So its no secret that I don’t feel that I’m the world’s best or fastest grosser. I didn’t read Lester or Westra (aka the grossing Bibles) as much as I should’ve first year and still have never finished either cover to cover. And the fact that we had surgpath fellows stand by our side and teach us how to gross initially was probably more of a crutch for me than I should’ve allowed it to be. I need to understand why I should gross a specimen a specific way because memorizing the steps does not work for me – because I forget the next time and because not every specimen is “perfect” and I may need to modify the general protocol.
But for the past two months, I’ve been at our program’s busiest surgpath site, a private practice in a community hospital setting that sees a whole lot of cancers. My first day definitely was not a good one. I had spent 10 hours traveling from USCAP back to my apartment and had gotten a mild migraine in between…so much so that I got off at my layover asking if I could take a later flight back. Unfortunately, the next flight would get me home close to 7 AM and it’s a 1-1.5 hour drive to this hospital for me during rush hour traffic. This site is close to the airport so I would’ve been better off going straight from there.
It was the perfect storm, both figuratively and literally. I was tired from travel and nursing the residual headache that always follows one of my migraines… it was snowing yet again…and this caused a few accidents…and for me to be late my first day at this site after I had missed the first two days of the rotation (which is generally a no-no). So my first impression was most definitely not a good one. Couple that with being assigned grossing duty for a moderately heavy day, not knowing where anything was or how things were supposed to be done at this site, not being able to access the EMR, and not knowing what my responsibilities were versus those of the tech assigned to stand by and assist me (at other sites, I had to do everything by myself), and its not surprising that I failed to impress my attending.
VoiceBrook (Medical Dragon dictation software), the bane of my existence right now, was not working and their staff kept calling since there was miscommunication about my appointment to re-train with VoiceBrook. On top of all of this, I didn’t get to do the compensatory rituals I usually do to feel less stressed about grossing – work up my patients/specimens ahead of time, read Lester and Westra, and triage my grossing day based on the OR schedule. I pretty much felt like a “robot” (a sick one at that) that went straight through the manual motions of continuous grossing until the time came to close the gross room.
The attendings at this site have very specific ideas of the “right way” to gross and their expectations varies from the other in terms of their views on these topics. It is very busy in terms of grossing, intraoperative consultations, and weekly tumor boards that the residents prepare and present. But this post is actually not to complain but to elaborate on a light bulb moment that I had today that I had subconsciously somewhat improved my speed and many of the gaps in my understanding of what to gross and how to do it. Sometimes, repetition can be a great teacher. Good communication with those you work with is key. And lastly, nothing beats a good mentor who is willing to work with you to address your weaknesses… so what were your light bulb moments during your most difficult rotation and how did you come to recognize them? I’ll continue next week with a little more on this topic but for now, its bedtime since I anticipate a busy grossing day tomorrow.
–Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.