Week One at Magee Womens Hospital

This week was a very exciting week for me as it was the first time I really got to delve into grossing and dictating. My previous rotation location was at the Shadyside Tissue Bank and although I handled patient specimens I didn’t get to ‘dive-in’ so to speak with each specimen. The tissue bank was very involved administratively, but you can’t get much more hands on than grossing and dictating. 

During the fall of 2011, our class spent a week at Ruby Hospital to practice grossing and dictating simple specimens, such as biopsies, as a kind of preparation for these rotations now. I’m very grateful for that experience because I struggled enough as it was through this first week.

As might be suggested by the name, UPMC (University of Pittsburgh Medical Center) Magee Womens Hospital especially deals with gynecological specimens and pathologies that commonly involve women. I may have mentioned this earlier, but the hospitals in Pittsburgh under UPMC each specialize in their own field and are known as “Centers of Excellence”. The pathologists and pathologist’s assistants who work here are highly trained and knowledgeable about women’s health and it’s a great opportunity to learn from the best here. 

That being said, starting out was a bit daunting. The surgical pathology laboratory at Magee commonly receives such specimens as placentas, endocervical/endometrial curettages, uteruses, ovaries, breast core biopsies and breasts. Perhaps their most routine specimen is the placenta and that is where I had the opportunity to spend the majority of my time practicing grossing and dictating.

The placenta was quite different from most of the other specimens that I had encountered up until that time. It may be difficult to explain for people who are unfamiliar with how a dictation works, so I’ll try my best to explain.

The role of the pathologist’s assistant is to create a gross description of a specimen, that is, to describe a specimen’s appearance, measure the specimen’s dimensions and submit appropriate sections (cuts of the specimen) to histology so that the pathologist can look at the specimen under the microscope. This is much easier said than done. The gross description is a medico-legal document and just by reading it you should be able to recreate how the specimen looks in your head. There is a specific ‘language’ that pathologist’s assistants use that make the whole description sound foreign, so I’ll try and give an example using something that happened to me after I had microwaved my potato last night.

“The specimen is received cooked, labeled “Mr. Potato” and 3122 (ok, it really wasn’t labeled). It consists of a 9.1 x 5.5 x 5.2 cm firm kidney-shaped potato weighing 184.2 grams. The external skin appears brown-yellow, rough and intact with multiple focal areas of pitting ranging from 0.2 cm in greatest dimension to 1.1 x 0.6 x 0.2 cm. Sectioning through the potato reveals a yellow-white, glistening, smooth and friable cut surface with a 1.1 x 0.2 cm in diameter tan worm which is filled with a  tan, watery fluid. The worm is located 2.1 cm from the nearest anatomical margin. The specimen is submitted entirely into the trash for disposal.

Time in trash: 7:34 p.m. 2-4-2012

fgm”

Hopefully you were able to get a picture of what this potato looked like just by reading the description. Describing a potato is leagues easier however than trying to describe something such as a uterus with bilateral adnexa attached.

Thus, my first week was more than just practicing on placentas. It was also getting used to the whole system of dictation, trying to come up with good descriptive words, learning how to cut with a scalpel and handle different utensils quickly, learning all of the different commands in ‘VoiceOver’ (the dictation system), remembering what sections need to be submitted for each specimen and learning how to approach a specimen.

The first time I I took on a placenta, it seemed almost overwhelming. Where do I even start? What do I say? What words do I use? How do I orient this thing? Fortunately, the kind PAs at Magee were there to answer every question I had, and I had plenty of them. By the time I had finally gotten through my first placenta, I looked at the time and realized that more than an hour had passed. Nonetheless, it was a triumph and I felt great. The next placenta I took on took me about an hour. The more that I did, the more that I became used to the flow. 

The reason that the placenta was so much more intimidating than just a biopsy was because it was difficult to tell where to even start. But, as I worked on each successive specimen, I realized that despite its complexity, it could be broken down into smaller fragments that you can accomplish one at a time. Basically, a placenta needs four things to be identified and described, 1) the umbilical cord, 2) the membranes, 3) the fetal surface and 4) the maternal surface. Once you take this large and daunting specimen and break it down into its component parts, it becomes much more workable. It’s as if you have a plan laid out in front of you and you are going to do each part in step rather than jump around wondering which part to do next. 

By the end of the week I had become proficient enough to gross and dictate a placenta within 30 minutes. It’s still a long ways off from the average 7 minutes or so that the PAs around me are able to complete these in, but I’m still very pleased with my progress. Now if I could only get the software to recognize my words more accurately I’ll be the go-to-guy for placentas. The voice-recognition software has been frustrating at times, but I’ll leave that rant for another time.

I also had the opportunity to work on my very first uteruses. I expect to do many more this upcoming week, so I’ll save that for another time, too.

It was an exhausting but very educational experience this first week. Completing my first week of grossing and dictating has been similar to the euphoria one gets when having hiked all day and come home. It’s going to be tough, but I can’t wait to get some more experience.