Week Three at Magee Womens Hospital

These past three weeks at Magee’s have really gone by in a flash. I can remember when I was still a fledgling not even knowing how to use the voice software and now… well, I still consider myself to be a fledgling, but I have made much progress.

As this was my first rotation with grossing experience there were many things that I needed to learn, not just about the specimens, but also about how to work as a PA.  Such things included how to handle a scalpel and forceps, how to keep my bench clean while grossing placentas, how to fill and seal bags containing formalin, how to predict when the VoiceOver software will misinterpret your commands, how to order additional cassettes, how to finish the specimens so that you can leave on time, how to read bad handwriting on requisition forms, etc… When it comes to grossing, there is only so much one can learn from just a textbook.

While in the gross room I had the chance to gross a good number of specimens and every day was filled to the brim. The following are just a few of my own personal observations regarding certain types of specimens.

-Placentas are perhaps the most ‘messy’ of all specimens so you need to be especially conscious of keeping your area, hands and tools clean. (Placentas are also messy because they are done in high volume.) I have always been a conservationist (I recycle whenever given the chance, walk instead of drive, turn off lights when they are not needed, never let food go to waste, etc…), so when I was first told to leave the fresh water running so that I could easily keep my hands and tools clean I was skeptical. Eventually, I realized that some things just can’t be helped and let the fresh water run for as long as I had placentas to gross. I also used copious amounts of paper towels to wipe all blood at every opportunity and changed my gloves much more often. Although I surely had created much more waste, it made my life much cleaner and reduced any blood-related hazards.

-It’s easier to stop what you are doing and clean-up blood while it is still wet than to try and clean dried blood.

-I’ve been doing membrane rolls of the amnion with forceps, but sometimes it can be difficult because the forceps taper to a point. The best tool would be one that has a flatter pincer but also leaves an area for a pin to be stuck through. I need to invent a good tool for that one of these days.

-I have found that when doing a placenta the most useful thing to do is to take the placenta out of the bag and hold it under the sink with running water to wash off all of the excess blood. Just make sure that no segments of previously cut umbilical cord fall down the drain. If you are good, you can dictate your clinical history into the computer while you are washing to save time.

-When taking sections of the parenchyma from a placenta, it’s easiest to start cutting from the fetal side. If you cut from the maternal side the cotyledons will often crumple and become deformed.

-When sealing the bags that contain the placentas that you have grossed, every time you must make sure that the inner surface of the bag is clean and dry, otherwise the plastic will not melt when you seal it. Don’t worry about the trees, just use all the paper towels that you need to.

-Almost every other specimen is easier to cut with a scalpel than a placenta.

-Viewing villi under the dissecting microscope is like entering into another world. For some reason, I feel a sense of awe come over me, every time. It is as if I’m being transported into the biological coral reef of a human being.

-Uteruses can be difficult to bivalve with scissors because they are thick and tough, but if you’ve got strong fingers I say go for it.

-It’s important to try and take sections from your specimen without eviscerating the entire thing into a myriad of unattached, un-oriented slices. My worst nightmare would be if a pathologist came back to me asking for more slices from a certain area and then I had to sift through all of my remaining pieces and try to find that one slice. It would be like trying to find a single piece in a jigsaw puzzle that has many pieces already missing. I’ve already got shivers going down my spine.

-Any time you cut into something that you think might squirt, it’s best to keep your head as far away as possible. Better yet, do the cutting in the sink.

-Wearing glasses is not enough to protect your eyes. You absolutely need to wear special visors for eye protection.

-Finding a biopsy clip in a breast is not always an easy feat. I’d like to get more experience in finding clips by just using my fingers, but sometimes, especially in a mastectomy where the lesion is large, you need to be a cheater and go to the faxitron.

From here on out I’ll be heading back to Morgantown to start my rotation at the medical examiner’s office. I’m looking forward to it, but I will miss the kind and patient PAs who helped me at Magee. West Virginia, here we come!