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!