Last Test at School!

I have been remiss in writing a blog post, but I’m happy to say that finally our last test at WVU is over and finished! It’s good to know that the only remaining test is the ASCP certification exam. I’m still registered to take it back in Fresno, California six days after the last day of our rotation. I’m feeling confident that I can pass it right now if I were to take it.

This latest test has been good in reminding me certain areas that I should be focusing more time on. I did very well, but I have been neglecting studying forensic pathology and histology/stains. It’s not uncommon for people in this field to focus on one subject to the exclusion of all else. My pathology and anatomy are down pretty well pat.

Still I haven’t heard any word from USCIS and our application for the K-1 visa. It has been over 7 months now which is very unusual to say it lightly. I have called, but the only answer that I get is that the processing center is still very busy and has yet to reach our application. It’s a big kink in our future plans, but I have only one option and that is to wait.

The days in Pittsburgh have been growing colder and colder and for a person who is ill-adjusted to cold weather, many of my conversations with those around me at work are about the harrowing adventures trying to get to work. The weather and the road conditions can play a surprisingly large role in your mood for the rest of the day. In the morning, if the roads are really clogged, then we’ll know that our specimen load is going to be really heavy. Likewise, if there’s little traffic, then the workload for the day will more than likely be lighter. It’s got to be more than just a coincidence.

With only two more weeks to go it has come time to pack up some of our belongings and get organized for our last big move of the year. We are giving away or throwing out furniture that we will no longer need. I plan on going to Goodwill and seeing how much from us that they will take.

I’ll try and get some good pictures of our graduation ceremony and convocation brunch for your viewing pleasure. It’s all coming to a finale!

One Year Ago

I can still remember how life was just one year ago. Finals were coming up and I was studying furiously while trying to juggle future living arrangements for Pittsburgh. Stress levels were high and I couldn’t wait to put down the books for once and use my hands. So how does life during the first year compare with this year?

   

I can say on behalf of all my classmates that not having three tests every week was a very welcome change. Whereas before I would spend a number of hours every day studying, this year I study according to my own schedule. For self-motivated students, being able to study when you want provides convenience and comfort. I can remember last year before many tests I would try and find a good studying spot. Many times that meant that I had to get bundled up in heavy winter clothes and brave the elements by walking to school or hopping onto the PRT to get to the library. This was all while freezing rain or snow was pelting my umbrella and body. I had to keep myself moving before the biting winds of the arctic tundra froze me in place. Now, our once monthly tests feel like a divine respite. With fewer tests we are at our leisure to study an hour here and there for the first and second weeks and then we ramp up our studying as the test date nears. It feels like a steady jog rather than an all-out long distance sprint. Stress from tests has definitely decreased during this second year compared to our first.

There are some other stresses that fill the stress meter, but they generally aren’t to the same degree as last year. There are times where work can be stressful such as when you are bombarded with specimens and you are rushing to complete them all on time before they have to go on the processors. But, generally, the stresses encountered at work can be left behind at work. At home, it is great to not have to worry about what may happen the next day until the next day actually arrives. Like in my first year, when I had one test coming up on Thursday and another test coming up on Friday, there was no way to truly relax from Monday to Wednesday, even at home.

This year, moving around from town to town was admittedly a bit of a pain, but after one day of packing and one day of settling in life would resume as normal. This year I moved a total of seven times between Morgantown, Pittsburgh and Charleston. That was more moves than all of my previous life. But, as I said before, once you have your place of stay all planned out, the moving step itself is not too troublesome. I knew that I’d be moving a lot so I purposefully packed light and all of my possessions can fit into two suitcases and a backpack.

Speaking of moving, one of the more stressful parts of last year was trying to find a place to stay in Pittsburgh. Each location has their own strengths and weaknesses whether they are related to price, distance from rotation sites, local crime, access to supermarkets and so forth. I was fortunate to be able to move together with a classmate to share the burden of rent and utilities. We decided on a place just outside of the downtown area and just west of the river. Our apartment complex has a couple of good things going for it. The price is relatively cheap compared to living downtown ($695 rent + utilities with free heating), there are supermarkets located nearby and the neighborhood is low crime. Commuting is a bit difficult for getting to Shadyside, but the other rotation sites are accessible. As I’ve mentioned earlier, I don’t drive in Pittsburgh so I carpool with my classmate and we save money by paying half and half for gas.

As the year has gone on, I have admittedly been feeling the pinch of tightening money supply. Debt only builds up the longer that one is in this program, so by the end, I have found myself doing silly things to save money. If there is free food offered at a conference for example I will fill my plate up as much as possible to save money on dinner. The bus system in Pittsburgh is unfortunately very expensive and so I don’t take trips to downtown, even though I would like to explore it. There is a great supermarket called Aldi’s where I go to buy groceries, even though it is farther away than the more convenient Giant Eagle. Admittedly, I do go to the occasional restaurant, but only for cheap buffets where I can eat a whole day’s worth of food in one meal. When new clothes are needed, Gabriel Brothers and sometimes K-Mart  are cheap places to go and shop. It’s necessary to micromanage your finances to alleviate the cost of living as the year progresses.

The amount of free time for relaxation and recreation that I’ve had this year has varied depending on each rotation site. On average, I would come home at around 5:00 PM and have the rest of the evening to do as I please. During the first year, classes may have sometimes finished by 2:00 PM or 3:00 PM, but with the amount of studying done after school the amount of time for relaxing was actually less than this year. This year, on some of my longer rotation sites when I came home at 6:30 PM or so I’d be too tired to do much so I would just make dinner, take a shower and head to bed. Still, in general I’ve had more time to relax and take life easier this year than last year.

Compared to last year, of course, I’ve become much more competent as a future pathologists’ assistant. The movements of grossing have almost become second nature, now. One interesting thing that I’ve noticed is that I’ve become much more ambidextrous than at any other time in my life. For example, I used to only be comfortable holding a scalpel and forceps in my left hand, but now, it’s just more convenient to work with a scalpel in my left and forceps in my right. Sometimes I even work with a scalpel in my right and forceps in my left. There has been a kind of rewiring in my brain such that the tools that I use are becoming extensions of my fingers. I’m sure that everyone else in my cohort is experiencing something similar.

A lot has happened this past year, but with good planning everything has gone relatively well without any major problems. Enjoying the second year in PA school isn’t hard to do. All it takes is to try your best at work, learn as much as you can from your PA mentors, don’t bring home with you stress from work and do some logistical planning in finding living arrangements. One year ago things were looking up, and I’m happy to say that things are still looking up.

Bureaucracy...

...if studying for the final fate-defining ASCP certification exam wasn't stressful enough, you can always count on our love for bureaucracy to make sure those catecholamines stay pumping. Lately, I've been stressed, not so much from studying, but because of my frustrations with paperwork and how sluggish some administrations are.

As many of you long time readers may know, for the past year, I have been in the process of getting Hanako's K1 visa requirements and forms completed. The K1 visa is required so that we can finally live together and marry after having been separated for more than 2 years. My forms from my initial application are currently being looked over by the Vermont Service Center. In fact, they've been looking them over for more than 6 months. While they look over the forms they perform a number of other different things such as background checks and if further forms are required then they will notify you. The average processing time for this form (I129F) at their facility is 5.6 months, so already our application is taking longer than average. It is frustrating to check on their website everyday only to see that our status is still stuck in the ever unchanging stasis of "Initial Review". I had incorrectly assumed that our application would be completed close to the average time and thus had already bought a plane ticket to go to Japan in December. Our plan was to then come back together on the same flight in mid January while using the K1 visa for her to enter into the US. Then our lives would be grand and you could stamp "happily ever after" at the end of our passports. Returning back together to the US at the same time is important because at the immigration window they are going to be very aggressive (speaking in brusk English) in asking her why she's coming to the US, who she's staying with, where she's staying and so forth. Previously, they were so rude that they brought her to tears. I won't let that happen again if there's anything I can do about it.

It looks like since I can't control how fast the USCIS processes our application, I'm going to have to return to the US in mid January alone and leave her in Japan until they get up to speed. When the application is finally complete, I'll have to fly back to Japan to meet her and then we can come back together as it should be. On top of it all, I get to pay thousands of dollars that I don't have for the pleasure of processing these forms. However, the responsibility is ultimately mine. I was naive to think that an organization of this size would be able to stick to their projected completion times that they publish. A part of me wishes that we could go back to the immigration efficiency once seen at places like Ellis Island.

In an unrelated but similar example of why I can't understand some aspects of bureaucracy is actually one of the requirements of the Pearson Vue testing center. Today, I was glad to receive a letter in the mail from the ASCP saying that I am now eligible to register a date on which I will take the PA certification exam. But, one of the strange things is that the testing center requires that when you go to the exam you must bring with you two IDs, both of which must contain your signature. Most people will use their driver's license for the first, but some people will have a hard time coming up with the second. How many people out there actually have two forms of ID with signatures on them? It makes me wonder if the testing center has had problems in the past with people faking driver's licenses so now they require two forms of identification. Perhaps one state derived ID is insufficient after all. I am fortunate in that I have a passport, but most Americans actually don't have passports. I'm curious as to what other forms of ID have signatures on them.

I had originally planned on taking the ASCP PA Certification Exam here in Pittsburgh before I returned home, but since my passport is back in California I have decided that it would be safer to wait until I got back. I can't risk mailing my passport to here because even if in the remotest chance that it got lost my life would be turned upside down. I certainly wouldn't be able to make it to Japan in time to meet Hanako and her family after all this time and anticipation. "It would be a disappointment" is a very big understatement. Taking the exam in Fresno, CA is no problem for me. It's just that there is a feeling of helplessness in not being able to follow through with the plans that you've already made. So many things are out of our control and we can't decide for ourselves when and where and how to plan for the future. I'm the type of person who avoids problems down the road by planning ahead of time. If there's something that can be done now, then I complete it and get it done. Unfortunately, it seems that no matter how well one plans, life has other plans for you.

That is perhaps the moral lesson of this all. You can't plan for the unexpected. Stay as flexible as possible and don't stress over the wrenches. Stressing never solved any problem. Stepping back I can see how silly this all is, now. I need to stop being so serious.

Week One at UPMC Shadyside Hospital

Our big monthly test for October has come and gone and it has been a heavy load lifted from our shoulders. This test was the last test on which we had specific reading assignments. The questions for our next test will come from any of the material that we've learned so far throughout this program. I believe that most of us are feeling confident now and we are prepared for most of what will come our way. To cram now for our next test would be an impossible task due to the amount of material that we've covered. Of course, I'll still be studying the material on some of my weaker areas, but rather than focusing on the specifics I'll be focusing on the general. Honestly, if I had the option to take our next monthly test as well as the ASCP certification exam tomorrow, I would go ahead and do it.

This last week at Shadyside I got the opportunity to handle many of the "gross-only" specimens that Shadyside gets. The ones that stick out the most in my mind are the femoral heads and knees, although there are many other smaller specimens as well. When doing many similar specimens over and over, the usefulness of templates cannot be overstated. What would be a 15 minutes job by free dictation is cut down into nearly 5 minutes. Each gross-only case is reviewed by the pathologist before being signed out, but it's up to the PAs to create not just the gross description, but also the final diagnosis and any comments that are needed. So long as my microphone doesn't mess up or my computer doesn't suddenly restart things should be smooth sailing.

Shadyside primarily handles two organ systems; genitourinary and bone/soft tissue. For the next three weeks I will be assigned to one and then the following three weeks I'll be assigned to the other. Shadyside Hospital is well known among the UPMC system for their entire examination of every prostatectomy. One of the special things that they perform is to strip the prostate capsule and examine it entirely for any tumor invasion. It ends up being a lot of blocks that need cutting, however you can't get any more thorough than examining the entire prostate. If ever I develop a malignancy in my prostate (which I hope not) then I might highly consider flying to Pittsburgh to get it taken out.

It's unfortunate that the apartment that I'm currently living in is on the other side of town from Shadyside. The commute to get there is the longest of all of my rotations. It will cut into my studying time but I'm sure I can make it work. A storm is coming in which is going to make traffic horrendous. If all goes well our car won't be blown off the bridge during our commute.

Book Review: Most Useful Textbook Award

Well loved and well worn.

A few minor adjustments.

Time and time again, ever since the beginning of the summer pathology course to even now, I have found myself coming back to reference and study from this textbook. It’s the BRS Pathology 4^th edition by Schneider and Szanto. It can be thought of as a condensed version of Robbins which removes a lot of the side content and tells you the main points behind each individual pathology. In fact, I find studying from this bullet-point style book much easier than having to wade through paragraphs and paragraphs to get to the bottom of my answer in Robbins. The information is presented with as little flair as possible which leaves just the delicious tenderloin meat of pathology left over. What would take me a whole day in reviewing an organ system takes me no more than 2 hours.

This book not only serves for me as a quick reference and study guide, but also as a practice review. The end of each chapter is filled with up to several dozen practice questions that hit the main pathologies from each section. The questions are in multiple-choice, which also helps us to review for our board exam once we graduate. The questions cover a good variety of topics, but the difficulty could admittedly be a little tougher. After having reviewed the entire book over and over and over, one gets to the point where just by reading the first sentence you already know that the answer is C.

As a book which condenses pathology into understandable bite-sized portions there are some pathologies which are glossed over or omitted entirely. It does a fine job at introducing most of the pathologies, but for the successful pathologists’ assistant, only knowing “most of the pathologies” is not going to cut it. You can see that I have made some “improvements” and have written my own notes within the book. Whenever I have come across a pathology that needed more elaboration or was not included in the book, I write it in myself in the appropriate chapter. Over this past year and a half it has become a much more personalized item and if there’s an entry I need to look up I know from my own memory the approximate page it’s going to be in. It has also been useful for me to write in non-pathology notes in the pages, for example explanations of different surgical procedures or surgical hardware/tools.

The last minor irk that I have with this book is that it’s not made from titanium. I’m afraid one day it’s going to disintegrate into dust and be blown away by a strong gust of wind. It’s only because I love this book so much that it is falling into disrepair. 

I think that many of my classmates will agree that this book has helped them immensely throughout both years of this program. As for myself, it will continue to be of use even after the completion of this program.

Getting the Bigger Specimens

It's both a good and sad thing that the end of this rotation here at UPMC Presbyterian is nearing. There are still a lot of specimens left that I would like to see and it's always a pleasure to be under the direction of the PAs here. As time is running short these next two weeks I expect to perform only on larger specimens, which is precisely the practice and experience that I am looking for.

Recently, I had the opportunity to gross my first lung case. As it was my first time, as always, I prepared beforehand by reading up in the texts on how to approach the specimen. It's nice when you are still a student and have the leisure to double check on the different procedures, but in the working world there is no such room for brushing up. It seems that no matter how long one studies the texts at home, without the hands on experience the material doesn't stick. I'm sure that there must be research out there confirming that most people learn better with hands-on work over reading.

In any case, I am still working on my speed as much as possible. I know one thing that is holding me back is that I stumble when trying to say a description. I often try to describe exactly what I see and without a "word bank" of important words that pathologists and PAs like to hear, it can become cumbersome. Also, I find myself backtracking sometimes to insert additional words that make the sentence more descriptive, but it still ends up eating my time. For example, I might say something like, "the external surface is tan-red, roughened and displays numerous adhesions" but I forget to mention that there is soft tissue attached or that there is a focal area of granularity so I have to go back and edit the sentence. Fortunately, I am fairly proficient at moving around using voice commands, but each command takes about 1 second for the computer to register, and even that takes up time when you aggregate all of the commands that you sometimes need to make. The best thing to do is to not omit anything the first time so you make fewer commands and save time.

Studying is continuing as usual. Many of my classmates and I have already applied to take the ASCP PA certification exam as soon as we graduate. The fee this year is $515. I had always thought it to be ironic for someone to pay to take a test. The demand however is such that the organization can charge this much and still attract willing PA students. Supply and demand. I wonder if there are any other certifying organizations besides the ASCP for pathologist assistants. I tend to usually view competition as a good thing. Election time is nearing and it's probably all getting to my head now. Another few more months of focusing on school and then it will be time to worry about other matters. It will be a welcome change.

Accepted!

This weekend has been a pleasant yet busy life changing experience. Although my interview was to be held on Monday morning I had Saturday afternoon and all of Sunday to spend some much needed time with my family in Clovis.

It is interesting to come home after being away for so long and to see all of the changes that have happened around the house. My mom and dad are always working on the house despite being retired and I could see the fruits of their labor. The house was getting new shingles and the kitchen had a new microwave, refrigerator and toaster oven. Some more striking changes were outside though. A small twister had come through in the spring and wiped out a whole bunch of things such as the arch to our driveway, a few old eucalyptus trees, and a gigantic old tree which fell over and squashed a whole row of bushes along the side of our house. My father had been busy chopping up all of the wood and the place just seemed a little empty without all of those trees. The most striking change for me, however, was to discover that my younger brother had invaded my room! What was once neat and tidy was now chaos with posters on the walls, my desk filled with his items and a floor that was in desperate need of some cleaning.

I was looking forward to the interview on Monday, but I didn’t know what to really expect so I prepared for any interview question that might come my way. In the morning I put on my best suit and with my portfolio in hand headed to the lab. There I met with their COO who was very friendly and enthusiastic. I learned some of the history behind the lab as well as its future direction. He drove me to another hospital from which the lab receives its specimens to meet with some of the other pathologists. I briefly met with each pathologist and introduced myself to each of them one-by-one. Everyone was very kind and the process was not nearly as stringent as I had partially feared. We headed back to the laboratory and met with a few of the other pathologists where I had the opportunity to talk with them one on one. Lunch was provided and I then moved on to the gross room.

I was happy that the supervisor of the gross room had remembered me when I first came to shadow at their lab nearly two years prior. I was given a tour of the place and introduced to the talented and hardworking PAs there. It’s quite a busy lab and they receive over 50,000 surgical specimens every year. The laboratory receives specimens from a number of hospitals and labs, so the range of specimens that they receive is pretty much everything from A to Z. For me personally, I couldn’t have asked for a better place to increase my abilities. I was also impressed in that the lab was specifically built with grossing in mind during the construction. Specimen processing is very stream lined and PAs are used efficiently to spend the vast majority of their time doing what they do best, that is grossing. Specimens are received on a one at a time basis and cassettes are created on the fly, nearly instantaneously. They use the Voicebrook speech recognition software that I’m familiar with, but I will still have to get used to their information system which is Power Path. It was amazing to see the PAs gross through complex specimens on the computer just as fast as a person speaking into a dictaphone could. The benches are high tech to maximizes efficiency and eliminate lost time. 

It’s also fortunate that the supervisor and everyone else at the lab are very focused on helping its employees achieve their highest potential and professional growth. I got the feeling that I was very welcome there and it really made me want to put out my absolute best. 

One of the other interesting parts about the interview was a special test that I was given. It was a test designed to measure my descriptive abilities as well as how much time it took me. I was given three everyday objects and asked to describe them on paper. I had heard of a similar test in a book I read a while ago for prospective surgeons having to carve a bar of soap. The test was a good mental exercise for me and I found what I had wrote to be surprisingly detailed, although it did take a little longer to put my thoughts onto paper than I had hoped. 

On Tuesday morning I returned to the lab and was elated to discover that they had offered me a position there. I couldn’t imagine a place that I’d rather be and so I was eager to accept. I’m still moved at how understanding everyone was that I wouldn’t be able to start work until mid-January (visiting Hanako and her family in Japan). Everyone was very professional and had not just their heart into the business but also their own workers lives. I still can’t believe how lucky I am. I’ve made it my mission to become the best PA that I can be and to repay them by adding to their team. Man, I can’t wait to graduate!