I first registered what a pathologist does during a morbidity and mortality conference in medical school. These lectures, called "M&M", are large lectures, attended by multiple medical specialty departments in a teaching hospital where a recent patient with complex medical care is presented. Difficult, even mysterious conditions are exciting, much like a great mystery novel, so these conferences can be extremely interesting.
At these conferences we frankly discuss:
How the patient came to medical attention;
What ideas the providing physicians worked with as they treated the patient;
What tests were ordered, and what could have been done differently;
and what happened to the patient.
The pathologist spoke at the end of this particular conference at my medical school. We had heard from radiology, oncology, infectious disease and surgery. But after all the presentations, the false starts and dead ends, the pathologist provided the answer. All the hypotheses about the patient's condition and the tests to prove them were evaluated by the pathologist. She had seen the cells and made the call; she ended the guessing. Now the treatment team knew the cause of the patient’s problem and could explain it. That, I decided right then and there, is what I wanted to do. The power of the pathologist’s interpretation was exciting and highly motivating. She was the definitive expert.
But I can almost certainly guess what your first impression of a pathologist was – a forensic pathologist. Movies and television have pigeonholed us as forensic pathologists, performing exciting autopsies that answer questions about a crime. Even I can get caught up in the glamour of the life they portray - and I know better.
Here’s the reality: all pathologists must perform 100 autopsies during our training and after that experience, most of us would rather not spend any extra time in the morgue.
Unlike the TV shows, the morgue is not a glamorous or even a particularly clean place. It is usually in the basement, alarmingly frequently located near the kitchen and cafeteria, and is among the last rooms to be updated or modernized. There is a large walk-in refrigerator (like in a restaurant), and bodies are stored in there on carts while wrapped up in white plastic bags that zip shut. When we perform the autopsy, bodies are usually cold and blood is already settling in the dependent parts of the body.
Although there are no secrets in an autopsy, there are not always answers. Autopsies rarely answer the type of questions that people expect; most death is not dramatic or unexpected. While I have been involved in autopsies that have a legal significance, as part of a death investigation, most are of the elderly with known health conditions. Families want an answer they did not understand in life.
Medical students, other doctors and pathologists all learn a lot from the autopsy. It is humbling, it is physically difficult and it is dirty. In fact there are many things to be learned about health and medicine from autopsies, but other pathologists and journalists have written eloquently about these areas. Although I have interesting stories of autopsies, I want to focus on the main work of modern pathologists. In our average work lives, a hospital pathologist will do one autopsy a year and thousands of surgical cases. I want to continue to share that work, even if there are no high drama shows depicting those decisions.
Maybe I will write one!