• Jena Martin MD

Kitchen Table Pathology

I have cut myself while slicing bread. Many times. Crusty, warm, delicious French baguettes at the trendiest bistro of the 90’s, delivered by me, the bus person, and covered in a blue towel with chilled butter slices on top. I would hold the serrated knife too close to my thumb and occasionally slice into my own hand.

“Damn it” I’d say, stepping back. I’d apply pressure, throw out that loaf, and head for the sink and a Band-Aid.

Now 20 years later, cutting myself is still a job hazard. But instead of just throwing out the bread and starting over with a new knife, it’s ... more complicated.

I haven't worked in a restaurant in over 20 years. I changed my life, went to medical school and now I’m a pathologist*. Although we pathologists spend most of our time behind a microscope, all of work starts in the pathology laboratory - a place that has a lot of overlap with a kitchen.

I've heard surgeons disparage our laboratory as a 'dirty operating room', but I've always thought of my workplace like an industrial kitchen.   In the lab we dissect tissues on cutting boards surrounded by lots of stainless steel with good lighting and ventilation - a setting that looks more like the butcher department in my grocery store than anything else.  

Once a surgeon removes something from your body – be it a breast, a uterus, a portion of liver or lung – a surgical technician covers it with a blue towel, and places it either in a plastic tub or on a stainless steel tray and delivers it to the pathology laboratory.

The basic tools we use are similar to a kitchen or butcher shop.  Instead of measuring cups and tablespoons, we need rulers, a scale, metal probes and small forceps. Sometimes we use a bone saw or a table saw to cut large amputations or bone tumors.  We need pins to stretch out and affix specimens like an esophagus or rectum to a waxy board while they are immersed in formalin. 

Knives are also a commonality between the kitchen and pathology lab, except that our knives have blades that are black and floppy and look like a foot long razor blade. These blades can quickly dull from cutting through surgical staples or hard, calcified tumors, and so require frequent changes. You use tweezers to pull the blade out of the handle and it quivers, covered in blood, as you delicately place it in a large sharps container.

The last time I cut myself at work I was still in training. My knife blade was on the cutting board, but I just didn’t see it. It was hidden under the breast that I’d just sliced, examined, and documented. I was finishing up my case, and was ready to clear my station for another specimen. This particular mastectomy covered the entire cutting board and underneath it was my scalpel blade. As I gathered up the 1600 grams of warm fatty tissue I immediately felt the pain and sting on the side of my right index finger.

“Damn it”, I said, setting down the breast. I peeled off my gloves and headed for the sink. Once I stopped the bleeding I called to report the incident to occupational health and, riding waves of gut churning fear, checked the patient’s record - did they have HIV?  How about Hepatitis?  After all that, I then turned again to the breast, to finish putting it away.

I was slicing up the breast, hunting for the previous biopsy site and any lesions, in order to accurately diagnose the patient’s breast cancer. I weighed the mastectomy, measured its 3 dimensions, and described it. In general, tissues are cut along the long-axis, called breadloafing (another kitchen-related verb).

My work at the cutting board, choosing which parts to sample for microscopic examination, went on to form the basis of this patient’s diagnosis and her treatment options. Whatever we don’t use in this process is placed into a well-labeled formalin-filled plastic container where it will sit inertly for up to a month before being incinerated.

All of this work - the act of examining, documenting and dissecting your private tissues - is called grossing, from gross examination. Gross also happens to be what people often say upon hearing what I do as a pathologist.  Much of what I did during my pathology training was gross in every sense of the word. When I’d discuss my work with friends from the non-medical world I’d once inhabited they were completely disgusted.

In pathology we’ve turned Gross into a verb, one amendable to many uses:

  • “I can’t get lunch, I’ve got to gross in this uterus”.

  • “I’m grossing in this colon, get the air freshener spray.”

  • “I grossed in the placentas and now everything is sooo bloody!”

Even if you think this is gross, historically pathologists would regularly describe tumors as pea-sized or melon-sized. Nowadays, we’re discouraged from using this kind of imprecise language. Peas, after all come in a variety of sizes. We use proper measurable data, like grams, millimeter or centimeter to indicate size, and words like smooth or irregular to describe the texture. But food-based comparisons still linger. There are chocolate cysts of the ovary, nutmeg liver, shredded carrot collagen, fish flesh lymphoma, apple jelly lupus, spaghetti and meatball fungus, and coffee-bean nuclei. I must say this food familiarity seems improbable. Just how did the old-school old-boys pathologists club have such knowledge of the kitchen?

While it may be uncomfortable to contemplate, there are many similarities between our body tissues and kitchen ingredients. Our body fat is remarkably like other fats you may have dealt with in the kitchen; it is slippery, greasy and has a shimmery sheen when compressed.  Muscles are muscles, no matter what mammal they come from. After my training in pathology, I can easily gut a fish and clean a chicken. And if you cook with organ meat, the organs of the human body will be very familiar to you, from the kidney, to liver and sweetbreads (aka the pancreas). The frankness of our physical body makes you realize that we are not so unique.

One thing I always liked about working in a restaurant was the camaraderie. This teamwork also brightens the anatomic pathology laboratory. There are grossing technicians who do the gross examination, histology technicians who slice your tissues on a small machine that is the lab version of a deli slicer, and microbiologists who smear your body fluids onto gelatin covered plates. The pathologist may be like the head chef in this setting, but unlike the kitchen where there are celebrity chefs, there are no celebrity pathologists. In fact we’re even unknown to other doctors. Many physicians and patients treat the laboratory like a mysterious ‘black box’ – tissues and fluids go in and answers come out.

The downside to being thought of as a black box is that our experience and perspective is truly hidden. When the public doesn’t see our involvement, lab results seem like magic – easily come by and easily dismissed. Pathologists understand each disease with immediacy. We’ve touched, cut up and looked at every kind of cancer. We’ve got the proof for modern medicine and we need to share more of it. While patients may not want a ‘chef’s table’ type experience for their hospital stay, they may want to learn more about how and where we found the real answers - in the lab.

*Pathologists are the physicians who diagnose all disease. If you’ve had something removed, at a clinic or a hospital, myself or one of my colleagues has examined this part of you. Here is a description of my work, from an Instagram post: https://www.instagram.com/p/Bob0VcCg8cy/?utm_source=ig_web_button_share_sheet