8830...what?

The other PA where I work has been promoted to interim lab director in a week or so, which I hope will be a good experience for her! As a result I'm now verifying the charges for the cases we do. I haven't  dealt with that much since leaving school but it is a good skill to have. It goes a lot faster now that I've refamiliarized myself with things and I don't have to think about the specimen types we see all the time.

I have other things I need to blog about but because of those other things, I haven't had too much spare time! Maybe in a few days.

Revisiting Duke

So last month one of my favorite bands was playing on a Monday night in Chapel Hill and I spent the preceding weekend in Durham revisiting old haunts. Since I was there on a weekday, I thought I'd take the opportunity to go back to campus and the hospital (the VA was closed since it was Columbus day). There was a bakery in the little town that I lived in that makes these amazing yeast donuts and I would bring them in sometimes, so I had called ahead and ordered five dozen to commit myself to going to visit (so easy to have the intentions but elect to sleep in more otherwise).

I got to see the renovated autopsy suites (SO BRIGHT!) and they've added lifts to help move the bodies, it is a nice improvement! Plus it was good to say hi to the autopsy folks and I popped into say a quick hello to Pam, the course director, and drop off donuts with her for the PA students.

Getting donuts to surge path was an ordeal... they moved to a new lab and it is further back from public areas. I didn't have an ID badge anymore or the number for the lab, but I ran into some residents I knew (they weren't going to surge path unfortunately) that gave me the direct number which helped immensely. I was able to call and someone came out so I was finally able to make the donut delivery!

It should be noted, that it makes me intensely uncomfortable to be somewhere like that without context. So I didn't stick around. It is nice to see people and catch up, but I'm also aware of the fact they're working and I don't want to overstay my welcome. Plus I had one more donut delivery to make! A small thank you for the friend that gives me a place to stay, who works downtown close to everything.

The concert was amazing and I had a great time in Durham, as always, and I felt slightly less bad about always going back to the area but never visiting!

A week with Voicebrook

First off, I'm so pleased at how much I remember about navigating the software. Go me! It has made the transition smoother than it could have been otherwise. That and my keyboard is a lot more accessible than it was last time I started using voice transcription software. Right now I'm doing things around 80% with voice controls and 20% with mouse clicks and typing.

Second, it makes everything take longer. A big contributor to that is how long each window takes to open, and that we're opening more windows than before. It is 5-10 seconds here and there, but it adds up. Then there's the proofreading and the editing, but I'm sure that will improve as I use it more and the software gets better trained. At least I hope so. I'm used to being able to cut while dictating instead of having to stop every time I say something to watch the words going into transcription to make sure they are the right words in the right place.

The net time turn around time is lower because it doesn't have to get dictated, go into the queue for the transcriptionists, and then transcribed. But it used to be handled by me and the transcriptionists, instead of just me... Meanwhile, the transcriptionists, who are still doing a bit of transcription (we'll just say that the doctors are easing into using Voicebrook, rather than going cold turkey), are picking up other administrative duties in addition to the ones they were already doing. What will happen long term remains to be seen.

Overall the software works well, the accuracy is 95%+ and that's good. But oh, that few percent that it isn't getting can be so frustrating!! Cholelith vs choleliths and having to correct things like 3 vessels to three vessels. I remind myself that it comes with training and it isn't nearly as bad as it was the last time I went through this 4 years ago.

I have added to the stock of templates with some personalized ones. Also, I've prefilled some bits with things that are the case much more often than not, like the aforementioned three vessels. It saves time to default to that and change it when it isn't right than to dictate something over and over. I'm working on maintaining a good attitude about it, mostly because I don't have a choice in the matter so might as well suck it up and forge on with what I have to work with. Hopefully speed will pick up.

Neglect, but interesting things upcoming

My laptop is not currently working, so I've been doing most of my internet accessing on my phone. It isn't the best way to blog, which is one reason why there haven't been any updates lately. Also... I don't have any study obligations this year, so I've gone INSANE with Halloween! I started sewing in August. I love it!

Next week we're transitioning from live transcriptionists to Voicebrook, so that'll be something worth talking about. I have experienced training my Dragon (medical) and it'll be interesting to compare the medical version to the pathology specific one. Voicebrook is specifically tailored to pathology, but Dragon had a solid pathology vocabulary built into it as part of the larger medical lexicon. Personally, I'm more concerned about how it will interact with our version of Cerner since there are different active windows that I'll have to navigate either using the mouse or with voice commands. I know the software folks say that voice navigation will be easy and intuitive but we'll see.

Attitudes at work are not entirely enthusiastic about the switch, but the powers that be want it, so we're going with it.

"On the job training with lectures"

A pathologist on reddit (yeah, I know, it is reddit... you can't take it too seriously) just described the Pathologist Assistant education as "on the job training with lectures".

Well... isn't all medical training that? Clinical rotations are OJT in a much more standardized form where you try to ensure that every student passing through has roughly the same guidelines and instruction. And sure, I guess if you wanted to be dismissive you could describe a grueling year of medical education as "lectures".

I suppose, if you wanted to paint with such broad strokes medical school, residency, and fellowships are also OJT with lectures. Nursing is OJT with lectures. Physicians assistants get OJT and lectures. I would hope that in regular life the pathologist who posted is not quite so dismissive of other's education.

Assistant obtained and conversations relevant to my interests

The new assistant started on Monday. He's learning all the ropes and seems keen. I'm fairly low maintenance so, I'm fine waiting until he's finished learning all the non-gyn processing and administrative tasks before making him learn any random preferences of mine (how the rack is oriented in the formalin tub matters!!!).

In other news, my husband and I were out watching soccer at a local wine bar and the lady next to me was discussing a friend of hers with diabetes. She checks up on him every other day and runs errands for him. Apparently he had developed a festering foot wound and for months the odor was nauseating. When she found out it had maggots she manufactured an issue with his prescription refills (working with the pharmacy and doctor's office) that forced him to go to the doctor's office for a follow up visit. Now, maggot therapy is a thing but that is under controlled circumstances and not wild maggots that have just shown up after being attracted to the necrosis. So the woman says how the man's doctor referred him to a wound care specialist and things are being treated currently.

It was a great conversation to be around and I joined in, because how often do I get to discuss maggots and necrotic toes in public serendipitously?

Having an assistant is great!

I really miss having one! All the little things that used to just get done aren't magically getting done! So the histotechs are doing some of them, I'm doing some of them, and the pathology manager is doing some of them. It'll be so nice when someone is hired again and trained.

I'm taking the gross photos myself, which I'm able to do and it isn't an onerous task. It is just an end of day thing that stands between me and going home. Whereas when there is an assistant it would all just happen while I was still grossing and it would have a picture before I even got it to describe. It was nice. The interviews continue on, but I think the last one will be next week sometime. I'll be out of town!

Things in my life and goodbyes!

The most important thing that's happened in my life lately is that my husband became an American citizen yesterday! His allowed to maintain his original citizenship so I'm glad that he didn't have to give anything up for this to happen, which is what my mother had to do when she went through the process almost thirty years ago. It means I don't get to make anymore jokes about deporting him when he irks me (usually with bad jokes of his own!), but now he can vote and really belong to the country he's made his home for the past twelve years.

Then today he had sinus surgery, which was less exciting and momentous but important all the same. His specimen went to the pathology group where I used to work and my old coworkers promised to keep an eye for it. It is one of those totally benign things where you're just sending it for insurance purposes though, so no need to prioritize it. He'll be hanging out on the couch for a week or so recuperating, with plentiful popsicles and DVDs to keep him company.

Grumpy cat says, Good Luck, you'll need it.

Now for work news... oh, sadness and happiness! My lab assistant is leaving on Friday to enjoy a few months break before she starts medical school in August since her husband has already moved up to start his job near where she'll be going to school. She's been a great assistant and I know she'll do well at PCOM! I'll miss her, since we've worked very closely together and she's the only one in the lab with me for several hours in the day, but she's leaving for a good reason and I wish her so well. To that end, the head of our department and I wanted to give her a little sendoff, and since she loves grumpy cat I made her this one! It is her sense of humor and hopefully she likes it.

Tan that is just...tan

A while back I was triaging a kidney and one of the pathologists wandered by and asked if it had a

So tan!

mass. I said that it did and he asked me what it looked like. I told him that it was tan. He asked if it was yellow tan, maybe hemorrhagic? And I told him no, it was tan... Solid tan. Uniform and...tan, just tan and didn't look like an RCC at all.

Then the kidney gets grossed and the slides go out.  The pathologist is on vacation, the one filling in for him gets the case and pops his head into the gross room to ask me what color the tumor was (while holding a copy of the gross description??). I told him it was tan and expressed surprise because I thought I had dictated that (I'm terrified that the dictation system, which is occasionally glitchy, will not pick up some really pertinent information). He looked at the paper in his hand, underlined something, and said "oh yes, tan" but... then he stood there. I went ahead and told him that it wasn't tan yellow, it wasn't hemorrhagic, it wasn't cystic, and it wasn't mahogany. It was tan. He said thank you and left.

About half an hour later the other pathologist comes in and says he wants to ask me about the kidney tumor.... Oh goodness. He asked me what color the tumor was, if maybe it was more tan red or mahogany. I told him, sorry no. It was just tan and I said there wasn't a central white scar in it either, since I knew that was going to be a relevant follow up question. Then he said thanks, said he thought it was an oncocytoma anyway, and left.

It was funny. I know that things tend to be pink-tan, white-tan, yellow-tan, brown-tan, etc, etc, but this one was genuinely just tan, like a paint chip of uniform color. Patients don't read the text books so things often don't present as expected and you can't take it personally if the pathologists question and dig to see if they can't get the gross description to match up to expectations just a little bit better. But all you can do is describe what is in front of you and trust that the microscopic matches up better.

Break a leg and then identify all the pieces!

The title is from a good luck message a friend sent in the wee hours of the morning, wishing me well on my certification exam.

That I took this morning.

That I passed!!!

Months of worry, months of study, and I passed.

I will have free time again. I don't have to feel vaguely guilty that there's some studying I need to be doing.

I passed the certification exam of a terminal degree, that might officially be the last major test I'll have to take in my entire life.

This is not a well written blog entry, I understand, but... it gets the point across! I'm done! I passed!

Hooray!

Looking for things that aren't there.

One of the pathologists came into the gross room at the end of the day to look at a multi part case
from early last week. It is always worrying when they say something like, "well, what do you think it was?"

There was nothing like this...

Eek! It didn't look like anything particular... but at least I threw out an option that was plausible  based on what I saw grossly. It wasn't right, but I'd argue that it made sense given what the surgeon thought was the primary and better than not having any answer at all.

Meanwhile we went back to the bucket to look at one of the parts, where he was interested in one particular area...already knowing before he saw it that the primary tumor should be there... Except it wasn't.... at all. There was a nearby tumor but nothing where we were looking.

Which is infinitely comforting. The idea of missing a tumor is terrifying--especially when it is a specific and semi diagnostic sort of one.

On a related note, I get paranoid when large swaths of bowel are removed for "neoplasm" and all that is in there is a lipoma or a little polyp. I always have to worry that there's something more sinister that I'm just not seeing.

That might be the saturation point...

I think I might have hit the point in studying where I feel comfortable, where all of the words are starting to look more and more familiar. I woke up this morning to consider what I felt like I needed to study and...there just wasn't anything pressing. I'll keep reviewing here and there, but there isn't the feeling of compulsion to keep reading/making notes/reviewing.

And what did we learn, boys and girls?

We learned that if we blog about getting legs and how gross they can be, you tempt the universe to send you more legs. What the heck? Between end of last week and the start of this week I had more legs than all of last month.

But! We've had students coming in from a local career center touring the various things we do in the laboratory and since they've been coming in I haven't had any legs! The only plus side to them is that they make a very interesting visual aid (and potentially fun Halloween decorations if you were so inclined and wanted to scar some children for life....) for when you have people coming in to see what you do. People know what a normal leg looks like, but very few people without a medical background know what a gallbladder looks like. I do like showing them gallbladders though, because there is the potential for stones.

A lot of the students are interested in nursing and labor/delivery or pediatrics. So at least I can bring out a placenta and show them the membranes and where the baby would go, etc. It helps to have something relevant to their interests.

She's got legs...

Oh legs. I don't know anyone that likes legs. On my best day, with a not particularly bad leg, I don't mind them. On the wrong day, I dread seeing one come in the door.

Why? Well, they are unwieldy and just won't stay where they're put. Sometimes all the vascular margins aren't clipped so if you grab it blood shoots out the resection margin because of the pressure you've applied. And they're fresh. They're fresh and bloody. They are the single largest exposure I have to unfixed, biohazard-y tissue (which I'm not particularly concerned about, but at the same time puddles of blood aren't exactly my favorite).

And the smells. Oh the smells! Gangrene is a popular reason to have your leg amputated, plus non-healing wounds, ischemia. These are not nice legs, these are legs that have allowed toes to rot off and nails to get hoof-like. Legs with popliteal arteries that are thrombosed and wide enough to stick three fingers in. Sloughing skin and muscle turned gray, green, and purple with rot.

The legs get wrapped up, in layers and layers. The more layers, the worse it smells generally, more layers to try to contain the stench. The last layer is the worst, it is a sort of adhesive plastic that sticks to the skin. Sometimes it comes off easily, and sometimes removing it brings part of the foot with it. 

At the end, it all gets re-wrapped, put back into a biohazard bag, thrown into a rigid biohazard box, and then put into the morgue fridge. The temperature keeps it from rotting too much more, but you still hope that you never have to go back to it. Time is not kind to detached legs.

Trying doesn't quite count...

Life gets in the way of things... like studying and signing up for the certification exam. So I'm finally getting to the point where I feel that I've studied enough that I can set up a date to take the exam (maybe that or I'm getting to the point where I'm tired of studying and figure I might as well get it over with). I started off by filling out a printed version of the application so I could just send a check (can I mention that writing the ASCP a $500+ check hurts?) but there was a number I'd have to email my course director to get and didn't want to be a bother. So I figured I'd just do the online application and skip that bit, except four minutes after I started filling out the online application the website went down for maintenance. Rats, foiled again!

So I'm going to stay up and try again in a few hours. I don't get any bonus points for just trying to sign up, I have to actually do it and having now finally gotten around to doing it (and having located my sealed transcripts) I'd really like to be done with it.

I have to do the online application and then mail in my sealed transcripts, and then I wait to hear back from them with my three month window for when I can actually take the exam. So even this doesn't mean that I'll know my date immediately....

But, still... it is a step in the right direction. I'm tired of having it hanging over my head.

Strangely busy!

I've been awful about updating, I know. Apologizes.

This past week has been busy, more colons, more breasts and lumps, random kidney, and more hysterectomies! I am starting to wonder if anyone over the age of 45 has their uterus anymore. I was chatting with one of my classmates the other day and we were in agreement about that! It seems that hysterectomies abound everywhere. Some days I'm baffled that as many of my autopsy cases has a uterus as did.

In the same conversation with the same classmate we both discussed how we should really sign up for the certification exam... And we should. I should. I just haven't. I feel like if I just keep studying eventually I'll feel like I'm ready, but I know it isn't true. I should just sign up and get it over with.

Meanwhile, I've been going to the library in the morning to study before work. It is easier when I'm not at home... when I'm here I just keep seeing things that I need to be doing so I study for a bit then load the dishes, study for a bit, start prepping dinner, etc. Life would be much easier if magic elves would just take care of all of that stuff while I'm sleeping, but sadly, childhood fairy tales lied to me and that sort of thing just doesn't happen. So... I just try to do it at night after I get home from work, provided I don't get home after 7:30. I hate late nights, sincerely.