On the Right Path(ology)

I’ve tried to keep up with this blog more often now that we are further into the semester, but I finally can take a moment after 6 exams this week to write about the specimens we grossed in the morgue lab. This will be the first specimen post I’m creating so if you’re reading and do not feel comfortable looking at real images of real organ parts I would suggest reading no further. Every other Friday we are allowed to practice what we learned in our anatomical techniques course. This is the course that we learn how to “gross” a specimen. Grossing involves the complete process of investigating a piece of organ you receive from doctors and being able to describe the specimen to put into a dictation, which is a summary of measurements and descriptive terms to give a visual image. The doctors won’t see the original whole specimen before you take small representative samples from it, so it is important to be descriptive as possible. There is a lot of detail and different steps to treating the same organ based on tumors or other diseased processes. There are many different health care professionals involved in the diagnostic process. In general, a patient has surgery and gets a piece of organ or tissue removed, it ends up going to a PA, we do our job and send a specimen to the next department, often histologists, who can make a microscope slide to then have a pathologist see the tissue under the microscope. So maybe giving a scenario will make this make sense. A patient comes in and receives a radiograph and a small tumor is seen on the inside of a lung. Surgery is performed and a small piece of lung gets removed. The surgeon makes a specific shaped cut called a wedge that can save as much as that healthy lung as possible (see last image for resections of lungs). The surgeon staples up the lung inside of the patient like “stitches” and closes with more staples where the cut marks are made on that little wedge piece to show that part is continuous with the rest of the lung. This part is important because often a tumor stage of an organ is dependent on the size and where other locations in the body it may have spread to or “invaded”. So, for a lung the tumor could grow inward towards other lobe sections or onto the outside into the body cavity or even towards the heart and other structures around. This little piece shows up on our bench, what do we do with it? That’s the question we are always asked because there are rules and guidelines to follow to properly inspect and give a lot of information. First you measure how big this wedge is and see if there are any abnormal divots called “puckering” that could be a sign of tumor inside. We use ink and place it on those divots or other abnormal areas. Then we can start trimming off that staple line of tissue and we use ink to mark where that resection margin line is under it. We make cuts in a perpendicular fashion in relation to that margin, 3mm thick section are required so that we can chose a piece that can be placed in a fixative such as formalin that can make mushy tissue harder without ruining the structure of cells. This makes histology possible to cut paper thin slices to mount on a microscope slide. We don’t just cut up specimens and make a million slides and a million cassettes and use every piece all the time. We need to select and use judgment and follow guidelines of what will give the best diagnostic piece.

We take a piece of tissue that would show relationship of the margin line tissue to a tumor, a piece that shows the tumor to the opposite side of the lung which is the pleural surface and a section that shows “full face” or the tumor in its largest dimension. And then a piece of uninvolved healthy tissue is submitted too. These types of pieces give enough information for the pathologist to decide if they got enough of the lung out if the margins are clear of infectious tumor or if more needs taken out and the type of tumor that is involved. Now, the scenario changes if the patient had a lung wedge for interstitial disease such as emphysema. We don’t do that whole process now! We do not cut up the organ off the bat. We re-inflate the wedge using a small syringe and needle on the side, allowing air in to show if the air spaces are opening to a normal diameter and then put the specimen in fixative, almost so it molds into that shape. There are many different diseases and steps and processes and that is just for one little lung wedge. We do this for a wide arrange of specimens. Pretty much anything that is removed from a person at a specialist like a dermatologist, GYN, or in the OR can land in our bench and we need to know how to handle it. The pictures below show a “partial nephrectomy” which is a kidney wedge version of the lung and we process that in a similar fashion to a lung wedge for tumor. The other pictures with the staple line are the lung pieces we made during the grossing session. Next specimen posts will be shorter than this, but I wanted to explain how we do our job! 

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Whether it’s a job or getting into a graduate program, interviews can be nerve racking to say the least. I interviewed at Rosalind Franklin University and for whoever else did too will tell you, their structure is very different. At West Virginia I automatically felt like I was at home as the interview was very open and you could sit down and answer some pretty straightforward questions. So, if you make it to this point you obviously have good essays and a good GPA or great experience from a past job. If you are in the earliest stages of applying the best advice I can give is being honest and creative in your essay. Show emotion and passion. I talked a lot about soccer, time management skills I gained from it, my family and friends, and future goals. They knew the person they invited to come to the interview would be the same one they heard from in the application. Talk about your struggles and adversity and what sets you apart from the hundreds of other people trying to get into the program. Talk about hiking, poetry, photography, sports or anything unique about you or just talk about your love of dogs because I think they might count that as a hobby here:) If you are older and out of school for a while and nervous about being back in the studying mindset use your experience because that is something someone like me didn’t have and you can apply how your work ethic and job can really help you have the same skills transfer over to the program. And if you’re a student fresh out of school like me make sure you can speak on your surgical path shadowing or internships so you can understand what goes on in the field even if you haven’t had that job experience. Think about what courses here you might do well in and which ones you’ll have to work harder towards (My Break it Downblog posts goes into detail about the classes here). There really isn’t one “type” of person they want for this program. My class is very diverse and all have some pretty different backgrounds and awesome strengths. When you get to the interview part you meet with the same people who will be your instructors in the classroom and in the gross room. A first-year student could be in there with the board members just to help ask some questions. Just remember, we went through the same thing you did so don’t feel intimidated if you meet anyone from my class that day, if anything feel some relief if they are there since they are someone who can relate. Again, it is a very personal environment and you won’t be meeting with random people so yes, your nerves give you an edge which can be good, but if you can find yourself relaxing a bit when you get further into the interview, get comfortable and get a feel for the environment. To prepare for some questions, I googled practice essays for interviews beforehand since there are a ton online and how to speak confidently without sounding like you’re bragging. If you walk into the interview expecting to lead with, “I have a good GPA” and “I want to be a PA to help people” it won’t get you too far. Think about why you really want to go to this program and how you know this is the right field for you because a lot of people have the same GPA as you and they hear patterns of the same responses to the question so elaborate on your reasonings and what makes WVU’s program the one for you over others. Think of reasons why you deserve the spot over others because you made it this far! If you really do not know how to answer a question, ask for a moment to think, breath and regroup (I did this, I promise it helps and they are patient). The board that interviews you are the people you spend every day with, and they truly make learning fun. Their tests are hard, the material is overwhelming, but they love to joke and laugh in lecture when appropriate so make them laugh too when you meet them. Point is, they don’t want robots coming in no matter how smart you are you have to be well rounded too! So, have a little fun, it’s an exciting, scary and rewarding time all at once. They might write things down so do not get anxious if you think you said something dumb, then see them writing (haha speaking from experience I really was overthinking when I saw their pens moving). They have so many different faces they honestly just want to remember who said what. You will tour with some of the first-year students and see the hospital and classrooms and then your time is over. Just like that short and simple. So good luck to whoever interviews and reads this. Everything happens for a reason and you always end up where you’re supposed to be!

Taking a break this weekend to write a post about week one and inform anyone interested in the program what to expect. I’m sure the way they run things change from year to year but for the class of 2021, this is what we spend our time doing. Now that I know my schedule and way around the HSC building (sort of) I’d like to give a little rundown on my weekly schedule plus some extra things we are expected to attend. The classes for the semester go like this:

Disease Mechanics discusses “General Pathology” which is studying the more common disease processes that cells often react to such as an infectious-bacteria and how our bodies change. Systemic pathology involves more specific disease processes on specific organs and are discussed in later courses. This is one of my favorite courses so far, and multiple instructors give lectures, so it keeps you on your toes! The other course is Anatomical Techniques. Basically, we learn how to gross and the proper way to make good decisions from the moment you receive a specimen, the process of dictating, and understanding how to set up the tissue for histologists and pathologists to make great slides to review for diagnostic purposes. PAs are the only ones to see the specimen’s details entirely so knowing what you are looking at, how to sample properly to show the relationship of the pathology and how to speak clearly and concisely is key. Many of my classmates have grossed before or are familiar with the histo side in this course, so I have a lot of practice to do. We all rotate through the Gross room with instructors to get one on one time to learn how to go through a whole process. We also visit the morgue for practice. We have our first session this week so to be continued! This class is different than a textbook and power point only class. A lot of critical thinking is combined with proper techniques and I feel like I’ve learned so much already in just a week! Anatomy is the next course. It’s divided into three sections, first is Microanatomy where we spend time with histologists teaching us in the scope room how to look at normal, healthy tissue structures. The basics in this class are critical. How do you know what a diseased tissue will look like if you don’t know what it’s supposed to look like normally? The next part is lecture, and our instructor is just as passionate about how cool our bodies are. He keeps it lively, but you’ll have a lot more studying to do than what undergad professors expected you to know. Hello, our job is knowing the body! The third part of anatomy is the cadaver lab. We are fortunate enough to have people donate their bodies to science so we can dissect and see the things we talk about in lecture such as muscles, bones, vessels and other intricate networks. Being a PA is gross, in many ways! So that course is a lot, but we see on a microscopic, physiological and gross level all the parts of the body from cell to organ system. The next class is Histology which is online with a few hours during the week to talk about what we learned on our own time. You learn about staining processes; tissue fixation and it seems to relate a lot so far to the techniques we use to gross and take samples and what happens in the processes after. We find out why the slides in microanatomy are colored that way and how they managed to not ruin the morphology creating these slides. Very cool stuff. Histotechs in my class will be my go-to tutors! The other class is an Educational Methodologies course that helps you learn how to teach and some psychological practices. We will do a big project where we become the teachers and make up a lecture. We also sit in on doctors’ conferences Thursday mornings with residents and rotate through an EM lab. Our schedules are very busy and weekends are filled with studying too, believe me you won’t want to cram. The most important thing I realized in just a week is that these instructors are training you to do a job. All material is relative to the job and the other courses. I often catch myself reading about cellular processes for my disease mechanics course and then go to the scope room and see the same material brought up there. We’ve learned about how to take samples to put them in cassettes for histologists and now we are learning why we needed to cut that tissue so thin. They aren’t here to waste your time, but you can’t waste yours either. Grasping the concepts and having the skills to learn the material that seem to hit all the basics transpires to higher levels of thinking when you are helping to find and recognize what went wrong with a person’s health. The key to getting through the heavy workload is to remember this is all necessary to further your knowledge about what you need to know for your job daily. You won’t be reading and writing papers about the Shakespeare play you had to do for a liberal arts degree. We all love this area of health science, and that is what makes studying a lot easier. Now, it is tough and stressful. They are big advocates for self-care. Step away from the textbooks and go for a run, meditate, don’t stop doing what you love. Find balance and stay healthy because you aren’t a robot although after week-one you might feel like one. I’ve set a personal goal to run the half-marathon in Pittsburgh with my dad again in May so that’s been my thing. Time management skills are critical here, and having fun learning this stuff is also what they want to see. I’ll let you know how first round of exams go in a few weeks. Say a little prayer for me!

To anyone reading this and tuning into my journey I’d like to give a quick introduction in this new platform. My name is Kelsie Balsam, I am 23 years old from Pittsburgh, Pennsylvania. I graduated from Carlow University with a B.S. in Biology. 8 months after graduation I am lucky enough to be 1 of the 16 students enrolled in the class of 2021 West Virginia University Pathologists’ Assistant Master’s program. The title is a mouthful so in this blog I will be referring to us as PA students, not to be confused with Physicians’ Assistants. It has been an honor to be accepted into a competitive program so throughout these next two years of a chaotic schedule, I will need little reminders of how great of an opportunity this is and how worth it the hard work will be. Through this blog I hope to find an escape from the negative thoughts that can creep up when a stressed student is feeling defeated. Before I get into things about the program, I must be clear. I will not be putting up pictures or any information that is personal of any patient. The internet is a great place but oversharing can impede in patient confidentiality (there’s a thing called HIPAA!!). However, I will do my best to be informative on what life is like for a PA student and give some information on the topics I am learning since alumni of this program helped in my decision to apply to WVU through their blogs and personal experiences (shout out to Nikki Scrubs big fan of your work!). This Master’s program is one year didactic and in the second year, clinical rotations begin. Doesn’t seem like a lot but I’ll be taking it one day at a time to survive of course! After graduation there is an exam to become a certified PA. I’d love for my friends and family to keep up with the blog and get a better understanding of what goes on in this program.

This road will not be easy, but I truly feel I found my purpose in this world. I can’t exactly trace the day that I fell in love with the medical field, but I do remember 6^thgrade Mr. Reffert’s biology course being the first class that piqued my interest. His charisma and passion for teaching the subject was infectious to his students. It was as if this subject demanded my attention right away and I soon found an eagerness to keep finding answers about the world around me. Looking back, my time in middle school and high school level bio classes kept me interested in the sciences. When deciding what to do after graduation, the human body became my focal point of interest in furthering my education. I had so many teachers helping me at an early age to figure out what I wanted to be when I grew up, and I always felt I was on the right path. Not everyone has an idea of what they want to do so young, but I plan to use that as a driving force to stay motivated when I feel like giving up in this intense career field. I am asked a lot about why I chose the career of being a Pathologists’ Assistant and telling people I loved studying the complexity of human body fell short of what I was feeling. I took a theology course my junior year of college and I found the words. There was much discussion of the miracle of life and how science may actually support there is a higher power to this world. The human body is miraculous and so intricate that it’s a wonder the systems orchestrate in perfect unison to function and make us alive, and healthy. Amazing I don’t walk around with the risk of the common cold killing me every day, right? 

 But this is where I take the most interest in the career field. Pathology is the study of diseases and understanding how to diagnose an affected patient. Basically, this is figuring out why our perfect systems stop working. I spent some time in undergrad watching autopsies and watching WVU PA students in their second-year rotations at Presbyterian Hospital confidentially take over the morgue. They were well prepared amongst a team of medical professionals and helped doctors and residents build cases by reviewing patient history and taking appropriate tissue samples to find cause of death. They took apart the physical pieces to complete the post mortem puzzle! I also spent time in the gross room of that hospital with veteran PA’s (many WVU grads). Surgical pathology involves the collection of appropriate samples of tissue received from the OR or outside sites using gross and microscopic techniques to help histologists create a clear tiny slide that can be examined under a microscope and reviewed for diagnostic purposes. (That’s just a little summary of the big picture there is a lot more to it all of course that’s why I’m here). These duties are critical in recognizing between normal and abnormal tissues, often relating to patients with cancer. As the year goes on in class we will learn about many diseases, techniques to distinguish these tissues, and be able to apply our knowledge to actual diseased organs. I will get into types of specimens we often receive and interesting cases if they make their way to our class. So, although a PA may not directly be giving CPR or distributing life-saving medicines to a person seeking medical aide, the job of a PA is pertinent to proper medical care in this community of health professionals. 

Okay I know that was a lot, but I think my job is going to be cool and I am surrounded by Doctors, PA’s and other classmates who love what they are doing also. There are recent graduates in my class, but also people who have experience working in path or histology labs who decided to further their knowledge and become a PA. Everyone is truly welcoming and approachable and it’s a good environment already to be in. I think no matter what we are all ready for this next level and willing to put in the extra effort that is expected. They say if you love your job, you’ll never work another day in your life. I find the more you love your job, the harder you will want to work for it. Stay tuned! A lot of hard work ahead.