Sunday, October 5, 2014

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.

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