Today I shadowed with Nicole, and it was freaking awesome! She's doing a surgical path rotation. Basically anything that surgery removes from the body gets sent to histology to be worked up. As she described "if someone swallows a glove, we get the glove. if someone sticks a flashlight up their butt, we get the flashlight." Mostly, though, I think they get specimen to check for cancer in the margins. She had a few lymph nodes, some mushroom shaped polyps, and "the tiniest prostate ever" before lunch. She also had a really gross gallbladder. It was full of dozens and dozens of gallstones, which kind of look like little fishing weights. There was a stone obscuring the duct. The organ was really fibrous and tough.
For lunch we had some soup from the doctors lounge (which is also freaking awesome. someone once made a joke that if you see anyone carrying in good food, it's probably going to the doctor's lounge). During lunch we listened to a presentation about blood bank adverse reactions given by another of the residents. All of the residents at the presentation and the pizza party after (for a retiring pathologist) were really nice.
After lunch, we got several more biopsies, few cervical specimen, and a segment of colon and rectum. We also got a gangrenous toe. The tip was black eschar. Getting entire appendages freaks me out a little, probably because I'm familiar with exactly where it comes from. Seeing a colon isn't as bad because I don't see them every single day attached to my body. It's like I know I have one, but I don't have the same visceral reaction as I do to a severed toe.
Nicole let me set up and dictate a prostate needle biopsy and another sample. The dictation was really stressful, because I was unsure what to say and afraid of making mistakes. I also watched the two med students (post sophomore fellows) work on their specimen. Bo had an ascending colon with diverticules and a constriction. The diverticules were really easy to see. Bo said usually they get collapsed in the formalin and are hard to see. He also got a complete mastectomy. I had never seen anything like it, just a thin layer of recognizable skin over a heap of glands and fat. Bo showed me the tumor, spherical with a diameter about the size of a quarter. Becca, the other medical student, had an entire colon. She said it was taken out due to chronic constipation. Apparently when it came in it was packed with fecal matter. I don't think Becca is going to end up as a pathologist. Everything seemed to gross her out. I guess she has two more years though. Bo mentioned that he doesn't know anyone that still wants to go into the area of medicine they were interested in when starting med school.
The final thing Nicole did while I was there was a larynx. It was the whole thing, from the epiglottis to the vocal chords. Apparently it is an onerous thing to set up, because there are several different regions that have to be sampled. It is also hard to cut up because of the bones. Nicole used the bone saw to cut through the hyoid bone. She took as many sections as she could, and then put the rest in some acid to digest and work on tomorrow.
In order to set up the samples, they slice the tissue and put it into cartridges. These cartridges are then filled with paraffin, which is sliced really thin and made into slides. Any margins or identifying segments are inked in different colors. For example, the prostate was inked black on one half and yellow on the other. That way, they can keep the slides straight to see if any cancerous areas are bilateral. When she put several lymph nodes in one cartridge, Nicole inked them all in different colors. She had me ink the needle biopsy in green. The tissue is so thin and the same color as the paraffin, so in this case the ink helps the techs setting up the slides see where the sample is.
I'm going to shadow with her again on Tuesday, and since I've gotten the day off work I'll be able to spend all day with her. We're going to look through slides, so I will be able to see how the gross sectioning actually translates into diagnosis.
I was only there from 11-5, but I saw so much, and learned a lot. I told Nicole that I had been interested in Pathology, but that I was starting to lean more toward internal medicine. She told me that I would "come back over to the right side." Haha.
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