D'oh

So, to celebrate the fact that I made it on time yesterday ... I promptly slept through my alarm this morning. Oops. I missed a presentation on two autopsy cases and a half-hour primer for the interns on how to gross a colon. I really need to get back on a proper sleep schedule, after staying up late and waking up past noon for most of summer vacation. Hopefully this will kick me in the butt a bit.

Besides not learning anything, I was counted absent for the presentations. We have to attend a certain amount of presentations over the year, or there are consequences, such as increased call or decreased book fund.

Wait, pathologists take call?

First-year residents have three weeks of CP call, taken a week at a time. It's usually home call, since we just field questions. In theory, we might have to come in and write orders. Most of it is blood bank/transfusion questions, and since we haven't had those rotations yet, we'll mostly be taking down information and contacting the transfusion fellow. Seconds years have two weeks, third years have half a week, and fourth years have no CP call.

AP call is different. If you're on surgical pathology, you have call every couple days, which is basically coming in and doing a frozen section if one comes up. If you're on autopsy, you have call every other weekend; if there's an autopsy, you come in and do it. Not paradise, but not surgery call either.

Holidays are also divvied up; each intern has to take call for one major and one minor holiday. I'm on call over Christmas and Memorial Day this year. Every remaining holiday, I don't even have to come in.

As for book fund -- we get a couple hundred dollars to spend a year on books. If you've ever seen a typical pathology program's library, you realize that this is almost chump change. There are dozens of books out there that people might recommend. Most residents will get one of the main surgical pathology references (either Rosai/Ackerman or Sternberg) and probably a CP book. Other options include Differential Diagnosis in Surgical Pathology (since we don't know what the diseases look like), Histology for Pathologists (since we don't remember what the normal tissue looks like), a grossing manual, and more organ-specific textbooks that you can shake a stick at.

Another "clinical faux paus" got discussed today during micro rounds. A patient had four out of four blood cultures come back positive for Bacillus, despite having a clinical presentation that wouldn't fit that diagnosis at all. Bacillus can be a contaminant, and if it shows up in one of four cultures, it's usually dismissed as such. Apparently, sometimes, the ER here will perform one blood draw (from one site), then inject the sample into four different culture vials. On top of that, they sometimes won't disinfect the top of each culture vial before injecting it. Voila -- one contaminated sample spread over four vials.

Later, we went over a few questions with the micro attending. He discussed proper sampling, and gave a talk about what is and isn't good to receive. Lots of people send swabs, which are really only good for a few things (nasal, throat, and urethral cultures, and perhaps a few others). A swab holds about 150 microliters of fluid, and only 3% of bacteria on the swab come off when culturing a plate. Tissue and fluid are much preferred. The attending said some doctors will draw a few cc's of fluid, then swab the fluid and send that. The lab would be much happier to receive the vial of fluid instead. He said he is trying to get the message out about stuff like this, with only moderate improvement.

The worst word I overheard today: "scrotectomy."