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[cjw0918]

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And I don't mean the way a good bra makes for great cleavage...I mean when some jerk surgeon calls surg path yelling because you didn't find enough lymph nodes in an axillary dissection to suit him (although he has plenty of info for prognostic implications and clinical management), do your fellows and attendings stand up for you? This happened to me and the fellow said, "Well she's a first year. You're right- she should have found more nodes. Would you like to talk to an attending?" WTF?! He could have said, "I'm sure our resident did a thorough dissection, but we'll look at the the specimen again." Would that have been too much to ask? Now this surgeon is going to harrass me constantly, because he feels I am incompetent. No one seems to stand up to this guy, not even attendings. I re-examined the specimen and found a few more nodes, but it was all basically to humor this jerk. Didn't change a damn thing. The attendings just do whatever he wants to placate him and move on. Anyway, I was really bothered that the fellow didn't even try to stand up for me. Is this a common culture in hospitals with path fellows and attendings allowing themselves to be treated like crap by surgeons and not having the guts to take up for co-workers?

 

[DasN]

next time you see him kick him in the croch. Then smile 🙂 and say I think i found 2 more

 

[b&ierstiefel]

sorry to hear that this happened to you. just take solace in the fact that some surgeons are bona fide dinguses and you can't do anything about that. perhaps the resident who didn't stick up enough for you did so because he/she also is intimidated by the surgeon. just try to not take it personally, learn whatever from the experience and move on.

this hasn't happened to me but i haven't started my surgical pathology weeks yet (give it another 2 weeks and i'll be in your situation for sure). i haven't had to gross in a big hunk of ass with mesentery and ass-fat but i can appreciate how hard it is to find lymph nodes cuz many are very tiny after watching our own Baby Rosai go elbow-deep searching for these little buggers at his grossing station (he seemed flustered by this...i think residency is starting to get to him...yesterday i stopped by the vag path room to see if he needed any help, and Baby Rosai had tears streaking down his face--"Andy, WTF am I supposed to do with this specimen, wahhh"--it's ok Baby Rosai, after this weekend, and believe me you'll be working this weekend , you too will have mastered the intricacies of the illustrious vag and you'll look back on that day and just laugh it off..."you know, Andy, vag path is fun and full of sh*ts and giggles, i shouldn't have bawled my eyes out that day"). anyways, i've heard of the saying that, "if you can't find enough lymph nodes, you better search again since they're there." oh well...it still doesn't change the fact that finding these little f*ckers is difficult.

wherever you end up, there will be a mix of jerks and cool folks regardless of departments. you basically have three kinds of people in the world: dicks, *******, and dinguses. dinguses just like to **** all over everything and there's not much you can really do about that. so it's basically your job to become a dick so that you can kick him squaw in the nuts and f*ck this dingus next time he decides to give you ****. if you don't, you might be seen as a ***** and that's no good cuz the ***** is only a few inches from the dingus.

Profanity Count for this post - 12 (highest score 14 set by Harbster).

 

[PsychMD]

you basically have three kinds of people in the world: dicks, *******, and dinguses

LOL!

Which led me to wondering: does one even have a choice these days to be a solitary monk anymore? I've always been fascinated by those contemplative silent orders!

http://news.bbc.co.uk/1/hi/wales/602641.stm

http://aolsvc.news.aol.com/news/article.adp?id=20050812000809990005&_ccc=5&cid=842

 

[yaah]

That fellow needs a bit of perspective, I think. Quite often, the first year residents are the ones who do the best job grossing (in particular when looking for lymph nodes) because they are so thorough. Here, if that happens, they will say "we did a thorough job sampling but we will look nonetheless."

The question is: Were there more lymph nodes in the specimen? I have this problem coming up on monday because I had an abdominal perineal resection that I grossed yesterday, and when the slides came back for previewing today there were only 6. Now, this was a big specimen. TONS of fat. But I'll be damned if I didn't discover that the largest lymph node was about 2 mm. And the second largest was less than one mm. I went through that fat for an hour, and no more luck. So, this weekend when I am finishing my work I am going to go back, preemptively, and look for more, even though I know I won't find more than 2 more even if I search for 4 hours. But this won't matter to some people, because, "There should be at least one lymph node for every centimeter." Bull****. I call foul. Sometimes there is, but some people just have a low number of nodes, especially around the rectum.

 

[deschutes]

The only thing I can think of to remark on is that perhaps the fellow is new too and hasn't had the experience in dealing with those situations.

Lymph nodes. I've quoted a similar article before, but from Mod Pathol. 2004 Apr;17(4):402-6:

"All of the mesenteric tissue was submitted for histology. The average number of nodes found by original gross inspection was 20.8, while the average number of additional nodes found after clearing was 68.6. In all, 83% of the additional nodes were 2.0 mm or less in size. "

Which doubtless we are all in the process of finding out first hand...

 

[Gut Shot]

Sounds like you should take that resident aside, look him/her straight in the eye, and say "Look ************, that **** you pulled back there was bogus *********. If you want to dry **** me again then just pray that you're never in a situation where you're beholden to my whims, because I will rip your ******* ****** out through your ******* and then *** ******* ***** couch and ******* *** ******* potato **** ** **** **** anus ********* zipper *** ****** ground up glass ******** *** **** flaming porcupine."

That'll set 'em straight.

 

[b&ierstiefel]

The path of the righteous man is beset on all sides with the iniquities of the selfish and the tyranny of evil men. Blessed is he who in the name of charity and good will shepherds the weak through the valley of darkness, for he is truly his brother's keeper and the finder of lost children. And I will strike down upon those with great vengeance and with furious anger those who attempt to poison and destroy my brothers. And you will know that my name is the Lord when I lay my vengeance upon thee.

 

[DarksideAllstar]

The path of the righteous man is beset on all sides with the iniquities of the selfish and the tyranny of evil men. Blessed is he who in the name of charity and good will shepherds the weak through the valley of darkness, for he is truly his brother's keeper and the finder of lost children. And I will strike down upon those with great vengeance and with furious anger those who attempt to poison and destroy my brothers. And you will know that my name is the Lord when I lay my vengeance upon thee.

Its the one that says bad mother****er.

 

[yaah]

"All of the mesenteric tissue was submitted for histology. The average number of nodes found by original gross inspection was 20.8, while the average number of additional nodes found after clearing was 68.6. In all, 83% of the additional nodes were 2.0 mm or less in size. "

Which doubtless we are all in the process of finding out first hand...

2 mm is huge. The largest one in this stupid specimen was 2 mm. When it gets below a certain size they will stop counting them as lymph nodes. I just find the variation in numbers so amazing. I had a right colon that I did today where there were about 30. And then the large AP resection where I may have found 6-8 if I am lucky. And that was after spending 3 hours looking through the fat over a two day period, making 2 mm cuts and then inspecting and squishing the 2 mm cuts.

 

[Brian Pavlovitz]

The path of the righteous man is beset on all sides with the iniquities of the selfish and the tyranny of evil men. Blessed is he who in the name of charity and good will shepherds the weak through the valley of darkness, for he is truly his brother's keeper and the finder of lost children. And I will strike down upon those with great vengeance and with furious anger those who attempt to poison and destroy my brothers. And you will know that my name is the Lord when I lay my vengeance upon thee.

brothers and sisters-ah! Can I get an Amen-ah? There's a God-ah...somewhere-ah!!

Preach on, brother Andy!

 

[quant]

brothers and sisters-ah! Can I get an Amen-ah? There's a God-ah...somewhere-ah!!

Preach on, brother Andy!

AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA-MEN!

 

[Supersheep]

AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA-MEN!

Oh no... looks like Monday morning's gross conference is going to be replaced by a good old fashioned revival... as long as it doesn't turn into a wake... 😉

 

[b&ierstiefel]

Oh no... looks like Monday morning's gross conference is going to be replaced by a good old fashioned revival... as long as it doesn't turn into a wake... 😉

So far, it looks like there won't be one. But we shall see what Sunday brings....

 

[Supersheep]

So far, it looks like there won't be one. But we shall see what Sunday brings....

Good, I was kinda worried that as hot as it was here today there may be a string coming in- glad to hear that didn't happen. Keep that white cloud a shining and let the countdown begin... (T-1 day and counting...)

 

[b&ierstiefel]

Good, I was kinda worried that as hot as it was here today there may be a string coming in- glad to hear that didn't happen. Keep that white cloud a shining and let the countdown begin... (T-1 day and counting...)

Well, I'll get called in if there is a third autopsy tomorrow. Today (well technically yesterday) I was on call for the first two autopsies. Now before I say anything about the typical numbers of sunday autopsies and put a jinx on things, I'll shut up right now. Overall, it's been a good week. Last week was good too. Things should be aight for the next 2 weeks then it's time to...

BRING THE PAIN!!!!! (for two months!)

 

[SLUsagar]

sorry to hear that this happened to you. just take solace in the fact that some surgeons are bona fide dinguses and you can't do anything about that. perhaps the resident who didn't stick up enough for you did so because he/she also is intimidated by the surgeon. just try to not take it personally, learn whatever from the experience and move on.

this hasn't happened to me but i haven't started my surgical pathology weeks yet (give it another 2 weeks and i'll be in your situation for sure). i haven't had to gross in a big hunk of ass with mesentery and ass-fat but i can appreciate how hard it is to find lymph nodes cuz many are very tiny after watching our own Baby Rosai go elbow-deep searching for these little buggers at his grossing station (he seemed flustered by this...i think residency is starting to get to him...yesterday i stopped by the vag path room to see if he needed any help, and Baby Rosai had tears streaking down his face--"Andy, WTF am I supposed to do with this specimen, wahhh"--it's ok Baby Rosai, after this weekend, and believe me you'll be working this weekend , you too will have mastered the intricacies of the illustrious vag and you'll look back on that day and just laugh it off..."you know, Andy, vag path is fun and full of sh*ts and giggles, i shouldn't have bawled my eyes out that day"). anyways, i've heard of the saying that, "if you can't find enough lymph nodes, you better search again since they're there." oh well...it still doesn't change the fact that finding these little f*ckers is difficult.

wherever you end up, there will be a mix of jerks and cool folks regardless of departments. you basically have three kinds of people in the world: dicks, *******, and dinguses. dinguses just like to **** all over everything and there's not much you can really do about that. so it's basically your job to become a dick so that you can kick him squaw in the nuts and f*ck this dingus next time he decides to give you ****. if you don't, you might be seen as a ***** and that's no good cuz the ***** is only a few inches from the dingus.

Profanity Count for this post - 12 (highest score 14 set by Harbster).

i've been away from the forum for a while...
baby rosai??? please clarify andy!!

 

[b&ierstiefel]

i've been away from the forum for a while...
baby rosai??? please clarify andy!!

You know the saying, "The force is strong in that one", right? Yeah, well it applies to one of my fellow classmates here. Exemplifies flawlessness and sheer brilliance. Hence, he is baby Rosai. All hail baby Rosai.

 

[SLUsagar]

You know the saying, "The force is strong in that one", right? Yeah, well it applies to one of my fellow classmates here. Exemplifies flawlessness and sheer brilliance. Hence, he is baby Rosai. All hail baby Rosai.

crap, this sucks...
here i thought you implied that the SON/DAUGHTER of the infamous Juan Rosai was in your class.... 😱

 

[Supersheep]

Overall, it's been a good week. Last week was good too. Things should be aight for the next 2 weeks then it's time to...

BRING THE PAIN!!!!! (for two months!)

Exemplifies flawlessness and sheer brilliance. Hence, he is baby Rosai. All hail baby Rosai.

Oh that's right... you get "Andy Milonakis property of Surg Path" tatooed to your forehead tomorrow. Let the inking begin! (literally)

Aw, there is just so much love floating around this place- you kinda almost need your waders... 😍 I dunno about you two...

 

[CameronFrye]

crap, this sucks...
here i thought you implied that the SON/DAUGHTER of the infamous Juan Rosai was in your class.... 😱

Nope, but the infamous "geddy" is in his class.

 

[b&ierstiefel]

Oh that's right... you get "Andy Milonakis property of Surg Path" tatooed to your forehead tomorrow. Let the inking begin! (literally)

Aw, there is just so much love floating around this place- you kinda almost need your waders... 😍 I dunno about you two...

No no...no surg path for another two weeks. Next two weeks shouldn't be too bad...placenta week and biopsy week after that. Then it's onto...BRING THE PAIN!!! Like I said, the next two weeks should be relatively cush.

As for you second statement, I don't know what you're getting at or implying...

Nope, but the infamous "geddy" is in his class.

He is no longer to be referred to as geddy. From this day forth, he shall be donned the title of "Legend."

 

[bananaface]

He is no longer to be referred to as geddy. From this day forth, he shall be donned the title of "Legend."

Say "hi" to geddy for me. Thanks.

 

[Supersheep]

No no...no surg path for another two weeks. Next two weeks shouldn't be too bad...placenta week and biopsy week after that. Then it's onto...BRING THE PAIN!!! Like I said, the next two weeks should be relatively cush.

As for you second statement, I don't know what you're getting at or implying...


He is no longer to be referred to as geddy. From this day forth, he shall be donned the title of "Legend."

Yea, the GYN room is more fun! And sorry about that... I meant that you two give eachother so much crap, yet can still be friends at the end of the day with no hard feelings... and have fun too. That was all- sorry, it made that sense in my head (which probably wasn't screwed on too tight). Happy placking (plaquing?)!

 

[Mrbojangles]

Stupid cardiothoraxic surgeon decided to come to the frozen room and chew me out on the way I was processing a wedge biopsy for intersitial lung disease. The attending wasn't there, but afterwards the PAs and the attending were making fun of him. Makes me want to slash the guy's tires 😡.

 

[yaah]

What was his problem? Perhaps you could suggest he does them himself. 😉

ILD biopsies can be annoying because everyone has "their way" that it should be done, and it doesn't necessarily match up with others. Inflate it. No, that's too much. Wait, that's too many holes. No, wait, that's not enough. Did you remove the staples? Are you taking sections on the long axis? How much formalin did you put in?

 

[Mrbojangles]

I wonder what would have happened if I told him to do it himself 😉. I'm 100% sure that I would regret it. Apparently from what I heard he does his own FNAs. He'll bring his own FNAs, makes the slides, stains them and then plops it in front of the pathologist to read it under the microscope. Sometimes he makes his own diagnoses.

The guy went crazy when I inked the pleural surface (which is unnecessary in hindthought but not wrong) and then accused me of man-handling the specimen when I was trying to remove the staples.

I geuss one bad thing is that we have so much interaction with surgeons. Is there a consensus that there is a greater percentage of jerks in surgery than other fields?

 

[beary]

I geuss one bad thing is that we have so much interaction with surgeons. Is there a consensus that there is a greater percentage of jerks in surgery than other fields?

YES. YES. YES.

I was going to dig out the anti-clinical medicine thread but now I don't have to. I am on my surgery rotation right now and it totally sucks. I am lucky too because the people on my team are not jerks. It could be much worse. But I am so tired that I literally feel sick - like queasy and headache. And I am only 1/5 of the way done. 🙁

 

[quant]

YES. YES. YES.

I was going to dig out the anti-clinical medicine thread but now I don't have to. I am on my surgery rotation right now and it totally sucks. I am lucky too because the people on my team are not jerks. It could be much worse. But I am so tired that I literally feel sick - like queasy and headache. And I am only 1/5 of the way done. 🙁

awww beary...chin up girl....
Dreadful days of clinical medicine will be over soon......4/5 ->3/5 ->2/5 ->1/5 -> done!!!!
It ll be over even before you know it!

 

[Aubrey]

YES. YES. YES.

I was going to dig out the anti-clinical medicine thread but now I don't have to. I am on my\0\0
??\0\0\0\0??\0fright now and it totally sucks. I am lucky too because the people on my team are not jerks. It could be much worse. But I am so tired that I literally feel sick - like queasy and headache. And I am only 1/5 of the way done. 🙁

I dealt with these symptoms by frequently saying "let me run that down to surg path for you, boss!" Makes for a nice break. 🙂 Drinking seems to help too, though it's hard to work it in during the workday.

 

[b&ierstiefel]

though it's hard to work it in during the workday.

It is not!

 

[deschutes]

...from what I heard he does his own FNAs. He'll bring his own FNAs, makes the slides, stains them and then plops it in front of the pathologist to read it under the microscope. Sometimes he makes his own diagnoses.

Does he sign them out? 🙂

 

[Mrbojangles]

Does he sign them out? 🙂

Well I heard that he would try to make his own diagnosis. Whatever that meant. Maybe in the past he would push his diagnosises on the pathologist? That would really make the pathologists look really bad.

 

[cytoborg]

There must be something in the water here because so far all the surgeons I've interacted with have been extremely nice, thanking me for my services, interestedly asking my opinion, etc. They will joke around with me in the OR and stuff which really makes frozen days more pleasant.

I know my turn will come though, as I've heard stories about a couple individuals I have yet to work with. I wonder if they have any idea what rotten reputations preceed them (or if they would even care).

 

[b&ierstiefel]

You know you've pissed off a surgeon when the surgeon takes the phone away from the nurse calling in the frozen specimen and asks you, "And who am I speaking with?"

Ha!

 

[yaah]

Here we generally have good relationships, although they will quite frequently tell the on call resident, "We will have a frozen for you later on on this case," like, 2 hours later. Then, 3 hours later you call and ask if there is still planning to be a frozen, and they have finished the case and the nurse says, "oopsie, I meant to call you!"

That, and apparently on thursday night they sent ovarian cyst fluid for frozen.