Wednesday, March 31, 2010

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.

Sunday, March 28, 2010

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.

Saturday, March 27, 2010

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.

Thursday, March 25, 2010


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.