Everything’s Bigger In Texas, Including Pathology

Hello there! It’s your favorite PA student from Sunny SoCal. Sorry for the lack of installments, this student is officially PGY2! Which means clinical rotations. Yes, you read that right, this girl survived her first year of PA school and her first clinical rotation which I will be discussing in this post. A girl is one step closer to becoming a Faceless Man PA.

As you probably could have imagined from the title, my first rotation was in Texas. I made the long journey driving from the Inland Empire to Houston, Texas without the accompaniment of a Dothraki Horde or dragons. After much trepidation from being in a foreign land, (I have never seen so many cowboy hats and boots in my life) I fell completely in love with Houston.

Also, I’ve been listening to Mi Gente featuring Beyoncé on repeat. She’s got a part in there about Houston and it’s awesome.

But back to the gross stuff. My first day, I was terrified. I was terrified of messing up, terrified of maybe potentially killing someone, and terrified of letting myself and my program down. But in the words of the greatest water dancer of Westeros, “Fear cuts deeper than swords.”

Or in this case, scalpels. After getting over my fears, I was ok. I have learned so much while rotating at the Medical Center. The most exciting part for me personally has been seeing all the things I’ve only read about in Robbins and applying that knowledge to real life. I saw sclerosing adenosis in a breast! I can identify that grossly now! I’ve seen vegetations in heart valves from Libman-Sacks! I know the classic gross appearance of renal cell carcinoma! I can go on and on about what I’ve seen and learned but I would probably bore everyone to death.

Another thing I’ve gathered from my experience at my first clinical rotation is that I have a better understanding of what kind of work environment I would like to be in. Rotating in an academic hospital has made me realize that I really enjoy working with residents. I also enjoy the complexity and variability of the specimens. There is also so much opportunity to hone your skills and add to your resume.

The most important thing I’ve come to conclude however, is that I love this field. I can’t imagine myself doing anything else. I looked forward going to the gross room every single day and I would wake up wondering what weird, gross and wonderful thing awaited me that day. I am so grateful I’ve found my niche, and I can honestly say going to PA school has been the best decision I have ever made in my life. Because of this, I’ve also built up my confidence. I know now more than ever I will be a great PA one day with hard work, time, and application of my studies.

To Pam, Leah, Kristine, Jen, Frank, Lessie, Shinika, Tiffany and all the people I had the pleasure of rotating with: if you’re reading this thank you so much for making this first rotation so enjoyable and amazing!

 

Is a Pathologists’ Assistant Career For You?

Hello Sers and M’ladies. Long time no post, so I have returned with an installment for anyone considering becoming a PA. First things first though, you must take the Pathologists’ Assistant Oath.

“Specimens gather and my gross begins. It shall not end until my shift. I shall take no two cases at the same time, hold no mislabeled cases, and father no faulty sections. I shall wear a N95, and win no TB droplets. I shall live and die at my post. I am the scalpel in the darkness. I am the watcher of the gross room. I am the shield that guards the realm of margins. I pledge my life and honor to the Night’s Watch Pathologists’ Assistants, for this shift and all shifts to come.”

Just kidding. You should of course, take your profession seriously. And seriously, wear an N95 when indicated. Also, this made me laugh.

Some things you should consider prior to pursuing the profession:

1) Do you have the guts?

Haha, see what I did there? I crack myself up.

For real though, this job is not for you if you’re squeamish. There’s a lot of things many people won’t get to see that you will, but some of it is not for the faint of heart. There will be gangrenous limbs, horrible stenches, pus, blood and poo.

2) Are you okay being around death?

This is an inevitable part of the job. Autopsies are a part of the PA skill set. Sometimes it isn’t someone you expect–sometimes it’s a 3 year old child who had ALL, or a 19 year old who died in a horrific accident. Sometimes it’s a gunshot victim, or someone who took their own life.

3) Are you willing to put in the work?

Are you willing to put in the effort to study to excel in a program? Are you willing to practice frozen sections and dictations? When you do start working, are you willing to stay later to finish a case? Will you ensure that the pathologist is getting the sections that are most representative of the pathology present? Will you make sure that they receive adequate samples of margins? When doing an autopsy, will you make sure you have examined every inch of the body thoroughly and accurately? If you can’t say yes to all of these questions, then this profession is not for you.

4) Do you have good attention to detail?

This is a very pertinent part of the job and critical for patient care. One section or special stain can completely change the course for a patient. Additionally, mixing up cases, losing tissue or blocks is a big NO. Also, if you have the privilege of having Cherie as an instructor she might give you a face like this.

 

5) Are you ok with working with others?

Part of the reason why I decided to pursue this path (HA another pun), was because I wanted to limit my patient interaction as much as possible while helping them at the same time. However this doesn’t mean that you don’t get to deal with people ever, sorry. You work with other PA’s, pathologists, grossing techs, accessioners, histotechs, etc. You need to keep an open line of communication  and work with them because at the end of the day they’re a part of the team and patient care should be your utmost priority. You are dealing with people’s lives.

Well, there you have it. In my opinion the best way to figure out if being a PA is right for you is to just find someone to shadow. If you contact a program director for a particular program you’re interested in, they can help get you situated.

By the way, WARNING MILD GOT SPOILER AHEAD


 

Was anyone else kinda glad to see Hot Pie in the last episode? What is hot may never pie, but rises fluffier and flakier.

 

 

Why LLU?

Hello,  sorry for my hiatus. After a crushing week of trial by combat finals, it was time for sweet release in the form of spring break.

I did not study whatsoever (hey I didn’t claim to be Baelor The Blessed), and spent much of my time with my family celebrating graduations and my Name Day. After crossing the Narrow Sea 91 freeway, I am back in Kings Landing Loma Linda. It is as hot as a Dornish summer here, and hardly tolerable. I am a direwolf of winter in this sweltering heat, not a sweet summer child. (Seriously it has been triple digit heat out here). Nonetheless, I am glad to be back in The Citadel school, and back to at the Iron Temple Drayson Fitness Center.

For this post, I will be addressing why I chose LLU out of all the other PA programs.

Location:

California. The Golden State. What else could you want? You’re an hour from the beach, the mountains, LA and 1.5 hours from San Diego. Okay, so maybe it isn’t Casterly Rock, but it is still pretty awesome.

The Faculty:

The Program Director Cheryl Germain (Cherie), is a very knowledgeable PA and educator with many years of experience. She is also the former Program Director for WVU, so you know she knows what it takes to make a good PA.

Michael Weitzel is the Clinical Site Coordinator, professor and an ASCP certified PA. He is an experienced professor, and overall cool dude. He teaches Anatomy, Microanatomy, and Disease Mechanisms. He also organizes group hikes on the weekends sometimes, and those are so much fun. (Bonus pic included!)

Shawn MacClary is also a ASCP certified PA and professor. He is new to the program,  but has years of experience as a PA. The first year students get to shadow him up at the LLUMC, which is a privilege itself because he is fantastic at what he does.

Maria Rabina-Vindua is also an ASCP certified PA and a graduate of Cherie’s. She is another PA we get to shadow during our first year at the LLUMC, and she is incredibly patient with questions, and really willing to help contribute to the learning process. She too is pretty amazing to watch gross.

Dr. Sheridan is a forensic pathologist at the San Bernadino Medical Examiner’s office. He gives lectures on forensic pathology that are seriously wicked cool. He is very intriguing and there is much to be learned from him.

Janine Davis is our office assistant and she is absolutely wonderful. She is kind and warm, and offers support for this program for both faculty and students. The program would be very different without her and I am grateful she’s with us.

The Environment

I was a bit nervous when first coming to LLU. I was not entirely sure of what to expect, but so far Loma Linda is an incredibly diverse school and very welcoming. It is very different than the rest of San Bernadino County.

Community Involvement

Loma Linda is very involved with the local community, and is very well known throughout California for it. There are lots of opportunities to get involved including mentoring, tutoring, coaching, etc.

Available Resources

The PA program offers some extensive resources. For one, we have the lowest student to cadaver ratio out of all the programs. We also receive a ASCP approved certification in lab management once we graduate which is awesome. Again, we are the only ones so far to have this. Students also have cryostats available to them to practice frozen sections on, and we have many clinical rotations that we go to. All of Cherie’s former students also have a 100% pass rate for the board examination. We also receive our own microscopes for microanatomy as well as cameras for our biomedical photography class. We are given literally every tool imaginable to be successful in this program, and to eventually be a successful PA.

Valar Dohaeris

Yup. That’s right. I’m at it again with my GOT references. It’s true though–all men must serve, so here I am with a PSA in this post. I’m also super hyped for the next season, I’ve got so many predictions about it! Summer is coming, y’all.

Despite the hype however, there is a sense of dread and trepidation. That’s right. Winter Finals is coming.

As the quarter comes to a close however, there is a subject that has been weighing heavily on my heart that I would like to get on my soapbox and discuss. Warning: this is a more somber post than previous entries. I’ll try and keep it lighthearted with my dank memes, but this is a serious subject. I want to talk about health, and maintaining health.

Going through this program has given me a serious appreciation for my health, and honestly I am just grateful to be alive with no serious issues. Since starting school, I have begun taking probiotics (at the behest of our pathology professor), increasing my fiber intake (more veggies), wearing sunblock daily, and taking my cardio more seriously. I hate cardio.

So, why have I started doing all these things? (Yeah, yeah I know I should have been doing them before). Think of your first car–mine was a 1986 Volvo 240 DL named Betsy.  Now imagine after buying your first car, you’re informed that it is the only car you will ever be able to own your whole life. You don’t get another one, and if something happens that’s too bad. Most would do their very best to take care of that car, because they’d be dependent on it the rest of their lives. That is essentially what it’s like to live in the body you own. Until we have robot bodies that contain our consciousness or aging is cured, that is all we get. So make sure to get your figurative “oil change” by reducing your risk for preventable diseases.

If you look at the incidence of cancers in the US, non-melanoma skin cancers rank #1 followed by prostate, breast, lung, and colorectal cancers. Please make sure you’re getting tested on the recommended basis–PSA testing, mammograms, breast examinations, colonoscopies etc. Wear sunblock to prevent skin cancers, moreso if you have family history. By the way, wear it under your clothes too. Just for perspective, a white t-shirt has an SPF coverage of about 7. That goes down to 3 when it is wet. Eat your fruits and veggies too, people with a diet low in fiber increase their risk for adenocarcinoma. Also, if you have family history of colorectal cancer, the recommended age to start screening is now 40.

So, we all know that cancer is the #2 cause of morbidity and mortality in the US. However, #1 is heart disease. Heart disease is an umbrella term for a variety of cardiovascular diseases. However most of these diseases are preventable with a sensible diet and lifestyle. Obviously not all are, especially for those predisposed due to genetics or for those with congenital heart diseases. Eat healthy and get regular exercise, even if it’s just walking 30 minutes a day. If like me, you love #lifts make sure you’re also getting your cardio in. Physiologic hypertrophy due to lifting without cardio exercise does not lead to more vascular formation in the heart–essentially your heart will be getting bigger without anything to supply it. (Thanks Robbins)! Also, caloric restriction promotes cellular longevity. (Thanks again Robbins).

Well, I’m going to get off my soapbox now. The point is, there are many diseases that are preventable. Not all are. Take care of yourself.


This post is dedicated to my middle school teacher, Mr. Williamson who died this past week after a long battle with melanoma. I will forever be grateful to Mr. Williamson for encouraging and cultivating my love for health sciences from a young age. My hometown has lost a wonderful STEM educator, coach, and friend to many. I will always remember how encouraging he was, regardless of whether or not someone was his student. He always encouraged a healthy lifestyle, and advocated preventative care. He set a precedent for education in TUSD, and his passing has left a hole in the heart of the community. But in the words of Master Yoda, (he was a big Star Wars fan),

“Rejoice for those around you who transform into the Force. Mourn them do not. Miss them do not. Attachment leads to jealousy. The shadow of greed, that is.”

I’ll see you again someday Mr. Williamson, Rest In Paradise. Also, if anyone feels moved to donate, a gofundme has been set up for Mr. Williamson’s family, and a scholarship fund is being set up in his name.
https://www.gofundme.com/3tm1mtc

What No One Tells You About PA School

Going along with my No One references again, haha get it?

Yeah that was a lame joke. In case you couldn’t tell, Arya is my favorite character from GOT. However, in all seriousness, this topic of this post will be all about what happens in PA school that does not generally get spoken about. Some of it you might think, “Duh. Of course.” Some of it however might be, “Oh–I didn’t really think of that.” Either way, hopefully I divulge some information.

First things first: PA school can be expensive. 

Yeah, I understand that this is generally known information.  Obviously some programs are less expensive than others, but most PA students I know are not working while in school and additionally take out loans. Luckily, financial aid is available for most. In my experience, if you are in a financially difficult situation there are also many options available and if you talk to your program director, you’ll find many people more than willing to help you. Also, there are scholarships available for PA students through the AAPA. Check out their website for details.

Second: You will undoubtedly convince yourself you have a horrible disease.

I think several of my classmates have developed lymphoma at some point. As for myself, I was convinced I had Addison’s Disease at one point. (Spoiler Alert: I was definitely being really dramatic). 

Third: It’s really important to keep a balance for the sake of your mental health. 

Yeah, okay maybe you got a 98% instead of 100% on your exam. Just breathe and relax–you’re still going to get hired after graduation and missing that one question on limited vs diffuse scleroderma isn’t going to damage you. You don’t need to punish yourself by studying 8 hours extra on top of what you’re doing. Move on. I guarantee you will never miss that question again. For the record, your classmates who got an 85% are still going to get hired as well. Don’t drive yourself up the wall and learn when to take a break–maintain homeostasis of your mental health.

 

Fourth: PA school will literally take over your life.

I am dead serious. For example, look at this baby armadillo playing with its toys, isn’t it cute?

YEAH. IF YOU LIKE LEPROSY. 

Or what about that trip for summer break down to Lake Havasu? That sounds fun, doesn’t it?

Yeah. If you want Nagleria Fowleri traveling along your olfactory nerve to your brain. Brain-eating amoebas make an excellent addition to any vacation.

What about sushi? Sushi is good, right? A lot of people like sushi?

Yeah sure, if lung flukes are your thing.

Hanging out with your SO? OMG, better examine that suspicious-looking mole on their neck! Quick! What does the acronym ABCDE stand for again? (Hint: Asymmetry, Border, Color, Diameter, Evolution).

Are you watching Grey’s Anatomy while you should be studying? Better yell at Christina and Izzie about where to begin with an autopsy. But seriously, did they really need a book to know that it starts with the Y-incision?

You might think I’m being a little dramatic here, but around test time all I hear in the mutual study area is a bunch of words being vomited out. “SMITH ANTIGEN” “CREST SYNDROME” “TAKE YOUR MARGINS, SERIAL SECTION ANTERIOR TO POSTERIOR” “DORSALIS PEDIS” “ASHKENAZI JEWS”

The other day my classmate described a fart as “flatulence in situ” since it hadn’t penetrated to other areas. So yes, it will take over your life.

Fifth: Despite all the knowledge you fill your brain with, you still develop imposter syndrome.

This is totally normal. I think literally every single person in my program has wondered, “Do I belong here? Do I fit in here? I don’t have the grades/experience as this other person here.” And the answer is always yes. Yes you do belong here. Those people who sat in and interviewed you  picked you for a reason. You contribute to the pool. You bring something that maybe someone else does not. Maybe you’re there because even though you don’t have any lab experience, you’re a fantastic student. You can help those in your class struggling. Or, maybe you’re a former grossing tech and you have tons of experience. You can help those scared to take their first cut in lab. Or maybe you’re just a fantastic candidate all the way around. You’re all in this together.

 

Introduction

Hello there! Sorry for the rather insipid title. Welcome to my first post. For my first topic I would like to talk about the academic aspect of PA school since that is my current predicament. I’ll go ahead and start by telling you what my daily life is like.

How my days go:

I wake up at 6 am. I am bright-eyed and ready to explore the world from the amazing sleep I got the night before. I have a high protein, moderate carbohydrate pre-workout snack of scrambled eggs with spinach on toast. With the slip of my Nike shoes, I am out the door and ready to go work out at Drayson Fitness Center. With some prayers to Brodin, I am ready to enter Swolehalla-may his Swole-iness give me all the gainz. Wheymen. I have a post workout meal of a protein shake, and a shower to wash all the salty goodness off me. I then follow with dressing myself in a killer outfit that would make Donatella Versace green with envy, and makeup including eyeliner wings sharp enough to kill a man. I am then ready to journey off into the rest of my day.

Once I arrive on campus, I have an enthusiasm within me that cannot be contained. The thought of seeing a gangrenous fingertip fills my heart with joy, and I cannot help but grin ear to ear. My classes are fantastic and I know all the answers when my professors call on me in class. I can’t help it, I’m just that amazing.

After a long day of classes, my eagerness to study overcomes my need to feed. Robbin’s and Coltrane Pathologic Basis of Disease satiates something within me which a big, juicy, medium-rare burger cannot. After reviewing the material once thoroughly, my giant brain with a photographic memory stores this information with incredible ease. Then it is time for me to binge watch Game of Thrones and go to sleep to begin my wonderful life all over again in the morning.

Just kidding.

PA school is difficult. It would be a huge, giant lie to say otherwise. Spoiler alert: I don’t have a photographic memory, and I don’t always have all the answers. My makeup and clothes are haphazard at best on most days (in my opinion), and I try to squeeze in 30 minutes at the gym daily to keep myself healthy. The reality is that I spend on average about 4-6 hours per day after class studying. I dedicate about 2 hours per subject, and I find the best way to learn is with repetition (looking at you Quizlet! Love you bae <3). Most days I am lucky to get 6 hours of sleep, and I really love my sleep. Sometimes, I even forget to eat if I’m being honest. Generally I have a voracious appetite, and you’re probably reading this thinking I’m a freak right now (and lets be real–you’re probably right), but it’s true. So why am I putting myself through this?

Because in the end, it’s all worth it. At the end of the day, I love the material I am learning. My classes really are fantastic, I wasn’t joking about that. I have a great support group of family, friends, classmates, and professors that genuinely care about me. My university has amazing resources and PA’s to learn from. So yes, the journey is a difficult and arduous one, but there are some amazing things along the way.  Besides–a girl will learn to take a face for the Many-Faced God.