A Trip to the Pathology Laboratory / Gross Room Part 2

I've been wanting to post about my experience in the gross room this week and I've finally found the chance to do it. Each of us students are assigned a week in which we'll go to the gross room everyday from Monday to Friday. So, in addition to regular classes and studying (well, lack of studying really) I spent a total of 21 hours in the gross lab at Ruby Hospital this week. It was a busy week to say the least, but I really got a much better feel for grossing than what I had before.

Before this week, the only grossing experience I had was observing the pathology residents and the 2nd year PA students do grossing and dictation. It was great to finally get some hands on experience and try it for myself. By Friday, even though I was still going much slower than everyone else, I had gotten the pattern of dictating down in my head. Of course, I only worked on the most simple of cases, but it was still really satisfying to make those first baby steps.

The easiest and most common cases that I encountered were the GI (gastrointestinal) biopsies. This is when the doctor looks down into your throat or into your bowels for any polyps or growths, cuts them out (they are mostly smaller than the size of a bb) and sends them to the lab for you to gross them. Typically, you'll receive 2-4 small formalin filled containers with tiny pieces of tan tissue from either the esophagus, stomach, small intestine, large intestine or rectum. I'm proud to say that I encountered so many of these that I can now give a simple dictation off the top of my head! This is an example of how a simple dictation is done here at Ruby.

Let's say we got some GI biopsies from Mr. John Smith:

Part A is received in formalin, labeled "Smith, John" and "esophagus." It consists of a 0.3 x 0.2 x 0.1 cm tan-white irregular soft tissue which is submitted in toto in cassette A1.

Part B is received in formalin, labeled "Smith, John" and "duodenum." It consists of two tan irregular soft tissues measuring 0.3 x 0.1 x 0.1 cm and 0.4 x 0.3 x 0.2 cm which are submitted in toto in cassette B1.

Part C is received in formalin, labeled "Smith, John" and "rectum." It consists of seven tan irregular soft tissues ranging from 0.1 x 0.1 x 0.1 cm to 0.3 x 0.3 x 0.2 cm which are submitted in toto in cassettes C1-C2.

What's really interesting about dictating is that you aren't necessarily typing all of this on a keyboard. An experienced PA can both cut open specimens and speak about what they are seeing at the same time so they use a microphone to cut down on the time it takes to gross. Plus, when you're cutting open some specimens your gloved hands will get a bit... messy, and although it's not a problem to get the keyboard dirty I like to keep my workplace as clean as is reasonable.

So really, when you're speaking into the headset, what you're saying in the dictation is really this:

part a is received in formalin comma labeled open quote john comma smith close quote and open quote esophagus period close quote it consists of a zero point three by zero point two by zero point one centimeter tan hyphen white irregular soft tissue which is submitted in toto in cassette a one period

.....


Now we're getting into some foreign language skills! Learning to speak like this brought back some memories of when I was studying Japanese. It seemed awkward at first, and it was, but within a week I was able to get the hang of it and decrease my time by about half. Of course, the other more experienced PAs were still going twice as fast as I was, but it was good to finally be able to do it on my own.

In addition to GI biopsies, with the help of the other PAs and residents, I was able to work on skin biopsies, liver biopsies, bone biopsies and breast biopsies, but the biggest and most difficult one I worked on was the placenta. There are a lot of parts to the placenta that each need their own dictation. The parts that need to be looked at are the umbilical cord, the amnion, the fetal surface, the maternal surface and the parenchyma inside the placenta. It took a long time, but with the assistance of a PA working there I was able to gross it. Now, I can look back on it nostalgically and think, "Ahh, my first placenta."

So, that is how my week went. I didn't get a chance to do much studying, but I lucked out because this is a three-day weekend. I'll definitely be able to catch up thanks to Labor Day.

Also, I received an email back from the AAPA. Unfortunately, they said that I could not use any data from the job hotline, as it is exclusively for members only. So, I can't write a post about in which states are PA jobs opening up.

But, I do have other great news. Our program director, Cheryl, came back to the university after having attended a couple of conferences and at one of those places she met a representative from the place that I briefly shadowed at in Fresno/Clovis CA, called Pathology Associates. The representative was on the lookout for new PAs to hire and she did me the favor of mentioning me. Since I'm originally from Fresno/Clovis, it would be an ideal place to start working as a PA as soon as I graduate. Could it be that I'll already have a job lined up before I even finish my first year in PA school? I'm really excited for this great opportunity.

So, thanks to all of the PAs, residents and our program director, I've had a busy but awesome week. PA school is great! (Did I just say that?)