Would you rather be dead?

[deschutes]

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I have been reflecting on my floor medicine experiences and I have to say they describe a spectrum.

[minor edit]
"This is not so bad" ----> "This drives me nucking futs" ----> "I would like to die, now".

The mean and the median is "This drives me nucking futs".
The "die, now" moments, while probably similar in quantity to the "not so bad" moments, are much stronger in intensity.

Which leads to my question for all the Path residents out there - has there been a time in Path when your work made you want to jump off a cliff?
If there is, I would like to be mentally prepared.

 

[yaah]

Deschutes, every career is going to have its bad or uncomfortable moments. I really haven't had many though. Sometimes it's tough when you don't fully have a grasp of something yet you are somehow expected to - but that is more of a challenge and exciting as well.

It's always tough to deal with uncomfortable attendings. I haven't really met any yet here but I am sure I will have moments later in my training. I have met attendings before who make signout an unpleasant experience. They critique every part of your gross description, make you feel small for not understanding something fundamental completely well, or simply make unrealistic demands. But it is part of becoming a better pathologist that you learn how to deal with this.

So I haven't had any "get me out of here" moments in path. But I have had a few, "this is a lot more unpleasant than it needs to be" moments.

I think I came fairly close to jumping out the window when I had a rectal cancer specimen to gross in during my PSF, and I spent an HOUR looking through the fat for lymph nodes. Found about 2. Then spent more time because I knew the attending wanted at least 8. Then I placed the remaining fat in Bouins (highlights lymph nodes, usually) and went back the next morning. Submitted more of what I thought. Eventually got the slides back, had 5 nodes (for about 3-4 hours work). And the attending saw this and asked me why I couldn't find more lymph nodes and said I needed to go back and find more. 😡 😡 😡 ..Cue the favorite smilie:

Then also one weekend morning I showed up and sitting in the cooler for me to deal with were 3 colons (2 cancerous), a neck dissection, a lung, 2 leg amputations, 4 placentas, and a big old fat kidney. Plus all the usual dozens of POCs, skin biopsies, sinus contents, etc. The resident from the day before had forgotten to make his late day run, instead he left early and decided that the weekend person would handle what should have been his work, so that he could go home and be lazy.

 

[deschutes]

I'm sitting here trying to remember if there was a specific incident that triggered that post.

I am not expecting Path to be a smooth sail - I can definitely see those situations you describe happening down the road. I guess what I am saying is the work has to feel worthwhile - and I know, that is highly personal.

Foaming at the mouth spending 2 days coordinating a dietician, a social worker, and an interpreter for a patient's mother at a specific time in the morning which oh just so happens to coincide with the time your team usually rounds - that is not my idea of "worthwhile".

But thanks as always for the insight 🙂

~
Any particular reason you bring up the subject of uncomfortable attendings? That wasn't what I was thinking of, but I know that is everywhere. (I don't mean to say you can't work well with people because that would be a very stupid thing to say!)

I was just going to remark that I actually rather like some of the "difficult" attendings. About half of them are really easy to please! Turn up, shut up and work - they don't expect anything else. I don't have to worry about being polite and well-mannered or have something nice to say all the time. And in time this 50% comes around really nicely. My experience anyway.

 

[yaah]

Absolutely, a lot of the attendings that many have referred to as "difficult" are the ones I get along with best. Some people seem to like those who are so easy going they never call you on anything. I like the ones who challenge you, show you what you're doing wrong, help you improve, critique your work, etc. At UMass there were a couple of attendings that some of the residents didn't like working with, and I really did and looked forward to it because I knew I was going to learn a ton and have things pointed out that I hadn't considered. In truth, most attendings I have met who I have initially seen as "difficult" often moderate in my mind once I work more with them and get to know their style.

It's just that there will always be attendings in every field who simply take every chance to just yell and scream without making any effort to channel their frustration into anything constructive. Or perhaps, their expectations of performance are unreasonable or inconsistent (like, "how could you not describe such and such feature of that gross specimen", while the day before they had blistered you for including it at all.). That I simply don't care for. Of course, sometimes I see some of the resident behavior that they have to deal with and I completely understand.

I also don't deal well with incompetence or laziness. I dislike when people are late for appointments or lectures (you should be 5 minute early for every lecture unless you are detained by something more important, which should not happen a lot); I dislike when people do a sloppy job on something or wait until the last minute to do it; I dislike when people learn only enough about their job to do the bare minimum; I dislike when people pawn tasks or work off on others by either working slowly, ignoring what is piling up, or whining about it; I abhorr whining. And I dislike when people continuously make the same mistakes. Thus, should I ever become responsible for resident education, I would imagine being somewhat demanding and having higher expectations. But I would also throw around praise when it is due or earned.

 

[gungho]

Perspective, as they say, is everything. In my short career as path resident, while encountering some unpleasant situations, in no way does it compare to the "stuff" involved in my daily primary care practice. For fear of risking the Wrath of Yaah, I will refrain from whining. No job is perfect or smooth sailing all the time. Someone once told me if you like 80% of your job you are blessed indeed. I think I would agree with that. When you look at 99% of the rest of the world, even clinical medicine ain't too bad.

Absolutely, a lot of the attendings that many have referred to as "difficult" are the ones I get along with best. Some people seem to like those who are so easy going they never call you on anything. I like the ones who challenge you, show you what you're doing wrong, help you improve, critique your work, etc. At UMass there were a couple of attendings that some of the residents didn't like working with, and I really did and looked forward to it because I knew I was going to learn a ton and have things pointed out that I hadn't considered. In truth, most attendings I have met who I have initially seen as "difficult" often moderate in my mind once I work more with them and get to know their style.

It's just that there will always be attendings in every field who simply take every chance to just yell and scream without making any effort to channel their frustration into anything constructive. Or perhaps, their expectations of performance are unreasonable or inconsistent (like, "how could you not describe such and such feature of that gross specimen", while the day before they had blistered you for including it at all.). That I simply don't care for. Of course, sometimes I see some of the resident behavior that they have to deal with and I completely understand.

I also don't deal well with incompetence or laziness. I dislike when people are late for appointments or lectures (you should be 5 minute early for every lecture unless you are detained by something more important, which should not happen a lot); I dislike when people do a sloppy job on something or wait until the last minute to do it; I dislike when people learn only enough about their job to do the bare minimum; I dislike when people pawn tasks or work off on others by either working slowly, ignoring what is piling up, or whining about it; I abhorr whining. And I dislike when people continuously make the same mistakes. Thus, should I ever become responsible for resident education, I would imagine being somewhat demanding and having higher expectations. But I would also throw around praise when it is due or earned.

 

[stormjen]

Med school has been filled with numerous "I'd rather be dead" moments. In fact, it might be more accurate to call it one long "I'd rather be dead" experience interspersed with rare "maybe there's hope" moments.

 

[b&ierstiefel]

Med school has been filled with numerous "I'd rather be dead" moments. In fact, it might be more accurate to call it one long "I'd rather be dead" experience interspersed with rare "maybe there's hope" moments.

I'd have to say that the 14 months of clinical crap from the start of M3 year to my last day on subI's was one big "I'd wanna shoot myself" experience that seemed to drone on forever and ever and ever. But there was a light at the end of the long tunnel...the white light that is so ever apparent when you look through the microscope!

 

[deschutes]

I also don't deal well with incompetence or laziness...

I would be tempted to agree whole-heartedly with you if it weren't for the fact that God knows I have been guilty of all those things at one time or another. 😛

The best experience I had with an attending (this was in the context of a research project) involved some goal-setting, lots of accessibility, and free rein to figure things out and do whatever I felt necessary. After a year I actually started to feel that the term "collaborator" was not such a sick joke.

Is Bouins the same as GEWF? How does it highlight nodes?

In my short career as path resident, while encountering some unpleasant situations, in no way does it compare to the "stuff" involved in my daily primary care practice.

Thanks gungho! Karma karma karma... by the end of this year of "suffering", maybe I will have earned the chance to "suffer" in a path residency.

 

[yaah]

Deschutes I think we are all guilty of laziness, etc, at points during our lives. Anyone who can examine themselves critically would hopefully be able to admit this. It is how we deal with this and in what circumstances it occurs in that are telling. No one can possibly be on top of their game every day, at all times. When clinical medicine (or whatever) is uninspiring and treats you like crap, I think you're entitled to not always give it your 100% best effort. Save it for when it matters. I always spend extra time preparing for attendings that teach more. Respect begets respect.

Personally, I just don't like being late for things like conferences, because when I give talks or present or whatever, I don't like it when people are late. I feel it's somewhat disrespectful to always be arriving late. Obviously, there are times when it's unavoidable.

I dunno what GEWF is. Bouin's is a yellow solution made with picric acid, often used as a preservative (alternative to formalin) for some things like lymph nodes or infant brain or testicle biopsies. It has the characteristic of staining everything yellow, but highlights lymph nodes in a white color, so that they stand out easily from fat which is yellow. It doesn't have the greatest smell though.

 

[deschutes]

GEWF = glacial acetic acid, ethanol, distilled water, and formaldehyde. That's what we use - and from what I know, it turns lymph nodes white too. I have zero practical experience with it; all my node-digging was pre-GEWF.

Gee-oof!! Don't you just love the name 😀

 

[Homunculus]

I dunno what GEWF is. Bouin's is a yellow solution made with picric acid, often used as a preservative (alternative to formalin) for some things like lymph nodes or infant brain or testicle biopsies. It has the characteristic of staining everything yellow, but highlights lymph nodes in a white color, so that they stand out easily from fat which is yellow. It doesn't have the greatest smell though.

bouin's also helps stains stick to the outer part of specimens that you want to ink to keep spatial relationships on. hose it with the yellow stuff, then ink the margins like usual-- i think the dye "sticks" better this way. not a big deal, but if you have a breast lump to the margin, you wanna make sure the margin is well demarcated 🙂 (first year path resident showed me this last year)

--your friendly neighborhood remembers some from his path rotation caveman

 

[Gut Shot]

bouin's also helps stains stick to the outer part of specimens that you want to ink to keep spatial relationships on.

Hmmm, usually the threads start out path-related but devolve. This one seems to be doing the opposite. Perhaps we need to store it in the teaching collection.

With regard to the topic of this thread, one of my older brothers is a radiologist who went to Wash U for med school. Before I started he told me that all doctors encounter a similar phenomenon while in med school. It's the moment when some attending is reaming you out over nothing and you're thinking "Man, why are you being so hard on me? If we were down in the parking lot right now you would probably not be saying these things."

Okay, I had to clean that up a bit. Suffice to say that my brother is an ex-college football lineman.

 

[deschutes]

bouin's also helps stains stick to the outer part of specimens that you want to ink to keep spatial relationships on. hose it with the yellow stuff, then ink the margins like usual-- i think the dye "sticks" better this way.

Here we ink first, then vinegarize it to fix the ink. Sounds like acid is a fixer. I wonder if there is a difference in end-product depending on which goes on first?

Havarti666 has a point. Actually he has two!
It's the bloody pecking order. Me doctor. You student. You shut up, you stewpit.

Phoned radiology to get an IVC filter put in on a patient who was bleeding and had a big clot in her leg. The DIC (doctor-in-charge) made me wait - I could hear him jibing about clinical clerks in the background - and when he did finally pick up the phone to learn for himself what sort of lowlife I was, his comment was "WOw they're really sending in the big guns, aren't they."

C'mon man... you've done this before, you should know attendings can't be everywhere!
My thoughts were not so much "Why are you picking on me" as they were "I am SO glad I am not going to have to beg from you in the future".

 

[b&ierstiefel]

My thoughts were not so much "Why are you picking on me" as they were "I am SO glad I am not going to have to beg from you in the future".

Screw em. Soon, when you become a pathologist YOU will be the one being CONSULTED by the medicine docs and surgeons...not the other way around. Stick it out during the remaining days of infernal medicine.