Drowning in a sea of autopsies

[Gut Shot]

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Somebody needs to lower the boom on the medicine interns here. We've had a logjam of bodies since July 2 and no signs of slowing. I guess I'll make 50 with no problem, assuming the learning curve in the ICU isn't that steep.

We had a real greasy one this morning. We couldn't hold on to any of our equipment, as we were coated in human emulsion. After wading around in that for a couple of hours we had to run and get lunch before case #2. What's on the menu today? Why, huge slices of New York style pizza, of course.

So I bit into the tip of my triangle of pepperoni pie, and the oil runs down my chin and hand, and I'm chewing away, and all of a sudden I feel like I'm chewing on the autopsy case. I can smell the bowel perf, see the blunt dissection of the pelvis, and hear the ribs cracking. I was pretty damn hungry so I kept on going.

Now all I have to do is figure out dinner: sushi vs. pork tamales.

 

[LADoc00]

I showed up my first day of work and did my very first autopsy without a PA to open the body/remove the skull cap. Needless to say it was friggin disaster, the clinical team walked in as I was physically yanking the heart-lung block out of thoracic cavity and was covered in blood. Panicked I couldnt find anything on gross examination I blurted out "Dudes, theres nothing wrong with this guy, other than he's dead now." Pretty sure that prelim autopsy Dx didnt go over too well.

 

[yaah]

You must have stolen all our bodies because since the new residents started there has been 3 cases for them (in the nearly two weeks). From July 1-7 while they were in orientation there were 10, however.

First one I had to do by myself (during my PSF) was when the diener yanked it all out and threw it on the table and there I was with metastatic bladder cancer and status/post CABG x 6. I was there for awhile.

 

[b&ierstiefel]

Man, I feel your pain Havarti666. I started autopsy this week and I did one yesterday and one today. Came back from the hospital both days at 11 pm. Granted, part of it might be because I'm a frickin' slow ass ****** but damn, two autopsies came in yesterday and one today. Who knows what the remainder of the week holds. And yaah, these bodies weren't stolen from the great state of Meeeechigan. My autopsy dudes were skinny.

 

[DasN]

"My autopsy dudes were skinny"


Your so lucky, the vast majority of mine have been very obese or been sitting around for a while or with ischemic bowel(yum). The first 2 weeks Ive have cranked out 11 so far going solo. Havent had time for lunch yet.

 

[b&ierstiefel]

"My autopsy dudes were skinny"


Your so lucky, the vast majority of mine have been very obese or been sitting around for a while or with ischemic bowel(yum). The first 2 weeks Ive have cranked out 11 so far going solo. Havent had time for lunch yet.

Wow that's pretty hard core, man. Congrats on completing more than 20% of your autopsy requirement though. Getting to the magic number of 50 seems pretty hard. First two days this week were rough but last two days were no-hitters. I'm at 4% status now. And the most I can get by the end of this week's block of autopsy is two more.

 

[beary]

Hey Andy -

How often do you change rotations? I was just wondering since you started on gyn path and are on autopsy this week.

How do you feel about having short blocks like that? I think I tend to like longer blocks because I get to feel a little settled in.

Tomorrow is my last day of my surg path elective. 🙁

Path rocks!! 😍

 

[Gut Shot]

"My autopsy dudes were skinny"


Your so lucky, the vast majority of mine have been very obese or been sitting around for a while or with ischemic bowel(yum). The first 2 weeks Ive have cranked out 11 so far going solo. Havent had time for lunch yet.

Eleven in 2 weeks is rough, particularly solo. We've had 7 in the past 4 days, but there are two of us to share the joy. I'd feel better about it but we can't even start on the tide of paperwork until we get a free day, and that just ain't happening. At least that pathology has been satisfying.

 

[b&ierstiefel]

Hey Andy -

How often do you change rotations? I was just wondering since you started on gyn path and are on autopsy this week.

How do you feel about having short blocks like that? I think I tend to like longer blocks because I get to feel a little settled in.

Tomorrow is my last day of my surg path elective. 🙁

Path rocks!! 😍

We do something different every week. We don't have month long blocks...we switch from week to week. We have different surg path weeks though (A, B, C, D, E) and most of us, at one point, will do these 5 weeks as one big chunk.

I personally like the weekly switch system. You never get bored and you're always learning lots of new and different stuff from week to week. No system is perfect though and one logistic drawback of the system is that on Mondays you could get swamped (wrapping up service work and finish signing out cases from the end of the previous week while starting stuff for the new week). On the flip side, not all transitions are bad. Overall, it's all good 🙂 because this system fits my learning style well. If I do one thing over and over again for one whole month, I'll get bored. Then I won't do that month for a while so I'll end up forgetting a lot of it. With the weekly system, you frequently visit certain topics in nice timely intervals so the reinforcement learning approach can work well here.

 

[bananaface]

You must have stolen all our bodies because since the new residents started there has been 3 cases for them (in the nearly two weeks). From July 1-7 while they were in orientation there were 10, however.

First one I had to do by myself (during my PSF) was when the diener yanked it all out and threw it on the table and there I was with metastatic bladder cancer and status/post CABG x 6. I was there for awhile.

Your explanation is... bodysnatchers?

 

[Apollyon]

This harkens me back to my student days, when I had to witness 4 - I only had 1, so I arranged to go to SUNY-Brooklyn on a Saturday. There, they do ~10/day, every day of the year, otherwise they'll get backed up. They have >80 crypts (including "decomposed"). The one ME was saying he'd gotten a job offer from a New Jersey county that averaged 2000 posts per year, divided between 3 ME's, whereas he had done 5000 himself in 3 years.

The dieners were sharp, too - one BIG FAT GUY was put up - do your folks play the weight game? One said "375", and this guy was 371. Impressive. Moreover, as one of my instructors in med school said, this guy really was very muscular under all that adipose - a "skinny person trying to get out".

 

[Gut Shot]

The dieners were sharp, too - one BIG FAT GUY was put up - do your folks play the weight game? One said "375", and this guy was 371. Impressive.

Tell me about it. Our senior diener nailed this guy's height down to half a centimeter yesterday, just by glancing at him. We told him that he should quit and get a job at a carnival.

 

[yaah]

The ME here can guess organ weight within about 5%. It's mighty impressive.

 

[deschutes]

I personally like the weekly switch system...you frequently visit certain topics in nice timely intervals so the reinforcement learning approach can work well here.

Interesting! Are there other places that do this, I wonder.

Would you take on a daily switch system? What about, hourly? 😉

 

[b&ierstiefel]

Interesting! Are there other places that do this, I wonder.

I think MGH does something like this too on surgicals. I don't know about the other rotations like cyto or other CP rotations (which are intertwined with AP rotations in a given year...which does not happen here).

Would you take on a daily switch system? What about, hourly? 😉

Now you're just being an idiot.

 

[deschutes]

Now you're just being an idiot.

Just doing what I do best! 😎

 

[DasN]

Eleven in 2 weeks is rough, particularly solo. We've had 7 in the past 4 days, but there are two of us to share the joy. I'd feel better about it but we can't even start on the tide of paperwork until we get a free day, and that just ain't happening. At least that pathology has been satisfying.

Yeah, I had shared the first one with the other PGY 1's but then I got put on Autopsy solo for the next month, and got slammed. I had to quickly learn an efficient way to piece toghther all of the prelim paperwork and dictation quickly after I finish the case because I know there is always another one waiting for me. I have had some really good cases as well, didnt start getting the easy MI cases till this week but I feel pretty comfortable with the whole process now,( trial by fire) but the slide trays are stacking up so ill definately be busy this weekend. I actually like autopsy better than I thought I would. I had tried to keep my desk clean but with this kind of sudden high volume that is a distant dream.

 

[yaah]

The problem with autopsy is that a lot of the work is done later, when you are on a different rotation - like me this month, I am on micro, but the end of last month on autopsy (and the beginning of this month when I was covering) was busy, so I still have a couple left to sign out. It's hard to make time when certain attendings can only meet at certain times of day. Why can't everyone meet at 6:30 or 7 am though? I always offer the 6:30 am meeting time but have only been taken up on it once.

 

[Mrbojangles]

Andy, 11pm for an autopsy? Sounds like they threw you a manual and told you "you're on your own".

Sounds like there's either too many autopsies or too little. There are so few at my hospital they combined autopsy service with whoever previews on surg path. So far I've only seen 1, 49 more to go.

 

[b&ierstiefel]

Andy, 11pm for an autopsy? Sounds like they threw you a manual and told you "you're on your own".

Sounds like there's either too many autopsies or too little. There are so few at my hospital they combined autopsy service with whoever previews on surg path. So far I've only seen 1, 49 more to go.

The first three autopsies that we do are done with the chief resident or another senior resident who serves as our trainer. So they don't throw us to the wolves here.

Anyways, this past Monday was the latest I've stayed in the hospital. There are a few things that contributed to this:
(1) The body that was to be prosected came right before the 3 pm cutoff time. The autopsy didn't start until 4 pm that day.
(2) The autopsy was completed around 7 or 8 pm or somewhere around then.
(3) Then I had 6 or 7 stacks of Gyn biopsy slides processed from Friday's specimens to preview for Tuesday morning signout. About 40 cases overall which isn't too bad but again, I'm a total noobie at this whole thing we call pathology.

Next day, I stayed late again but that's because I got another autopsy on Tuesday, which was in addition to all the photographing and cutting in blocks from the previous day's case. Then I had to write up the provisional reports and prepare for gross conference on Wednesday. So I had to get all my **** together that night.

Fortunately, I got home at a much more reasonable time for the remainder of the days this week. No hitters on Wednesday and Thursday. Had to do a perinatal autopsy yesterday which was a breeze since I had done 2 fetopsies during my first week of residency. Plus, all the interesting findings, if any, are probably gonna be in the placenta cuz the baby was grossly normal. Then it was on to the normal drinking festivities for Friday night. All good. Check.

On call for autopsy tomorrow. I am hoping that my pager remains silent. But if I end up getting one, I'm not gonna cry about it...that'll bump me up to 4 out of the required 50 so I can't complain. The only crappy thing is that I would have to get my provisional report together and prepare for presenting the case at gross conference on Monday morning. C'est la vie. I'll take it as it comes 👍

 

[b&ierstiefel]

I got beat down like a little bitch today. 44 more autopsies to go! **** at this pace I should finish my 50 by the end of this year. From this day forth, I shall be known as Andy "Black Cloud--Pound Me In The Ass" Milonakis.

 

[yaah]

Yeah, the first years here on call had at least 4 cases this weekend.

I always seemed to get BMT patients and liver failure patients. I was lucky - avoided the heart patients for the most part.

 

[beary]

I always seemed to get BMT patients and liver failure patients. I was lucky - avoided the heart patients for the most part.

Ignorant question - why are heart patients worse autopsies than others?

 

[b&ierstiefel]

Ignorant question - why are heart patients worse autopsies than others?

maybe cuz you have to dissect the coronary arteries and serially section each of the major branches to look for plaques. but i kinda think that this is fun and not too much additional work...but it is additional work nonetheless.

 

[yaah]

Well, it's ok, but when you get those 5 bypass grafts that get scarred over it's a real pain. It's nice when they all have separate ostia in the aorta then you can probe them all if you got it all out intact. But sometimes one ostia leads to two grafts. I had one case that the history said "CABGx4" and there was one aortic ostia. Found a LIMA for one of them. The other one (the operation had been 13 years previous) seemed to go a few different directions, it took quite a while to figure out.

Plus, it can be hard when the coronaries are really calcified - sectioning 1cm apart, sometimes you need a saw to do it. Or, just strip them off if you can and decalcify. I just don't like them that much. Although I did have a case where I found an acute thrombus that caused the guy's death and it was more satisfying than any other case I did all year.

 

[Gut Shot]

Monday morning, four cases, and another one tomorrow. Well, another one that we know about. I'm sure between then and now the clinicians will find at least two more utterly unecessary cases for us to do. Brain only, people. Brain only!

 

[yaah]

Well, she had end stage liver disease and documented sepsis and coagulopathy, but we still want to rule out PE.

 

[Lagarta]

the last one I did was an MVA superstar. Not fun. Lots of adipose tissue, to boot.