Uno mas

So I hate Tampa.

For clarification, and to avoid the wrath of a few Tampa Bay Ray fans, I've been to Tampa like... once.  And it was to take AP/CP boards.  And while I passed it, it was one of those experiences you get through much like you get through a divorce or the death of a pet.

Tomorrow, I get to head back to take what better damn well be my last major (1800 dollar) exam for the next nine years.  The cytopathology boards.

I'm not filled with dread.  I probably should be, since adulting has made me far less interested in cramming algorithms for post pap screening into my addled brain since I *literally* have an app for that.  So I'm doing a great deal of studying tonight to attain that ever sought triple board status.

There are a few pathology unicorns out there with quadruple boards.  Some are MD/PhDs with multiple subspecialties because they just hate making a livable salary that much or just really love knowledge, I don't know.

But I feel like a grown up.  I have a mortgage loan pending.  I took a tea tasting class.  I successfully argued a case against one of my colleagues (nicely).  I nailed a diagnosis that was reinforced to be correct after the chief surgeon made me sent it to Hopkins.  Despite crawling bleeding and broken from the bottom of the totem pole a mere eight weeks ago, exams already feel like this weird thing of the past.

Until Wednesday.  Then they're very much of the present.

I'd say more, but despite being a staunch materialist, doctors are superstitious creatures.  More info once everything is secured.  Until then, I have books to study so I can memorize information that doesn't need to be cluttering up my brain.  Keep in mind, I never plan to stop learning and adding to my information.  But I'd much rather be learning about new stains that have better sensitivities for tough diagnoses and recognition of rare disease patterns rather than things I can look up in 20 seconds.

In a sense, though I tend to do all right with them, I truly hate the whole multiple choice approach to medicine.  My diagnostic capability is not based on whether I can recognize a tyrosine crystal in a single poorly 2D image from a pleomorphic adenoma slide.  What is my triage method?  What tests do I run on a scant specimen?  If I have a malignancy of unknown origin in an elderly woman's pleural fluid, I don't need to have the "second leading cause of malignant pleural effusions" memorized and then try to figure out whether the questions as written ten years ago or ten months ago and whether a few things switched places on the charts.  I need a basic, streamlined workup that is most likely to lead me to the correct diagnosis for the least money and waste of specimen.  I need to know when to ask for help, when to ask for flow cytometry, and when to get a cell block and what stains to order on the cell block, and when to stop throwing money and time down the drain and call the clinician to ask for repeat collection.

That's what I do.  I don't parrot algorithms because if that were all there were to medicine, machines could do it and we wouldn't need doctors.

Such is life, and at least for now, it's a happy one.  So tomorrow I'm off to the land of evil and fairly solid beer (thanks Cigar City brewing).

Freedom!!! Freedom!!!

I've been blasting the Pharrell Williams song all over my house on repeat.  Maybe that's why my newly acquired husband chose that moment to go do chores.

Yesterday was the last day of training.  Ever.  Things were so generally chaotic yesterday that it didn't really dawn on me until I'd slept like the dead and woke up at 10:30 this morning.

I'm.  Done.  Sure I have one more board to take for the triple crown, but it's nowhere nearly as soul crushing as the others with lesser the consequences, but that's it.  I'm off to Pittsburgh with a song in my heart, invectives at my overpriced movers on my lips, and an epic party starting in a few hours.

Am I scared?  Oh sure, I have imposter syndrome with the rest.  Will I be able to hold my own as an adult; will everything work out, but that feeling is so overwhelmed by relief and happiness that I can go into it with a positive attitude and excitement rather than fear.

Leaving yesterday was weird.  It's been no secret that my training here away from my happy familiar faces of residency was pretty rough on me.  There were about three people I trusted, and one of them was gone half the year, leaving me lonely, paranoid, and generally regretful.  When I left residency and the now hubster picked me up, I was bawling.  Couldn't stop.  Just sat in the car and cried.  Cried on the attendings.  Cried on the friends.  Cried on the support staff.  Finally got to a nice lunch place where the owner knew us.  Had to excuse myself to cry some more.  Told him the food was fine; I was just losing my mind.

Drove to about an hour out where my Charleston-mom and Charleston-dad were waiting with my Charleston-dogs to say goodbye.  The girls climbed over each other in the SUV to lick my hand as I was presented with a fairly pricy pair of pearl earrings "because you love to dive".  A big platter of lasagna so her baby wouldn't be hungry on the trip to Texas.  More sobbing.

Yesterday as I negotiated phone calls, cleaned out my desk, and went on a signature scavenger hunt, and dealt with the general chaos of having a moving company shift your dates forward by 10 days to the start of work with less than a week's notice for a price that would easily by a CPO used car, and got all my "ducks in a row" as one of the few people there I trust would say, as I careened toward the end of the day and an hour beyond it, I just kind of strolled out.  Gave a tentative hug to a couple people who seemed more upset than I am, and walked smiling out into the humidity.

The party tonight may be a bit more difficult.  I will miss being so close to my family.  I will miss the friends who have adopted us.  But training?  Nah.  I'm good.  35 and I'm finally an adult.  36 and I'll have my own house and a dog.

I'm free.  Bring it on.

Coming full circle

Where to start; where to start?  Should I end?

I can't say I have a lot of advice for you all now starting in Grenada (or in Newcastle) other than good luck, really enjoy the time you have because you'll look back on it fondly (maybe not the harassment but otherwise) and work hard, but the island is so far away from me that it feels like a dream.  Nearly 10 years now since I shipped off, terrified, and a very different person than I am now.

I've alluded to and generally complained about the pathology job market being terrible.  I can officially say I've accepted a job offer that seems like an excellent fit for me, and we're really happy about it.

There's an official "we" now.  I'm engaged.  The impossible has happened, and no, there's no big wedding.  This year has been so stressful that doing anything other than a quick inebriated cakeless wedding just isn't worth the effort or money.

I can continue the "travelogue" portion of the blog to an extent.  For the past few years, my PTO has been used for less fun things - interviewing for a fellowship; the next year moving for fellowship and the year after applying for jobs, but having secured one with a healthy amount of time left, the future husband and I took off for the Belize jungle and had an amazing time.  It was the first I've felt truly relaxed in years.  Amazing country and who knew you could hop on Southwest for less than a flight to San Francisco?

The cytopathology boards are sometime in August.  Not too stressed.  Maybe I'm finally entering a time in my life where the exam difficulty starts going downhill.  Either that or the AP/CP exams just broke me entirely, which is likely.

Everything's winding down.  I'm in my last away rotation, which would be nice except it's been complicated by a knee injury sustained during crossfit, so now I need to get a scope stuck in my knee.  Then it's back to my main hospital to wind up my year and hopefully say goodbye to trainee status forever.  Not that I have any intention of ceasing learning, just that I get a decent salary and am higher than *someone* on a ladder.

So things are working out, for all the pain and difficulty.  It's been an insane ride, but a fulfilling one, and I've been extremely lucky all the way.  I wish a great deal of luck to all of you.

Board certified and it feels so good!

So apologies for the delay, but yes, on the last week of July, a mere 12 weeks after taking that nightmare of a test, I received confirmation in the form of a nondescript email (or more accurately by my refreshing the website every ten minutes for 12 weeks and driving everyone crazy) that I was "successful" in both the Anatomic and Clinical Pathology portions of the exam.

So I'm a double boarded pathologist, baby!  At the end of this year, if all goes well in Cytopathology, I'll be TRIPLE boarded, which I believe doubles my mana on all offensive plays.

As far as the fellowship, well, there's no place like home, but I'm getting really spectacular training and experience.  But I do miss my own office and my surrogate Charleston family.

Now, the greatest challenge: Finding that first real pathology job.  Clock is ticking!

But yes, the short version:  I PASSED!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Give me my board scores

Give me my board scores.

Guess who's back, back again

Wow, this may have been the longest I've left the blog, eh?  Apologies, it is not so long and thanks for all the fish, at least not at this point.

It's hard to find a relevant point, to not make a blog intended to be a first hand look at life going through SGU and entering residency as an IMG, and not my personal livejournal and travel blog.

But Grenada is so far away.  I know there are changes on the island, new restaurants, new hotels, new apartments, probably new professors, a new deal in the making, the details of which I have no knowledge of, nor how it affects the school, nor how the teaching is currently going.  I don't know what their current going tuition is or how it compares to other schools in the states, nor what the current fixed interest is on graduate student loans and Grad Plus loans, all centers of my universe and increasing amount of time ago.

New York keeps me closer, and I still get up there, but again, that's all social.. the amazing people I met in Grenada or in Brooklyn and kept as friends.   Those in three year rotations are settling in for their real jobs, one in Maine, one in New Hampshire, others moving around, and I follow them as friends, remembering our times in New York as apartment parties and park walking and bar hopping, rather than as a harried short coated medical student only now realizing that not a single resident I worked with remembers my name, save for the one that miscellaneously showed up in South Carolina to do a fellowship and I ran into him at the gym.

I could talk about the effect of being an IMG on my current residency, but the simple fact is, there isn't one.  Pathology is poorly prepared for in *any* medical school (that's a rant for a different day), and once you're in, you're in.  I have two other IMGs in my class and a DO, and none of the former since (I hope we didn't break them), and unless we remind everyone else, which we will occasionally do with gusto since no one appreciates both the grass clearance and taste of goats, it doesn't flicker on their radar.  I got the fellowship I wanted without a lot of difficulty in the application process, which is considerably cheaper than the medical school and residency processes.  Things still cost a bit more, but that cost is offset by our generous education fund.  So what's life in a pathology residency in South Carolina like as an IMG?  Pretty  much like it is for any other pathology resident in South Carolina.  We eat, we drink, we ill advisedly run over the Cooper River Bridge, and we read books and squint at slides.  And no, don't call us squints.  We've seen Bones too.

And it's been difficult to write as of late because things have been so busy, but largely busy in a completely unbloggable way, though I can do my best.

Someday, I'll get to the end of Nicaragua and Christmas...

I mentioned I'd been accepted onto a committee, which holds meetings four times a year, which is both time consuming and incredibly awesome.  I've now been to three of them (San Diego, Chicago, and Portland) and have enjoyed luxury hotels, fine wine, and eight hours a day in a room with a ring of microscopes hanging with awesome people.  It's one of those things you never really picture in medical school because it seems so ridiculous.  Pathologists travel with microscopes?  These ones do.  So you just sit in a conference room, talk about cytopathology projects, and look at pap smears?  Yup, sure do.

I could attempt to start from the beginning but that would be difficult.  July was a rough month but also marked the meeting in Oregon's wine country, which also featured the nicest hotel I've probably ever stayed in, and it gave me a chance to make some headway on a project I've been working on for them, but it's difficult to do projects at home and projects on the road.

July was also noob month.  It marked the time that someone trusted me to be competent enough to train others in their most difficult rotation.

It was frightening, since I don't feel particularly qualified to teach anyone anything, but it also made me appreciate how far I've come in the meantime.  I'm much faster now.  Still slower than most of my colleagues, but so much faster than first year.  I know what to skip.  I know when to stain.  I joke with the attendings who still intimidate people.  I get praise from attendings who used to intimidate me.  The first years would ask me things that seemed silly.  Not stupid, but just... wow, that used to be me.

So hopefully they came out of it confident, but I know that it did wonders for my confidence.  Now I'm in an elective month, which gives me some breathing time, work on presentations, work on papers, and start the intimidating march to the board exams, which actually seems really scary.  Everyone is so relieved to finish the USMLE series, particularly when it's dragging into the Step 3, but then reality hits you.  Every test is the big one, and failing the dual pathology boards invalidates the others.

You're really all in too.  Fortunately I like my job because the reality of the loans sits in a panic on my chest from time to time where I realize... I can't go blind.  I need my eyes.  I can't get brain damaged.  I need my brain.  I need my ability to work.  I can't have a high risk pregnancy (didn't want a kid, so this is fine), I can't get sick for months on end, I can't rely on the boyfriend to support me (wouldn't want to anyway) and all has to stay on track because there aren't other options.  That's kind of the scary part.  With compound interest knocking my loan figures over 400 grand at this point, it's even more succeed or die than it was previously, but when I finished first term in Grenada, my world, and the maybe 20 grand I'd taken out for that term seemed like the world, and it seemed like my world was crumbling, and that was a moment where it could all go sour and ruin my life.

But twenty grand is nothing, ultimately.  It's in the low range of a new car (which is why I don't drive a new one).  Every value seems a little bit more insignificant once you pass it.  I remember before I started medical school when having bad credit and less than a thousand dollars outstanding seemed insurmountable.  It's weird how it happens when you least expect it.

But things are good with the boyfriend; things are good at home; with a few exceptions, things are relatively good at work.  I try to encourage the new people to talk to me or to talk to each other since I remember being so certain I was going to quit first year, so certain I would get washed out in Grenada, always so certain that each step would mean failure.

But despite the sweat generated by carrying a 400 thousand dollar loan on your back, I can't say I have regrets.  That's a question I get asked a lot as an IMG by prospective students.  Would I recommend others do what I did?  No.  Go to a US allopathic if it's at all possible.  Take out loans to apply to more schools and fly to them.  Don't wait after college.  Don't become a doctor at all.  It's a fiscally irresponsible decision.

But it was also the best decision I've made.  Medical school and residency have given me some of the best friends ever, and it kicked me out of my home state in the most immediate way possible, took away all promises of security and stability, and made me become something else.

Now I'm going to get back to work before I start quoting Arrow (because it's an awful show) but I'm back, kids, hopefully with something of value to say.

Fellowship Achieved!!!!

Huzzahs and the like.

It's strange; a fellowship is a one year commitment where you're not paid much more than a resident, and gives you no guarantee of a full-time position, and yet the overwhelming relief of being able to somewhat relax and focus on my studies and my patients since I now have employment through mid-2016 is pretty great.  I still want to build up my CV and go to conferences,  but now I'm not scrabbling to get publications in during a surgical pathology month because applications are due.

I'm really happy with where I'm going, and I'm really happy with the responses to my applications.

Essentially, I had a fairly solid bet of a cytopathology fellowship at my home program, which is groovy and kept the application process from being as stressful as it could have been (or as expensive, since it meant I only applied to programs that I thought could be a step up from mine rather than "any job"), and my attending pulled me aside to tell me that I was safe, but that I should fly out of the nest if possible to get different training.

But I didn't apply to enough medical schools, particularly for my stats, which weren't bad, but not good enough to put all my money on the California schools, which I did.  I went to SGU, as you know, which is a decision that may be pretty darn expensive, but I don't regret.

I did learn my lesson for residency.  Despite going through the hellishly expensive ERAS program, I applied to 51 programs, got mid 20s interview invites, went on 16 interviews (gah), and ranked 14.

Fellowship, I hedged more, despite it not yet being an ERAS process for most pathology fellowships (thank the gods), and applied to six, two of which I didn't expect a response from, and the four that I was hoping for all offered an interview, and the three where I went (including home), expressed a strong interest in me.

It was hearsay until now, but I do feel like the Caribbean stigma decreases with each stage of training.  Though make sure all your stuff is in order because your biggest skill will need to be your unofficial degree in red-tapeology.  I had a couple of days of sweating for the program where I'm going because some of my rotations weren't greenbook according to this particular state.  For those of you heading for your fourth year clinical rotations, that means doing your rotation in a program that has a residency program *with that residency*.  In other words, orthopedic surgery needs to have ortho residents, not surgery residents.  Most states either don't care at all or allow umbrella coverage (ortho and anesthesia could be covered by a program having a surgery residency) and you should know what those states are, how many weeks are required, and what extra requirements you need.  And if you say "I'll never live in that state", you'd be surprised.

So it's going well.  Also, start all paperwork processes early.  Way earlier than you think you need them.  You need weird extra paperwork or your home state takes 8 weeks to send a birth certificate?  Apply near the deadline, and that's sweat and tears.  Apply 18 months early, and it's vaguely annoying.

Medical school feels farther away.  I'm not sure what Grenada is up to lately, or how much the resources around the school have been built up.  I remember all the residents' and attendings' names from third and fourth year and remember smiling and chatting with the in the hall five months after my rotation, and only am aware now that those residents largely had no recollection of me at all, saw the short white coat, and had the same "how are applications going for you?" conversation that is always a safe bet, because that's exactly what I do now when they wave and smile at me in the hall.  They rotate for two weeks, maybe a month, two or three at a time.  I get that difficult "Oh... um... tomorrow I have a lecture/interview/blood draw/drug test/dean meeting?" question that I remember finding so hard to ask because I was afraid my residents would think I wasn't interested in the rotation and realize now that oh my god, we don't care at all.

I still try to teach them, advise them, show them what I'm doing geared to their specialty, and not scut them too much, but I'd be lying if I said that I didn't call them "short coat" or "medical student" when I'm addressing them if their name tags aren't showing.  We tend to reference them by appearance "hey, did you have giant medical student?  He was amazingly helpful."  Or "Did you have Harry Potter med student?  He wouldn't stop checking his Pinterest app for the entire sign out".  Then I wonder if I had a designation as a medical student, or if I'm the jerk resident that every medical student hates.

I briefly contemplated tutoring the MCAT when specifically asked to, because hey, free money, and upon a rudimentary glance at the study materials, realized there is absolutely no way.  Friction on a bike tire?  Seriously?

Cytopathology is going well, despite constantly having to ditch out on my chosen specialty to fly to interviews, since I thought invites would come *way* later than they actually did.  My attending has been very understanding about it, fortunately.  I managed to complete a successful FNA without bungling it or upsetting the patient.  I'm upping my reading now.

So it's good.  Things are good.  Life is pretty good.

Adventures in Cytopathology

Me (to clinician): "We have adequacy.  I've got abundant follicular epithelium, macrophages, and colloid."
Patient: "And in English, that means..."

Me (in other room): "Yes, as you suspected, this is consistent with metastatic disease from her earlier lesion."
Rads tech (from other room): "Ma'am, you're hypertensive?"
Patient (cheerfully): Yup!  But on a list of two things, that's not going to be the one that kills me.

Clinician: "Whadda you see?  What do you see??"
Me: "The technician staining my slide."

Clinician (leaning on his elbows on the counter next to me about six inches from my face): "Now, don't let me make you nervous."

Clinician: "Well?  Do we have enough?"
Me:  "We have adequacy."
Clinician: "Is it cancer?"
Me:  "It's suspicious.  I haven't seen enough of the groups my attending saw to tip the scales."
Clinician: "Can you tell me what it is?"
Me: "It's suspicious."
Clinician: "If you tell me that it's cancer, we can stop the procedure.  Otherwise we're going to have to go in and get a biopsy."
Me (sweating): "I can't call it cancer at this point."
Clinician: "Well, what would your attending think?"
Me: "Sir, if I knew what my attending thought, I'd be an attending."

Wait, what, already?

Fellowships?  Seriously?  Already?

If I haven't mentioned it before, pathologists are pretty much required to do a fellowship to get a real job in reality land and start paying off those monster loans.

I'm sure I've mentioned *that*.  What I should have mentioned, and been thinking of, is that you have to start applying for fellowships like... uh... now.  Yes, 18 months prior.  And I'm already out one fellowship because you have to start cranking out the paperwork even earlier than that (A program that rhymes with Who Be Ann Sancisco).  So now I'm in the eternal dilemma of whether I stay nestled in the safe bosom of a program that already has done well by me and where I know I like the cytopathology person, or whether I fly out, try to get an in back in my home state, or at least my home coast, and rack up some new experiences.

The fortunate thing is that fellowship applications don't cost money until you book a flight.  This contrasts to residency applications through our match monopoly which cost me 1800 dollars before I left my apartment.  The unfortunate thing is pathology fellowships are far less vetted, since there aren't all that many of us, so I'm throwing my applications into the abyss and hoping they want to grow me into a decent community pathologist, rather than using me for scutwork or ignoring me entirely.

Then the job hunt after that.  Then maybe, I can settle into being an adult with a job and a house and a place that's home rather than living the life of a perpetual student.  Not that I can really complain much other than the six figure debt leavings.

Scary though.  The last two years have flown by, and I by no means feel ready for the next step.  I'm just happy I don't cry during readouts anymore.

I'm at a weird stage though.  I don't feel ready to be independent but I feel far removed from it.  I was attempting to remember who wrote a poem quoted by my attending from a "college English class" and realized I was in college ten years ago.  The antics of the medical students seem immature and their questions weird, despite the fact that I needed to be shuttled home from a bowling alley as recently as two hours ago.  Yet I feel comfortable giving attendings from other specialties update reports.

I'm removed from a lot though.  No one really knows much outside of their own very limited experience so it's hard to know where to go for advice.  Within the hospital, you get "The job market is fine in this academic setting where I've been working".  The other residents are "I have a fellowship in 'x' secured and that's where I'm going, but I'm not an IMG or from California".  People at my level are in the same boat.  The advice on the internet is "JUMP SHIP!! PATHOLOGY IS DOOMED!!  OBAMACARE WILL HAVE US IN POVERTY!  DO ANOTHER SPECIALTY", which is disheartening, but unhelpful.

So I feel a little trepidation.  On the other hand, I think I have a good chance at securing a fellowship if I merely stay put (something not an option in medical school), good friends, a great boyfriend, and hey, kayaks.  So we'll see what happens.

Remember remember the month of December?

Because I certainly don't.  November... clinical chemistry.  The day after November.  Work.  8 AM on December 31.  No longer work.  Party downtown for NYE and then burn rubber for New Orleans before anyone else can page me.

I'll back up.  As I've mentioned previously, now that I'm a high and mighty second year (though since it's a four year residency, still a junior resident), I can take call.

I probably explained this in a previous post, but I'm too lazy to look back, so quick recap.  Most pathology residencies have people take call a week at a time.  You are on call starting at 5 PM on Monday night until 8 AM the next morning and that's the pattern.  You then take call from Friday at 5 PM straight through until Monday at 8 AM.  If there's a holiday during the week (like Christmas), it's like the weekend, you're on for that entire time.

There are two types of pathology call: AP (anatomic pathology) and CP (clinical pathology).  AP is the headache that frequently requires you to come into the hospital.  Surgery is running late or got scheduled on the weekend and they need tumor margins?  AP.  LifePoint has a potential donor kidney but needs to evaluate whether it's viable for transplant at 2 AM?  AP.  Medical autopsy between Friday afternoon and Sunday afternoon?  AP.  Patient is immunocompromised and may have a necrotizing fungus in their lungs?  AP.

CP is all the lab stuff.  Authorize nonstandard or nonindicated blood transfusion?  CP.  Transfusion reaction?  CP.  Stool cultures?  CP.  Oops, someone forgot to label a specimen may I pretty please oh please I swear I know it's the right patient, PLEASE let me come down and relabel it?  CP.  CP is far more likely to roust you from sleep at 3 in the morning, but typically requires a series of exhausted phone calls rather than rushing out the door with wet hair pulling your sneakers on.

For our first year of call, we are supposed to take AP and CP weeks separately so we don't get overwhelmed.  The thing is... you can have a call week with virtually nothing... maybe three phone calls for the entire week and one frozen section that keeps you at the hospital until 6 PM.  OR you can have your pager go off constantly, fill your weekend with complicated autopsies that you're forced to pause to deal with other calls.

For December, I was on my old friend surgical pathology, which really heats up at the end of the year as everyone attempts to get in their surgeries before they have to pay a new insurance deductible.  People also may also have a week off around Thanksgiving or Christmas or have it easier to arrange so they can put their surgeries then (making a depressing holiday, I'm sure).  So December was beating me to death in general.  Just to get to our own office Christmas party required two other residents tag teaming to get all my specimens handled by 6:30 P.M., which was a job that otherwise would have taken me until 10.  Boyfriend was cooking for me a great deal of the time.

But then Christmas week... that was my call week, as the second years tend to get the holidays.  We lost a resident to family stuff who was my co-call person, which meant either take both calls or cost someone their Christmas.  I figured how hard could it be, and had several reassurances that Christmas is a slow week which turns out to not be entirely true.

Here's the thing... the most junior people are the ones stuck on Christmas, present company included, which means the hospital runs at half staff with the lowest people on the totem pole, who are the most likely ones to be calling me with weird questions, a lack of justification for why they're calling me, and reasons for procedures like "My chief wants the values to be X".

So during the week of Christmas, my pager went off 41 times.  I had autopsies and frozen sections and SO many mislabeled specimens and bizarre requests.  As the week progressed and my grinchitude grew dire, I was pretty much saying no to anything that couldn't be considered irretrievable (like lumbar puncture specimens or brain biopsies).  I did the longest autopsy in the history of autopsies just because the darn pager kept going off.  I took to referring to it as "the wife" because it kept frigging nagging me.

My mom also got to be in town for Christmas, which unfortunately didn't leave me much time with her due to the above.  Unfortunately she got to see the absolutely least exciting/sciencey part of my job "What do you mean you didn't label a random urine catch?  No, you can't relabel it.  Yes, you do have to call the patient back." and not the good stuff.  She also saw me swear at my computer a lot since the apps you need to access really like to bug up when you're on a deadline.

During this time, keep in mind that except for the actual holiday, when you're taking call from home, you're still doing your normal duty hours, and except for Christmas Eve, it was kind of a nasty week.

So when I got off call at 8 AM on New Year's Eve and did the official hand off of my cases, I actually said "If anyone has any difficulty with anything I did last week, I don't want to hear it.  My first week of dual call... I am officially above criticism."  And to everyone's credit, I haven't heard a word about it.

But I handled it.  Gone is all the panicky nonsense from last year, replaced by an aggravation by heavy workloads and unrelenting paging, but I overall like my job and feel like I'm getting better at it, which is awesome.

NYE was pretty fun.  Ended up going to a party at a bowling alley/bar/arcade/silent disco (?), had a hotel downtown, and avoided getting completely ridiculous like I did last year (though in my defense, that was a few days after the house went).  But I knew I needed to be unhungover for the drive to Nola via Jacksonville because hooray.  Replaced my hurricane glasses that got torched last year, got some great cajun food up in Baton Rouge, where it's 15 dollars cheaper, and bummed around Frenchmen street listening to great live music that involved songs that were not hacked up covers of Play that Funky Music.

Came back to cytopathology, which I'm loving far more than I expected.  So in surgical pathology, they deal with larger specimens, at least biopsies, so you are not just getting a cell that may look cancerous, but it is in the context of the surrounding tissue architecture.  For instance, your body frequently gets violently pissed off about getting invaded by cancer, so even when you don't initially see the actual tumor cell, you see the surrounding reaction to it.

Cytopathology deals with single cells, either from aspirates from suspicious tissue so that if it's nothing, the patient is only subjected to a deep needle stick and not a full surgery, or fluids that aren't blood (hematopathology's territory).  For instance, urine is supposed to be relatively cell-free.  People with bladder cancer; however, may shed those cells into the urine where we see them and go "AHH  Bad Nucleus!".  Any fluid that's accumulating around the lungs or in the abdomen, we check for cancer or bacteria.

It's teaching me about problems at a cellular level so I'm getting to know the features to look for, which will help me for surgical pathology particularly for sneaky cancers like melanomas, which the surrounding tissue may ignore.

We also see patients when we go on aspirates.  Granted, we barely speak to them and we *definitely* don't tell them what we see other than "this specimen is adequate" since the last thing a patient wants to hear is a positive cancer diagnosis by way of a complete stranger looking into a microscope near your feet and going "Holy crap".  Rapport fail.  The process is important though.  We literally influence the number of times a clinical has to stick a needle into someone's neck.  And they get frustrated with us for it.

What else.. we had a sudden warm snap, which was awesome.  It coincided with a visiting Jersey friend, which led to a beach day, a failed surfing attempt (on my part; not on her part; that crap is harder than it looks), so she finished off the surfing day while I drank beach juice (tm) with Boyfriend and Friends.

So that's what I've been up to.  Another call week is heading up on me, so I'm throwing myself into restaurant week to go out with a bang.  Unfortunately, holiday baking + stressful month + no exercise due to workload + New Orleans + Restaurant Week = the next three months of broccoli and treadmills.