A Bone-zai tree
Updates
Today is the EXACT HALFWAY POINT between January 1st and December 16th (graduation day)!!!
I finished my rotations in Martinsburg, WV and Pittsburgh, PA (Allegheny General Hospital), and now I'm on to my first autopsy rotation at the Westmoreland County Medical Examiner's office (Greensburg, PA). In Pittsburgh I lived with a classmate and her husband at a place they are renting for the year. In Greensburg I'm staying in an Airbnb with a classmate who has a rotation at a different site nearby.
The schedule at AGH in Pittsburgh was pretty straightforward, show up everyday and stay until all the work is done (even if they tell you that you don't have to stay, you stay). Here in the ME's office, we only come in if there is an autopsy to do, which is not everyday. Some weeks are heavier than others, so sometimes we will only come in for 4 hours a day if there's only one autopsy to do, and since deaths can't be planned, we often don't know if there will be anything to do until the evening before. It's nice to have some time to job-hunt and study during this rotation, as opposed to the last one where I was basically in an exhaustion-induced coma by Wednesday every week.
I am beginning to look for jobs. I'm not necessarily applying for anything yet, but I am reaching out to my contacts on the west coast and feeling out the job market in the cities I am interested in, namely the Seattle and Portland Metro areas.
Reflection
Impatience is a special flavor of excitement that challenges us to continue live in the moment while we simultaneous plan our futures.
One of the things I really wanted to get out of the grad school experience was clarity on what I wanted in life. I definitely feel that I've gotten that! I am now sure that I want to live on the west coat (you know...the best coast 😜) near my friends and family, put down roots in a community, and maybe even find a workplace that isn't going to work me to total burnout (like maybe a couple of these rotation sites have...). It's easy to get impatient now that I know what I want. It feels so close and so maddeningly far off. I have to take a little time to myself at the end of the week to acknowledge just how much I want these things, and how amazing it is that I am on the right track to get them! There are plenty of people out there that want similar things, but many are not lucky enough to attend graduate school and set themselves up to actually GET THOSE THINGS. My impatience is a good thing, its the final psychological hurdle. It's the drive I've had this whole time, carrying me to the finish line.
Disease of the Day
Multiple Endocrine Neoplasia Syndrome 1 (MEN-1)
Etiology: MEN-1 is caused by germline mutations in the MEN1 gene. The product of this gene is a protein called menin, and depending on what this protein binds with, can either suppress or promote tumor growth; therefore, both loss-of-function AND gain-of-function mutations can lead to MEN-1 syndrome.
Pathogenesis: MEN-1 is best known for affecting the "three Ps" - Pancreas, Parathyroid, and Pituitary
Pancreas: Endocrine tumors can be both functional and non-functional. Among the functional tumors are gastrinomas (associated with Zollinger-Ellison syndrome) and insulinomas.
Parathyroid: Primary hyperparathyroidism is the primary manifestation of MEN-1 and includes both hyperplasia and adenomas.
Pituitary: The most common pituitary manifestation is a prolactinoma
Other than these three MEN-1 can also manifest as neoplasia in the duodenum, thyroid and adrenal glands, as well as lipomas and general neuroendocrine tumors.
Clinical aspects:
Insulinomas: causes hypoglycemia
Zollinger-Ellison syndrome: presents with intractable peptic ulcers
Primary hyperparathyroidism: causes hypercalcemia and nephrolithiasis (kidney stones)
Pituitary Prolactinomas: cause amenorrhea, galactorrhea, loss of libido, and infertility
Malignant behavior by one or more of the endocrine tumors arising in these patients is often the proximate cause of death.
Pictures from Pittsburgh!
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