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.