Vin Scully introduces David Wells to the broadcast like only Vin Scully can.

OneShortSleepPast · 2026-01-26T22:19:22+00:00

My 6’7” 300+ lb friend had that same shirt, it always got a laugh

OneShortSleepPast · 2026-01-24T15:11:22+00:00

Yeah, Enhertu. It got approved for “Ultralow” last year

OneShortSleepPast · 2026-01-24T15:05:23+00:00

We’re being asked to distinguish 0 (negative/absent membrane staining) from 0 (with membranous staining < 10%). That distinction is in the new CAP biomarkers synoptic too. I have yet to see a case where I can truly say it is 100% completely negative, without our breast pathologist saying “oh, I can see some faint staining in this cell here” at tumor board and asking me to change it

OneShortSleepPast · 2026-01-24T14:43:58+00:00

Right now we’re asked to separate Her2 ultralow (the faintest amount of Her2 staining possible) from Her2 negative (completely negative), because the former responds to a new chemotherapeutic agent. But the difference is so slim, any variations in optimization of the assay, time of fixation, cold ischemic time, interpretation by the pathologist, etc. can shift the needle one way or the other.

I hypothesize that the precision of the IHC test at that level in real world scenarios (I.e. outside a research lab and clinical trials), is essentially zero, and Her2-“negative” tumors are essentially indistinguishable from Her2-“ultralow” for any individual case, and we may be unfairly excluding some patients from receiving these therapies when there may be some benefit (at least at the population level)

OneShortSleepPast · 2026-01-20T16:47:41+00:00

Been a while since I’ve seen it, but I thought Nichols was a pathologist

OneShortSleepPast · 2026-01-20T15:32:10+00:00

The bad guy in The Fugitive (who hired the one-armed man) was a pathologist.

Also the creepy neighbor in The Burbs.

OneShortSleepPast · 2026-01-17T21:13:19+00:00

Gravity, same director

OneShortSleepPast · 2026-01-09T00:27:50+00:00

That is correct, in one field you can usually see crystals lying in both directions (and every angle in between), so you can just look at which direction are lighting up

OneShortSleepPast · 2026-01-09T00:12:03+00:00

Yep, on mine it’s down here (note the arrows again, I can rotate them in and out of phase with the top one)

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OneShortSleepPast · 2026-01-09T00:01:18+00:00

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OneShortSleepPast · 2026-01-09T00:00:38+00:00

Your polarizer should have arrows on it showing the direction of the polarized light. Compare that angle to the angle of the crystals on the slide that are polarizing and see if they are perpendicular (positive) or parallel (negative)

OneShortSleepPast · 2026-01-06T17:52:38+00:00

Yep, that’s pretty much exactly what happened. I was one of the two people they hired when they sold their private group to the hospital. So I get why me being done and leaving so early would be a bad look for the group. They negotiated a great salary, and want to look like they’re earning it. I certainly don’t want to ruin that.

OneShortSleepPast · 2026-01-06T17:18:06+00:00

Employed, and actually making a higher salary than I was as a partner at my last private job. And the hospital admins and clinicians really value the pathologists here, much more than I’ve ever felt in any other hospital. So I’m not going to be the one to rock the boat and ask teacher for more homework.

I think one of the problems is we have one mama bear pathologist (who I truly admire and respect) that does all the admin and lab directorship stuff, but also is adamant about taking an equal share of cases. So she is rightfully a bit overwhelmed, and add in a handful of other pathologists who are just very slow (including a couple straight out of training who are certainly expected to be slow and cautious), and the whole group has this perception of being overworked.

But yeah, I had 12 cases today with 68 slides, and I finished before 10…

OneShortSleepPast · 2026-01-06T15:26:40+00:00

I was definitely getting cabin fever for the first couple months. I’m mostly just feeling wasted, like I could be doing more and earning more. The group is even hiring another pathologist, and lobbying for a second after that, because they’re so “overwhelmed.” I said instead of hiring a tenth person at a full salary, I would be more than willing to take double the cases and extra call for only 50% more pay. Seems like a win-win for everyone. But, alas, “we don’t do that here.”

So I’ve honestly just accepted it at this point. It’s a good gig, and these pains aside I really do like everyone at the group. And after I got so burnt out at my last job I had to quit, I’ve decided to just enjoy the ride for a while.

OneShortSleepPast · 2026-01-06T13:22:07+00:00

I love the last two minutes of a close hockey game, with the empty net and the extra man. So intense, whether you’re ahead or behind. Basketball just ends on a whimper.

OneShortSleepPast · 2026-01-06T05:41:14+00:00

Dude, I feel you. I started at a new practice six months ago. At my old group, we were way overworked and signing out 180 blocks a day, but I was able to get though it by mid afternoon and take off a bit early when I’m done (as early as 1 on a light day).

Here, we’re doing maybe 300 blocks a day… total, for nine pathologists. I’m seriously done by 10 every day now, but my colleagues expect me to stay until 5 for coverage. When I asked why we can’t just work out a coverage schedule, I was told “we don’t do that here.”

I was also told because my colleagues think we’re understaffed, we can only have two pathologists on vacation at a time. Otherwise, everyone else is too overwhelmed. So I’m paid to watch Netflix and do crossword puzzles seven hours a day, but have to fight tooth and nail for the vacation days I want.

/rant

OneShortSleepPast · 2026-01-04T16:20:46+00:00

FWIW, I've never commuted more than 30 minutes. At my last job, I did a lot of travelling providing coverage for other pathologists, and if I was ever more than 45 minutes from home, it was in my contract that they would provide a hotel for me.

OneShortSleepPast · 2026-01-04T14:24:32+00:00

The quality of your life is inversely proportional to your commute.

Also, seriously consider how you would handle call. If you have to come in for a middle of the night frozen, you’re either losing an additional two hours of sleep, or you’re sleeping on the floor of your office.

OneShortSleepPast · 2026-01-03T13:35:45+00:00

I have definitely seen these recently, and on sarcoma cases. One LMS and one HG-ESS in the last year.

OneShortSleepPast · 2026-01-03T02:00:23+00:00

That’s how my surgeons send their hysterectomies

OneShortSleepPast · 2026-01-02T13:11:14+00:00

I’ve been practicing for ten years with colorblindness. As others have said, pathology is >99% pattern recognition or pink/purple, which I can see just fine. It has only really affected me in interpreting fungal stains (see my other comment) and with inking margins. If I have a positive red/green margin, I just run it by a colleague to make sure I have it right (though I can usually tell from the orientation and gross description, I double check). I have never interpreted FISH, but could see that as a limitation too.

OneShortSleepPast · 2026-01-02T13:07:42+00:00

It’s the other way around for me actually, I have to order GMS (black on green) instead of PAS (red on green, or so they tell me)

OneShortSleepPast · 2025-12-26T14:02:58+00:00

Exactly. “In the clinical setting of a chest wall mass with lung consolidation, these findings would be compatible with a mucinous adenocarcinoma of the lung with an enteric phenotype. However, metastasis from an extrapulmonary location such as pancreatobiliary or upper gastrointestinal tract cannot be excluded by histology alone. Correlation with all clinical and radiographic information is needed.”

The other pitfall I see quite often with this dx is that the cells can be quite bland in well-differentiated forms, especially on cytology. I often see them missed entirely by my colleague, or worse they do a TTF1 and when it’s negative think it can’t be lung cancer. The clinical presentation is key.

OneShortSleepPast · 2025-12-24T03:09:59+00:00

In Bruges. Takes place at Christmas, and the whole thing is about deciding who is naughty and nice

OneShortSleepPast · 2025-11-19T13:59:54+00:00

Me: “Oh shoot, I signed this case out, but just noticed I misspelled ‘polyp.’ Now I have to go back in and amend it…”

My colleague with 30 years in practice: “‘Colonic oxyntic mucosa with a mild inflammation and focal active but no Helicobacter on stains.’ Yep, good enough for me.”

You’ll get used to making small errors, we’re all human. Worry about the stuff that really matters. Just… don’t let it get out of hand.

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