This week in frozens

This is my third week at Duke North on this rotation, which means I'm doing triage/frozens.

Pinned specimen from this site

Triage varies by specimen, but almost everything gets weighed, measured, or both. Margins may be taken, specimens may be inked for orientation, and opened up or bread loafed (sectioned but not cut all the way through) to allow better formalin fixation. Some specimens may be pinned out on cork boards so they fix in the shape they are pinned into (useful for things like an esophagogastrectomy). And everything gets put into adequate formalin. Larger specimens are held until the next day for grossing, which is nice when you're a student picking out the cases you'd like to do for the next day.

Where I worked before didn't do that much with triage. Sometimes we would open the colon specimens, and sometimes we would ink mastectomies for orientation and bread loaf them. Colons and breasts were held until the next day, but everything else was grossed the day we got it. Most of our specimens were received in formalin, but larger things like spleen and liver were usually not. And being in formalin isn't the same thing as being received in enough formalin! Sometimes there was so much specimen crammed into a container that there was just a splash of fixative on it and most of the tissue was still unfixed. So I can appreciate that the PAs or residents doing triage at Duke are the ones ensuring there is enough fixative, and that there is enough flexibility on the the turn around time that things can be held for a day.

Frozen sections are interesting. We go with the staff PA or resident to the operating room and are handed the tissue of interest to take back to the gross room. Then we triage the specimen and whatever section(s) we need are taken and given to the techs. The techs section the tissue and stain the slides. The staff PA works with the tissue bank/research folks to provide needed tissues at that time as well if they can. The pathologist reading frozens that day may see the specimen or ask for additional sections, but once they are done the specimen is put into formalin and accessioned.

It has been nicely steady and I've gotten to work with one of the staff PAs that I haven't worked with before. Plus, I've worked with several residents which isn't something that happens often when we're at Duke North. It is good to get to learn from so many different people.

In other news, today is my dad's birthday! We had a small family celebration at home.