Clinical Week 4-6

I have developed a routine and started settling into it during weeks 4 and 5. I start the morning setting up my work station: fill water bath, lay out my supplies, choose 15 initial blocks and lay on ice. I let the blocks chill for about half an hour to an hour, during which time I continue with filing and moving old slides to make room for more recent slides in the archive room.

And that is how I spend my time: alternating between filing and cutting. On any given day, I cut between 30 to 55 blocks.

I find that filing is very therapeutic. It is a welcome break from the intensity of cutting (especially if you have been cutting for over an hour; and especially if you are frequently introduced to underdecalcified tissue that just crunches and bunches and refuses to ribbon properly 😆).

At times, I will be pulled aside to help with accessioning and quality checks--this is to make sure that the patient identifiers match the correct specimen vials. The accessioned specimens are then directly handed off to the pathologists' assistant, who relies on the accuracy of accessioning to properly identify samples for grossing.

Some patients (cases) have several samples submitted, each with its own identifier, vial, and cassette, and I check that those elements are accurate as well. I was able to catch a missing cassette for one patient and quickly informed the histotech I was helping; this taught me how crucial accuracy is during the accessioning step. Even a small oversight can slow things down and disrupt workflow if a staff member has to track down something like a missing cassette.

Things I learned/re-learned in weeks 4-6:

• If knife marks are caused by calcification, put a warm Kimwipe on the tissue block and let it sit for about 5 minutes; then put the block back in ice, then cut again --> you must get the first 2-4 sections, these are the most "decalcified"; the deeper you go, the more you will meet calcified tissue again.

• Once you start cutting, don't stop in the middle of a rotation. If you stop, this produces uneven sections--and pathologists don't like that.

• FISH techniques mark for DNA and RNA; it visualizes genetic material.

• CISH is for cytology: Chromogenic in situ hybridization

• Enzyme methods are catalyzers that mark specific elements in muscle, colon, kidney. This technique is usually inexpensive.

• Stereo microscopes are low-power; they are often used to count the glomeruli in kidney biopsies (must count at least 8 glomeruli for proper studies).

• Fluorescence microscopes must warm up for about 15 mins before use.