One Step Closer to Graduation

I have 10 days (7 more "working" days) until GRADUATION!! It is hard to believe that the day is almost here, but I am beyond ready to be finished with school forever (well at least I think so...)!

These last few weeks at in Surgical Pathology at Conemaugh Memorial Medical Center have been very busy with specimens ranging from placentas to breast cases to colectomies, which is nothing out of the ordinary. There haven't been any "crazy" specimens lately, which is bittersweet since we don't want a patient to be sick, but at the same time, we don't get some of the experience we would like. On top of our clinical rotations, we took our final test of our graduate career last Friday. Our final exam had 100 multiple choice questions that ranged from Disease Mechanisms to Lab Management to Autopsy.  This test was little different from our other exams in that we had to make an 80 or above in order to pass. That made this test a little more stressful than usual, but I was confident that our whole class would be just fine.

The only other test we have to take is the Board Certification Exam so we can be certified by ASCP to work as a PA. I'm taking it the week after graduation while everything is still very fresh in my mind since I've been studying hard for the last two years. It was recommended to me by previous students, and even though I haven't taken it yet, I would still highly recommend it to students currently still in the program.

The countdown is on and I'm ready to see what our careers have in store for not only me, but all of my classmates as well! :)  

The Last Leg

We have almost made it! We are on our final clinical rotation of our graduate career and are inches away from graduation day. If hasn't been the most graceful journey, but we are on the final stretch and are more than ready to start our careers.

My last rotation is in Surgical Pathology at Conemaugh Memorial Medical Center in Johnstown, PA and it is a little longer than the previous rotation at 8 weeks rather than 6 weeks.  That number is a little bittersweet since I wish it was only 6, but it is just part of program.  In the end, we are almost finished and I can deal with an extra two weeks.  This particular rotation had an interesting start in that the hospital was undergoing some changes in their electronic system. They have recently switched to Epic, which is an interconnected information system that connects all aspects of the hospital from the emergency department to surgical pathology. It's meant to allow a more seamless communication system.  In addition to that, the gross room implemented Dragon speech recognition technology to replace dictaphone. Needless to say, there was a lot happening at one time during our first week, which meant some small problems here and there to work out, but I think it will work out for the best in the long run. It's beneficial to be a part of something like this in the work environment because it can happen anywhere you go. Luckily, both Emily (my classmate) and I had both worked with each of the systems at previous rotations, so that helped not only us, but the other employees as well.

As for the workload, there is a diverse array of specimens that includes a lot of biopsies, placentas, hysterectomies, breasts, and colon specimens. We have also gotten two lung lobes for mass, prostates, and amputation specimens. As a last rotation, we have seen a lot up to this point, so it has been nice to get a little bit of everything to keep us on our toes as we move forward into our new jobs. I hope to see even more in my last 5.5 weeks so that I'm ready for anything.

On an awesome note, the Chicago Cubs are WORLD SERIES CHAMPIONS! If you didn't notice, I'm quite excited and it was a dream come true to finally see it happen...even though Game 7 may have stressed me out quite a bit. Not only that, but the Mountaineers are having a great football season and I look forward to see how far they will go! So GO CUBS and GO MOUNTAINEERS! 

Fall is Here and Graduation is Near

I'm beginning my final week of my Thomas Memorial Hospital rotation in Charleston, WV and am anxious to start my last rotation as there are only a total of 9 WEEKS left before graduation! It certainly cannot come fast enough, that is for sure. My senioritis is in full swing at this point and I'm ready to be finished and move on to the next adventure I have in store! :)

These past couple of weeks have been pretty laid back in the surgical pathology gross room with a lot of biopsies, placentas, and skin specimens.  We have gotten a few bigger cases here and there, such as a breast, colon, or hysterectomy, but just enough to keep things interesting. I can't complain about having a little bit of a break after my last two rotations, so I am enjoying while I have it.  However, as of last week, Thomas Memorial has picked up specimens from another local hospital to gross, so the volume has been slightly higher. Due to that, there has been a higher volume of skin ellipses and shaves as well as additional GI biopsies.  It has been nice to have a higher volume of skin specimens because I do enjoy grossing them and learning about skin pathology.  Every person has their "favorite specimen" and I suppose I could say mine are skin ellipses.

As for things outside of clinical rotations, we only have two more tests remaining, which will be the end of October and the beginning of December. They will be the same format as before, with 100 multiple choice questions that will be comprised of information we have learned over the past two years in PA school.  This aspect makes it a little more difficult to study since there isn't a definitive set of information or objectives, however, that is how our boards will be set up so it will be good in preparation for that. The only difference between our last two exams is that we must make an 85 (which is the lowest B on our grading scale) or above in order to pass and graduate. That puts a LOT of pressure on us, but it will only make sure we are well prepared to take and pass the board certification exam and succeed as we begin our careers. All in all, it is nice to know we have all made it this far and only have a few more weeks before we have finally completed our degree.

In case you weren't aware, the Mountaineers are currently UNDEFEATED in football so far this year and are ranked 12th in the NCAA!! It has been fun to watch such a talented team this year and I'm excited to see how far this season will go! Go Mountaineers!!

Starting Off Strong at Thomas Memorial

I am a week and a half into my 7th rotation at Thomas Memorial Hospital in Charleston, WV.  I am continuing my journey in surgical pathology, however, this rotation is slightly different than the other surgical rotations so far. I have the privilege of being able to work with one of my classmates, so we are able to divide and conquer the work we have placed in front of us. There are three pathologists here, and have all shown to be very nice, helpful, and encouraging as we are in the home stretch of our graduate career.

The set up here is a little different than what I'm used to because they have dictaphone and transcriptionists rather than Dragon or VoiceOver software.  It has been an adjustment, but I have grown to like the change in how I go about doing my work.  I feel like it has been a lot faster in regards to doing small specimens such as biopsies, gallbladders, and appendices, however, I sometimes forget where I'm at when it comes to dictating the more complex specimens.  I have just gotten in a habit of writing down everything on a paper towel and taking all my sections, and then dictating it all at once so that I don't lose my place or forget anything. Another difference in this rotation is that we come in and start at 7:00 a.m....it was a little rough the first week, but I've enjoyed getting off around 2:00 p.m. every day because it leaves me the whole afternoon to do whatever I like!

As for specimens, we tackle a lot of placentas, POCs, and biopsies on a daily basis.  That is a bulk of what we do here, however, we also get a lot of hysterectomies, thyroid specimens, breast specimens, and colons. All in all, my partner and I get at least one complex specimen a day each, if not more. We are also responsible for frozen sections if we choose to do so, but it isn't a requirement.  However, it is nice to keep up those skills! After the last rotation where I was the only "PA," it's been nice to have a little bit of a break and take on the workload with a partner.

On a very bright note, after job applications and interviews, I'm excited to say that I have officially accepted a PA position at Stanford University and will be starting at the beginning of the year. I'm beyond excited to already have a job this early in the year, so the rest of the school year won't be as stressful with all the extra work that it entails.  Now it is just the adventure of finding an apartment in an area I like that is within my price range! So let the fun begin!! :)

Another One Down

Where has the time gone? Summer is over, September is here, and the end of my 6th rotation is almost complete.  Tomorrow is the last day of my Butler Memorial Hospital Surgical Pathology Rotation and it's hard to believe it is coming to an end. It's amazing how quickly these rotations come and go, because just as you are getting used to your environment, the people, and how things operate, it is already time to start over again.

My past few weeks at Butler have been filled with a diverse array of specimens ranging from colons to kidneys to breasts and everything in between. It has been an exciting rotation, especially being the only "PA" in the lab, so everything that came through, I had the opportunity to do. I liked that aspect in that I wasn't having to compete for specimens, but it could get stressful at times when a lot came in at one time.  However, I feel that being in a situation such as this one has only made me a better PA. Aside from grossing, I did have the opportunity to do frozen sections the entire time I was there. It was a little different in that, a majority of the time, I was only responsible for the actual cutting in the cryostat and putting sections on the slides.  The pathologists enjoyed having an active role in the process, so they would cut the specimen, select the section they wanted to see, and then would stain the slide after I had completed my part in the cryostat. It was a different process, but I liked that they wanted to interact directly and would even allow me to sit with them to see the slides after it was complete.  The pathologists were all willing to teach and interact with me as a student and I really enjoyed that aspect during my time at Butler Memorial Hospital.

Another aspect I enjoyed at Butler was the weekly tumor board conferences.  At Butler, they would have the pathologists, radiation, oncology, and the specific surgeon for a patient come together in one room to discuss a case in order to determine the best plan of action for treatment.  It was pretty incredible to see that aspect of the medical process and I wish I had the opportunity to sit in on more.  It was a great learning experience and it really demonstrated how our part in the process plays such a large impact in all the other areas as well.

So it is almost time to say my goodbyes to this rotation, but there is much more in store for me on my next rotation at Thomas Memorial Hospital in Charleston, WV.  I will have another new experience here and that is working with dictaphone and transcriptionists, which I haven't had the opportunity to do before (so it will be VERY interesting for both parties :P).

On a much lighter note, since we all like to have a fun here and there, you should catch the biggest game of all time (attendance wise anyway) this weekend between Virginia Tech and Tennessee on Saturday, September 10th!! I will have the pleasure of experiencing this "historic event" in person in good ole Bristol, TN and I'm pretty excited! However, if you're not a fan football or just not ready for it, no worries! To be honest, I still can't grasp that it's even football season yet, because in my mind, it doesn't begin until baseball ends! I still have to watch my Cubbies win the World Series ;).

Taking On Butler

The 7th rotation of my clinical year has been off to a strong start in surgical pathology at Butler Memorial Hospital in Butler, PA. Butler is about 40 miles north of Pittsburgh, so it makes for a rough commute, but I can manage it for six weeks.  As for dynamics of the facility, the gross room is directly connected to histology, so there is a lot of interaction between the employees of both areas.  I am the only "PA" in the facility and work with a gross tech to take on steady load that comes through from not only the hospital, but facilities around Butler County as well. There are five pathologists that work in the department, with one specializing in dermatopathology (so we get a LOT of skin specimens). It has been an interesting two weeks adjusting to a new facility and their way of doing things, but other than the commute, it has been quite enjoyable.

The rotation has been consistently busy with only a day or two that have been on the slower side.  As I stated before,  a bulk of the work is composed of skin specimens (skin shaves, ellipses, etc.). In addition to the these, I have had the opportunity to gross breast specimens, hysterectomies, colon resections, extremity amputations, and lung lobectomies. I usually get one to two complex specimens a day, so it's mostly the simple specimens and biopsies that comprise a majority of the work.  I am also responsible for all of the intraoperative consultations.  Intraoperative consultations are when a surgeon sends a specimen down to surgical pathology in order to obtain a quick, tentative diagnosis while the patient is still in surgery.  This helps to guide the surgeon in deciding the next step of surgical procedure.  For example, if the surgery is for a tumor resection, margins will be sent to ensure the they are clear of tumor cells before finishing surgery.  When we receive the tissue, we use a cryostat and flash freeze the tissue in OCT (Optimal Cutting Temperature) embedding medium and then cut sections with a microtome blade. The sections were put on slides and a quick H&E stain is performed in order for the pathologist to evaluate the tissue. The whole process from the time the specimen is received until the pathologist reads the slide and calls the OR is 20 minutes or less. 

Overall, being the only PA at a facility means a lot of responsibility, even as a student, so it has been a great experience so far and I enjoy the challenge!  As for school, we have only had one test since my last post, which was the last Friday in July. The test covered the last 4 or 5 chapters of Robbins, a.k.a. the disease mechanisms textbook. From here on out, our tests will be "random," so there won't be any direct objectives or set chapters that the tests will cover. With that said, it will be very good preparation for our boards since they are supposed to mimic what they will be like. 

Other than school, the job search continues! I have had interviews, but am just waiting for the right offer to come along...fingers crossed it will be a good one :)

Five Weeks Down, One to Go

Where has the time gone? I literally feel like I just began my Ruby Memorial surgical pathology rotation yesterday and now I'm about to start my last week. It has been a very busy fives weeks, but I have welcomed it with open arms because I have had the opportunity to gross so many complex and interesting specimens that I had never had the chance to do before. For example, I finally was able to gross a laryngectomy, which other than a Whipple (which is still on my "to do" list), is one of the most daunting and complex specimens that will probably come across my bench. It's not that the overall process is complicated, you just need to have a thorough understanding of the anatomy before tackling the specimen because it is important for tumor description, sectioning, and staging. I made sure to review the anatomy before I started and had Lester close by just in case I needed a reference or confirmation on anything along the way. Overall, I thought it went well for my first laryngectomy, so I am confident in my knowledge and abilities to take on another one in the future.

Another specimen I had the opportunity to do was a 21 week old fetus with Trisomy 18, also known as Edwards Syndrome. This condition can be characterized externally by a small head (microcephaly), small jaw (micrognathia), low set ears, and clubbed feet to name a few. Internally, you can see things such as kidney abnormalities, congenital heart defects such as a VSD, and esophageal atresia. Since I received the fetus at 21 weeks, I was able to appreciate some of these characteristics. These particular cases are a little more difficult to do than other's, but I do find genetic cases like these very interesting. It's fascinating to see how one additional chromosome can create so much "chaos" within the body.  When you receive a case like this, you essentially do a very thorough external examine, taking all measurements of the body and describing any features that could be abnormal, such as webbed fingers, clubbed feet, fused nares, etc. This was the most demanding aspect of the process.  Then, a "mini" autopsy is performed to make sure all the organs are there and in their respective positions as well as to make sure they have been developing normally.  As for sections, we submitted the gonads to definitively determine the gender, and put through representatives of the lung, kidney, liver, heart, and brain.

Other than these particular cases, I also had the opportunity to do a gastrectomy, multiple lumpectomies and mastectomies, colon specimens, and melanoma skin excisions to name a few.  Even though this has been a busy rotation, I think it has been my favorite so far just because of the vast majority of specimens I've had the opportunity to do.  Other than the routine biopsies and small cases, every day brings something different and that is one thing I've really enjoyed about it.

I can't believe I'm already over halfway and in the home stretch of my graduate career at WVU, but I'm ready to see what the future holds with my up and coming career as a Pathologists' Assistant. I have applied to a couple of jobs and am just waiting to see what those opportunities may have in store for me!

The Return to Mountaineer Country

Another rotation has ended and I've jumped right into the next. I am a week into my sixth rotation at Ruby Memorial Hospital at WVU and needless to say, it was quite an eventful week.  I've been through autopsy and surgical pathology rotations for six months now and this rotation has by far been the busiest. I expected a higher workload and I've come to like the change of pace because it keeps me on my toes and makes the time go by much faster. For the first week, I was able to gross a few breast specimens that ranged from benign fibroadenomas to invasive ductal carcinomas, thyroids, partial colon resections for tumor, and a lot of skin specimens. This rotation has had a large variety of specimens, which I have welcomed with open arms because I would like to see as much as I can before I dive into the workforce after graduation. Up to this point, I haven't had the opportunity to do a large amount of specimens that originate from the head and neck and thoracic regions, so I'm hopeful that I will get some of that experience while on this rotation.

Aside from grossing, we also had our sixth test of the year this week that covered the urinary system, male genital tract, female genital tract, breast, and endocrine system. It was the same format as all of the other tests, with 100 multiple choice questions. As usual, it required a lot of preparation time and studying, which was difficult with the transition between rotations.  However, I made it happen with early mornings and late nights to get everything accomplished. It will be such a relief once I don't have to worry about studying and tests anymore, but that day will come soon enough.

With the year flying by, I have also started applying to a few PA positions that have caught eye and was honored to have my first phone interview last week (yes, it was quite a busy week all around). It was the first phone interview that I've ever been a part of it and I was quite nervous going in.  I wasn't sure how to prepare so I just made a list of general questions that I felt could possibly be asked during the interview and made notes in response to that. I also made a list of questions that I wanted to ask them about the position and the facilities, so I could learn more about what would be expected of me if I was to get offered the job. Overall, I thought the interview went well and I hope to hear something soon on whether or not I will have the opportunity to go in for an in-person interview.

Round 5: Children's Hospital

My short time in the ME's office came and went and it's hard to believe that I've already completed one week at my new rotation at Children's Hospital of Pittsburgh of UPMC. This is a three week rotation just like my previous one, however, this is in surgical pathology rather than autopsy.  It has been an interesting week so far, but I will note that it is slightly difficult going from an autopsy rotation back to surgical pathology in relation to getting back in the groove of creating dictations. My first day was a little rough and for a split second I was concerned I forgot everything, but after the first couple of cases, I was good to go!

The Children's Hospital has been interesting in that you could have the opportunity to see rare childhood disease cases that you may not be able to see elsewhere. On my first day, I was able to observe one of the PAs do a Wilms' tumor, which is a rare childhood kidney tumor.  I had never seen one before in person and it was interesting to see one and how it was processed at their facility.  As for regular, day-to-day cases, I have been doing a lot of gallbladder, appendices, testicles, and small masses from various parts of the body.  The only complex case I've done is a metastatic cancer case in a 1 year old.  Cancer had spread all over the body and they were sending in all the masses to be grossed, so it ended up being quite a large case.  Other than grossing, I have had the opportunity to attend a lot of conferences that range from pediatric autopsy to pediatric tumors and new cancer screening techniques.  They have all been very informative and I get to experience a how a group of pathologists come together to see histological slides for a case and discuss the potential diagnoses and the reasons why they came to that conclusion.  It has been eye opening and I have really enjoyed getting to be a part of it.

Other than school, I have just been enjoying the nice summer weather that has finally come our way! My only wish is that I lived closer to the ocean so that I could enjoy even more :). Maybe one day soon, I only have 6 more months of this journey before it's time to see what else is in store for me! 

Three Weeks in the Life of a Medical Examiner

Yesterday marked the first day of rotation number 4 in the Medical Examiner's Office in Morgantown.  I expect these next few weeks to be filled with exciting autopsy cases that I didn't get to experience while on my hospital autopsy rotation in Pittsburgh.  On this rotation, I will get to see and assist on cases that are "suspicious" in nature and do not fall under death due to natural causes.  These cases are typically classified as accidents, suicides, or homicides. The office does do hospital autopsies as well for Ruby Memorial, but a majority of the cases performed are medical examiner (ME) cases. The ME cases are performed on Monday and Tuesday's and the rest of the week is set aside for hospital cases.

So far this week, I have been able to observe and take part in four cases, which included a drug overdose, a work-related accident, drowning, and a stabbing. In comparison to hospital autopsies, ME cases have a larger emphasis on the external and internal gross examinations and toxicology results rather than the microscopic examination. However, the latter can be important in some cases. As for toxicology, femoral blood, heart blood, bile, vitreous, and gastric contents are taken to be sent off to be tested for drugs, alcohol, electrolyte levels, etc. to help in determining a cause of death or contributing factors to the death.  The external examination is extremely important in all the cases and can be correlated to the internal gross examination, especially in cases of trauma, gunshot wounds, or stabbings. Extensive photography is also utilized in these cases to document all findings to be used as evidence in court hearings.  For identification purposes,  a headshot, fingerprints, and occasionally a DNA sample are taken for all cases.  After all of the external steps have been performed, the body is opened and the organs are removed one by one, which is known as the Virchow method. These organs are then prosected and examined for any additional abnormalities, with focus on the lungs, heart, and kidneys since this is where most systemic diseases lie. Sections are submitted for each of these organs for histologic examination. As for the remaining organs, including the brain and tongue, sections are kept in a stock jar in case it is needed in the future.

From what I have gathered in my first two days, ME cases have a much more systematic approach in comparison to hospital autopsies, which is understandable with the nature of them.  If the pathologist is to go to court to present their case, it is helpful to have performed every autopsy the same way so it is easier to explain and present all imperative findings. I'm excited to see what the next 2.5 weeks have in store for me!

Midway on Round 3

Today marks the beginning of my fourth week here at UPMC Shadyside and it has been an eventful rotation so far.  Since this is a "Center of Excellence" as I noted in my last post, my last couple of weeks have been filled with bladders, kidneys, prostates, and lower extremity amputations. In addition to these daily specimens, I also had the opportunity to gross a sarcoma, which was very interesting since I hadn't had the chance to do one before.  It wasn't as difficult to gross as I had expected it to be after seeing the size of it, but it ended up being an interesting case.  I started out the case by differentially inking the specimen like a "box," so I inked the medial, lateral, superior, inferior and deep margins.  The anterior surface would normally be inked as well, but in this case, the anterior aspect was covered entirely by skin. Then, I described the lesion on the epidermis and it's relationship to all the margins. Finally, I serially sectioned the specimen and submitted my sections, which included submitting the medial and lateral margins completely, the lesion to all margins, and sections of just the lesion. 

Another case I received was a lymph node search for a melanoma case. I have a love/hate relationship when it comes to doing lymph node searches, just because sometimes you find them and sometimes you don't.  I could have a giant container full of fibroadipose tissue (fat) to search through and may only find one lymph node.  Luckily, in this case, I found over 20 and it made if feel more worthwhile and successful (in my eyes that is), than only finding one or two.

Other than rotations, I've just been keeping up on my readings and preparing for a presentation I have to give at the UPMC Regional Conference.  I will be presenting with my classmate, Sierra Sheppard, on rectal cancer specimens and different grossing techniques. We are a little nervous, but I think it will be very worthwhile to do it!

Round 3 is Underway

My time in the morgue has ended, but the new adventure of UPMC Shadyside has begun. I just completed my first week at my new rotation and I'm pleasantly surprised at how much I am enjoying it.  UPMC Shadyside is a "Center of Excellence," which means they specialize in a certain area of pathology and in this case, it's bone, soft tissue, and genitourinary specimens.  Even though it was only my first week, I had the opportunity to work on several complex cases and gross specimens that I've never had before.  Some of the things I have received, such as hip and knee replacement hardware, were gross only specimens.  In this case, I just have to do a dictation to describe what I have in front of me.  These types of cases aren't difficult to do at all.  Some of the more complex cases include the following:

• Below the knee amputation (BKA): I had the opportunity to do two amputation cases this week.  One was for an non-healing ulcer on the foot and the other was a traumatic amputation due to a crushing injury.  The process of grossing these specimens isn't too bad, but it requires knowing the vessels of the leg and where they are located.  To gross a BKA, you begin by taking overall measurements, measurements of any lesions and/or scars and taking photographs.  Then, a bone saw is used to take the bone margin of the tibia.  A vascular margin and skin/soft tissue margin sections are also taken.  Then, for the fun part, you have to dissect the leg to find the anterior and posterior tibial arteries, the peroneal artery, and the dorsalis pedis.  These have to be evaluated for occlusion and atherosclerosis to determine if they contributed to the injury that lead to the leg having to be amputated.  Sections of these are submitted and sections of the lesion are also submitted.
• Cystohysterectomy: These are bladder resections that also come with the uterus, ovaries, and fallopian tubes.  Most of the time, these types of surgical procedures are performed because of cancer.  I received two of these this week for bladder cancer and it was one of those specimens that I never thought I would have the opportunity to see and I was able to do two in one week.
• Prostate: I had the pleasure of doing one prostate this week and that was an interesting process.  UPMC Shadyside has a special procedure with their prostates that isn't done in a lot of places.  They "strip" their prostates of the capsule so it can be evaluated separately.  I had never seen it before and it actually is quite easy to do.  You first differentially ink the prostate (right and left), take your proximal and distal urethral margins, and then score the prostate to separate the anterior and posterior halves of the capsule.  Then you just carefully remove the capsule so it can be submitted entirely.  I know that may not be the best way to describe, but it makes a lot more sense to see it in person than to describe it in words.  
• Nephrectomy: I received one kidney resection this week for renal cell carcinoma and it was a very interesting tumor to see in person, especially after learning about it throughout last year.   

Needless to say, it was fulfilling to finally be able to see and do specimens that previously, I had only heard about and seen in textbooks.  I learn something new everyday and I can tell I am getting better day by day as well.  I look forward to what the next 5 weeks have in store for me.

On a more fun note, I hope everyone has been enjoying the craziness of March Madness this year.  Even though my bracket was busted after the first round, I have still enjoyed all the games and upsets that have occurred and am excited to see who wins it all on Monday night.  Oh, even more exciting news, baseball season starts this weekend and I'm quite excited to see how my Cubbies do this year! Maybe 108 years without a World Series title will finally come to an end ;)

My Time in the Morgue

I have just completed the fourth week of my autopsy rotation at UPMC Presbyterian and I honestly am not ready for it to end.  I have established an appreciation for the autopsy process and have come to enjoy (I suppose that's not the best of words, but you'll understand in a second what I mean) going into work every day and seeing what the day has for us.  Autopsy is more of a "big picture" view of the body systems and how a disease process can cause a cascade of events that ultimately lead to death.  That is what I personally enjoy most about what I get to see and do in the morgue.  Unlike the gross room, most of the time you only receive one organ or even just part of one.  You aren't able to see how the specific pathology of the received specimen relates to or affects the rest of the body.  Clinically, one will know the signs and symptoms, but you don't have that clear picture of all the organs and their gross picture.  I know that may sound wrong or sadistic, but when you just see such a small part in the gross room, it really opens up your eyes to how the whole body is affected by a specific disease process when you see it in autopsy.  It really demonstrates how important the autopsy process is and how seeing, knowing, and experiencing what particular things look like can help to prevent similar deaths occurring in the future.

From my four weeks, that is what I have gathered from my time so far, and I still have two more weeks left before I move on to my next rotation.  Up to this point, I have been able to observe and/or partake in 15 autopsies.  The causes of death have varied to include sepsis, lymphoma, congestive heart failure, drug overdose, and cancer cases.  Each week, I have been allowed to do more and more during the process to include the external examination, evisceration (removal of the organs from the body), and prosection (dissection of the individual organs).  The only part of the process I haven't done of a lot of myself, but have observed our pathology resident do, is the writing of the report and reading of the slides to determine a final cause of death.  It is fulfilling to see the process from the beginning to the final diagnosis and to be able to see the slides and relate them to what was seen grossly.  All in all, I have learned so much more than I thought possible with this rotation and I look forward to what my last two weeks has in store for me.

From 80 and Sunny to 20 and Snow

As sad as I was to leave the beautiful city of Los Angeles, I am enjoying my new rotation in Pittsburgh.  It has been quite the adjustment getting used to the weather change, but I just keep piling on the layers of clothing.  This new rotation is in autopsy rotation at UPMC Presbyterian.  Up until this week, I had only observed an autopsy so it has been quite the experience being able to get hands on during one.  I have loved every minute of it so far, aside from some of the smells that come along with it.

The autopsy rotation is pretty laid back and the work goes on a day by day basis.  If there is a body, we work and if not, I study most of the day or look at slides from previous cases.  At UPMC Presbyterian, the staff I work with consists of Dr. Nine, a resident, a medical student, an autopsy tech, and then myself.  We always work as a team on all the autopsies and switch off doing different tasks during the autopsy so we all learn every step of the process.  The autopsy begins with an external examination, which includes documenting physical characteristics as well as any tattoos, scars, and medical devices in the body.  We then start the autopsy by doing a "Y" incision, removing the rib cage, and removing any abdominal, pleural, and pericardial sac fluid.  Then, we remove the bowel by clamping off at the rectum and the duodenum.  We use the en bloc evisceration technique, which means the organs are removed as one big "block." For us, this means we take out the abdominal and thoracic organs together, still connected, then the bowel, and finally, the pelvic organs.  Once they are removed, we dissect each organ, weigh, describe them, and take sections.  Finally, the brain is removed, weighed, and placed in formalin to be dissected at a brain cutting conference after it has been fixed.  In all, the process takes anywhere from 3-4 hours to complete.  It's a long process, but it's very interesting you learn a lot in the process.

I'm only one week in and I'm looking forward to next week and the interesting cases to come!

Update on California

These past four weeks at PathMD have been flying by and I am not ready to leave this wonderful state in two weeks.  The weather has been warm and sunny and I've had the pleasure of missing out on the east coast snowstorm. My rotation hasn't been that bad either. :)

Over the past couple of weeks, my days have been full of GI biopsies, skin shaves, and prostate biopsies.  However, I have had the opportunity to do a couple of more complex, interesting specimens as well to include a thyroglossal duct cyst, rectal tumor, hydrocele, dermoid cyst (aka teratoma), products of conception (some with fetuses), neuroma, and a toe amputation.  To say the least, I have already learned a lot from working at the bench and I am getting more comfortable every single day when it comes to evaluating the specimen, formulating a dictation, and submitting the proper sections.  I am ready to see what all my other rotations have in store for me to experience.

In addition to the everyday grossing, we (PA Class of 2016) had our first "monthly" test of the year.  It covered a variety of topics and books to include multiple chapters out of Robbins (Pathologic Basis of Disease), Laboratory Safety, Laboratory Management, Handbook of Autopsy Pathology, and Handbook of Forensic Pathology.  In addition to the readings, we also had to know CPT codes, organ weights, grossing techniques, anatomy, microanatomy, and a variety of stains and what they stain for.   To say the least, it was a lot of information and required a lot of reading and preparation for the test.  The test was comprised of 100 multiple choice questions that covered all of the above topics and we had up to two hours to take it. It was a little nerve-wrecking since it was the first test, but I feel like it went much better than I expected and now I have a baseline idea of what to expect for the future tests. 

Now for the fun stuff, because no one just comes to California for six weeks and doesn't do a little bit of exploring.  I have been all over the place the past couple of weekends exploring the state and making new friends.  One weekend, I traveled down to San Diego to explore the city and beaches and let's just say, this beach bum fell in love. :) Last weekend, I went to Las Vegas and celebrated the weekend with some new friends for one of their birthdays.  So as you can tell, I'm taking full advantage of my time here in Los Angeles.  This weekend, I plan on exploring more of the city and it is free museum day tomorrow, so I will be hitting up as many of the museums around here as I can! 

To everyone on the east coast, stay warm and I hope the snow starts melting quickly!

New Year, New Adventures

Hello from beautiful city of Los Angeles!! I have been here almost a week and I am absolutely loving every bit of it from the city itself to my rotation site.  I am currently working at PathMD, which is located in Beverly Hills. They are a private lab and receive specimens from multiple local practices and we process them from the gross specimen to the slide, and then they are sent off to various hospitals to be evaluated by pathologists.  It has been a pretty laid back rotation so far with a lot of simpler specimens (a lot of GI biopsies), but I've also had the opportunity to do some cervical cones, ovaries, toe amputations, skins, breast capsules, and even penile implants as a gross only and kidney stones to be dictated and then sent off for stone analysis.  I have only spent five days in the lab, but I am getting more comfortable at the bench every day.  All of the things I learned the first year are really getting put to use on a regular basis.

Aside from work, I have also been exploring around the area a little bit.  To expand my exploring options, I have rented a car for the weekend and went out to hike the trails around the Hollywood sign and it was absolutely gorgeous.  I had the perfect view of the entire city.

It was a little over a 6 mile walk round trip for this hike, but it was totally worth it once I got to the top!  For continued weekend fun, I am heading to Disneyland tomorrow and I'm super excited to go there for the day.  I'm taking full advantage of these six weeks in a new part of the country by not only learning all that I can at the grossing bench, but also adventuring and exploring the area too!