Your Eureka! Path moment or when you decided path was for you

My Eureka was not really a moment, more like a gradual realization, as that is the type of person who I am, not one to make rash life changing decisions. During 2nd year path labs, I was almost always the last one to leave every day, spent time asking questions of the staff and examining nuances on the slides we had. Other people in the class just wanted to make sure they knew what was important for the test, but I was genuinely intrigued. Then I had the opposite reaction to the physical diagnosis class. I still find physical diagnosis to be a generally useless exercise since lab studies and films tell you most of what you need to know. I wanted to make sure pathology was for me, which was why the PSF was a good experience. Support for pursuing the career came really more from interactions with the attendings and residents. During my PSF, I started with autopsy, did a couple of months of surg path, elective. A few months into the year, I was signing out with an attending who told me that I really had a great mind for the specialty, and that even though I was still a med student and only on my 4th (or 5th) month of pathology, I was doing better than many of the senior residents she had encountered, and I had the right work ethic, etc. That was a nice compliment. That was probably the point when I realized it was seriously a potential career. I had other attendings consistently encourage me in the field. I gave it some more time, and during april in particular I had some great days on the grossing/frozen section service when I saw lots of interesting cases, did good frozen sections, knew how to approach grossing in everything from the standpoint of what I wanted to see on the slide and how to help make the diagnosis, and had great interactions with the staff and the attendings. A couple of those days we also had some great lunch conversations. It was during those weeks that, while I was very busy, often there for 12-14 hour days, it was really both intellectually stimulating and actually fun. That kind of solidified it for me. When I figured out, after a time, what being a pathologist actually entailed and how a career would look it really was no contest. I gave myself a bit of 3rd year when I went back to med school clinical rotations to see whether I would be able to have a career without being an internist, as I had thought I would be when I started med school. Not much of a contest.

My pathology eureka moment: Day 1, internal medicine internship. 'Nuff said.

Every other rotation besides pathology left me with at least a few days of muttering to myself, "What in God's name am I doing here?"

Surgery: A 9 hour neurosurgery procedure to decompress a cranial nerve. The patient had experienced an explosion that had deformed his face and thus the surface anatomy was, to say the least, distorted. The neurosurgeon was shorter than me and I was first assist. Thus, since the entire procedure was done with a microscope, I obviously had a sore back at the end of the procedure (I'm 6'5"). He was also a southerner and his accent was grating on me by the end of the procedure. That, and his tossing of the bipolar cautery around the room. I also got tired many other times in surgery of having the attending throw things. And spending 4 hours on a surgery to relieve adhesions is just downright painful.

Psych: The whole freaking rotation. "How are you feeling sir?" "What the hell are you talking about you $%&#!* piece of *&@#! Get me my $%&#!* cigarettes! There is something odd about a specialty where half of the patients don't want your help.

Pedes: Around about the 5th time of trying to see inside a 7 year old's ear by asking them where Big Bird is (is he in your ear? Let me see?) It gets just a little old. And if I have to explain to one more parent why it is more advantageous to have a vaccination than not to...

Family: You have diabetes? Let me send you to a specialist. You have a gall bladder problem? Let me send you to a specialist. You have thyroid problems? Specialist. Cancer? Specialist. Your kid has asthma? Specialist. However, I can give you a vasectomy and remove an ingrown toenail.

OB: The smell and visual of a baby entering the world kind of loses it's luster for me after one viewing. Unless it is my wife, get me away. Gyn Onc was interesting though.

IM: The prospect of having to go through an internal medicine residency makes me seriously think about quitting med school and enrolling in computer repair school.

Plus, I spent all of these rotations much more interested in pathology results whenever my patient had a biopsy. And the physical exam, my goodness. Take the vitals, feel the pulse, listen to the heart, push on the belly. Beyond that, just get the cat scan and the labs already and give me the results. It doesn't matter if I can feel his liver or not. The cat scan says it's huge. It doesn't matter if I see scleral icterus. I know his bilirubin. It doesn't matter if his lungs sound "junky." I have his xrays and his pulse ox.

I know there is an art of the physical exam and everything, but gee whiz. What else is left after all this but pathology! Good thing I really like it! Actually, I probably could have gone through an IM residency if I had to...

My sides still hurt yaah! You did an excellent job describing my last year of rotations. I am currently in medicine right now and computer repair school does sound pretty good right about now. Anybody else get the feeling that IM is just mental masturbation? I always feel strange when I get home. Not sure if its a "post-coital" state or if I am just dizzy from rounding all day...

yaah said:

Family: You have diabetes? Let me send you to a specialist. You have a gall bladder problem? Let me send you to a specialist. You have thyroid problems? Specialist. Cancer? Specialist. Your kid has asthma? Specialist. However, I can give you a vasectomy and remove an ingrown toenail.

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This is absolutely HILARIOUS and they say pathologist don't have personalities?

joedogma said:

Anybody else get the feeling that IM is just mental masturbation? I always feel strange when I get home. Not sure if its a "post-coital" state or if I am just dizzy from rounding all day...

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Uh oh, that sounds vaguely sexually related. This thread now has an FT-13 (FT=Forum-Thread) rating. I tried to sanitize my description of the psych rotation by using symbols to represent expletives. Closing of thread will probably occur with one more sexual reference, because as we all know, this is a dirty topic and the president will probably make it a sin soon.

Speaking of relentless drivel, I have to do ACLS training (today was day one of two) before graduation. Anyone want to guess how many people made jokes about how useful ACLS was going to be for me, a pending pathologist? At least 10. Everyone is just so funny! "ACLS might cut down on your business, won't it?" Ha. Ha. Ha. Anyone want to make a crack about dead people again? ACLS training is irritating. Necessary, but irritating. This algorithm, that algorithm. They should teach it to us, however, before third year, not right at graduation.

p.s. I am trying to give away free karma to the excellent individuals who post in our forum and keep us living and breathing, without the need for the ACLS algorithm.

Yaah, after reading your thread on clinical rotations, I found myself laughing, and somewhat concerned...I begin rotations this Fall, and I hope the thought of pathology will see me through!

Clinical Diagnosis--what a crock! "I think I hear something...oh wait, that's just the sound of my fingers moving..." "Yes, he does have a dorsalis pedis pulse....oh, wait, I think it's just me pushing too hard..."

Anyhow, I'm looking forward to clinical rotations; I've got some computer repair school applications right here...

Brian Pavlovitz said:

Yaah, after reading your thread on clinical rotations, I found myself laughing, and somewhat concerned...I begin rotations this Fall, and I hope the thought of pathology will see me through!

Clinical Diagnosis--what a crock! "I think I hear something...oh wait, that's just the sound of my fingers moving..."

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No, that was a pericardial friction rub. Wait, you say the EKG is normal, he is asymptomatic, and the echo is normal? Ok, that was a lung rale.

9am: abdominal exam report: (+) BS, soft, NT ND. No Hepatosplenomegaly.
11am: CT scan shows splenomegaly, enlarged cirrhotic liver, ascites.
5pm: abdominal exam report: (+) BS, distended, (+) fluid wave, (+) Splenomegaly, Liver edge palpable 3 cm below costal margin, nodular surface.

My favorite thing on the physical exam: "RRR S1 S2 No M/R/G"
I had an IM preceptor who would see this on a report and say, "What the hell does that mean? Did you even listen?" Luckily I never wrote this on a chart. I have noticed that most people look at the echo report before writing their physical exam findings.

I have seen some real gems in the medical record. My favorite: resident writes..EOMI, PERRLA on soap note for three days straight. Finally, the attending notices and says "Did you know the patient has a glass eye?" Resident responds "Really? I should go check that out..." Needless to say, the attending was not impressed...

I am on ID now, and we were consulted about a patient who was admitted with an infected femur hardware device. He had been there 4 days, surgery on day 1, sitting tight until day 4 when we were consulted because the cultures came back.

No H&P in the chart.
Total extent of Op note: Preop dx infected hardware; post op dx same; procedure removal of infected hardware; surgeon dr x; resident dr y.
The progress notes from each successive day were the same: "No complaints. AFVSS. Awaiting PRS (plastics) recs." The last day, they added "awaiting ID recs." There weren't any PRS notes. That's quality care! Meanwhile this patient in fact had some complaints, including dizziness from a HCT of 17, nausea and vomiting, and was being anticoagulated due to paralysis below the legs and prior clot.

I am double posting because this is too funny to pass up. Because of this, I had another "eureka" today. Actually, more like thank the good lord I chose the right field.

Another consult today from my friends the plastics folks. A poor unfortunate guy who had undergone a hip disarticulation and leg amputation for uncontrollable osteomyelitis and perineal ulceration. Anyway, he had his surgery almost 3 weeks ago, and after the cultures came back he was put on Bactrim to, I guess, prevent any future infection.

Fast forward to today. We get a consult from the plastics service,on the same guy, who has basically been in the hospital this entire time waiting for rehab placement because he keeps refusing a certain place where they want to send him. He has been on the Bactrim the whole time. They have not checked labs, xrays, anything except feeding him, pain control, dressing changes, and the Bactrim.

So they consulted ID today because they want to know if they can stop the Bactrim. "Can we stop the Bactrim? All infected tissue has been removed."

So I get sent off to do this. Decide to check the "consult" section of the chart because every single plastics progress note says "VSS graft sites C/D/I await dispo." Guess what's in the consult section? A consult note from ID, from one week after his surgery (this is two weeks prior to the current consult).

ID consult at this point: "All infected tissue has been removed. May d/c antibiotics." Bear in mind the reason for the consult was "Can we stop the Bactrim? All infected tissue has been removed."

I called the ID fellow to ask if this was some kind of trick or there was something else they had told her that I was missing. She called the plastics resident. Her response: "Oh. OK. So can we stop the Bactrim?" Guess they forgot to check the "consult" part of the chart.

Bear in mind, also, that it takes a significantly elevated USMLE to get into this field!

After reading that last post, maybe I should think about an MD/JD instead of an MD/PhD!

I am a first-year student. I am interested in Pathology for many reasons, but, I have not had my Eureka moment yet. I want one, though. I like pathology because I love studying diseases, histology and pathological changes. Also, pathologists can have good lifestyles. But, there is a part of me holding back. I am not totally convinced that that is what I want to do because there are other fields that I am interested in, like surgery. More patient contact. Also, I think I am more procedurally oriented, and would like a career where I actually do procedures. However, there are some things about surgery I don't like. I don't know if I would be bored with surgery after a while, or if I would get burnt out because of the time required away from family. So, I guess I'll just have to wait. I'm confused. Any suggestions? Yaah, others, come through for me!

yaah said:

Every other rotation besides pathology left me with at least a few days of muttering to myself, "What in God's name am I doing here?"

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Yaah - You couldn't have said it better. That is the essence of my personal pathology " eureka moment". Can I quote that on my signature? Good luck with residency.

My moment of enlightenment occured during my Ob-Gyn rotation. Fate decided that while I was doing the rotation, all of the Ob-Gyn docs decided to go on strike because of the insurance malpractice premium crisis in on of the NE states. I enter the OR on the first day... Some meathead doc asks me who I am, and then promptly tells me that I already wasted 3 years of my life in medschool, and that I should get out ASAP.

Encounters like that really make you reconsider your career choices. Later during the rotation, bunch of us were hiding from attendings at nurses room and complaining about life. I remember somebody mentioned pathology: 'they are the ultimate diagnosticians.' Hmmm... why not check it out, I thought? At first I had to shake off the bad memory from first year anatomy lab, that's how bad my ignorance was. After I took the elective, and did some soulsearching, there was no looking back.

Hey yaah, did you consider writing for TheOnion?

So many things to respond to. Shall I post-pad and respond individually, or shall I condense and used the wizardry of HTML to combine responses in one coherent, if not jumbled (oxymoron, anyone?) response? Perhaps I shall create one long response. Perhaps I shall stop using the word, "shall," because it makes me sound pretentious and snobby. This is post 19 on this thread, which of course means, for most, the next one starts a new page, at which point everything on page one becomes meaningless and ignored. Meaningless, I tell you! The attention span of the average pre-med and med and post-med, despite high achievement and intelligence, is still just above the labrador retriever on the scale that ranges from severe ADD to chess master.

elperro said:

I am a first-year student. I am interested in Pathology for many reasons, but, I have not had my Eureka moment yet... I am not totally convinced that that is what I want to do because there are other fields that I am interested in, like surgery. I'm confused.

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I snipped some content so we could keep this post somewhere between USA today-like length and "Boston Sunday Globe expose" length.
Mr Perro, you are right to be confused. You are in 1st year. I would hope you had not made up your mind about your future career yet. I didn't settle on path until my 3rd year, and this was after I did a PSF. Props to you for thinking about it so early, but it is still early, and thus too soon to worry too much. Once you reach third year, you will be able to experience patient contact, procedures, etc, and determine whether it is, for you, all it is cracked up to be. I was always interested in patient contact, but once I got to third year I realized that I didn't necessarily need it. Many patients are lovely, and it is quite a thrill to take care of someone in their hour of need. But more of them are either 1) total obnoxious pills, 2) the center of the universe, or 3) smelly. Pathologists do some procedures, depending on where you work. FNAs more commonly, some do Bone Marrows. Frozen section and grossing (as well as autopsy) involves a significant amount of working with your hands, clearly. I got bored with surgery. Being in the OR was dreadfully dull. Glove up, gown up, enforce the sterile field, and most of the time spent there is spent either opening up, closing the wound, or maintaining hemostasis. Things are done through smaller and smaller holes too. Laparoscopes are very interesting though. Don't worry, you will have plenty of time third year before you have to decide on a career to see how much you really like patient contact and other fields of medicine. Good communication skills and interpersonal interaction does not make one unsuitable for pathology, by the way. It actually helps a lot. Keep your curiosity open and come back and ask us more questions.

Mr. Plow said:

Can I quote that on my signature?

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Go for it, man. Mr. Plow can do anything he wants. That name again is Mr. Plow, of course. Lousy Plow King!

nilf said:

Encounters like that really make you reconsider your career choices...I remember somebody mentioned pathology: 'they are the ultimate diagnosticians.' Hmmm... why not check it out, I thought? At first I had to shake off the bad memory from first year anatomy lab, that's how bad my ignorance was. After I took the elective, and did some soulsearching, there was no looking back.

Hey yaah, did you consider writing for TheOnion?

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Ha ha, no the Onion has never called me. They are brilliant though. I really like their book of 20th century newspaper headlines. "Dadaist movement ends. 'Victory!' Cry Dadaists."

I like your Eureka story. If you hadn't expressly checked out pathology, might not have found out about the field. That seems to be pretty common. People see slides during 2nd year, a lot of schools expose you to an autopsy during 2nd year, but for most that's the extent of pathology exposure. It's too bad, because 12 weeks of surgery in my case was a little too long. You have to go out of your way during clinical years to get much pathology exposure, other than waiting for reports to come back.

That's it for now. hopefully haven't exceeded the post limit. Have a good saturday. Gonna hit >70 here in the greater worcester area today. I already can't wait for fall (I am not a big summer person).

Ahh, the eureka moment...

I spent two months doing autopsies at the medical examiner's office in Syracuse during my post-sophomore fellowship. During and after that experience I thought I could accurately guess the appearance of someone's internal organs just by looking at their habitus... things like "enormous omentum" and "splenomegaly" or "aortic aneurysm" or "fibroid uterus." I still make bets with myself over what I will find on someone's inside during a post.

So, I thought this meant I wanted to be a surgeon, because even though I had spent a year as a pathologist, I did not want to be a pathologist. But when my surgery rotation came around, I never stopped thinking that the whole process of surgery was way to controlled. I could not see the organs and all of their beautiful attachments. I could not dissect. And worst of all, I had to put it all back together again (well the surgeon did at least!) Then one day, as I retracted the abdominal wall, and the patient's rectum was removed, all of my attention was focused on the bucket heading toward pathology. It was that moment that I knew I wanted to be a pathologist. I cared more about the what was in the bucket, than sewing this patient back together.

To this day, I love the gross anatomy. I am not always certain what this means for my career path...

Mindy

Mindy said:

Then one day, as I retracted the abdominal wall, and the patient's rectum was removed, all of my attention was focused on the bucket heading toward pathology. It was that moment that I knew I wanted to be a pathologist. I cared more about the what was in the bucket, than sewing this patient back together.

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I had a bucket moment too. Actually, quite a few of them. The one I remember the most was a head and neck case of an oral SCC. Basically, to get at this tumor they had to make an incision from the lip down to the neck, and half of this woman's face was peeled off to get at the tumor which was invading jaw bone. She also had to have a good portion of the mandible taken off. Plus a neck dissection. When it all came out I offered to go down to the path lab to orient it for the pathologist because it was a bit confusing, but they wouldn't let me go because I had to retract, tie in the trach tube, whatever. This was major league "cool" surgery, the kind that the residents line up to try to get in on and the chief resident ends up stealing. And I wanted to go down and see the tumor. That happened a lot with me. In medicine, similarly, we had a patient with a liver mass. They do ultrasounds, cat scans, pet scans, keep repeating the physical exam, lab tests, detailed history. And none of it really tells you what it is! Get the biopsy! Enough with all the tests to confirm, rule things out, etc.


See? My prior post was #20, the last on the page, doomed to a life of being ignored. The poor 20th post. Sounds so noble in theory but really just serves as a place filler so that the 21st can assume glory at the top of the page.

yaah said:

Frozen section and grossing (as well as autopsy) involves a significant amount of working with your hands, clearly. I got bored with surgery.

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this was one thing that was interesting at first, then dreadful by about day 3. grossing sucks. walking in to stacks upon stacks of specimen containers with thyroids, nodules, ditzels, nodes, colons, and uteruses was at times overwhelming. the only saving grace is that, unlike surgery, you can take a 10 minute break if you need to clear your head (of the formalin *and* boredom). "mashing the fat" on a colon CA removal was especially time consuming and monotonous.

what i find is interesting, and it has been the case not only with me but with probably 80% of pathology residents i have spoKen to, is that pathology seems to be a "field of exclusion". meaning that people eliminate everything else until only path is left. look at the posts here-- for the most part it's not "i love pathology because . . . " it's " i hated this because . . . . and i hated this because . . . " it's not a bad thing; like i said i was the same way.

my "anti" eureka moment was realizing that i wanted to be able to change the outcome, to have a direct effect on patients clinically (in my case, kiddos) and to be able to see the results of my work. i *hated* internal medicine (i have nightmares about non compliant hypertensive diabetic smoking hyperlipidemia patients, lol). surgery was fun, but bored me to tears at some point daily. when i left the day on my peds service i had the feeling i had *done* something. anyway, this isn't a post to tell you my reasons for doing peds, i just wanted to point out something i noticed that was different among the path residents (other than the smell ) just kidding!!!

someone had mentioned psych being their second choice. i don't think you're weird, because i was down to peds and path. there are probably more of us out there than you realize

Homunculus said:

what i find is interesting, and it has been the case not only with me but with probably 80% of pathology residents i have spoKen to, is that pathology seems to be a "field of exclusion". meaning that people eliminate everything else until only path is left. look at the posts here-- for the most part it's not "i love pathology because . . . " it's " i hated this because . . . . and i hated this because . . . " it's not a bad thing; like i said i was the same way.

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Interesting point, although I think in many cases it isn't necessarily ruling out other fields and coming to path as a default. It's more like, when we (or at least, I) experience a lot of these other fields, it makes me even happier I chose path. I wouldn't ever go into a field just as a default, as if it was the only one I could stand to do. I don't think you were saying that, though.

We have plenty of other threads where we talk about why we love path. It's just sometimes more enjoyable to make fun of other fields, and sometimes this is more tangible. We started out this thread with saying why it was the field of choice, anyway!

So, I love pathology because of the study of disease, for the ability to correlate microscopic and gross findings, to see on a slide a disease at the cellular level and extrapolate this to the greater whole. It is also a field with a great emphasis on education. I also enjoy the variety in the day (I know, some consider it monotonous. Those people have problems with their attention span, cannot sit still, or have no imagination ), as you never quite know what you are going to see on a slide. Pathologists do not quite lead the hectic lives of other specialties - more time can be spent in learning and thinking, and less time running around like a headless chicken, being late for lectures and rounds all the time, and paperwork! Plus, you don't have to deal with the PHYSICAL EXAM as much. Ah, my dreaded nemesis, the physical exam. I may have to create a separate thread to honor you.

There, I've done it again. I've ignored CP totally, again. Those 18 months of my residency will be interesting too, I just don't quite know enough about it yet to praise it in song.

After almost finishing my first year as a path resident, I must say that I really enjoy this stuff. My eureka moment came on gradually. I do remember going over the various specialties during my second year of medical school and totally ignoring pathology. I thought those guys weren't real doctors and just crossed them off the list. I ended up matching in ob/gyn. It was great. I remember match day and having my future all planned out. I was taking the last quarter off to vacation and sit around and do nothing until the intern year got going. Then a friend of mine took a pathology rotation and recommended it to me. Well, I guess I still had reservations about ob/gyn given the lifestyle, schedule, malpractice insurance, residency, future, etc. I remember thinking how I actually enjoyed pathology as a medical student. I remember being on radiology and getting the pathologist to come over and read an ultrasound guided FNA we had just done. She just took the slide, looked at it and gave the diagnosis. How cool that was. So, with prodding from my wife, I took on a pathology rotation just before graduation. It was great. Those guys seemed so happy and were really interested in what they were doing. They were eager to show me stuff and teach me. I had been with good (and bad) attendings in other fields, but these guys seemed laid back and smart. I remember one of the attendings asking me what I was going into. I told him and he had a similar background except he started in IM. Then he said that one of the things that he really enjoyed about path was that he was not tied to his patient. He could leave at 5 pm and finish his cases the next day if he wanted to. I didn't get it at first. I thought that I wanted to be tied to my patient, to be needed. I finished the rotation with a new respect for path but on the verge of starting ob/gyn. Hey, things were still ok. I still knew I chose ob/gyn for a reason and I was all set and eager to get going.

Ob/gyn was tough. Call was 36 hours, labor and delivery was crazy, endless post partum rounds, etc. Yet, I have to say that I liked it. I liked the mix of clinic and surgery. Then I had two tough deliveries back to back that got me to re-evaluate my decision. No one died but one baby didn't look so good. That was tough and I tried to shake it off. Then one ob/gyn attending was with me on a delivery and things were going great. The toco was ticking away. Mom was a multip, baby felt small. Nothing bad happened but I remember him saying that we were there to pay attention to all the warning signs. To act if needed. Duh, of course that was our job. But then he said stuff that really made sense. He said that delivering a baby is easy. Anyone can deliver a multip, the baby practically falls out. His job was to pay attention and possibly do the emergency C section if needed. He was there to save the day. Then it hit me. I guess I imagined that I would labor more with the patient. You know, be there for her for the process and top it off with a good delivery. In a way, I was more of the midwife type. But times have changed. Ob/gyns need to deliver more and more women. At Kaiser, you deliver whoever comes through the door. If it's your patient, great. If not, you deliver them anyway. Hardly anyone made an effort to come in and deliver their own patients. Don't get me wrong, I have the utmost respect for any ob/gyn that can pull a baby out in a few minutes and mom and baby are ok. I just knew then that I didn't want that person to be me.

So, working hard the day before, and being up all night on labor and delivery, I went to my clinic. With a full schedule, and everyone deciding to show up, I saw patient after patient. Had a short, hurried lunch and got back into it. Clinic went late. I was exhausted, missed a dinner date with my wife and headed home. That's when I understood what tied to my patient meant. It's one of the things that I didn't like about IM or FP clinic. That feeling that you are tied to those patients and hopeful that no one takes too much time because it throws off the whole balance. That's when I started to think about path.

Well, needless to say, I made the change. Pathology is so different. I remember getting about 10 cases from the chief on my first day and finishing them before lunch. I went to the chief to get more. In ob/gyn, you are on full speed almost all the time and I guess I was still in that mode. My chief told me that now was my time to read about those cases. Read? What a concept. Of course, by now, I realize how diverse, challenging, and stimulating pathology is. The stuff a good pathologist has to know is almost overwhelming. Reading is a must. And now, even after spending a tough day on surg path and grossing all day, I still can't get over how much of a good time I am having. Path is definatley for me.

Thanks for tolerating my dribble. Ironically, next year we are getting someone from neurology. I guess I'm not the only one with a revelation.

I guess my eureka moment was many years ago-when I realized I wanted to study medicine to learn medicine. Sounds pretty simple. Went to med school, loved my soph path course. Due to other circumstances, ended up in FP, been there for 18 yr. BUT, starting path residency in July! Can't wait.
Sure, it's nice to be "needed" and to "make a difference". But, what I have found increasingly frustrating is the inability to really make a difference-so many people come in with illnesses/complaints secondary to lifestyle choices or stress that is due to poor life choices that I really can't do much in a 10 minute office visit to effect change, except to smile, pat their hand, and rx an SSRI or narcotic. Obviously, I'm grossly oversimplifying and using hyperbole, but basically, patient care ain't all it's cracked up to be, at least not for this guy. Thankfully, it is for some people. Pathology is why I went to med school, though I didn't know it at the time. Bring it on!

Pathology is the guilty pleasure of medicine.

All of the wonderful peripherals: cool work, decent hours, and decent wages. .

Without the responsibility:

"Hello Dr. So-and-so, this is Pathologist Jane-or-Bob calling to let you know your patient has cancer. Yes it looks aggressive. Yes it is at least Stage 3. Sorry to break the news to you. No, I really don't know what you should do now."

We look at disease, the "good" cases, the cream of medicine, all of the time. Our rate of interesting cases is much higher than other fields because by the time someone is biopsied or resected, there is a much greater likelihood that they have an illness. I mean even the lowly tubular adenoma is probably exciting for an endoscopist to find after enduring so many normal colon screens.

Because our field is so different and exciting, and so dramatically different from everyone's impression of a medical doctor, I think many soon-to-be residents try to justify their choice of pathology. Often it comes across as a default choice. In reality I think this is a mechanism of "downplaying" or explaining away our desire to be a part of a career that is still viewed as a terribly non-traditional role for a doctor by the medical community and society at large.

I love pathology. There is not another specialty that is nearly as interesting to me.

Mindy

Mindy said:

Pathology is the guilty pleasure of medicine.
We look at disease, the "good" cases, the cream of medicine, all of the time. Our rate of interesting cases is much higher than other fields because by the time someone is biopsied or resected, there is a much greater likelihood that they have an illness. I mean even the lowly tubular adenoma is probably exciting for an endoscopist to find after enduring so many normal colon screens.
Mindy

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I wonder if those people realize pathologists spend an average of 2.54 seconds per GI polyp to make the dx of TA. Everyone I have worked with always loves getting trays of GI biopsies, because they will go quick, AND there are convenient abbreviations for the dx. TA. TVA. HP.

It is true, you kind of get a skewed realization of what kinds of diseases are more common. We only see stuff from "abnormal" colonoscopies, in general. Think of all those patients with abdominal pain, strange CT findings, breathing troubles, etc, who don't get any biopsies. Sometimes you forget how common pneumonia is.

Koehler I like what you said about patient care! When people talk about how it is kind of a shame that since I am nice, I am not going into primary care, they seemingly forget that the majority of patients out there are the people that other individuals in society also do not like. OK, I'm oversimplifying.

yaah said:

I wonder if those people realize pathologists spend an average of 2.54 seconds per GI polyp to make the dx of TA. Everyone I have worked with always loves getting trays of GI biopsies, because they will go quick, AND there are convenient abbreviations for the dx. TA. TVA. HP.

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but what about the breast or prostate slides? ugh, lol. "prostate CA is a low power diagnosis-- it's a 'gestalt' more than a particular feature" good stuff

my favorite slides were post vasectomy slides. take exactly .25 seconds. "lumen? lumen." done.

Homunculus said:

but what about the breast or prostate slides? ugh, lol. "prostate CA is a low power diagnosis-- it's a 'gestalt' more than a particular feature" good stuff

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Yeah, my attendings would leave the breast and prostate slides until the end of the day out of fear. Here, they also cut 3 levels on each core and the urologist usually biopsies 8 different sites. That's 24 slides of gestalt. Wait. What was that? Sorry. Seminal vesicle. Wait! How about that? Nope. Wait! Nope. Wait! OK, mark that one. We'll stain it. Wait! No, that's too ugly to be cancer. Has to be normal. (Prostate is kind of strange in that cancer often becomes cytologically and architectually bland, whereas normal gland can be suspicious).

Sometimes the attending would give me or a resident the entire tray of prostate slides and say, "find the cancer and get back to me." That would be good for a nice couple hour headache. Actually, I kind of like looking at prostate slides, it improves your diagnostic acumen.

I like prostate. There is a feel to it. We do 1 week rotations on GU pathology 3 to 4 times a year at MGH. That means we get 15 to 20 trays of prostate cores (including consults) a night! Holy prostatectomy. My largest consult case was 49 (5 trays) individual biopsies (over 2 years, but still!)

Tubes and Vaz's do rock! Except when 2 lumens degrades into 1 lumen...

Mindy

I've known I've loved path since way before medical school, when I was a colposcopy coordinator, and was completely and totally obsessed with the path reports. At the time I mistook this to be an interest in gyn or maybe gyn onc, but it didn't take too long to figure it out. Thank God.

I'm doing a 4 week elective rotation now in path, and I am so totally in love with each and every resident and everything they do. They are intellectual and love to teach. They actually let me do stuff. They cuss more than I do. The average emotional age of the department is about 13 or 14. It's so much damn fun. Every day I laugh so hard my stomach hurts and I cry. Who wouldn't want to work with people like this? I know the standard OR jokes about lifeless, people-hating pathologists, but really, every one I've met and worked with has been a happy, humorous, interactive person (who may or may not hate people). I mean, come on, look at surgeons - they hate people too, plus they are miserable, bitter, and unpleasant. And self-righteous. Ugh.

Whoever said that path is the guilty pleasure of medicine is right on. That's a beautiful way to sum it up.

cookypuss3 said:

I've known I've loved path since way before medical school

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I'm in the same "loved path before med school boat" although I have yet to matriculate into medical school. Most people think I'll change my mind, but I seriously doubt it. Like a previous poster stated, I'm also interested in prostate although doing immunohistochemistry with large slides is a bit of a pain. I'm looking to concentrate my graduate research and residency in urological oncology, especially kidney and maybe add some breast pathology too!

It's so true. Every single pathologist I've ever met loves his/her job, has a lively personality, and a great sense of humor. So much for "dead people" docs.


Most of the clinical docs I meet are tired of their jobs, freeze swimming pools with their personalities, and have a sense of humor that shows itself only when they're taking pleasure in a peer's discomfort or mistake.

Both happiness and dissatisfaction are contagious, so why not hang around the happy people?

Yeah, for a lot of clinical folks I met, it seems like their job turns into "routine" after a few years (or quicker). I am not sure why that is. There are some who enjoy their job and get a thrill out of parts of it, whether that is the teaching, seeing new patients, making a diagnosis, whatever. OK, that probably isn't fair, probably most of them enjoy at least parts of their job. Perhaps part of the reason that pathologists tend to enjoy their job is that the field somewhat self selects its personnel. There isn't much exposure to the field in med school unless you specifically go looking for it (other than 2nd year teaching). A lot of people end up in surgery, methinks, not only because they love the field and all its possibilities, but because they think it is a challenge and their egos tell them it is the field for them. A lot of people end up in medicine, methinks, because that is often the default. Pediatrics, IMHO, often seems to contain a lot of people who are not completely interested in medicine itself. They love kids and interacting with people. I'm of course not trying to slam anyone, just some observations. There are of course people in every field out there (probably more than are readily apparent) that love what they do, are inspired by it, and would never do anything else. Pathologists, however, tend to have more of a love and respect for what they do (and an understanding) because of the self-selectivity. There is so much to learn and see that the field doesn't become routine as easily.

Generalizations, in general , are just what they are, and never apply to anyone in particular. I have met a few miserable pathologists, some of whom seem to want to just get the job done, not worry one bit about teaching, and also don't seem to want to go beyond the absolute necessary knowledge level. But they are in the minority. I would wager, however, that some people in surgery would say that the jaded and totally obnoxious are in the minority also, but I would postulate that the individuals who think this are seeing what they want to see.

As always, though, our psyches tend to color the things we see with our own biases and opinions. For us who may see an abrasive, sarcastic pathologist as an incredible wit, dedicated worker, and committed to bettering themselves, there will be those outside the field who see this individual as a cold, unfeeling boor. Just as we might see a haggard primary care clinician, always stressed, on the go, quick to snap when things aren't done right, spending the minimum time with a patient, not caring about side issues, while others see this person as incredibly dedicated to their career, thoughtful, and reasonably demanding.

BTW, hey cookiepuss, since you like Nietzsche, he has another quote, "everything absolute belongs to pathology." Although, to be honest, I snipped a bit, it actually starts with, "Joyous distrust is a sign of health. Everything absolute belongs to pathology." Thus he was "spaking" about mental health and emotional pathology. But still, we can borrow. As I said before, the ubermensche may have been a pathologist. At least, the admirable character traits.

Of course, Nietzsche also said, "Is Wagner actually a man? Is he not rather a disease? Everything he touches falls ill. He has made music sick." This I tend to disagree with, although Wagner's personal views on many things are sick, his music I rather like.

yaah said:

As always, though, our psyches tend to color the things we see with our own biases and opinions. For us who may see an abrasive, sarcastic pathologist as an incredible wit, dedicated worker, and committed to bettering themselves, there will be those outside the field who see this individual as a cold, unfeeling boor. Just as we might see a haggard primary care clinician, always stressed, on the go, quick to snap when things aren't done right, spending the minimum time with a patient, not caring about side issues, while others see this person as incredibly dedicated to their career, thoughtful, and reasonably demanding.

BTW, hey cookiepuss, since you like Nietzsche, he has another quote, "everything absolute belongs to pathology." Although, to be honest, I snipped a bit, it actually starts with, "Joyous distrust is a sign of health. Everything absolute belongs to pathology." Thus he was "spaking" about mental health and emotional pathology. But still, we can borrow. As I said before, the ubermensche may have been a pathologist. At least, the admirable character traits.

Of course, Nietzsche also said, "Is Wagner actually a man? Is he not rather a disease? Everything he touches falls ill. He has made music sick." This I tend to disagree with, although Wagner's personal views on many things are sick, his music I rather like.

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Oh, ye of the diplomatic mindset, you're annoyingly right. However, I still think that pathologists rock, surgeons are pretentious, overinflated adult-sized children, anesthesiologists are the kids in your high school that used to smoke too much weed, and ER types listen to too much Greatful Dead. Oh well.

BTW - I'm going to add in that Nietzsche quote about pathology into my signature - now if I could only find it in German, I'd be one happy girl. You're just fabulous.

cookypuss3 said:

Oh, ye of the diplomatic mindset, you're annoyingly right. However, I still think that pathologists rock, surgeons are pretentious, overinflated adult-sized children, anesthesiologists are the kids in your high school that used to smoke too much weed, and ER types listen to too much Greatful Dead. Oh well.

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Cookypuss, you are my kind of fraulein. You quote Nietszche, make wicked fun of the surgeons, throw in a "ye" every now and then, and enjoy pathology. If, perchance, you also enjoy baseball and the occasional 19th century opera, with a nice Chianti thrown in, I would think you would be too good to be true. If I actually spoke german, I would find you the original quote. But alas, nein. Je comprende un peu de francais seulement. Y tambien un poco de espanol.

I often try not to be diplomatic, but sometimes I am of the mood where I become so. You have very well described surgeons and gas-people. I agree that pathologists rock. I had some very fun times during my PSF. A lot of it was with the ancillary staff (PAs, secretaries, etc) who were much more fun to be around than the crop of residents we had that year, many of whom struggled to be humorous in their primary language, let alone ingles. Many of the attendings were also fun. Quite often I would go to lunch and stay there for 2 hours while different departmental people came and went. Oh the stories we told! The times we had! Surgery was about as much fun as a room full of incontinent (and deaf) elderly. The only things that passed for jokes in that department were crude sexual references. Not that I am completely opposed to the occasional crude joke, but when that's all there is, I raise the flag of protest.

Back to my frozen pizza and straight vodka.

Straight vodka!!! Who needs a nice Chianti when you've got a Price Club sized bottle of Absolut in the freezer??

I wish I knew why surgeons are such humorless cows. I guess their hours suck and they don't make quite the bank they used to. I'm extra bitter since I just finished my surgery rotation recently and had to resist stabbing her in the eyeball with a #10 blade more than once. Ugh she was hideous. The only fun I could have was when I would actually cut her knots on purpose so all the sutures would fall out and she'd have to do them all over again. Hee hee hee.

As for baseball... any activity that allows one to be inert for hours while drinking beer is not all bad.

As long as it's not Absolut Kurant. Dear heavens that stuff made me nauseous for nearly a fortnight. First with the taste, then with many days memory of the taste. I got this little "sampler" package of 5 or 6 different absolute flavors, so I tried them. I like the citrus. But that kurant. Yowza.

The only times I actually got to operate with a female surgeon were #1, my time on gyn-onc, and #2, when I operated with an alpha male attending and a female resident who had not done her reading about the procedure we were doing prior to starting. It was an incisional hernia, but was very complicated due to adhesions. Boy did he tear her a new one. The alpha male decided the best way to make the operating room environment a pleasant and low-stress one was to constantly berate her about her lack of preparation. "I really wish you had read," he said on more than one occasion.

I was first assist with a neurosurgeon on one occasion and he had me cutting his knots while he was closing the dura. He would say, "cut 2 millimeters from the knot." I think I only succeeded in doing this on about 15% of the cuts, because after he finished he took the scissors out of my hand and went back and trimmed the knots himself to the correct and evidence-based-medicine mandated 1.964 millimeters. No post op wound complications for this patient! I think the surgeons now are just angry because the residents are mandated to 80 hour weeks and the attendings often work more than that.

So you like baseball too. When I go home tonight I will have a vodka shot in your honor.

yaah said:

So you like baseball too. When I go home tonight I will have a vodka shot in your honor.

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Get a room, you two.

ugh. I'm getting painful surgery flashbacks just by reading your accounts of 2 mm vs. 1.964 mm long ties. I just want to scream, "Think outside the box!" when they get all caught up in some minor detail and get the same look cats do when you run a laser pointer up and down a wall.

My female surgeon was a general surgeon who suffered from extreme overcompensation via her appearance. She is obsessed-jogger gaunt, with enormous fake boobies, a fake tan, long bleach blond hair, too much poorly applied makeup, and short skirts with ruffles and bows and FMPs at all times except when in the OR -- even on rounds. It was all very surreal and I kept myself amused by wondering exactly what her issues were that made her feel the need to present herself like that.

I think we should go over to the surgery forum and start a new thread of our own, a poll if you will, and try to ascertain the origins of all this bitterness.

As for Absolut Kurant - haven't tried - I'm not super crazy about all the flavored stuff that's out now. It gets kind of cloying. What's wrong with nice plain old stuff, with a little splash of club soda, and a wee bit of a lime squirt? Mmmmm.

Mr. Plow said:

Get a room, you two.

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A 2 headed microscope will be fine.

p.s. that female surgeon sounds like a piece of work. Also sounds like she might have had one or two dalliances with the male surgeons. I spent a lot of my time in the OR with a different alpha male surgeon discussing his personal life. Then, I got to talk about this with one of the nurses, and apparently this alpha male surgeon and a different one had bought a large boat together (50 footer) and they had parties to which they invited all of their poor nurse friends. Both of these surgeons were married, BTW, and their wives didn't know about this until one of them found out, invited herself to the party, and the rest is history. But if we started a thread on the surgery forum, I am sure we would get plenty of intelligent responses like "$#@! you" or "you just wish you were talented and smart enough to be a surgeon," etc etc etc. Actually, they would probably be worded like, "Me smarter than you. Me cut tumor out. Tying knot is hard."

Three cheers for unenhanced vodka! Hurrah! Hurrah! Wait, what was that? I forgot what we were cheering about.

edit: yes, I am painfully aware of the Freudian significance of the large boat to these poor misguided surgical types.

Actually, the 2-headed scope DOES have its potential... mrrrow....

What is it with male surgeons lusting after female nurses? The opposite, female docs-to-male ancillary staff, is really not so true. I tend to lust after people of similar educational status, with the rare exception when I go way out of left field and date the 22-year-old apartment salesman. But I digress, and the 22-year-old is history. There is something weird about the OR that breeds sexual tension. I'm not quite sure I understand it, but I can say by the end of the 4 weeks on surgery I was all hot for another student on my service (no pun intended). Maybe it's just the Department of Slovenly Lust. It's all that scrubbing... and hot body parts... and latex... and humiliation. Oooh yeah.

There are two versions of the two headed scope. Some people will put the two viewing spots side by side, so the people sit next to each other. Others put them facing each other. One person I once sat with said she put them side by side because too many of the residents had severe halitosis and it made signout unpleasant. Since I was not a resident at the time, I was not accused. Anyway though, the head to head scope is more appropriate for checking out the person on the other side and perhaps nudging them with your knee. The side by side scope, you feel a little closer but can't look unless you are obvious about it. Of course, all of this is completely useless when the other person at the scope is not a fine lady (for me, anyway).

Apartment salesman? I'm not even sure what that means, since most apartments seem to be rented. Perhaps he had found a niche in the market.

Man, I had a crush on one of the Gyn residents during my 6 weeks there. She was married though. And the pediatrics folks were pretty something-something too, although once they started talking about pediatrics I lost interest fast.

You only had 4 weeks on surgery? I had 12 (all required, 3 of which was the 7th circle of hell that is vascular surgery)! What the?!?!? I am now angry. I went so far as to fake a vagal episode so I could get out of a particularly objectionable AAA repair. Well, that's not entirely true, but I wish I did.

I did not find surgery to be a particular turnon. In fact, the relationship I was in at the time somewhat fizzled because I kept saying at 7:30, "well, I have to go to bed, so I'm going home now." It was a non medical student, so there was little way of making her understand this. But alas, if it had been worth saving I would have gone the extra mile and stayed up until 9pm. Surgery at my school seemed to be a good excuse for everyone to not bathe at all. There was one particularly sultry PA student on the service but she kept getting paged by the resident who was so desparate he would watch her do a postop check.

Med school killed my relationship. Familiar story, I guess. It killed off another one with a particularly nice school teacher. Grrrrrr. She even liked opera.

To keep us on topic, Eureka! Pathology doesn't kill as many relationships!

Hey everyone,

I too have recently had a Pathology eureka moment (2 nights ago actually).
Even though I'm only a first year, I realized my calling while preparing for a physical exam test.....it also occured that this is the field for me when I came home after a long day yesterday and dislodged my copy of Robbin's from my custom made belt clip (Is that book on Palm yet!?)

I've had enough relationships, if you care to deem them that, come and go during medical school to know that it's not school that is causing the demise. Rather, school actually can provide a nice excuse....

Apartment salesman? I dunno, leasing agent? I never quite understood it, to be honest, and since he liked to refer to himself as a salesman (as if that is a prestigious title) I guess it stuck. I didn't really listen to him too much.

We actually had to do 4 weeks of general surgery third year, and then have 4 more weeks of "subspeciality surgery" our fourth year. My answer to that was to sign up for anesthesia for 4 weeks, fulfill their stupid requirement, and avoid scrubbing in at all costs.

I don't see how pathology could be detrimental to a relationship. You're home a lot, you're not exhausted, you don't have to get up at 4.30 a.m. the following morning... the only downfall might be the occasional odd odor.

Mike59 said:

I too have recently had a Pathology eureka moment (2 nights ago actually).
Even though I'm only a first year, I realized my calling while preparing for a physical exam test.....it also occured that this is the field for me when I came home after a long day yesterday and dislodged my copy of Robbin's from my custom made belt clip (Is that book on Palm yet!?)

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Oh my gosh what a pathetic loser! Just kidding of course, I admire you for having the stones to carry around not only a copy of Robbins, but a custom made belt clip. I hope Robbins actually doesn't come on palm version, because I was frankly hoping to give my palm pilot the old heavenly discharge upon completion of my last clinical month, towards the end of may. Judo chop!

Welcome Mike59. Is there a significance to the 59 or are there just 58 others who want the name mike?

And cookypuss you are right again. Maybe I'll create a bumper sticker (after I create my sonnet, "Ode to Cookiepuss,") that reads, "Pathology is for lovers" to steal it from Virginia or whatever state (sorry, Virginia's a commonwealth!) currently has the patent on that phrase. Med school can provide a nice excuse at times. As I said, the surgery rotation ended that one relationship, which was actually kind of fortunate. Pathologists do have the occasional odd odor, or more commonly the occasional odd fleck that is stuck to your shirt.

What's that, dear? Ah, nothing. A piece of somebody's prostate.
Is that a piece of blood vessel stuck to your shirt? Ah, it's nothing. You should see the other guy.
What's that junk on your pants? Whoops! Piece of a tumor. Hope it's not contagious!

yaah said:

Welcome Mike59. Is there a significance to the 59 or are there just 58 others who want the name mike?

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Hey-Yaah! (I will withhold my musical analogy for the sake of good taste in comedy)

Actually, the name has both sociological and anthropological significance-
However I would probably be in violation of the TOS for this messageboard if I go into any more details about the "59"....Let's just say the ladies aren't complaining

too funny! Karma for you!

joedogma said:

too funny! Karma for you!

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Ditto. I gave you karma for the "quote-unquote 'ultimate belt'" reference. ALthough you didn't refer to it as the "quote-unquote ultimate belt." I took that liberty.

My name Yaah has nothing to do with a song, by the way.

See, what was I telling you all? Another pathology stud! Mike59 has the unmistakable aura of a pathologist, and the ladies flock to him. Hey Mike, how much can you bench?

Mine was a gradual process, a plodding realization that I didn't really care for clinical medicine and thoroughly enjoyed pathology. The point and which I decided was on my pathology elective early in 4th year. I got to gross in a few small things (gallbladder, appendix,etc) and thought "Man, this is really cool!". So there you go.