Thursday, November 26, 2009

Happy Thanksgiving!

Happy Thanksgiving everyone! The Lone Coyote is finally emerging from a 2 month block of brutal scheduling, where she barely had time to eat and pee, much less blog. She is very thankful that no elective surgeries are done over the Thanksgiving weekend and she is not on call, so she now has 4 days off to rest up.

On that note, let me mention one thing I am very thankful for. Pathology Assistants. If any of you out there are applying to pathology residencies, one thing you should try to get a sense of is how much grossing you will be doing in residency. You need a program where the volume is high enough that you will see interesting things, but not where it is so high that you will be grossing all of the time. Grossing can have very little educational value if you are just cutting in small ditzels and cassetting biopsies for hours. We are a very high volume program and have PA support. They do a lot of the small stuff and free us up to focus on learning how to do the bigs. This makes our grossing days sometimes heavy, but doable.

This past week I had a grossing day without PA help due to vacations and it was a nightmare. We are talking over 14 hours of cutting, much of it being of little learning value. Then you ge tto go and try to take care of all of your other work. By the end of a day like that you are just cooked and resentful. I have talked to people who routinely have days like this in their residencies. I cannot imagine doing that day-in and day-out and surviving, much less learning much of value. So be careful. Find a place where you do not just work long and hard on grossing days doing volume, but you do good cases. There is no glory in being a cutting scut monkey.

Okay, off to enjoy the holiday. I will try to be better about posting now that things should improve schedule-wise.

Sunday, November 15, 2009

Time Flies

It is hard to believe it is the middle of November already! Such is life, I suppose, when working really long days with tons of cases to deal with. I am more than halfway through a 2-month block of surgicals right now at our main hospital. This is definitely the roughest section of my schedule this year and it is wearing me down. On one hand I am "in the groove" in terms of rolling with the schedule and getting my cases done. On the other hand, it is a long stretch to work at such high intensity and the burnout starts to set in after about the 5th week.

When I think about how many patients cases I have seen, it is pretty mind-blowing. Sometimes clinicians call and ask, "do you have results on Mrs. Smith's biopsy?" They seem shocked when I have no idea who Mrs. Smith is. If she has a rare presentation or an awful diagnosis I can often remember who it is once they tell me some history. But if Mrs. Smith had a standard GI biopsy that showed nothing, I have to look it up with the medical record number. It is just a different way of caring for patients. The resident on the other end may have a handful of patients that they know well. I have stacks of "patients" that I know 1-2 sentences of history for and am constantly trying to turn over cases.

I am looking forward to December when I get some elective/vacation. The temptation after all of this is to do very little on elective, but at the same time we are expected to use the time to fill in gaps in our education. It will be nice to do some work at a more relaxing pace though.

Wednesday, November 4, 2009

On Street Sweeping and Other Musings

It was a light-ish day on frozen sections so I had some time to ponder a few random things. An update on my last post about ENT surgery: we have had more eyeballs arrive, so it seems that enucleation is done at least somewhat frequently here by them. There is an Eye Pathology department that some of the eyes seem to go to. But it is unclear to me when they go and when they do not. Hence the reason why we sometimes get to cut them up. Yuck.

I was driving in the other morning and there was so much traffic approaching the hospital. It was just bizarre. Looking ahead I realized that the street sweepers were out since it was within the designated street cleaning time. And driving all around me were huge vehicles--SUVs and trucks. After a few minutes of inching slowly along the street, I suddenly realized that all of the SUVs and trucks were circling the block and waiting for the street sweeper to move on. Then they were swooping in to claim the few spots that were large enough for their huge vehicles. It seemed pretty cut-throat. I have always wondered how people can deal with owning large vehicles in the city and parking them on the street. Now I see it can be quite the sport a couple of mornings a week.

My best frozen section of the day involved being called down to the OR long before the specimen was ready. As I stood there waiting, I watched chaos unfolding around me. It seemed this surgeon was driving the nurses crazy by making constant demands. They were running in circles trying to meet all of the surgeon's requests, which held up the frozen even longer because I could not get the specimen and leave. Finally, the surgeon realized I was still standing there and demanded to know, "what are you still doing here?" "I'm waiting for the specimen."

Now he got pissed. He started yelling at at the circulating nurse, "why is she still waiting? What are you doing? Go and get the specimen and give it to her. I need this analyzed and time is being wasted." One of the scrub nurses chewed him out a bit, "maybe if you stopped asking him to get you so many things, he could get the specimen ready!" I was happy to get the specimen and get out of there as the fireworks started,

Then we get the frozen done quickly, diagnose cancer, and I run down to the OR with the results. The freaking case is done and the patient is in the recovery room already! Yeah, that frozen was really so important for the outcome of the case. How fitting.