Pathology: Days 4-17

Now that I'm nearly finished with my pathology clerkship, I suppose its time to give you all an update of what it's like "in the basement" of the hospital!

I spend most mornings in conferences with other specialties, showcasing the biopsies and cellular morphology of various surgical and cytological specimens and integrating that information in to the patients' care plans. From there, I have had different experiences, ranging from visiting each section of the lab (immunology, blood bank, microbiology, molecular genetics, chemistry, etc) to attending frozen sections to assisting in the gross lab (where we cut up the surgical specimens before examining under the microscope) to examining slides under the microscope for hours on end. The afternoons consist of either conferences, teaching sessions, or more time with the microscope. I'm surprised by how much I'm picking up, considering that there isn't too much teaching going on for the students (the residents get a very good education, but it is usually too intricate or detailed to be of much use for non-pathology physicians). 

I can't complain about the hours. They've been really nice. I only wish that I could learn more and utilize my time in work a little bit better. During third year, I would always have a book with me and I would study during any down time; since there aren't any shelf exams this year (and I don't have a good textbook on pathology), I'm not finding my time to be managed very well. But no complaints, I have had so much time to read for fun and socialize with my peers instead of always having my head in a book.

This week, I performed my first frozen section on a lung specimen - it was a lot of fun to do. You have to cut the specimen that you want to investigate, measure it (of course), then place it in a block to be "flash frozen" before slicing it into 4-8 micron thin slices and placing it on a slide - carefully - before finally staining it and examining it under the microscope. What we diagnose under the microscope directly influences how the surgery is continued, so the job is really important. For instance, if a patient is undergoing a lung resection for presumed squamous cell carcinoma but is found to have small cell, surgery is not going to be beneficial for this patient and the surgeon will end the surgery (but might have completed a lobectomy had it been squamous cell). So the job is vital - and the diagnosis is so crucial. It's also kind of fun because the surgery basically stops until a diagnosis is declared - brings a bit of excitement and a rush to the otherwise slow-paced world of pathology.

A frozen section:

I have a lot of respect for pathologists. The diagnoses they make directly impact patient care, and there is really no room for error (even though medicine can definitely be ambiguous).