Last Week at Ruby Hospital Surgical Pathology Laboratory

This past week has been a bit busier than usual, but I've become inured to that by now. Ever since the start of this weekend however, I have had so much free time I didn't even know what to do. That's a good problem to have. So, this morning I decided to take a trip to downtown Pittsburgh and finally check out the Strip District. It might have a racy name, but what it is is an open market where people gather to sell their produce and crafts. There are all sorts of foods that you can buy and there are a lot of ethnic supermarkets over there as well. Also, I saw one of the most bustling fish markets of my life over there. It was an interesting break from the studying and presentation preparation that I had been caught up with.

My presentation on the pituitary gland went as smoothly as possible. I modeled the style after our pathology power point lectures, introducing each pathology one-by-one and explaining them in turn. I believe that I covered the major pathologies associated with it and am satisfied that I created it to my own flavor. Each professor has their own 'feel' to their lectures and I hope to follow that mold.

While in the gross lab I have become quite good at completing biopsy specimens at a rapid and efficient pace. It's just the larger specimens that are still a stumbling block for me. I'm grateful for every big specimen that I can get, but I still need more practice to increase my speed. There are a variety of factors that are inhibiting the rapid completion of the bigger specimens that I do. My biggest problem is trying to find the right wording in how to describe an object. (eg. The renal medulla is comprised of... no... The renal medulla displays multiple tan-brown, pyramidal... no, that's not good... ah, screw it. The renal medulla is unremarkable.) Thank goodness I had the residents and the PAs to help me improve my dictation. I just need more big specimens. The people at Ruby have my sincerest gratitude.

I also recently went to go get my cholesterol checked and surprisingly it went up. In the winter or fall of last year I was surprised at my continued high cholesterol so I made changes to my lifestyle that included cooking with extra-virgin olive oil, not using margarine, limiting my meat, avoiding cheese, avoiding salt and sugar, eating whole wheat products, eating more fruits and vegetables, jogging every other day and so forth. Looks like that hasn't worked, so now I'm really pissed. I also discovered for the first time that I'm in the 'pre-hypertension' range. Before it had always been below 120/80. I'm going to conquer this cholesterol and blood pressure thing once and for all. For the next six months I'm going to absolutely not use any oil, sugar, or salt in my cooking, nor eat a single piece of chicken, pork, beef, hamburger or hotdog. Not a single scoop of ice cream, a single slice of pizza, a single piece of pie or cake, not even a measly cookie is going to reach the bottom of my stomach. (No, I'll not become bulimic.) Instead of jogging every other day, I'll be jogging at least 20 minutes everyday. I've done too many autopsies where people who don't look unhealthy have ended up dying from MIs caused by atherosclerotic coronary arteries. I'm not going to go out like that if there's anything I can do about it.

As you can probably see, working in the field of pathology gets you thinking about health issues a lot.

For the next couple of weeks I'll be starting an autopsy rotation again, this time at  UPMC Presbyterian. I'm really looking forward to it! I don't have any particular disliking of autopsies, but when compared to my classmates you could say that I'm a little more enthusiastic to preform them. Nevertheless, it's always important to approach the autopsy from a forensic perspective rather than a human one. I don't want people to pass away just so that I can do autopsies. But, if they are coming my way anyways, I'll do my best to shed the light that will bring comfort to their family and friends.

The back-way to the strip district. A lot of the shops on this side were closed and abandoned, so it must have been quite a bustling place in the past.

So many homemade delicious pastries to choose from. I soon left for greener pastures.

If you can make it by hand, you can find it here. There was a plethora of great food available for tasting as well.

Next to the costume shop was a haunted house! It won't be open until Halloween, but it would be a good diversion from studying for a night.

This place seemed to be the hot spot for brunches. Every seat in the house was packed and all the people outside were waiting to get in.

The legendary fish market. Your source of omega-3's for studying.

Lots of outdoor shops. It doesn't look crowded from these pictures, but it was really bustling.

Walking down the strip. There were a multitude of ethnic supermarkets to choose from.

Farmers selling their fresh and organic produce.

Test and Presentation

A test and a presentation on the pituitary gland on Friday are keeping me from writing a new post at the moment. Saturday can't come soon enough! Until then, take care everyone.

Week One at Ruby Hospital Surgical Pathology Laboratory

I've always preferred living in the countryside and moving back to Morgantown from Pittsburgh has been like a fresh breeze after a smoggy day. I'm back with my landlord who has been kind enough to create a special lease just for myself that covers only the few weeks I'll be here. One of the advantages to staying at a person's residence is that you can form a very cordial relationship with your landlord. Their family has made me feel welcome every time I'm here, going so far as to invite me to their family events. I'm more than happy to oblige. I don't mind solitude either, but it's a nice perk while studying in graduate school. I've become a part of this family so much now that I'm taking care of the house as if it were my own. Today, after they had treated me to a buffet for Mother's Day, I worked outside for a while gardening along the side of their property. You can't do something like that at a faceless rental management agency.

Work at Ruby has been surprisingly smooth thus far. At Allegheny I had become accustomed to the voice recording dictation system and assumed that I would have difficulty transitioning back into using CoPath for dictation. Within the first few days however, many of the things I had learned in CoPath at Magee Women's Hospital came flooding back to me. I have noticed that because of the headphone-dictation system the gross room is a bit more quiet than what I was used to at Allegheny. That hasn't stopped me from absentmindedly leaving my recorder on plenty of times while talking with the people around me. When I turn back to my computer I'm greeted with a novel of words which have transformed the screen into a blob of gibberish.

Another slight difference I have noticed is that the tools that we use differ between each site. For example, many of the biopsy specimens at Allegheny are submitted in biopsy cassettes which have holes that are small enough to prevent the specimen from leaking out. At Ruby, the normal cassettes are used more often which means that many biopsy specimens need to be placed in between a pair of sponges or placed in small biopsy bags. Also, over at Allegheny, cassettes had to be ordered from the accessioner directly because we didn't have access to a computer terminal, but at Ruby we can order cassettes directly though CoPath.

Ruby has also instituted an interesting system for inputting requisitions, containers and cassettes into their computers. Each case has a special square label/code that is assigned to it in the gross room and requires that you scan the requisition, container and associated cassettes into the computer before starting. I think that it's a good idea to prevent cassettes and samples from getting mixed up. Sometimes it can be a pain though when you have multiple containers and multiple cassettes for each container and they all must be scanned. Even though they are all scanned, I still spend the brief amount of time it takes to double check visually that I have the right containers and cassettes.

All in all, I'm looking forward to another week building more experience in the gross room. This rotation is especially short (only three weeks) and it's hard to believe that by Wednesday it will be half completed.

Just your average gross dictation.

Last Week at Allegheny General Hospital Surgical Pathology Laboratory

Last week I had intended to write another post about something practical, but time caught up with me and before I knew it I was busy just as before.

These rotations are really flying by, but I'm very grateful to the people at Allegheny who helped me while I was there on my rotation. I was introduced to a wide variety of specimens and wish that I had more time to spend there. Everyone was very helpful and I believe that I fit right in.

There were times when I made a few mistakes (and I also caught a few mistakes made by others) but it was a very instructive experience. I'm a very 'by-the-book' type of person and I follow textbook instructions almost religiously. At this rotation I learned that I need to be more accommodating. Each pathologist has their own preference in what they want to see in a specimen. For example, some pathologists just want representative sections from an appendix while others would prefer that you submit the appendix entirely. Some pathologists want you to separate the fat from lymph nodes in a cancer case whereas others want you to submit the lymph nodes and fat all together.

When you're just starting out at a new place, you don't have a good grasp of what the protocols are until you've spent some time there. It's for this reason that 'CYA' or 'cover your arse' is so important. I have been saved numerous times when a pathologist has requested more sections thanks to me saving and stocking every little bit of remaining tissue. Another thing that I have learned to 'CYA' or as it pertains to me 'CMA' is to ink multiple pieces from the same part into multiple colors rather than just use one color. (It ends up being a bit amusing when you're looking into a cassette and you think to yourself, "Why does it look like I'm submitting skittles in my blocks?")