Still Alive

Wow, I took quite a leave of absence from writing here. Things are still going well overall, and I am so happy I made the switch to pediatrics. I have survived almost 5 months of being an intern. The call schedule is brutal. After months in a row of q4-5 call, the sleep deprivation is really taking a toll. I had one blissful month without call, and now am back in it with no break in site until March. The good news is that my program will be going to a day-night schedule come next July with the new work hour rules starting, so my last 2 years will likely be much better.

1 Down

I made it through my month of NICU. It was definitely interesting, and I think a good place to start overall. Now I am more comfortable with babies, and got a rough call schedule month out of the way when I was still somewhat well-rested. I have been trying to get my life back in order this weekend. On to clinic and wards cross-cover tomorrow.

Over the next few weeks I am going to be doing some housekeeping here and on the other Lone Coyote blog. We will see what comes of it...

Golden Weekend

My goal of surviving my first month in the NICU is working so far. I made it to my golden weekend relatively unscathed, except for being really tired.

First of all, I have to day that there is no doubt in my mind that I made the right decision in leaving pathology. The past few weeks have been really hard in some ways, but I am so much happier. It is like night and day, and the people in my life have all noticed.

So what has been going on for the past few weeks? I survived a *really* long period of orientation. It was much longer and more tedious than that at my previous program. Much of it was not all that useful, but it did allow me some good time for bonding with my intern class and some of the others in my program. That was probably the best part. I like my intern class--they're good people, and I think we will definitely have some fun in the next three years. We did get to do some fun stuff during orientation, like hiking, being taken out to dinner, BBQs, etc. My program has also given us some very useful sessions with orientations to different rotations and is taking some time to get us set up on the hospital's EMR. All of this is really helpful and a nice change from the "here you go, figure it out" mentality that I have encountered elsewhere.

I started in the NICU July 1. While I was expecting to be lost and useless, I was not really sure what it would look like. By the time rounds started that day, I had figured it out: I did not even speak the language. That first day I understood maybe 20% of the words being said. That is slowly getting better, but I am still pretty lost on the details of feedings and ventilators, which is the bulk of NICU. My basic function is to collect tons of data each morning on the babies and to read it out during rounds in a somewhat systems-based manner. Formulating a plan for my babies is a work in progress, and usually goes something like, "Baby A is a 24 day old male infant who is...uhhh... doing well on his current feeding regimen... I think we should, uhhh.. continue this." Overall, I think it is going about as well as it can, and everyone tells me that the 2nd month of NICU that I will do later this year is where a lot of things will start to seem much clearer.

I have had 2 call nights so far. They were polar opposites of each other. One was very calm and light, and we actually slept 4-5 hours. The other was really busy with sick-baby chaos erupting from every which way, and I felt lucky to get to lie down for an hour or so. It is definitely going to take some getting used to the q4 schedule again, and I have yet to figure out the best way to deal with the post-call day. Not sleeping at all during the next day seemed not to work well, and napping for a few hours was okay but made it harder for me to sleep early that night. If anyone has suggestions, let me know.

Well, I am off to enjoy my 2 days off. The 2nd half of this month is going to be much harder for me, since I have the bulk of days off early on. But hopefully by then I will be a little more comfortable with the work so it will flow a bit better.

And So It Begins... Again

The last 2 weeks have just been pure craziness... all in a good way. My last day in my pathology program was about a week and a half ago. It all ended about as well as it could have. I was on "elective" for a few days and tried to get my stuff as wrapped up as possible. On my last day we had some cake, I turned in my keys, said goodbye to people, and left. It was sad in a way, but I also felt like a huge weight had been lifted.

Then we headed out of town for a few days to visit some of my medical school buddies who are getting through their residencies. Rabbit, Bender, and Delerium are doing well and it was great to see them and to change the scenery for a few days.

We got back and I had 48 hours before my orientation at my new program started. I had grand visions of all of the things I was going to get done before starting--home organizational projects, reading, brushing up on my Spanish, exercising. Suffice it to say, not all of that got done. Not even close.

I started orientation on Friday and I think this is going to be good. My gut reaction is that this is such a better fit for me than what I was doing before. Granted, it was just a day of standard hospital-admin lectures. But my new colleagues seem wonderful, and the senior residents are very cool and supportive. I have another 10 days of orientation before getting started in the NICU. Hopefully, it will help my brain get back into a bit of a clinical mindset before July 1.

T-5 Days

Today was my last Thursday in pathology. It is hard to believe that this is about to end. This year has been very long, particularly since I knew fairly early on that I was leaving. But I have learned a lot, more than I could have expected in some ways. While reviewing some of my pediatrics books from medical school, I have realized that I have a lot of familiarity with a wide spectrum of diseases. Granted, I know next to nothing about management anymore, but hopefully this training I have gotten will be useful in some ways.

Last Friday was my last day of surgical pathology. It was my last day in the gross room and my last day venturing in to the ORs for frozens. I cannot say that I will miss either grossing or frozen sections very much at all. Lately, our pagers have not been working well, which has added another interesting dimension to the rather strained relationship that already seems to exist between pathology and the OR nurses and surgeons at this hospital. Let's just say when the callback after the first page begins with someone yelling, "we've been paging you for 30 minutes and you have ignored us," it does not bode well for the encounter.

Somehow, I had managed to make it through the entire year without having to gross in a leg. Maybe it was all of the Whipple specimens that I seemed to get without fail. Ironically, my colleagues who seemed to want Whipple specimens to get good at doing were spared. I digress. Anyway, we do get a lot of below-the-knee amputations, but often the PAs took care of them and I had never had to do one. Late afternoon on my last day my luck ran out. I was given a large leg covered with necrotic debris from chronic osteomyelitis. It was awful to look at, but it was pretty easy to gross since the disease, unfortunately for the patient, was so extreme.

At the end of the day there was no place to put the leg. It was too big to fit into a container and it could not stay in the gross room without formalin. I called the morgue attendant to come and fetch it, but it was the start of a long weekend so no one was there. Finally, the cytotech got wind of my predicament and tried to clean out some room in the already-very-full-of-chemicals cytology fridge. Meanwhile, another tech and I consolidated all of the trash into one can so that we could accumulate enough red biohazard bags to wrap the leg. I then spent my final few minutes of grossing duties attempting to stuff the leg into the crisper of the fridge. Yes, the crisper. It was a disgustingly appropriate end to my grossing experience.

Middle Earth

There is a small outdoor seating area near the cafeteria at the hospital. It has a few tables and looks out onto a nice view. The lawn beneath the tables is full of bumps and holes made by dozens of gophers. One has to be careful when walking near the tables because some of the holes are quite substantial and can envelop an entire foot or ankle.

I was sitting out there earlier this week enjoy a couple of minutes of fresh air and clear cell phone reception. It was lunchtime and most of the tables were occupied. A man came along walking a large dog on the leash. I am not sure exactly what type of dog it was, but probably a mutt mix of several breeds. The man sat down at a table and took out his stuff. He had the leash draped over the edge of the table.

All of a sudden I saw a little tan gopher head pop up in one of the holes. In a split second that dog leapt over the hole and started barking and veraciously digging. It appeared the gopher had gotten the quick head start it needed to burrow back underground. The dog was digging, throwing dirt everywhere, and stuck its whole head into the hole. His owner ran over and tried to pull the dog out of the gopher hole, but to no avail. That dog wanted the gopher.

The whole time the owner was pulling on the dog's leash and yelling, "Frodo, no, Frodo no! Frodo we aren't in Middle-Earth yet!"

Burnt Out

Out With The Old

The end is finally coming into view. The last month has been busy and hard. It has been difficult to be motivated about the work I am doing since it will have little relevance come mid-June. Luckily, I am ending at one of our lighter rotation sites, so it is not quite the onslaught that I became used to on other rotations. Basically, I go in, do my work, and come home. There is no more attempting to read, looking at teaching slides, or preparing for unknown case sessions. I have definitely come to see that if I just went through the motions in this residency and just did service work, there is no way I would learn enough to pass boards and to know what I would need to know. Pathology is a reading-intensive field, which I knew coming in. Not really enjoying the reading was a huge red flag for me and a sign that I needed to get out. Other than that, I am trying to wrap up some research projects I have been working on. I am hopeful that some of them can eventually become nice line items on my CV, and one project even has a pediatric-focus so maybe could turn into something more down the line.

In With The New

I got my intern schedule and I will be starting in the NICU. I am sure it will be intense, but I am all for trial-by-fire learning and am excited to have a schedule that is more front-loaded overall. Life is definitely going to get even busier and I will have to re-adjust to sleep deprivation (yuck). But I am excited about getting back to the bedside and feeling more energized about work again. Right now I am wading through all of the paperwork and things that need to be done before starting a new residency. I had forgotten how much paperwork there was the first time around.

Thicker Skin, Broader Vision

One thing I can say for the experiences over the past two years is that I have developed a much better sense of how hospitals run. My current field is so administrative in many ways, and we deal with every specialty at some time or another. I have gained a much broader knowledge of the proverbial chains of command that all orders/decisions/etc must flow through. And, after all of the dealings that I have had with angry clinicians/staff, there is not too much that goes on behind the scenes that is going to surprise me. Of course I know that the new residency will have tons of its own stressors and different things to adapt too. But I am hoping that I will go in at least somewhat more comfortable than I was leaving medical school and entering my current program.

The Match: Revisited

I have now been through the match twice. It has worked out well for me both times, so I cannot complain too much. But I must say that I still feel that it is a bizarre and rather draining ritual. I am not really sure if there would be a better way to apply for residencies. A colleague told me that a similar match system was used at her undergraduate university for people rushing sororities and fraternities. She said it worked out well for most people and that even if they felt disappointed on rush night, they usually realized in retrospect that they ended up in the best fit sorority for them. From what I have heard from medical school classmates, most people now seem pretty happy with their matches 2 years later. So I guess it does produce good results for many people, even if the process can be rather painful.

Here are a few thoughts on the match after the second time around. Hopefully, they will be helpful to someone out there.

1. Don't panic if the interview invites come late. Both times I received interview invitations from great programs after the dean's letter came out. Some programs send invitations later than others. Also, do not panic if other people have gotten invitations and you have not. It takes some time for programs to get through reviewing all of the applications.

2. The interview matters. Speaking from both sides of this process, as a resident and an applicant, I can say that the interview matters in this process. It really shapes both the program's and the applicant's viewpoints of each other. Having the best package on paper does not matter much if the residents from the interview lunch remember you as being combative, arrogant, or a total douchebag (all terms I have heard used to describe resident impressions of applicants who did not behave well at their interview lunch). And from an applicant's perspective having an uncomfortable interview or a bad experience with some aspect of the interview day can really color one's opinion of a program for the worse.

3. Do not believe everything the program tells you. Luckily, I felt like most of the programs that I visited both times on the interview trail were decent programs with program directors who sincerely cared about resident learning and development. That said, remember that the program is selling itself to you. No program will ever be perfect and without flaws. Residency training is an experience that is going to be painful at times, no matter how good a fit a program is for you. Knowing this, especially the second time through the process, made it easier for me to evaluate the programs more critically. Try to have realistic expectations of what they can offer you, so that you are not disappointed in the end.

4. Make sure the program matches your goals. This sounds obvious, but too often we are encouraged, especially in academic medicine, to solely focus on factors like prestige, fellowship placement, and research prowess when selecting a residency program. Think about your career goals and how the program will get you there. If you want to do a competitive fellowship then some of the above mentioned factors may be really important. If you want to work at a community hospital in primary care then things like job placement in the community and outpatient experiences during residency may be more important.

5. Look beyond intern year. On a related note, probe deeper into what the program will offer you in the long run. Ask residents if the program is supportive when they are applying to fellowships and looking for jobs. A lot of interview days focus on things like the intern year call schedule and how to transition to the city the program is located in. It is similar to the focus that many medical school applicants have on the preclinical curriculum when interviewing for medical school. The later years likely will be more influential on the direction of your career.

6. Talk to residents. Try to meet as many residents as you can and talk to all of them. See if you could really see yourself working with them. Determine if they seem happy, overworked, stressed, relaxed, etc. You may need to talk to residents outside of the program-sponsored lunch or meet-and-greet at the interview day to get the full story. Social events the night before can be a good place to get a decent sense of this.

7. Do second looks for yourself. There is a lot of debate about whether one should revisit top choice programs before making the rank list. I have been on both sides of this one now, as an applicant and as a resident lunching with re-visit candidates, and I really have no idea if it really helps an applicant move up on the rank list. There are some programs that emphasize re-visits at the interview day, so maybe at certain places it is more important to go and show interest. I am not really sure. Anyway, do re-visits if you feel they will help you make your list. I did two at programs I was having a hard time deciding between and it dd help me get a better sense of both programs. I got to meet more residents and to see the true work environment in real time. In the end, I thought they were helpful and luckily I did not have to travel too far to do them.

8. Assess the administration of the program. I have been lucky to be in a program with great administrative support for the past two years. Our program coordinators are awesome and I remember feeling that my interview day flowed really well. If the interview day seems disorganized, ask the residents how they feel about the program support. Things like getting a medical license and setting up computer access at various sites can be time-consuming, so having good administrative support behind you can be a lifesaver.

9. Trust your gut. Listen to that inner voice that tells you one place would be a great fit and that another would make you unhappy. First impressions are really important. I really think that we can pick up on subconscious cues while visiting places that influence our decisions. The vibe you get at the program is important.

How To Switch: Know Yourself

Going through the switching process you will do a lot of self analysis. First you have to make your decision, which can involve a lot of thinking and second-guessing yourself. Once you are set to go it is important to sit down and figure out a way to articulate why you are switching fields in a clear, concise manner. If you go through the match again, you will have to write a personal statement, and the new programs that are reviewing your application are going to want to know why you are switching. Even if you pursue a spot outside of the match, programs are going to want a personal statement or a cover letter that explains why you are leaving another field for the one you are applying to. And you will need to be able to explain why you are switching at interviews. I was asked about it at every interview, as I expected, except one where the interviewer said he never understood why anyone would want to be a pathologist in the first place, so there was no need to tell him why I needed to leave. That was quite an interview...

Basically, you need to be able to convince a new program that you have legitimate reasons for switching, that you know why the current field was a bad fit for you, and how you know that the new one will be better. Think about past experiences you can use to make your case. For me looking back to medical school and even before was helpful. Be able to articulate clearly why your current specialty is not working for you and how you came to that conclusion. Have a vision of what your future in the new specialty will look like 5-10 years down the road.

How To Switch: Get Support

I must say on some days throughout this process I felt like I was crazy. This feeling seems to be pretty universal among specialty switchers with whom I have interacted. So it may sound obvious, but make sure you reach out to people you trust and get some support while going though this. People outside of medicine are great to give you different perspectives. But you will need to find some support from within medicine too. You will need help in figuring out how to proceed and having someone supportive while going through the process will help save your sanity. And from a purely practical and strategic standpoint, you will need to gather letters of recommendation for making your switch. Here are a few places where I turned for support from people within medicine.

Medical School. Initially, especially as I was struggling with whether to stay or go, I did not want my program to know that I was considering leaving. I also wanted to get a sense of what my options were, so turned to my medical school for help. My former dean's letter writer, the registrar's office, and the GME office were all very helpful in giving me big picture advice about how one goes about switching. Faculty in the fields I was considering switching into gave me good information about what programs would be looking for in a specialty-switching applicant. An adviser who had helped me decide to go into pathology gave me some advice about things I could consider within pathology that might be a better fit for my interests.

When I had made the final decision to leave, I turned to my medical school to help me go through the match again. My dean's letter was updated and I had to get some new letters of recommendation. Luckily, the pediatrics department at my medical school and some of my past letter writers were very supportive and helpful with the needed letters. In the end, I could not have switched without having my medical school behind me. I am very grateful that I attended a school that is so supportive of its students and graduates.

My program. Although the idea of telling my program that I was thinking about leaving felt daunting and scary at first, I knew that things would go much more smoothly for all parties involved if I was up front and honest with them. In the early stages, when I was unsure of whether I really wanted to switch, I needed some advice about how to find my niche in pathology. I identified a faculty member with whom I had a good relationship. This faculty member was someone who worked with a lot of residents and was familiar with the training program. I felt I could trust this person to give me good advice and to keep my dilemma confidential. I was right. We had several meetings over the course of my decision making and the faculty member was supportive, gave me things to think about, and also helped me change my schedule a bit to explore areas that might be a good fit for me within pathology. When my decision was final, the faculty member helped me determine the best timeline for notifying my program director.

I spoke to my program director in the early fall. This was the time when I was starting to put together my application for the match and when the program was getting ready to start screening applications. It really well--my program director was very supportive, offered to write me a strong letter for my application, and gave me the date by which I had to tell them my final decision so that they would determine how many positions to take in the next match.

At that time I also spoke with another faculty member, with whom I had worked fairly extensively, about obtaining another letter of recommendation. Ultimately, I ended up with two good letters from my current program to supplement the letters from my medical school. Even though I had re-entered the match, I was till not 100% sure I was leaving until December. I wanted to get some more surgical pathology months in before I made my final decision. Once I realized I was definitely leaving, I told a few of my fellow residents and gave my program director my final decision. I was set to switch.

How To Switch

Once the decision is made to switch fields, how do you go about doing it? As I quickly discovered there is no one-size-fits all answer to this question. There is no formal system in place for residents who want to change fields. In a way this makes sense because people decide to switch at different stages of training and, depending on the switch that is being made, may have very different needs when looking for a new training program.

For me leaving pathology would mean starting over. Since we do not do a typical intern year, I would not get credit for the work I had been doing that would be applicable to the new clinical field. Having to start over made things simpler in one sense. I would be looking for an intern position, so going through the match again would give me the most options. Otherwise, I would have to find an open intern year position somehow.

There are several websites that offer to help residents find new residencies like FindAResident, and Resident Swap. Once I realized I would most likely need to go through the match again, it seemed like they would not be that helpful for me.

Much of what I learned about switching fields came from advisers, blogs, reading stuff on Student Doctor Network, and talking to people who had switched. In the next few posts I will go into detail about some of the key things I learned about switching.

Bread and Butter

I found an intact bread and butter pickle chip in a resection of cecum today. It was snuggled inside a diverticulum. Damn, that must have been painful. And to think a little pickle could cause someone to need a bowel resection. You never know what you will find in pathology on a grossing day.

And yes, I submitted a segment of pickle in a cassette for processing. Tomorrow it will appear under the microscope. My attending has a good sense of humor, so I think he will enjoy it. The PA told me today that she once submitted a piece of sausage for processing and sectioning to see what kind of meat was really in it. They put it under the scope and saw kidney, liver, and some unidentifiable tissue. She said she really has not eaten much sausage after that. I guess the moral of that story is do not ask questions if you are not prepared to deal with the answer.

Time To Go

The year progressed. My schedule was pretty diverse so I got to sample several different areas in pathology. Early in the winter I met with a really supportive faculty member in my department who gave me an open ear and some advice about my struggle with missing patient care. We got my schedule rearranged a bit so that I could sample the areas of pathology that were more clinically-oriented. I also started reaching out to advisers from medical school to see what my options were if I decided to switch. They were all very supportive and helpful. In the end it seemed like my best bet was to keep exploring pathology. Since I had invested so much to get to this point, and had really enjoyed what I had seen of the field as a medical student, I was not convinced that I had explored the field enough to make a decision to walk away from it. And from a logistical point it was already pretty late to re-enter the match for that year. Because pathologists do not do a standard intern year, I would need to start over as a PGY1 in a new field.

There was not really one moment that I can point to as the turning point for when I made the decision to leave. I knew that I wanted to give the field enough time to get a good sense of all of the options available to me in it. Since I was missing patient contact I figured I either needed to find a niche where I felt that need was fulfilled, or I needed to find something that intellectually excited me enough to give me fulfillment in another manner.

So I did a month on the FNA service where I got to see patients. I liked the interactions but was not drawn to the morphology of cytology. Blood banking was a pretty clinically-driven rotation. I had a list of patients getting special products that I followed, did a lot of consults, and even saw some patients; however, I was not drawn to the lab side of things at all. Hemepath was similar--I loved the consults and even some of the initial morphology. But I was not passionate about the molecular side of things, which would not bode well for a future in that area.

Then there was anatomic pathology, which had drawn me to the field as a medical student. I had not enjoyed autopsy as a medical student, so was not surprised when I hated my autopsy rotation. But surgical pathology was a surprise. As a medical student I had really loved it--the excitement of frozens, following a specimen from grossing to looking at the abnormalities under the scope, the satisfaction of making the diagnosis. It just wasn't what I had thought it would be when I did it as a resident. I hated going into the ORs and the stress of frozens. Grossing was gruesome and tedious. And I just did not feel that excited or intellectually stimulated by the work at the scope. That excitement I had felt in the course during 2nd year of medical school and on my rotations 4th year just was not there. Given that the majority of private practice and many academic jobs have surgicals as a large portion of the daily work, not feeling the love for surgicals was a big problem.

As I was feeling of these things, I saw that my colleagues were thriving. Where I saw a complicated, tedious specimen that I dreaded grossing and doing a multiple stain IPOX work-up on, they saw a challenging, interesting diagnostic puzzle to solve. It became clear that the field was just a bad fit for me. While the prospect of having to enter the unknown and go through the match again was really scary and unsettling, I really could not see myself doing pathology for the next 3+ decades of my life. That was the final driving factor in needing to make a change.

How Do You Know It Is Time to Go?

As I was saying in my last post, now that things are set with my new career move, I feel more free to write about what occurred. It is my hope that writing about switching specialties will be helpful for someone out here. From what I saw, there is not much concrete information out there about switching. I think that this is because there is no formal process for switching fields and the experience can very different depending on one's situation. But I do know that I am in good company. Several of my medical school classmates have switched fields already, and my own program has several residents who came to pathology from other specialties. And two of my favorite medical bloggers, Scutmonkey and Panda Bear switched specialties. So it is not that uncommon.

The question above was the first one that I had to answer when this all begin. It is also one that has been posed to me by many people as I went through this process. Unfortunately, the answer is not a simple one. If it was, I probably would have made the decision a lot more quickly and spared my friends and family endless conversations about what the hell I should do with my career. {A huge thank you to all of you out there who stuck by me in this rough period.}

Anyway, it all begins when residency started. I was excited and thrilled to be at my top choice program in a wonderful location. At first everything was fine. Yes, it was a big transition from medical student to resident. And it was a huge transition from clinical medicine to the world of pathology. It hit me early on that something might be slightly off. Whenever I presented a case or gave a talk, I got feedback that I was doing such a great job of addressing the clinical issues at hand. To me this was surprising because I was just doing what I had been trained to do in medical school. When it came to the lab side of things, I was lost. Completely lost. But I was told this was to be expected, since we do not learn about the clinical lab in medical school, and that I would get better at dealing with lab issues in residency.

It hit me that fall that I really missed patient care. I had expected this would happen, since I had enjoyed a lot of aspects of clinical medicine and struggled to decide between pathology and peds/FP during my 4th year. But I had not really expected the feelings would be this intense. I spent tons of time reading through patient's charts when dealing with their lab issues. Also, I was studying for Step 3 and realized I was more interested in that studying than doing the reading I should have been doing for my rotations. My friends from medical school were all suffering as interns. But I found myself being a bit envious of what they were doing while I sat at a desk all day (of course I valued the sleep I was getting most nights). So I put some feelers out to my fellow residents and tried to find out of this was a normal part of the transition to pathology. It seemed like for some people it was something that had to be gone through. And maybe I would be more interested in the more clinically-oriented subspecialties in pathology, like Blood Bank, Hemepath, and Cytology.

I figured things would get better if I gave it more time and moved forward. As the year continued I saw how diverse of a field pathology is. Medical students usually get exposure to surgical pathology and maybe to autopsy. But the field is so broad and encompasses everything from running blood bank or microbiology lab to forensics to seeing patients in an FNA clinic all day. It is possible to have a career in pathology signing out only subspecialized surgical specimens or only looking at flow cytometry in a reference lab. I remembered being told when I was a medical student that medicine was so broad that everyone would find their niche somewhere. Pathology seemed similar. People found what they liked, did fellowships, and could try to mold a career to cater to their interests. I would find that, I thought. It would just take some time.

To be continued.

Changes

Wow, it has been over a month since my last post. That is really bad. If I had gone more than a couple of days without blogging in the past it would have been a really bad week.

Anyway, a lot has been going on for me. Actually, a lot has been going on with me for quite awhile now. I just have not been able to write about it. But now I finally have some resolution, so it can come out so to speak.

I am leaving pathology. Last week I matched (yes, you read that right, I went through that nightmare process again) into a new residency program in pediatrics. I will be starting residency over in a new field come June.

This may seem out of left field, but believe me it is not. I have been really miserable with my choice of specialty for quite awhile now. It just took me some time to figure out that the field was truly a bad fit for me and how to extricate myself. Overall, it was one of the hardest decision I have had to make in a long time. But now that it is done I feel so good. It is so freeing to have an end in sight.

So I am finishing up my year in pathology and then will get started in peds. My program has been nothing but supportive and super-nice about this whole thing. I have not regrets whatsoever about my program--it is excellent and I would recommend it to anyone doing pathology.

Believe me, I have a lot more to say about this whole thing. But I have to end this post and get some work done. More to come. I will be better about writing now that this is all resolved. Stay tuned.

Autopsies

We had an autopsy today. On my current rotation, we do a bit of everything. Most of the workload is surgical pathology, but there is also cytology, and the occasional autopsy. For some reason having the rare autopsy seems rougher than doing an entire month of autopsy rotation. Like most pathology residents I am not a fan of autopsies. I get that they can play an important role in providing closure for the family after the death of a loved one. Sometimes they can solve medical mysteries. And autopsies can provide a good learning experience for pathologists and for clinicians.

But I just find the whole process to be disturbing on a very visceral level--the smells, the sounds, the general gore. When I did a month of autopsy there were cases so frequently that I was emotionally prepared (at least on some level) for doing them. The guard was up. Now having one dumped on our desks at 11 am to be performed at 1 pm does not give much time to prepare emotionally. It is one aspect of this field that can definitely be really draining.

2010

Happy New Year! I have been quite a blogging slacker. I have realized that it is just not that easy to maintain blogging as it was as a medical student.

Anyway, I had a nice December full of elective time and vacation. I still need to post my Hawaii pictures. We have yet to get them onto the computer! I spent my work days working on medical education materials for medical students on the Hematology rotation, looking at interesting Hemepath cases, and generally leaving by 5 pm every day. Life was great. In very exciting new we got a Wii for Christmas and that has been sucking away tons of our time. I am playing Zelda and remembering why I loved this series of games so much as a kid/teen.

Now I am back on surgicals. At least I am at the county hospital, so the workload is a bit lighter and the atmosphere more mellow. It is nice to have a different type of caseload as well. Instead of the zebras and the hours of grossing in tumor after tumor, I am actually seeing more of the variety that one would see in the typical private practice job--appendices, gallbladders, bowel resections not for cancer, skin, GI biopsies, etc.

Of course, being county we also get our share of things one would rarely see in private practice: organs with stab wounds, bowel resections for gunshot wounds where we hunt for the bullets, and, everyone's favorite, objects extracted from body cavities. According to the PA, the most dramatic objects ever extracted were 3 softballs.... I will go no further to keep this PG-13....

The Haiti situation is just heartbreaking. Partners in Health has been my choice for donations. Other than that it is frustrating feeling like I cannot do much more to help. CAP, the national pathologist organization, sent out an email addressing this for pathologists, suggesting that we can get involved in re-building hospital laboratory facilities once things are a bit more under control there. What a tragedy.