Tuesday, August 30, 2011

Just Another Manic Monday

No one has written about a typical day in their field in a while. I thought today would be a good example to remind, most importantly the surgeons who think we are sitting back drinking coffee while they are waiting for their frozens to be read, but also everyone that pathologists do not just sit around admiring each other's ear hair grow.

I was in the carpool line at 7:30 this morning when my pager went off. I was happy sitting in the carpool line, since last Thursday and Friday I had to drop the kids off at 7:00 so I could make it to the Conway hospital to cover the OR. I watched the kids bound out of the car and then called transcription. "You are on standby for CT3 for a needle."

Standby can mean either five minutes or thirty minutes, depending on whether or not a tech remembered to call and give us a heads up, and also how long it takes the radiologist to guide the needle to the mass of interest in whatever organ is under investigation. I told her I would be there as soon as possible, and hastily trucked it down the interstate. Luckily I made it to the transcription area in about 10 minutes, right when they called to say they were ready for me. Unfortunately I simultaneously remembered that I had a record seven pending cases from Conway sitting on my dining room table. One was a medical liver that needed to be sent out for consult. Three were diagnostic cancer cases. Oh shit, I whined to a colleague. Headed to CT.

As I walked into CT3 I noticed that the tech, a sub, was placing the slide into alcohol for a modified Pap stain. I sighed and glanced at the radiologist. "You forgot I am a diff-quik girl." We all have our stain preferences, and they hadn't screwed mine up in a couple of years. He looked at me and said, "You want me to get you some more? I can get more. You haven't been around here in a while." It had been about six weeks since I covered EV cytology. I glanced at the CT monitor and saw that the needle was in a large mass in the lung. I told him I would give it a shot and see. Peered into the microscope and luckily it was a no brainer. I wandered back over to the radiologist. "Despite the fact that I feel like I am Alice in Wonderland, I think I can call this one. Positive for malignancy." I got the schedule from the tech and saw that there were many needles today - liver, lung, mediastinal mass, a couple of inpatients that needed to be worked in, but nothing for an hour.

I got coffee, got coverage, and booked it home to get Conway cases and bring them back to work. I was busy with cases and needles until noon. I got a call around 10:00 from one of the transcriptionists asking if I would do an outpatient referral FNA from an ENT in fast-track ED at 1:00. "Sure, I'm not going anywhere, thanks for asking." At noon I was hungry, but got paged for standby. I normally don't like to eat when I might get called out, but hell, I thought, I've got this lunch thing down to a ten minute fine art. Heat Morning Star spicy black bean burger in microwave 45 seconds. Prepare nuts and carbs of my choice. Add liberal honey and small amount of spicy mustard to heated burger. Eat quickly and chase with bottled water. Finish off with Take 5 for dessert. I managed to squeeze it in before I had to go to CT again.

At 1:00 the cytotech preparing the outpatient came into my office. "The patient is here but they can't get us a room for another hour in fast-track ED." I asked him how in the world did this happen, didn't the transcriptionists call ahead to reserve the room? We are supposed to call ahead if it is scheduled for after 11:00, ED gets busy in the afternoon. I was a little mad, we had been over all this months ago - it was supposed to be working smoothly by now. I went out and apologized to the luckily good natured gentleman with a facial mass. He had another appointment at 2:30, but said he would stick around until then in case a room opened up. It didn't. He said he would come back at 4:00.

I called the head transcriptionist into my office. "Can you please gently remind all the people that schedule needles that we have to call ahead to reserve a room after 11:00?" She told me the problem was that some of the people in ED told them they didn't have to call ahead, and it had become confusing. I told her, "Tell them to ignore those people, from now on. This is compromising the patient's time, and that is not fair." She agreed, and I decided that was enough for right now.

The week filled up all afternoon - fat pad aspirate on Thursday, special request from a breast radiologist for us to do and immediate on-site evaluation of a breast mass at the breast center at the end of the week, etc., etc., all requiring phone time and logistics. Cases got finished, needles got evaluated, and I even found time to fill out picture order forms for kids school pics and print out their menus for the next couple of weeks. The kind gentleman came back at 4:00. We chatted in between me sticking a needle in the side of his face. "That thing is pretty scary," he said. "Oh, you mean our gun?" He laughed. "You call that thing a gun?" I said, "Yes, isn't that funny - it is really only there to create negative pressure. I thought about using the French technique here, meaning I wouldn't use this gun to hold the needle and syringe, but the texture of the lesion requires this contraption, sorry."

I made it out the door in time to problem solve some phone issues at Verizon before heading home to relieve my after school help and start dinner for the kids. Cecelia had been to the orthodontist, her mouth was sore, so I suggested pasta for dinner and prepared elbow noodles, cheese tortellini, Parmesan, hard Romano, basil pesto, and spaghetti sauce - we had a sort of a pasta bar going on and everyone was happy. After 15 minutes of itouch time and 15 minutes of me demonstrating yoga poses (I started back last week after a 9 year hiatus) to the kids for copying, much to my son's amusement and my daughter's amazement, we started bedtime.

I hope tomorrow is a little bit lighter. Based on the last two weeks, I'm doubting it. Something about school starting and everyone, doctors and patients included, returning from vacation has made our lives much busier lately. Hard to complain about work, I guess. But there is something ominous about the pager going off in the carpool line. It sets a frenetic pace for the rest of the day.


  1. Hope the rest of your week is not "manic"

  2. Gizabeth - glad you are so upbeat about your hard day(s). I enjoy your thoughtful entries more though. We are all overloaded with information (see laughing doc recent entry below). Really have to ask yourself - why do others have to put their days on hold to read about your day? Sorry, just found day reports least appealing on this blog.

  3. Thanks Ramona!

    Anon - you were warned in italics at the top of the entry, therefore you chose to put your day on hold. I think these entries are helpful to those who have yet to choose a specialty and might be wondering what it is like - I have surprised even my cohorts on MiM about what pathologists do. Thanks for the compliment about other entries - hope you keep enjoying.

  4. Hey, Gizabeth, you sounded defensive, not a good sign.
    I apologized didn't I? Again, I am sorry, but when I see people give complete description of what they had for breakfast/dinner I find it least helpful for those choosing future specialty (I know its part of your day, and you so deserve it, honestly you are a superhero for doing so much). Now I expect to be fully chewed up by you and others. And, yes, I will keep enjoying, women authors on this blog are simply phenomenal. Let's please, not continue arguments

  5. Hey, Gizabeth, you sounded defensive, not a good sign.
    I apologized didn't I? Again, I am sorry, but when I see people give complete description of what they had for breakfast/dinner I find it least helpful for those choosing future specialty (I know its part of your day, and you so deserve it, honestly you are a superhero for doing so much). Now I expect to be fully chewed up by you and others. And, yes, I will keep enjoying, women authors on this blog are simply phenomenal.

  6. I don't want to chew you up, Anon, I appreciate any comments, positive or negative. I just have to tell you that if you click down there on Gizabeth you will see that in my two year plus history here I am more of a storyteller/entertainer overall than a thoughtful piece writer. I talk about parasailing with my kids. I talk about baking with them. And yes sometimes I talk about what we are eating for dinner. This is Mothers in Medicine, food and what to feed your kids has been a hot topic around here in the past. Again, I am sorry to have bored you, but I'm not going to change what I do.

  7. Thanks for the post, Gizabeth. Hope your week settles down.

    PS I especially liked the food descriptions. The pasta bar sounds like fun!

  8. Thanks Liana! Today is much better - no needles yet and I am about to head to NYtimes with my lunch.

  9. Gizabeth - great & fascinating post, as always. I am amazed, as an ED doc, that you have *any* system worked out -- there is no way that ours would "allow" scheduled outpatient procedures! You must have an amazing administrator/negotiator on your side :).

    I love these windows into everyone else's daily reality. Thank you, all.

  10. MLR - thanks. The ED is great to work with us, since we lost our outpatient room when my office was needed as part of a lab supply closet with new ED expansion taking over part of the lab. I now inhabit our old needle clinic room. I was frustrated that it was us dropping the ball - one of the old radiology techs who I am good friends with now works in ED and she goes above and beyond to accommodate us. In retrospect, I can see how the miscommunication occurred and the rules got too lax. Monday the ED waiting room was full. Tuesday it was empty. Sometimes it is easier than others to work us in at the last minute.

  11. Can I come work in your ED? I'd love to have that kind of relationship with path, ENT, etc! :) Anyhow, glad your week is getting better...

  12. I believe you can e-mail me from my profile of my other blog, if you are being serious! If you have trouble, just comment your e-mail on my blog somewhere so I get notified and I will be happy to tell you exactly where I am in Arkansas. Don't have control over hiring - but the ED expansion is gorgeous.

    Hope your impending windfall leaves you with much happiness.

  13. Contrary to anonymous, I actually love these post styles. Isn't that what blogs are for, to peer into another's life? And I enjoy hearing about both career and your family life. The balance and blending of those two is one of the things I love about Mothers in Medicine.

  14. Great post Gizabeth. I think this type of post is especially helpful to people undecided about what specialty to pursue. When I sat down a few years ago I tried to work out how each day would pan out (eg wake up at 6am, ward round 7am etc). It helped me to be realistic about what sort of specialty is possible with a family (for me, maybe not for others). Its easy to dream...but being a surgeon and mother are two big commitments. I decided to pursue ophthalmology rather than plastic surgery.

    PS I love gcs15's posts. Her day in the life post made me weep. Try to read it if you have not already, gcs15 - I think you sound like an amazing mother and surgeon!

  15. Thanks so much joleyne! Having this community to support me - fellow MiM's and commenters, has meant so much to me over the past two years. I could not have gotten through rough times nearly as well without it.

    anon@1:34 - thanks! I almost did ophthalmology - my best friend from med school is one. Bailed out at the last minute because even though the specialty has a lot more star appeal, I knew I would be happier in path. Love listening to my friend tell stories. I love gcs15's posts, too. I wept in my coffee cup when I read that.

  16. Great post. I loved hearing about the details of what you do, from covering the OR to what and how you eat lunch.

    Yesterday my lunch involved grabbing some chicken tenders from med ed, turning around immediately and eating them while walking through the hospital back to L&D.

  17. Hope they were some good chicken tenders!

  18. I love the food descriptions! I think it's a genius writing style, and perfect for this setting.
    I'm about two weeks into my m2 path course and I love it. I'd always written path off bc I assumed there was little patient contact. But I want to keep an open mind and posts like this are so helpful! Keep it up.


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