Seeing pink and purple/blue… Lessons in Pathology.

This is a hematoxylin and eosin stained slide ...

Sea of pink and purple. This is normal skin. Clearly. Image via Wikipedia

Week two of the Lab Medicine rotation.  Much to my surprise, it is not as bad as I thought it could have been.  It has some elements that I dislike (for instance, eyestrain and lack of patient contact), but overall it is reasonably interesting and relevant to my future career.

Pathology is a bit of a black box.  In medical school, we learn a fair bit about pathology in our first two years, but I feel like we never really got the detail or clarity that we get from other specialties.  Pathology is not a core rotation, so we have the option of covering it in a two-week non-core selective in fourth year.  I am one of the 5 people in my class who opted to do this.  A lot of what I expected from Pathology was based on the glimpses from the first two years of school and what I saw of it from the media and my other rotations.

From my other rotations, I heard a lot about how they work with pathology.  Generally, this includes complaints about how long they take to get reports out and questions about the integrity of said reports.  I learned a lot about documenting specimens and proper collection of specimens.

The site I am working at has been the centerfold for several pathology inquiries, one of which made national news.  There have been many changes to the way the department is run, how and where certain tests are done and how they communicate data to the physicians on the floors.  The aforementioned inquiries came down to systems issues (overworked, under resourced… the unfortunate usual in healthcare).   Unfortunately, there is still a great deal of tension in the community as a result, with distrust of the pathology system at times.

Going down to the lab is in and of itself an adventure.  The architects that built the hospital felt it was clever to build the floors so that no more than two staircases connected (to prevent smoke from travelling) and that hallways should not all run parallel or perpendicular in a reproducible fashion.  I had a vague idea where the lab was based on where we drop off stat specimens, so I wandered down there and was hoping for the best.  I picked a random door that was marked specimen receiving (promising, no?) and realized it was locked.  So, I tried my trusty key card and shockingly it worked.  I never knew that I basically have swipe access to all of the labs.  Not that I usually need it.  But now, in case I ever have a compulsion, there we go.  There I am, wandering aimlessly through the lab.  Nobody asks who/why I am there.  Finally I found the pathologist’s office I was supposed to report to.

Prostate cancer

Prostate adenocarcinoma. I spent an entire afternoon looking at and for this with one very enthusiastic pathologist... When people get biopsies of the prostate, it usually includes upwards of 7-10 biopsies, each of which are sectioned into several pieces. Each one gets examined. That means for each patient, there can be 40 or more sections to look at. Image via Wikipedia

I have been bounced between various people to see different aspects of the lab.  One of the most interesting (not really) things that happened has been when I get placed at a desk in the resident room and told to look at these slides and see what I think.  I don’t even know what body part I am looking at, let alone thoughts.  Pink and purple.  That is about it.

A few of the pathologists and residents are ridiculously pumped to teach.  Well, as excited as they get.  They really don’t get many clerks, so there is a great deal of puzzling about what to show me and how much detail to go into.  They all ask if I want to do pathology when I grow up.  And I say no.  And they look sad.  There are a few people in my class going into path and a couple of the residents are excited to get more “normal people” in path… Not sure what they were going for there.  Needless to say they teach me, especially the oncology side, where we will be working together in the future.

The pathology people are different than some of the others I have worked with.  More quiet, on the whole.  More social too… But in a quiet way.  For instance, it took two days before I actually spoke to most of the residents because they are so engrossed in doing their own thing amongst themselves.  I was convinced they all just didn’t really converse and when they did, they were awkward (not that I am a social butterfly, but I was trying because it was weird to me).  Then, they realized I wanted to learn.  And they became more friendly and open.  They show me the cool cases now and suggest the interesting rounds to attend.  They are big on consulting amongst themselves and showing cool cases.  I think we in clinical medicine could learn a lot from their collaboration.  They have a different work ethic too.  I noticed that they pace themselves more.  Not running with their heads chopped off.  They work later, though.  Not actually later, but I have been in until after 5 every day, whereas on the floors or clinics, if you are fortunate enough to get done early, you peel because you don’t know when it will happen again.  They love what they do, just like the people on the floor.  I have had several of the pathologists look at cases for hours with me on the multihead microscope.  Long after I am getting an eyestrain headache and am doing the sleepy head bob.  I appreciate the enthusiasm.

Funny thing is that I have somehow absorbed something.  I have never been able to see things well under the microscope.  It is a miracle I passed our histology course in first year.   I still can’t see through the microscope with both eyes simultaneously (despite people telling me how to properly adjust it and such).  But then, I was doing the whole look at random slides thing today and some of them made sense.  I can pick out obvious tumors.  I was giving myself imaginary high-fives today.

Histopathology: microscopic appearance of inva...

Invasive ductal carcinoma... aka breast cancer. This specimen would also have slides sent for special stains to determine hormone receptor status (influences treatment). In my neck of the woods, that would involve them being sent to another hospital many hours away. Thus, these things take time. Image via Wikipedia

Many people in my class have asked why I wanted to do a path selective.  I love clinical medicine, so why bother?  Why not do something “cool” like anesthesia.  The thing is… I will work with pathologists every day.  I will trust their reports.  I should know where they come from.  What they need to know from me when I send specimens in (it is amazing how terrible some of the requisitions are… clinical information does affect pathologic diagnosis).  Why sometimes they send things away for further analysis.  Why they aren’t always 100% certain on diagnoses (most different cancer subtypes have only subtle histologic differences, but sometimes significantly different treatments and prognoses).

They say medical school is when you get to see your options, when you can explore medicine.  That is what this path selective is doing.  It is showing me a world I have never seen this closely.  It is decreasing the stigma of the unknown.  It is increasing my trust (but in an educated manner) in those I depend on for definitive diagnosis.  Cells and specimens can tell a whole story if you pay enough attention.  The pathology people see the forest through the trees and are trained to interpret that to those of us who may not always be able to see it for ourselves.

3 thoughts on “Seeing pink and purple/blue… Lessons in Pathology.

  1. Pingback: My head hurts (welcome to pathology) | At least we made it this far...

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