I Have a Job!

I can’t believe I’ve made it to this point - PA school is actually wrapping up. We’ve taken our last exam and only have a couple of days left at our clinical rotation sites.  This time next Friday I will have already walked across the stage and received my diploma! The only thing left to tackle is the ASCP Board of Certification Exam. I’m terrified, to say the least, but I’ve signed up to take my exam at the end of January. Unfortunately I’ll be hitting the books hard until then.

So without further ado, I think it’s time to share that I HAVE A JOB!  Starting in January I’ll be working at a hospital outside of Baltimore, Maryland. The department has three pathologists and I will be the first pathologists’ assistant they’ve had. I will work 100% in the gross room and will not be doing any autopsies, as they are sent to another location. The lab receives around 9,000 surgical cases annually and does a decent amount of intraoperative consultations.  I loved that the lab receives a variety of specimens including Whipples, mastectomies, and quite a few penectomy cases (a rare specimen, typically).  It was important to me that I’d be in an environment that would continue to challenge me and expand my pathology knowledge.

The lab is also a clinical rotation site for PA students attending the University of Maryland. This past year increased my confidence, knowledge, and skills exponentially because of the mentors I had at my clinical rotation sites. I’m excited (and a tad nervous) to be able to have a role in educating future PAs, ensuring that they have a clinical experience similar to mine.  

Accepting a position in a lab with a wide variety of specimens and teaching opportunities was at the top of my priorities. An added bonus was that the job was in my desired location, only 45 minutes from home! After so many years of schooling, I can’t wait to finally start my career in a field that I love!

Top 10 Tips for Clinical Year

With only 4.5 weeks left until graduation, I thought I'd give my top 10 tips to having a successful clinical year!

1. Never take a pathologist's criticism personally. You'll soon discover that every pathologist has their quirks and preferences. Just be willing to go roll with it; you'll develop thick skin in no time. But at the same time, welcome constructive criticism with open arms. Listen to their critiques and adapt yourself for the next time you receive that specimen.

2. Try your best to never make the histotechs angry. You don't want to make them work harder if it can be avoided. Strive to not submit staples or super thick fatty sections!

3. If you notice that the techs need help accessioning, printing cassettes, etc. and you have a few minutes to spare - lend them a hand! They'll appreciate it and it'll give you a better understanding of what goes on in the lab.

4. Don't get discouraged if your first ever lymph node search takes 2 hours (it happens to the best of us, you'll get better)!

5. Don't be afraid to ask questions. You're learning; it's ok to not know something. Better to ask than to jeopardize patient care.

6. Along those lines, sometimes you will feel that you are asking a million questions. Don't worry - your mentors are saints and are incredibly patient! They will do anything to help you out.

7. Don't be scared or intimidated of specimens. This is your chance to soak in as much as you can. It's better to stumble through things now than to have no clue what to do once you're working in the "real world". If you've already grossed 36 hysterectomies, try getting out of your comfort zone and picking up that kidney instead.

8. Build relationships with the pathologists and PAs - networking can land you a job that you may have never been originally considered for!

9. Work smarter, not harder. Pick up tricks/tips from your mentors.

10. Have fun and love what you do!

PathMD

I’m not sure where this year has gone, but here I am at my 10^th and final rotation site – PathMD in Los Angeles, California.

PathMD is a private lab, aligned with UCLA and Miraca, providing pathology services to clients throughout the country, primarily Southern California.  The lab is relatively new and started accepting specimens in September of 2012. The Director of Operations, a pathologists’ assistant, had major input in designing the laboratory. As a result, the lab is state of the art with beautiful Thermo Scientific equipment and a well-designed layout.  In addition to the gross room, the lab also houses histology, cytology, and billing offices.

The lab processes specimens primarily from outpatient procedures and averages around 13,000-14,000 cases annually. The typical workday will include grossing GI biopsies, nasal contents, skins, EMC/ECC, and hysterectomies. Occasionally, the lab receives breast specimens, thyroids, salivary glands, gallbladders, and tonsils. All the specimens are grossed in the lab and then sent out to be read by board certified pathologists.

The lab is extremely generous and provides the PA students with housing for the duration of their rotation - an apartment in walking distance to the lab.  They also provide our flights to and from Los Angeles.  The environment at PathMD is really positive and lively; everyone has been awesome to work with.  They also made a really well done YouTube video describing the workflow in the lab.

Loving the sunshine during the walk to work every day

Trips to the beach have been an added bonus!

UPMC Presbyterian Hospital

This post, like many of the others, is long overdue. It seems the closer we get to graduation, the more hectic each day becomes.  It’s crazy to think that in three weeks I’ll be leaving for my last rotation, in Los Angeles. And then just eight short weeks after that I’ll be graduating (and hopefully have a job). Where has the time gone?

I’ve moved back to Pittsburgh and am starting my fourth week at UPMC Presbyterian Hospital.  The Anatomic Pathology Services at the UPMC sites are based on a Center of Excellence model. This means that all pathology material gets triaged to subspecialty benches so that pathologists who have fellowship training and subspecialty interest in that organ system are the ones signing out those particular cases.

UPMC Presbyterian has the following Center of Excellence specialties: gastrointestinal, ENT, thoracic, cytopathology, neuropathology, medical kidney disease, transplant pathology, hematopathology, and autopsy pathology.

Presby has a countless number of pathologists, multiple residents, seven pathologists’ assistants, and three grossing techs. They have a beautiful set up with state of the art grossing benches, CoPath, and VoiceOver systems.

This has been my first experience at an academic hospital, in which there are residents who also do some of the grossing.  Sometimes it’s like a fight to the death to get the “cool” specimens. Ok, it’s not really that dramatic, but since I’ve been used to automatically getting whatever cases I want, it has been a change to have to share with the residents.  Every night I go home praying that my super cool specimen survives the night, untouched by residents, and is still sitting there the next morning. 

This past week I got my first pancreaticoduodenectomy (Whipple) specimen. This is one of those specimens that seem super scary while you’re in school, but aren’t actually too bad once you have it on your grossing bench. For those without a medical background (or just need a refresher) - the Whipple procedure is a surgical operation, which involves removing a portion of the pancreas, duodenum, common bile duct, and other organs (sometimes the gallbladder and a portion of stomach). This procedure is used to treat pancreatic cancers involving the head of the pancreas, tumors involving the common bile duct, duodenal ampulla, or duodenum near the pancreas.  Our job is to describe where the tumor arises, figure out which structures and organs it involves, and make sure the margins are clear and that the surgeon has removed the whole tumor. It seems really daunting at first because you end up with an en bloc removal of multiple organs, but if you use a systematic approach to grossing the specimen, it isn’t too bad.  

This is the "normal" configuration of these organs.
The blue depicts the parts of the body that are
removed during a Whipple procedure
(courtesy of Wikipedia).

After a Whipple procedure. The pancreas, small bowel, and stomach are joined back together (courtesy of Wikipedia).

It’s been really exciting being able to gross some unique cases and specimens that I've never seen before. In these last few months I’m trying to soak up as much as I can in order to be best prepared for my first job.

Conemaugh Memorial Medical Center

Time has been flying by and it’s hard to believe there are only 18 weeks of rotations left! It was sad leaving Thomas Memorial, which had quickly become one of my favorite rotation sites. The past few weeks have been consumed by serious board exam studying, applying for jobs, and preparing for interviews and presentations.  I promise to work on more creative posts for the upcoming weeks!

Tomorrow starts the third week of my rotation at Conemaugh Memorial Medical Center in Johnstown, PA. Conemaugh Memorial is a general medical and surgical hospital. The hospital has a plethora of graduate medical educational programs, which include medical student rotations, histotechnology rotations, pharmacy rotations, and of course us – the PA students.  As for the city, Johnstown is located 60 miles east of Pittsburgh, has a population of 20,402, and is most famous for their three major floods (they even have a "Johnstown Flood Museum").

The pathology lab has three pathologists and receives around 16,000 specimens annually. This is a paired rotation, meaning two PA students are working in the lab at the same time.  Just like at Thomas, we are responsible for all of the surgical specimens. So far the more complex specimens have consisted of mastectomies, colectomies, orchiectomies (testicles), and prostatectomies. It’s also a unique rotation in that we gain both surgical and autopsy pathology experience. We primarily work in the gross room with the surgical specimens, but whenever there are autopsy cases my classmate and I will alternate who goes down to the morgue to assist with them.

Thomas Memorial Hospital

This post is long over due since it’s already the end of my third week at Thomas Memorial Hospital.  I've been preoccupied with moving out of my Pittsburgh house (for good), becoming acquainted with Charleston, going back to Morgantown for a test, and watching the World Cup (biggest, yet best, distraction). It's hard to believe that I'm at my 7th rotation site already, only 3 more to go! Which means it's also crunch time for finding a job.  I've been applying to many places, but am really hoping to find one in DC, Maryland, or Virginia.

Now for a little about my current rotation site. Thomas Memorial is a general, community-based hospital located in Charleston, WV. There are three pathologists here and the two PA students are the ones responsible for grossing all the specimens. The pathology department receives around 10,000 surgical cases annually so it’s been more of a slower paced working environment than some of the other hospitals we rotate through.  The specimens we typically see here include placentas, gallbladders, total hysterectomies, colons, and thyroids.  I’ve found that I really enjoy working at these community-based hospitals where you get to have ample interaction with the pathologists and histotechs.

The grossing stations are really nice and we even get our own office, which has been great for studying if we finish our specimens before the next drop off time! And get this- they give us free lunch every day! Taco Tuesdays are now the highlight of my week. I’m not sure if I mentioned this before, but the pathologists at Thomas Memorial Hospital provide a house for the PA students in Charleston while they are rotating through Thomas and St. Francis hospitals.  I am so grateful that they were so accommodating and that we weren’t responsible for finding our own housing down here.  

Uh-Oh - A trip to the ER!

When you work with scalpels for 40 hours during the week your odds of cutting yourself are significantly higher than the average individual.  I was able to go six months before the odds were no longer in my favor.  I had just put away a really gruesome leg amputation specimen and changed my scalpel blade (thankfully) to start working on some bone specimens. I took my first section out of a femoral head (remember this guy from my getting a workout at work post?) and was going back for more when the specimen rolled and the scalpel rolled with it – straight through my middle finger.  And when I say through, I mean the blade went in one side of my finger and out on top of my knuckle (there was a lot of force behind this cut).  Thankfully, I work in a hospital and could walk upstairs to the Emergency Department.  Because I was working with another human’s body parts, it wasn’t enough to bandage me up and send me on my way. I had to be sure that I didn’t become infected with any bloodborne pathogens (mainly HIV and Hep C). After testing of all parties involved, the results were negative, which was a huge relief!

All smiles in the ER - yes my supervisor did capture
every step of the adventure

Of course it had to be the middle finger!

Injuries like this are a very real part of being a Pathologists’ Assistant – typically they aren't as severe as this one, but nicks and scrapes are bound to happen.  We handle many tissue types and bodily fluids each day that it’s important to be aware of the exposure risks that we may encounter on the job. I was very lucky that I had been cut with a new blade, on a specimen that had been in formalin and then a decalcifying solution (makes bones softer) for two days.  If I had cut myself on a fresh specimen, like the leg I was previously working on, I may not have been so lucky.  Moral of the story –  stabilize femoral heads and if a specimen requires that much force to take a section, it's probably not ready to be cut!

You could definitely say I went out with a bang my last week at Butler Memorial Hospital. No worries though, I’m able to continue grossing as usual and have moved down to Charleston, WV to start my next rotation at Thomas Memorial Hospital.

Butler Memorial Hospital

Tomorrow will be the start of my fourth week at Butler Memorial Hospital (BMH). This is the first year that WVU PA students will be rotating through this site.  The hospital is located about 30 miles north of Pittsburgh, about an hour drive.  BMH receives around 16,000-18,000 surgical pathology specimens annually and does not complete any postmortem examinations.  The specimens range from simple GI biopsies and skins to more complex specimens such as colons, prostates, and mastectomies for cancer.

The pathology department has six pathologists with specialties in dermatopathology, hematopathology, and general pathology/cytology.  Butler has a pathologists’ assistant who is actually the mom of one of my classmates (she is awesome!).  In addition, the laboratory, gross room, and histology are all in the same area so we get plenty of interaction with the histology/cytology techs as well.

Butler, like many other pathology labs, uses voice recognition software (turns your talk into text so that you don’t have to keep touching the keyboard with bloody gloves) for dictations.  After three weeks, I’ve come to the conclusion that voice recognition software can be your best friend or your worst enemy.  It’s a great alternative to manually typing dictations, but sometimes it is quite finicky.  Sometimes it will comprehend the most complicated medical terms such as “malacoplakia” or “biliary dyskinesia”, but then won’t understand you when you say “with” or “the”.

And then there are the times where your mouth just stops working and spews out an incoherent word “cholelithalksjjs” and you think, “there’s no possible way the computer understood that”, and then it does “cholelithiasis”.  For any Harry Potter fans, it reminds me a lot of the first time Harry Potter used Floo Powder (except in this case the software still lets me into Diagon Alley):

Voice recognition software conundrums aside, I’m loving my time at Butler Memorial Hospital.  I love having the high specimen load to keep me busy throughout the day and love being able to gross some more complex specimens. It’s definitely a competitor for my favorite rotation site.