mass
graves of bodies to be identified later...to hear the worries of people still waiting to hear from family...and of survivors left wondering, "Now what?"

More than anything this past week I've thought about the story of the three little pigs... The Philippines has a type of housing called nipa huts (or bahay kubo), which is made of bamboo, grasses, and/or woven mats and is built on stilts. These are not homes designed to withstand 150 mph winds.The people who have been displaced are not necessarily people who have a lot of resources to replace the things that have been destroyed. I don't know what will happen in the recovery process, but I am heartened by the attitudes of the people there. They are hopeful, they are hard working, and they are resilient.

If you can help in anyway, please do. Because of how long it takes to ship goods internationally and the difficulties with transporting things between islands (especially where the roads have been damaged), money really is the easiest and most effective way to help.

Flashback to rotations

Nothing specific, but an interaction with a random person in a store today reminded me of the weirdest experience with one of the residents.

Me on dictation: "The specimen (an aggregate of normally soft tissue) is diffusely indurated; however, no masses are grossly noted."

Two days later, the resident to my staff PA (that I'm standing next to), "Was there a mass in that specimen."

Staff PA, "No, I don't think so, but you can double check with [me]"

Me, "There wasn't a distinct mass, it was an aggregate and it was all relatively firm."

Resident, "But a mass would upstage the diagnosis, so I need to know if there was a measurable mass."

Me, "There was not a mass."

Resident, "Nevermind, I'll just pull the bucket and look at it myself."

Me, "..."

Sometimes some people just really need to see something with their own eyes to confirm or disprove a mental picture they've developed.... that mass was her Schrödinger's cat of tumors, neither there or not there until she directly observed it.

Plus, I'm pretty sure she always disliked me and when you don't like someone it taints all of your interactions with them. Luckily, I really only had to work with her on autopsy so it didn't impact the year too much (except... you know, on autopsy).

Frozens

So, most of the surgeries for frozen section happen in the morning, which means that by the time I get

Blue is the prettiest!

into work they've already been done and are fixing. Well, one day not so long ago we had a busy day for frozens that stretched until after the hisotechs left. Usually one of the pathologist will do the afternoon frozens, but we had a fill in while one of our doctors was on vacation and he seemed to assume that I was going to do it. So I did it. It is a different cryostat from the other ones I've used but they're similar enough and the sections were tolerable. I do like having tinted OCT, which is something we didn't have at school. It makes it easier to differentiate one chuck from another (other than the positions in the holes in the cryostat). 

One foot out of the door...

Some days you just have to accept it. Specimens come in right at the end of the day, when everything else is already loaded on the processors and the clock is already reading quitting time. And then... after those get grossed and the processors are loaded again and everything is shut down, that's when the pathologist comes in to talk about a specimen from the day before. So the specimen gets dug out and looked at, and finally the day can end.

And that is what happens. Not every day, but sometimes. Usually, as Murphy's Law decrees on the day you need to get home early for some reason or another. But it is part of the job, it is never a steady workload. Medicine tends more towards feast and famine than anything else. So you accept it, gross the things that come in last minute because no one wants to wait another day for their test results and maybe tomorrow would be a busier day and you'd hate yourself for not doing it. You look over the specimen with the pathologist because he's working even later than you are and can't wrap up his work until he sees for sure that the specimen is the way it is.

Meanwhile, I have a pile of pathology mp3s to keep me entertained on my commute.

QUEST

I went to a residential high school and every night from 8-10 pm we had QUEST, quiet uninterrupted, enforced study time. It isn't exactly a lifetime habit that's stayed with me... But in the past year I've been making an effort to not screw over my future self. Procrastination is one of those things that always harms your future self. Of course sometimes it doesn't work, like the time my laptop crashed and ATE my portfolio a week before it was due. But mostly having enough time to not feel rushed is great.

I know that I have to take the certification exam, so I'm making an effort to study Robbins at a comfortable pace. It would be fantastic if I could utilize some of my commute for studying so I'm working on figuring that out :) It is 2+ hours a day I'm not using otherwise, unless you count whatever it is I learn from NPR.

But until then I'm making it a point to study a little every day, my own self inflicted morning QUEST. It is much easier to study now, this is all stuff I've been before. It isn't effortless (and I can honestly say that I've thoroughly enjoyed not having to study on a regular basis so there is the psychological hurdle to overcome), but it isn't so bad.

How to spot which child takes after me...

All the men in my household are currently carving pumpkins (I stepped in to help with the gut removal). The youngest child is singing "Knife goes in, guts come out" which if you know the song means we enjoyed the same sort of pop culture back in the 90s. He's gleefully playing in pumpkin innards and making jokes about guts, even going to far as to help his father empty his gourd.

Meanwhile the oldest child is dry heaving and almost threw up in his bag of pumpkin waste... Poor kid, but he toughed it out and hollowed out his pumpkin. I appreciate that he didn't give up.

Peeled grapes

My kids were sitting at the table eating grapes on Saturday, and the youngest one asked me why

My family of grim reapers.

people used peeled grapes as eyeballs in haunted houses. And I explained that they're kind of the right shape (although the ones they were eating were not globe grapes) and the right size, and they're wet and slippery. I told him that it wasn't really what an eyeball felt like, but it was close enough for most people. Then we had the following conversation:

Oldest to me, "You don't know what an eyeball really feels like!" (He's starting to get very pre-teen in his outlook on life)

Youngest to oldest, "Dude, seriously?" (yes...this is how my youngest talks).

Me to oldest, "What does mommy do for a *living?"

Oldest, "Oh...yeah." *long pause* "What does an eyeball really feel like?"


*Not that I've had an eyeball since before grad school, and the ones I did get were for generally for melanoma. At Duke the neuropathologists did the eyes for surgpath and on autopsy the techs removed them and one of the pathologists who had an interest in eyes would dissect them (sometimes ophthalmology residents would come down for those). 

Dear Durham, I miss you! And familiarity.

Just thought I might leave this link here... It is a fun town to live in. Meanwhile I went back to visit

this past weekend since I like seeing my Durham BFF on a regular. We made pies! Because at work on Friday, pies came up and it made everyone want pie. It carried over to my visit and Saturday evolved quickly from looking at yelp reviews for bakeries to deciding to spend our whole day baking. The results were pretty delicious, and can be seen at right. I also made cookies from the leftover crust dough used for the top two pies, and they were amazing.

It was a slow week at work last week and today was fairly quiet as well. All fairly normal routine specimens and I found myself today remembering what we were told in school, which is that if you can gross at Duke north and keep up, then you can gross anywhere.  And it makes more sense now. Outside of a major academic center, you tend to see a lot of the same things...a lot more horses than zebras. Which is nice, you start to get really comfortable with those familiar specimens. But because of the exposure from school, even if something unexpected and less familiar shows up on the grossing table, I can't imagine being at a loss as to what to do. Even if something I don't see as often pops up, I poke my head in the other PA's office and I ask her, follow her instructions, and feel relatively okay with what I've done. I can't imagine being anywhere and just feeling at a loss... even though I don't need to be able to do everything I saw in school every day, I'm fairly secure that if it came up, I could do it (maybe with a little extra guidance). No real point to this...just to say that I'm glad that I got the exposure so that if I need the experience, it is there.

Stink revisited!

I had to go back to the bucket on the specimen that smelled so bad that I blogged about it. Oh misery! And it wasn't that I'd missed sampling something, just that the pathologist wanted to see more of a certain structure that is normally just sampled in one block. The smell had not improved with age. Ah well, you endure what you must.

This week has been a light one. Tuesday, I finished grossing and then deep cleaned the grossing bench. Yesterday I helped the other PA with paper work for a little while. Hopefully it'll pick up next week. I like to have enough to keep busy!

Grossing still stinks

This would be a follow up to an entry I wrote even before I started grad school.

In the two plus years since the bar for what I consider the worst thing I've ever smelled has risen. Considerably. The worst still goes to a case that involved multiple rectovaginal fistulae that had been present for some time. Veterans in pathology were taken aback by the smell and it is where I realized that my body opts for the "flight" coping mechanism when faced with overwhelming stench. One moment I was standing and observing one of the staff PAs working and the next I was standing outside of the room without ever having made the conscious decision to move. I'm not entirely sure but in an effort to escape the rolling tide of scent I may have spontaneously developed the ability to transport. Decomposed bodies at the medical examers office (in varying states of freshness), countless colons, gangrenous amputated limbs, and multiple autopsies later the things that I consider to be particularly pungent are, trust me, significantly unpleasant to be around.

Today, we got a specimen in and I started my day off by triaging it. It was an awful smell, to the point where I had to go into histology several times to get air I could breathe. I finished triaging, I hosed everything down, scrubbed the grossing bench down, surface cleaned the outside of the specimen container, and put all the trash that had come in contact with it in a sealed container. The lab tech came in to the gross room to print a few blocks a few minutes later and dry heaved. One of the histotechs was at lunch during the triaging and has a notoriously easy gag reflex, so as a practical joke the other histotech sent him into the gross room on a made up errand. He walked in ten minutes after everything had been cleaned, took one breath, then turned around and headed back out to histology where he dry heaved for a while. As I told my boss, the smell was so bad that my eyes watered and I seriously started regretting the professional choices I had made that led me to that moment.

So there was that... and it was awful, but the worst part came later in the day. I knew the specimen was thin enough to be fixed by the end of day and I would have to gross it in. And I lived all afternoon in dread, knowing that I was going to have to open that bucket again and knowing that it would still smell as bad as it had earlier. I would say that the anticipation was the worst part, but it wasn't. The anticipation didn't help, but having it out on the cutting board, enduring the smell again was the worst part. Seriously, the worst part by a long shot. But now it is done, and I know that things that are truly repulsive are greatly out numbered by the things that have long since become familiar from repetition and once again, I'm quite content with the career path I've chosen. 

That is not where those go... and OCME shoutout

The larger specimens show up in trashcan sized biohazard containers fresh since the formalin containers aren't big enough and are held in the morgue fridge until time for disposal. The specimen shows up in the gross room in the large container, I gross it, and then the lab tech takes them to the morgue which is tacked on to the back of the hospital.

I had a large specimen today and at the end I bundled everything back into the chux pad, put it back in the biohazard bag, and tossed it into the biohazard bucket. Then I triaged a specimen that needed better fixation and grossed a few small things. After a while I started doing a larger specimen and realized that I couldn't find my scissors anywhere. I checked under the cutting board, in the tool cleaning bucket, on the floor, everywhere! The dawning realization came that the only place the scissors could be was the bucket. Wrapped up in a chux pad...in a biohazard bag... in the biohazard can... in the fridge...in the morgue... on the other side of the hospital. So glad that the lab tech is super nice and was willing to go get the bin for me (I wasn't going to even ask her to try to dig them out) since it was a steady day specimen-wise and I had enough work to keep me busy right up until time to go (and my husband is out of town so I had to get home by 7 to relieve the sitter).

So I dug everything out without blindly reaching into the bucket and stabbing myself in the palm.

Also, there was an article in the paper about one of the rotation sites we went to, you can read it here! Forensic pathology can be a very difficult job, but it is good to know there are people out there trying to give names to victims.

A nice easy week so far...

So this is the week of the AAPA conference, which means my boss is out of town enjoying all the continuing education opportunities and sight seeing available in Portland. Hopefully she's having a good time and not worrying too much about things back home... And as though the universe wanted me to not have to call her with any problems, it has been a relatively calm week. I've even been able to leave around 5, which has been great! I like being able to have everything done by then, some days it is harder since we accept specimens until then and I gross whatever comes in. And then there are other days when there aren't a lot of specimens but the ones I have are time consuming (oh colons and lymph node hunting, sometimes they are my worst enemy).

At some point I will have to worry about continuing education credits, but for now it is something to think about for the future. It is one of those things they told us about during second year that has been sort of filed away for future reference (I do remember that it is 45 credits in 3 years, and there are online ways to track your credits, etc). Conferences are a great way to get a lot of credits in a short amount of time, but they also come with a price tag and require time away from work/home/family.

Fun things in jars...

Have I mentioned that my grossing station has an eyeball in a jar on it? It sits on the top shelf by the baby scale that doesn't get too much use (not to say that I'll never use it, but there is a really nice digital scale that has been able to measure everything I've put on it so far). I asked my boss why it was up there and she said it kept an eye on her, and now it would be watching me. I love pathology... you only get a certain type of person in pathology.

Picture stolen from the internet (not a testicle)

And I've gotten more testicles than I thought I would. Those are usually fun. I had one on rotations in school at one of the sites that was 147 grams (10-14 gm being normal), which is still my personal record for weight. I had to have my boss come in to look at one of the testicles too, because it was just not what I was used to seeing on one...which leads to the next point....

My boss is going to the AAPA conference in Portland next week so I'll be all alone!... well, except for the pathologists who are right across the hall and very nice about answering questions. So... that was needlessly melodramatic. Still, it is comforting having her on hand for advice and tips. But, hopefully there is nothing too out of the norm while she's gone.

In personal news, the car accident is still causing annoyances. I have to go to court on Thursday as a witness against the lady who hit me unless she pays her ticket between now and then. Every day I call, but she still hasn't paid it. In the month and a half I've been employed I've missed one day for the accident itself and this will be my second time being late arriving (with notice) because of it. Thank goodness I have my mornings free for the physical therapy appointments (which are helping somewhat) so all they're costing me are gas and time out of my life.

Pathologists' Assistant Program in California?

Looks like Drexel University Sacramento is starting up a program on the west coast starting Spring of 2014. You can attend an online information seminar on October 2nd (sign up link), or go in person if you're local.

That's interesting! Especially considering how many job openings there usually are in California.

Direct feedback, work load, and random life news

A big difference between the learning environment and work is that if there is a problem, issue, or concern with a specimen then the feedback goes to me directly rather than through a staff PA (although, at the VA we were sitting in on sign out so that feedback was pretty direct). Sometimes things get filtered through my boss (ie: use "portion" instead of "fragment", things like that), but other times I look up to see a pathologist standing there holding a slide with a comment to make (ex: only one section of fallopian tubes for sterilization, that's all they need for verification...). Generally it is a fairly painless process and over pretty quickly. I'm glad that they're comfortable giving feedback and I'm working on keeping everything in mind.

Technically my hours are 1-5, but I'm getting leeway with that as I get up to speed. I tend to arrive around 12:30 and leave somewhere between 5 and 6. Every day there are some placentas (I think the highest so far in a single day was 11, but that was after a weekend), there are GIs, gallbladders, appendixes, and ortho specimens (humeral or femoral heads, knees, amputations). There are regularly hysterectomy specimens (the most in a single day has been four), segments of bowel for tumor or non-neoplastic (sometimes a couple a day), and a smattering of *breast cases. Sometimes there are kidneys, segments of lung, and the standard small larges. Oddly... not a lot of tonsils, but I guess those mostly go to an out patient surgery center somewhere.

Fuel economy makes a huge difference....

So... following up to my previous car accident announcement. My crossover was totaled (completely heartbreaking) and I'm still dealing with aches and pains (and an annoying host of medications) from it. But luckily, the gross room was set up for my boss after she had neck surgery so it is probably more ergonomic than it would have been otherwise. And I bought a new car, or rather a new used car since with my current commute I'd put a minimum of 37,000 miles on a car per year and a brand new one would lose all value after me having it for a year. I was shopping solely for fuel economy because of the 140 mile a day commute, so it ruled out most vehicles. I also needed something that would fit my human family plus my 120 lb dog, which ruled out sedans. I ended up with a hatchback Honda hybrid (alliteration!). The upside is that it saves me around $12 a day in gas costs (seriously...), the downside is that I really loved my old car and the space it gave me. Before the accident the idea had been floated to keep my old car and get a small commuter car, but the accident expedited the latter part and negated the former. Oh well. In a few years maybe technology will allow me to have a larger vehicle with excellent fuel economy.

*They use gel foam in the biopsy cavities, which makes it really easy to find the previous biopsy site. I'm a fan of that. Less of a fan that we don't have radiology on demand--it is easy to get spoiled with things like that... UNC had the capabilities in the gross room, they could do a quick scan to make sure they'd gotten all the staples out of an anastomosis section.

I have *no* idea why I'm doing something...

At my job I was asked why, on mastectomy specimens, I give a nipple to areola ratio. And I realized... I honestly don't know. I know that certain types of malignancies can involve the nipple and to look for a history of Paget's disease of the breast before grossing a specimen, etc. I know to mention skin changes like peau d'orange and if the nipple is inverted or everted, hard or soft. But, still.. I don't know why I'm measuring the ratio other than it was part of the template I used in school. I read my Lester's manual this morning and didn't see anything in there about the nipple to areola ratio. Maybe it was one of those Duke specific things that was asked by an attending who had particular preferences? Oh well, it was an interesting conversation with the other PA at work trying to figure out the reasoning behind it and for now, until I find a compelling reason why I should be doing it, I'll just give a measurement and description of the nipple itself.

In which I've instructed my husband not to let the MEs office do an autopsy on me...

So yesterday I had a car accident. It was odd, as I was turning into a parking lot to go look at bicycles for myself the car behind me carried on as though I wasn't there, which resulted in me being half rear-ended. It was upsetting and I'm still waiting back to hear about the fate of my car (to which I am emotionally attached, and has more bells and whistles than any vehicle I've ever had or am likely to ever have). Meanwhile, I went to Urgent Care to get checked out because...well, car accident and I was (and am) quite sore and experiecing funny back twinges I didn't have before, etc. I received some prescriptions and instructions to come back if pain worsens. But...meanwhile, part of me thinks that my abdomen is slowly filling up with blood and I'm going to exsanguinate in my sleep. If that happens, I've told my husband that I don't want an ME office autopsy. They're terribly impersonal.

It isn't logical, but I've had a rough few days (including missing a day of work this soon into starting the job, which was... mortifying) and I'm going to allow myself some time to wallow in worse case scenerios.  I could be developing a hemothorax right now, but I rather hope not.

As far as work goes, can I say what a huge difference a full day's fixation makes in having to gross placentas? They're so much nicer to work with when they've been in formalin for longer than an hour and a half. 

Oh, hey! Paycheck...

Paychecks are nice. I haven't gotten one in two years, so it is a welcome change to be in a position to be receiving one. Except... I think my first paycheck will be a paper one, which means I should have gotten that from someone last Friday. I forgot to ask about it then so I'll have to follow up on that tomorrow.

In the meantime, work seems to be going pretty well! My boss said that normally when someone has filled in grossing for her while on vacation the pathologists have given her feedback to pass on to them, but so far they haven't had anything they'd like me to do differently. It is very encouraging! Everyone continues to be very nice, and--with permission--I've brought in headphones so I can listen to music while I gross. The gross room is off of the main histology lab so it can get relatively quiet in there, especially since the histotechs leave in the early afternoon.

It hasn't been that bad of an adjustment going from a massive academic hospital to a community hospital. I think it helps that I worked in that sort of setting before I went to school so even at Duke I tried to be economical with my block counts as much as possible while still submitting the necessary sections.

I'm adjusting to the commute fairly well, I think. And my hours mean I have time in the morning to go to the gym and do a bit around the house before heading into work.

Week one begun and done

First off: Welcome to the Duke Pathologists' Assistant class of 2015! I missed your first day last week, but I'm sure it was a lot of orientation materials and figuring out where you're supposed to go for class tomorrow followed by some awesome eats at Pam's house. Good luck guys, it is an adventure (and if anyone wants to write a guest blog post, let me know!).

Back to me now! I finished general orientation Tuesday morning and got laboratory orientation (always good to know where the safety equipment is). Wednesday started my first full day in pathology. I learned enough Cerner Millennium to work for now and got to start grossing under the observation of the full time PA (aka my boss). Thursday and Friday I was much more on my own.

I should mention that when I started my first job in pathology there was one other grossing tech and I was to learn by watching him (and reading the manual). Which would probably have been much less stressful if he hadn't also chosen that week to stop smoking. Or... had at least told me that he had just decided to stop smoking and was really grumpy and irritable for that reason. I spent the first few weeks of that job convinced he hated me. Which is kind of funny considering how well we ended up getting along.

The contrast between that first week and the first week I just had is marked. Everyone has been so nice! The histotechs have said that they're happy that things are getting grossed in earlier so they have more fixation time (the current PA was promoted and spends her days dealing with management duties, leaving the evenings for grossing) and my boss is more relaxed because the grossing has been delegated. I'm glad to be useful and appreciate that they've gone out of their way to be so welcoming. I need to work on getting everything grossed by 5 (my going-home time) and try hard not to screw anything up!

I'm 2/3rds oriented!

Today was my first day at work. I'm not in the lab yet, just going through the group orientation where I learn about corporate culture and policies. We have another 4 hours of general orientation tomorrow hence the 2/3rds oriented. Of course, that has nothing to do with the lab orientation or training in their computer systems, etc. But I start some of that tomorrow afternoon.

As for where I'm working, I don't think I need to say where. It makes things easier social-media-policy-wise. I do read them, and I try to stick to them. Since I like blogging but would like to never, ever have to go talk to HR about awkward things I will stick with being relatively vague (sorry for the folks that annoys).

Anyway, orientation has been great so far. The main facilitator is one of those people that just has a lot of energy and enthusiasm, which makes something that can be quite dull into a completely different experience. It has been a lot of fun really, and hopefully tomorrow morning will continue on in the same vein. There's been a surprisingly amount of singing and dancing.

Tomorrow afternoon I think I'll learn Cerner Millennium, we'll see if it is anything like CoPath.

Other random tidbits: Today was my husband's birthday, so I'll always remember what day I started work. As a fun coincidence, his first day at his job was our youngest son's birthday (literally... 20 minutes after he started working his boss escorted him to the parking lot and told him to go meet his new son).

Er, and also I found out that apparently I wasn't getting emails anymore when someone leaves a comment. I just figured no one was commenting. So sorry about that... I have a backlog to wade through.

Unexpected Development and Preparing for work

A few weeks back I received an unexpected email from a pathologist in SC saying a PA they were in touch with had given them my contact information for occasional vacation coverage for their staff PA. Since I'll have my mornings completely free, it could be a nice side job. I know one of the staff pathologist assistants from Durham has developed a pretty solid network of other groups that she works with to fill in gaps in their coverage.

It did lead to an interesting dilemma of what exactly do I charge for my services? I did some research and came up with a number, which seemed agreeable to them. Since it'll be a 1099, I may find that I needed to factor more in for taxes, etc but we'll see. It also depends on if/when they'll need me.

Also, whoever passed on my information, thank you for thinking of me... Not sure who it was and not entirely sure how to find out.

Yesterday my future boss gave me a call to go over some of the expectations for the first week, which was greatly appreciated. I think, like anyone, I'm nervous about doing well and not embarrassing myself. There are differences in every pathology practice that will take a while to learn (what? Everyone isn't okay with 97 blocks on a prostate? I know... surprising, right?), even small preferences like having the umbilical cord slice and the membrane roll in the same cassette or in different ones, etc. But she was very reassuring and as nice as she was on the interview so hopefully all will go well. Monday and Tuesday will be official orientation, lab safety, learning Cerner millennium, and all that comes with onboarding, but Wednesday is when the grossing begins.

Concerts and goodbyes (nothing really to do with pathology)

 

I'm comfortable with being strange, everyone is in their own way. Sometimes--if we're lucky in life--we find people to whom our personal brand of strange feels normal. I've been fortunate to have found three people whose weirdness resonates with my own, where I talk and feel understood instead of having to try to explain things in a different way that makes sense. I married one of them, one has been my best friend since 1996 (when our residential high school paired us as roommates against our will...we'd met at a biotech summer camp the year before and did not get along then), and the third is a friend I met in Durham outside of school (who know knows more about biology and medicine than he was ever expecting just by hanging out with me for a couple years). July has been a month of upheaval. I said goodbye to my classmates who scattered around the country and moved myself back to SC, albeit to a new house that I'm still working to make feel like home. I said goodbye to my Durham friend last week, with promises to visit as often as I can (with more made to the classmates remaining there). And this week my best friend is moving to New York where her girlfriend will be starting her clinical rotations. I'm excited for them but it is hard to have to say goodbye to someone else I love!

Meanwhile, I took a quick trip back to Hillsborough on Friday to clear out my apartment (with the help of my Durham friend, who adopted some of the things I originally inherited from my best friend's girlfriend two years ago, which is nice in a way...) and to see an amazing acoustic duo my best friend introduced me and a classmate to last year when they played a Durham cafe. That cafe closed abruptly a few weeks ago so they relocated to Mystery Brewing Company in Hillsborough (they have an interesting collection of seasonal microbrews, if you're into that. I can't say if they are good from personal experience since I'm not a beer drinker, but they are locally popular). I felt like it was a sign that I should go see them. It was a great show and the pub folks seemed to appreciate them which made it extra nice...that everyone in the bar got into watching the music (Hillsborough folks are the best). I enjoyed the performance so much that I drove across the state to see them again the next night in Asheville... where my best friend happens to live. So we had an impromptu concert/going away party. It was so awesome and so fun to see them with other people who love their music too! A touch bittersweet but great all the same.

I don't tend to wax poetic about my personal life (although, tomorrow is my oldest son's birthday! He's 9, which is a terrifying realization... I have a 9 year old.), but I like documenting change, and there has been a lot of it lately.

A week from tomorrow I start orientation. I'll have more medically related things to mention then.

Class of 2013 Student Video

I feel like this is one of those moments where I should just be quiet and let the video do the talking. My classmates performing "All My Fellow PAs" they did an amazing job, still sad I was in Tennessee that weekend!

I've graduated and moved

A lot has happened in the last week.

Classes of 2013 and 2014!

Monday and Tuesday we practiced our seminars, and Wednesday we presented. In front of an auditorium overflowing with residents, attendings, and classmates. We sat together, dressed up, in the front two rows on the right side where we never sat before. The students and residents tend to be in the back left corner during grand rounds, so it was unfamiliar territory. But we were all together, cracking jokes and comparing the physical symptoms of nervousness we were each experiencing (sweating palms, shaking hands, and lightheadedness predominated. GI distress threatened but nothing-thankfully-materialized). It would have been impossible doing it alone, but like so many things that we've done over the past two years we made it through together.

The banquet was the next night with even more dressing up, fancy foods, and mingling with so many of the people who have been a part of our education. The evening was topped off with a few speeches from the pathologists we worked with the most and Pam gave a presentation sharing things about each of us. Our class made a short video a few weeks back (I'm not in it! I had to drive to Tennessee that weekend.) and we shared that as well. I'm so glad it got made, one of our classmates did such a good job with the lyrics that it would have been a shame for it not to have been (link pending, the classmate that has the url has been traveling).

So that's how it ended. After that, we handed out gifts and there were a lot of hugs, and quite a bit of lingering. But eventually, we all made our ways to our separate cars and drove away. It happened so fast...the two years, the clinical year itself. And we learned so much and did things we would have never have believed of ourselves. Now it is up to us to take that knowledge and those skills and apply them (for money!). Hopefully we do a good job of representing the program.

As for me... I'll keep blogging my experiences from the transition of student to professional. There is still the certification exam to take (which I'm not thinking about for a while!) and a few other things to touch on. 

This is how things wind down

Yesterday was the dress rehearsal, today we're technically on rotations but the auditorium is reserved
for us all day so people are taking advantage of that. I'm going to go in a little while to do one more run-through but right now I'm still tweaking things ever so slightly. I was hoping there would be an autopsy, just to finish out the clinical year by doing something...well, clinical, but so far it is all quiet on that front.

I just love my dog, so here's yet another picture of him

Tomorrow I'm taking my laptop in to get wiped clean, dropping off the scrubs I've accumulated from the vending machine, giving my presentation, and clearing out my study cubby (which I've already made a start on). It'll be someone else's space next year and while some things convey (the pound puppy from who knows with, a random worry doll, the drawer lined with the collage the previous owner made, the LGBT button center button), they probably don't want all the random debris that I've collected over the past year.

It is strange being around the first years/rising second years (1.5 years?) as they're starting out with clinical rotations. Some of them were watching the autopsy prosection videos on the room computer which doesn't have sound so I narrated some parts of it.

Penultimate Week as a PA student

Next week is seminar practice and autopsies. This is my last week at North, but as first year residents and upcoming second year PA students are grossing I'm mostly stuck on triage/frozens. Traditionally, when I've been on my third week duties I've grossed larges in the morning and done triage/frozens in the afternoon. The PAs were very accommodating about that but right now there just aren't any stations open.

If today was any indication it is going to be a rough week.... Not a lot to do this morning so I went ahead and stocked supplies and cleaned. It took two hours, but now I'm worried I'll spend the rest of the week desperate for something that needs to be stocked or cleaned. But maybe I will get lucky and something interesting will come in... One hopes. It is hard when there are so many things I'd like to be doing (finishing my portfolio/working on my seminar/packing) and instead be hanging around waiting for work to come in.

Technology should be my friend... but it really isn't lately.

The website that we use for autopsy information isn't working. I took a screenshot and emailed it to the pathologist who handles that sort of thing and hope to hear back from him soon... today is a holiday but if it doesn't work soonish then... life gets significantly more stressful!

The VA from the other side!

Tomorrow my dad is going to the VA for a procedure. As much as I've been in that hospital over the past year, the only department I know how to find is pathology so figuring out where to go will be an adventure! Hopefully he won't have anything to send for pathology, but it'll be interesting to see what the reporting process is like. I know the turn around time is minimal for the clinicians to get the diagnosis but I don't know what the report time is for the patient, so we'll see. If he ends up having something, I could make an update on it.

Meanwhile I'll be using my wait time during his procedure to work on my seminar. Not very exciting times, but necessary. I also have autopsy reports to work on... those are due July 12th which will be here pretty soon! And I'll be spending this weekend driving 18 hours with a brief stop by to visit my best friend's guestroom, but sadly not my best friend since she's working that night.

And in thinking about things today I realized that leg amputation specimens would be nicer to do if they were in more accessible containers instead of tied up in giant bio-hazard bags. It is hard to get them out of the bags without being touched by the sides, which is sort of repulsive. Of course what the alternative would be, I couldn't say! In a perfect word they'd be accessible and not wrapped in layers and layers of ace bandage. Not that I did a leg amputation today, just a thought I had about them in general since they are a relatively easy specimen type that a lot of people don't like to work with.

Last Food Truck Rodeo of grad school

Does that not seem momentous to anyone else?

It isn't even necessarily that I do a lot at the food truck rodeos. I have my favorite trucks (Sweet Traditions by LeAne and CJ's Street food, although I'm kind of sad that I haven't been able to get their surf and turf dog since last year!) that I visit, and I might check out a couple new ones with friends, but it is more just being immersed in a sea of people all coming out to support local businesses and entrepreneurs. Plus, you get to see people you know and check in with the vendors you really like (and who recognize you, which is always really nice!) to see how business is going. I love being a part of that community, which Durham has in spades.

I was thinking about it last week, sitting between a popular microbrewery where you can play board games/old arcade games/pingpong and what is technically a music hall and watching the ebb and flow of people biking up, running into friends unexpectedly, moving a brightly decorated bass drum... It is a vibrant little area, a random side street with never enough parking that I will miss. I drove through a random street festival downtown Saturday night and asking one my friends that lives nearby if she knew what was going on she rattled off a handful of things it might have been since so much was happening that day... It is a fun place to live and I'm not looking forward to leaving it.

But I will come back to visit, which is why it was my last rodeo of grad school and not my last food truck rodeo full stop. I have people I care about here that I can't imagine not coming to visit and places I'm fond of...

Last TBL of the year for the first years!

I like how most of my entries right now are dealing with, holy crap time seems to be flying by! But yeah... that's the sentiment at the moment. The first years had their last TBL today, which means lots of studying to go, some final exams, and then a week and a half of vacation or so. And then preceptor week! Preceptor week, followed by the week of our senior seminars, and then... it is all on them. I think technically they are still first years through the summer semester but once rotations start they are second years for all intents and purposes.

That second year goes so quickly! But you learn so much and gain so much confidence!

I'm at Durham Regional again this week with the staff PA I wasn't with the first go-round. It is nice to work with as many different people as possible to see their different styles of doing things, etc. I've been pleased this week that every time I've had to go to him to ask a question about something I hadn't seen before it has been something that has also given him pause. So the things I find strange and want to consult someone on are things that are genuinely less normal (the human body is infinitely variable some days). I'm glad that I'm not having to call him over for typical things that are old hat for him.

So I feel comfortable with the knowledge that in just over a month my classmates and I will be loosed out into the great wide world. From here on out it is more an issue of figuring out how a particular practice/pathologist wants things done and repetition than lack of any specific skill or knowledge. I know that they could expand the program to have more students, but I like that they haven't because it matters to them that they know the skill of each of the PAs they turn out and that it matters to them that the standards remain high. Can't wait for next year's class to get their chance to learn.

Three day weekend time!

They've already messed up my reservation!

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

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

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

I accepted a job offer!

It is literally the only job in the country that will allow me to get to go home to be with my family every night. And right now, that matters more than pretty much anything else. I'll only be working part time but considering how little turn over there is in the area I'm glad something came open.

It means that I don't have to travel and that the kids will have two parents at home together. That is just about the best benefit I could imagine.

6 and a half weeks...

Oh wow... I started this blog four months before we even began classes and now we're looking at six and a half weeks until the program ends. We're picking out the menu for our going away party (er, or we will be. I'm going to make a survey and then we'll do it that way).

I've learned so much and feel really comfortable that I could be dropped into any situation and do fine. I'm so pleased with that. I don't know what the future will be since I'll be limited to SC but even if I'm traveling, I don't worry that I will be overwhelmed.

Speaking of overwhelmed (potentially but not at the moment!) I'm working on my slides this weekend for the seminar presentation. I wish I could come up with a cute title, but at present nothing is coming to me. Maybe inspiration will strike in the next few days!

Free knowledge makes me happy!

I'm using some downtime on autopsy to work on my seminar case. I wanted to look at the WHO classification of bone tumors and in trying to track down a hard copy I found out that it is available free online. Which made my day, so I thought I'd share.

Seminar and the reality of change

The last thing we do as students is present a case study or disease process at a seminar with all of our classmates, some family, and various staff (attendings, course director, some staff PAs, etc). I spent my memorial day immersed in patient history and looking up things in pubmed. The Duke library system is really good about emailing electronic copies of articles not otherwise available, which means I have more reading to do tonight. Ha! I thought I could buy myself a day off with that.

I have a general outline and a meeting with the attending that is advising me so we can go over the outline to see if I'm on track. This week will be spent fleshing out the outline and doing my slides. The class has a preliminary meeting next Monday to go over everyone's rough draft, which will be good. I don't want to go too far with the work if I'm going in the wrong direction all together.

Meanwhile, I looked over past year's presentations over the past few weeks and I've decided autopsy cases are so handy because you have so many more things you can take gross photos of. Unfortunately, there weren't any cases I had that stood out to me as seminar-worthy. There was a very interesting case a few weeks back but I wasn't on it and only heard about it after the fact, which was disappointing. Surgical pathology offers up a lot of good cases and fairly rare conditions to choose from but you only get the specimen for photos. I do have a lot of slides though...so I have a lot of different things I can use for microscopic photos (and I do like the microscopic photo set up). I just have to meet with the attending and figure out what exactly I'm looking for in all of those slides and special stains.

My husband came up this weekend and drove off with my dining room table and boxes of assorted non-essentials. We have about ten days before the kids are done with school and we do the big shuffle. Most of the things in the apartment will go to our new house, but a few things will go a hundred miles west to my parents' house and we'll pick some things up from my parents' for the new house (since they're selling it, they are kindly handing down some furniture. Great timing!). Not having a dining room table and having the boxes around the apartment make the move seem more concrete. It is almost scary how quickly time has been passing! Still so much to do and learn! No time to slack off now.

My autopsy rotation has been productive. We're faster than we were at the beginning of rotations by a lot. No where close to the staff PAs, but not doing too badly I think.

12.5 miles down the road

UNC

Duke and UNC are 12.5 miles away from each other. There are a lot of connections between the two schools... academic collaborations, love of NC barbeque, medical residents from one school who go on to fellowships at the other, basketball (okay, so that's a rivalry, but both schools like basketball, that has to count for something right?), etc.

And the staff PAs at UNC are either Duke graduates, worked at Duke, or both. That doesn't mean that being at UNC is like being at Duke. The grossing stations are set up around the periphery of the room in little nooks. I'm in the front of the room and I've felt relatively on my own all week. The person I'm working with this week is available when I have a question or I want him to check out my blocks but otherwise it is just me and my specimens.

I've been on GI large, which has involved a lot of searching for lymph nodes in mesenteric fat and a lot of cleaning out colons. I like the templates they have, which seem fairly comprehensive. And I like that all of their specimens have bar codes. I'm a fan of scanning a bar code and having the blocks print for the case based on that bar code. I know Duke is in the process of upgrading to Cerner Millennium and with moving to the new gross room will be adding new printers and technology. I can only assume that bar codes will be a part of that. It really reduces the incidence of mislabeled blocks to basically nothing.

Tomorrow things change and I will be assigned to some other service. We'll have to wait to see what that is!

In completely unrelated news, house closing was today! Three weeks until the kids are out of school and everyone else moves into our new house! My husband will move there this weekend, but he won't have much furniture for a while. Still, it will be nicer for him there than our old house which is mid-kitchen remodel. I hope the dog adjusts, he's a little neurotic about certain things.

Graduation day!

Don't get too ahead of yourselves, we still have another two months of clinical rotations (we do the May graduation because otherwise we wouldn't get our degrees until well after rotations end) but it was still nice to get the degree. To have a reminder of what we are doing here and give us a boost to make it through the tail end of our second year. My staff PA for the week mentioned on Friday that the next time I'm at North it'll be time to start training the first years to be the new second years.

It is terrifying how little time it feels like it has been since I was taking a few hours out of my studying to go to graduation for the class of 2012! And how we only have a few weeks left until our seminar presentations and we are truly done... Of the 8 of us, 5 have contracts signed and one more has an offer on the table and interviews lined up. The two of us with limited geographical options are still working on it.

But still, even if I'm unemployed, it is good to have the degree. Considering there were times in my past where everyone despaired of me even obtaining a bachelors, it is extremely gratifying to have a masters.

I honestly couldn't have done it without my family. Literally--without my father's willingness to pack up and move here, I wouldn't have been able to juggle family and classes. And he's had to put up with me at my most stressed out and frazzled and short tempered. My husband came up every test weekend and took care of the kids and cleaned up. And my mother... oh my mother. She worried most of all that this would never happen and I hope she enjoyed the graduation ceremony. It might have taken up quite a bit of our Mother's Day but I'm pretty sure there's no other way she would have preferred to spend it (of course, maybe we all would have been happier if we hadn't been running late this morning! I made it to the field with three minutes to spare before the deadline!).

So congratulations to all of my classmates. Two more months to go!

It is May... yikes!

So my entire family, plus my best friend (who is family in everything but genetics) will be at my apartment this weekend for graduation. I have a funny hat, the sashy thing, and the black gown...and on Sunday I'll have a Masters Degree. If it weren't also my mom's birthday in a couple days I might have tried to skate by on Mother's Day with presenting her with that, but I'll have to figure out a real present instead ;D

I'm at North again. It is so different from when I started out there at the beginning of second year... I'm not even phased by grossing specimens that were incredibly intimidating nine months ago! I made it through my first three weeks but was worried that I'd never survive the year. And now? Now whatever come across the gross bench is fine, I know I can gross it.

Lungs are definitely my favorite specimen type and legs are my least favorite. Not that I really dislike legs, they're just a bit unwieldy and a pain in the rear end to unwrap. If they came in really large ziplock bags, they would be so much easier to do! Instead they come in a giant biohazard bag, usually in another giant biohazard bag, with so many layers of bandages over the limb itself. It is a lot of unwrapping! So a silly reason to make a specimen my least favorite, but something has to be at the bottom.

In personal news, closing on the new house is next week! I'm excited! We're doing this in stages. My husband is moving in next weekend, the kids move as soon as school lets out in a month, and then I'll join everyone six weeks after that! We'll all get to live together, and it will be lovely! After the beginning of June I'll basically have a bed and a few cooking pots. Which I kind of feel bad about. The apartment will finally be tidy enough to have folks over, but I won't have any furniture... I've been intending to have a dinner party (it is much harder during clinical rotations!) and just haven't. Boo :(

Oh... that's bad, right?

Blue screen of death on my laptop... Plus my external hard drive isn't working, and my dropbox was full so... yeah, no back ups from anything past the beginning of March. I was going to back everything up on google drive last night, except... my laptop died yesterday afternoon. Unfortunate timing there.

This is what I get for being so pleased with myself for having gotten all of my autopsy reports done in a timely fashion this go-round. The universe smacks down smugness quick enough. At least it happened this past weekend so I have a week to recreate everything, instead of next weekend where it would have been impossible to get everything replaced. It will make this week unpleasant, but there's not much I can do about that.

Meanwhile, my laptop is dead. The IT guy thought it was a RAM issue, but when he tried to put my hard drive into another computer it wouldn't work. Off it went for repair. My external hard drive may also still be under warranty, which would be nice considering it has been living on my desk for the past 18+ months and not manhandled at all and shouldn't have a reason for failing (I'm a little frustrated by that...). 

Oh goodness...that happened quickly!

Apparel for graduation is going to be available for pick up starting tomorrow, and I picked out a dress for the event. My family has arranged travel plans and childcare is in place. Yikes!

Lab week at Durham Regional

I showed up at Durham Regional on Monday to find out it was lab week and there was breakfast in the conference room. It was a good week to be there, very social! It is a cozier set up than Duke North so the lab services are along the same hall and lab week involves them all. There were lunches, snacks, and treats all week long. It is easy to get spoiled with a week like that!

It is much more of a community hospital set up than Duke North so the specimen load is closer to the VA (except without its overwhelming male patient bias). The staff PAs cover both that hospital and Duke Raleigh and are currently short handed so they are switching off weeks instead of both covering Durham Regional in the morning and one of them joining a part time PA at Raleigh. It is good being there as a student because you get to feel useful since there is enough work to go around.

It was funny being there... at North we get so many complex specimens and we get to be pretty good at complex specimens, but we don't do a lot of the full range of benign things out there that PAs deal with on a regular basis. We get things at the VA but, once again, not that many female specimens. It was useful to experience the pacing and specimen types there.

Slowing down (maybe?)

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

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

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

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

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

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

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

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

Productive week on autopsy

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

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

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

Durham VA

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

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

Musings...

I still have the list of things meant to blog but not yet blogged... I will have to get to that eventually.

Spring break was spent driving back to South Carolina to help my husband repaint our old house, do some minor home improvements, and begin the process of ripping out our old kitchen to replace it. It was a very useful and productive week in many ways. We also did some house hunting and made an offer on a property in a better school district so when we move back to Columbia, it will be to a new location. We are going to keep our old house for a while though, and just see about renting it.

Shot mid-repaint and fireplace renovation.

I've had a month or so to adjust to the idea of moving back to SC and it has been an interesting process. I watched a documentary film with a friend last month which was one in a series where the same group of people are followed over the course of their lives every seven years. It started when the people were seven and they are now fifty-six (you can read the wikipedia article about it). It was a good thing for me to watch honestly.

It is frustrating to be so narrowly focused on one place when job hunting and increasingly disheartening to be asked (by seemingly everyone) about the likelihood of finding a PA job in the town where I used to live. It doesn't help that one of my classmates is also from there and will be employed with the hospital system he worked for before he started the program, so the possibility of them adding yet another position in the foreseeable future is minimal. The other hospital system is the one that I worked for and they have need of two staff PAs and already have those two. Both of them are settled, long term employees years away from retiring. It was rough several weeks of adjusting to the possibility of having to work somewhere else during the week and having to only see m
y family on weekends.

But, the documentary was very good for adding perspective. It reminded me that we all make plans in our lives and very rarely does life follow those plans. My husband and I had planned to pick up and move wherever I found a job, enjoying the idea of a new adventure somewhere we'd never been before. But now we are remaining where we were with every intention of putting down solid, actual roots. So we'll see how that goes. I feel much better about being limited in my job hunt now than I did this time last month. I'd much rather live with my husband and kids than... well basically more than any other alternative, but if I have to travel for a while then I'll travel as long as I have a home to come back to.

I've attempted to network, but none of the pathologists I know in SC know of any openings either (but it was still nice to see how they were doing, and it was really great that folks seemed genuinely pleased to hear from me). It is the nature of such things. I will hold tight for a while and just hope. Something will eventually come along and in the mean time I am very fortunate to have a safety net.

Solicitations...

So I finally remembered to ask some of the first years if anyone would be willing to write up a short blog entry about what their classes are like this year compared to ours last year. I know changes have been made, so we'll see if one of them has some spare time to jot their thoughts down.

Also, for people who have been going through interviews, if anyone would like to share their interview experiences at any of the PA programs I'd love to post them!

In other news, so sorry for the silence. I have a list of things I've jotted down that I want to blog so I won't forget them. My laptop has been having issues so as a result I've just avoided being online much lately. I've taken it to the med education IT help desk a couple times, but so far no improvements. It has meant things like missing out on emails reminding us that our autopsy conference is one place instead of the normal place (that was a bad morning!) and such things.

Speaking of autopsy, I'm back on autopsy after a three week stint at Duke North. It was a good rotation, lots of different complex specimens, and I had a practical exam. It is harder grossing with a staff PA over your shoulder watching you with a critical eye, but it went well. I got an A so I'm not complaining in the least and it was great getting that feedback.

Next week is spring break and I'm going to spend mine going back to South Carolina to do home improvements because I love painting, but until then I'd like to have a busy rotation this time around. Brain cutting today was really busy with med students and first year PA students, but we had some very interesting cases so it was good that everyone got to see those. There was a great moment when the neuropathologist was quizzing the students on neuroanatomy and the first year PA students were getting all of the answers right, so she had to tell them that they weren't allowed to answer any more questions. They did an awesome job and all PA students can name the locus coeruleus thanks to one of our staff PAs!

Interviews and figuring out the future...

It has been an interesting week and I'm really sad that I missed out on the earlier interviews. I really do trust my classmate's opinions since the group's opinion on the folks we've met this week has tracked right along with my own. Tomorrow is the last interview and the admissions committee will meet next week to make decisions... we're sending a representative, so I'm glad that I don't have to be there. It is a hard decision every year and I don't see it being any easier this year, but they keep the program the size it is because it means that we can get much more personalized instruction and they can maintain the standards of its graduates.

In the meantime I've had a challenging time personally. I've done some research into locum tenens/traveling PA jobs including talking to one of our staff PAs who has done it in the past and getting in contact with a graduate from last year that wanted to travel. Unless a permanent job opens up within commuting distance of where we live (even a miserable commute), it is most likely the route I'm going to have to go after graduation. I'm still looking at permanent positions in other areas since it would be worth it to live apart for the right opportunity, but I've somewhat come to terms with moving back to SC.

My husband is amazing and my future is uncertain...

Today my husband was officially promoted into a management position with his company back in South Carolina, which is an amazing opportunity for him. I am so proud of him, and he's worked very hard to get where he is now.

It is funny to think back over the course of our marriage and the ups and downs of finances and employment outlooks, and how given where we were when we first got married to see where we are now. On paper, we looked dicey but I know I married someone that was smart and hardworking, and good things happen when you are willing to put in the effort. He is amazing and we've completely blown past what our ten year plan was ten years ago... It is time to write a new plan and see if we can leapfrog those goals as well.

But still, it means that instead of being able to throw open our options to anywhere in the country we are faced with some hard choices. My options are to try to find something within commuting distance to where our house is (in Columbia, SC), pursue part-time travel jobs with Columbia as my home base, live apart from my husband (again) until something comes up in Columbia, or... become a housewife (this one is probably not going to happen, I can't picture myself not working).

Injury, interviews, and surveys.

It happens when you work with scalpels all the time that you might cut yourself, and I did while I was at the medical examiner's office. It was the first time I was doing a full evisceration by myself and resulted in two stitches and a visit with the exposure folks at Duke who talked to me about infection rates, blood draws, and side effects of anti-retroviral drugs. If I was going to cut myself during my clinical rotations I would have preferred doing it on formalin fixed tissue or on a case where I had the full clinical history. Of course if I could have chosen, I probably would have opted not to cut myself at all but these things happen.

Anyway, the time at the medical examiner's office was busy and instructional. It was so much evisceration, and really good exposure. It did make me realize that I missed being involved in the prosection part of the autopsy! Two weeks of doing no organ dissection at all felt like a long time, so I'll be glad to be heading back to surg path at Duke this coming week.

And being back means that I'll get to meet some of the interviewees for the class of 2015! I missed the first week or so of them, but I trust my classmate's opinions on the folks that I wasn't able to meet. Good luck to everyone and I hope that people are having a good experience throughout this application season.

In other news, I'm still job hunting. It is getting more into the time period where most people tend of find jobs. I've been applying here and there as there have been openings that interest me, but nothing too seriously. I had an interview on Friday that went really well, but I withdrew myself from the running because of salary. As an AAPA member I have access to its member surveys which are broken down by state and include things like salary, so going into an interview I have an idea of what typical salaries are for a given area (in addition to using cost of living calculators online for specific cities since some places are cheaper to live than others). It was unfortunate, but it would have been a waste of their time and mine to continue on given how large the disparity was between their salary range and the range typical for the state. Still, it was good interview practice!

Day one at the medical examiner's office...

I'm on an external rotation for the next two weeks at the office of the medical examiner. It will be good practice eviscerating, which I really look forward to getting. They had around 1,500 cases last year so I don't doubt that there will be a lot of opportunity for observation and hands on learning. I was told that I'd be watching for the first few days and start eviscerating on Thursday.

I had to go by Duke this morning for a class before heading over so I came in during the middle of their work day. Someone showed me the PPE and then it was sort of self guided from there. I watched as many cases as I could and as many different techs as I could for today. As Mondays tend to be their busiest day (they are closed on Sunday), there wasn't a shortage of things to see.

It is very quick, and they take a lot fewer measurements. And, the patient population is different since a lot of the Duke cases are patients who have been treated at the hospital for a while or who have a long history of disease...whereas the ME gets homicides, accidental deaths, etc. Or at least that's my opinion so far, could be wrong. We'll see. I think people imagine that a lot of pathologists assistants work in forensic pathology, but PA programs are not the route to go if that is your interest (even the FAQ for Duke's program says so). Our studies focus on pathological processes and disease, and not on forensic science.

Also, one of the pathologists at the ME's office worked at the company where I grossed before starting the PA program. He left a year or so before I did and worked at one of the hospitals while I worked at the main location (although I do remember seeing him sometimes during the monthly doctor's meetings). It is funny because as soon as I was accepted into the program* our chief medical officer said I would get to see him, and has apparently been telling him to watch out for me for the past year and a half. He took my picture today to send to her. It is so nice to be remembered.

In other news, I think tomorrow I'll hit 40,000 blog views, which is a strange thing to think about. Thanks for everyone who reads!

And in other, other news, the ankle is getting better-ish! It hurts steadily, but it isn't keeping me from sleeping anymore and most of the swelling is gone except for this weird (8 x 4 cm) area that feels like it is going to stick around for a while. The walking cast helps a lot (and is driving me crazy at the same time!) and serves as a solid justification for all of those knee high cutely patterned socks I bought ages ago.

*Almost literally. I think I got the phone call and then walked down the hall to tell my former manager (and best boss ever) that I'd been accepted and she happened to be in my manager's office at the time.