The Doctor's Doctor Talks To You
In a dark room in the hospital, everyone is waiting to hear your diagnosis. Your internist has a list of ideas, as does the radiologist. All the physicians and nursing specialists gather around a table at the weekly tumor conference, presenting their best guesses. They're waiting for the final answer - from me.
I'm a pathologist, and me, or one of my colleagues, prepares for the tumor conference and presents your case. Pathologists go to medical school, yet we don’t interact with patients. But if you've had a biopsy, an aspiration, or a scraping you've been examined by me or one of my colleagues. Or at least a part of you has. All day we diagnose disease, making decisions that affect you and your loved ones. We see your cells, and make the call – do you have cancer or not? And when it’s not cancer, we diagnose that too. Dermatitis, hepatitis, appendicitis… we’re trained to diagnose any condition that arises in the body.
I'm also the mom at the party, talking about tumors and blood smears, and telling my kids the frankest descriptions of STD's you can imagine. I've seen every organ and disease and I know exactly how everything bad happens. When I give people my perspective on what I call 'Kitchen Table' pathology, everyone pulls up a chair to hear it.
Pathologists are called by some the ‘Doctor’s Doctor', because we talk to your doctor - not you. Consider this blog a new and direct connection. I want to share my knowledge - greasy, granular and fascinating - directly with you.
My stories start from the opposite end of most medical tales. But what may appear ‘upside down’ is actually the true understanding of disease.
I let your doctor share the pathology results with you, the patient. But, frankly even your doctor doesn't really understand what I do, and they may not always understand the meaning of your pathology report. Although I frequently explain pathology to other doctors while talking to them on the phone or at conferences, I have limited experience talking about pathology with patients.
Two times come to mind:
The first was in residency. A patient who’d had nearly his entire colon removed wanted to look at it. So I got the colon specimen from storage, where it was kept in preservative-filled sealed plastic bags, and met him in the laboratory. He was recovering from surgery two days earlier and was in a wheelchair pushed by his girlfriend. He was young, seemingly too young for such a radical surgery, but that’s why it was performed – to prevent him from getting a colon cancer later in life. He had been diagnosed with a pre-disposition to develop cancer, called Familial Polyposis. His colon was studded with small bulbous growths and none of them were yet cancer. I showed him the colon, already yellow-grey and hard from the chemical fixation, pushing on the plastic bag to reveal the growths peeking out of the normal colon folds. And that was it. He didn't ask many questions, just wanted to see it for himself. I’d want to see my colon too, if I’d had it removed at age 24.
The second time was after I started my job at a community hospital, with a young woman who’d had a Desmoid tumor removed. This process is like an over active scar that grows down and out, subtly infiltrating into her abdominal wall. Like many other patient’s with desmoid tumors, hers occurred after pregnancy. She too was wheeled into my office, a day after surgery, to peer into the microscope and get a look at the process that had caused her so much grief. We looked at the cells together, but it's hard to look through a microscope if you're not used to it. **
How we've met until now:
I know parts of your body (what we call 'tissue') , often a day or two after you’ve left the doctor’s office. Or I handle your still-warm body parts while you are unconscious on the operating room table. And while I know who you are (although completely impersonal), you've likely never thought given much thought to me or whomever is examining and cutting up your tissues.
That's about to change with this blog. I want to tell you about your pathology.
This blog will offer two kinds of content:
- a Behind the Scenes perspective of medicine and disease from the most important place in the hospital - the Pathology Lab; and
- Moments at the Microscope, where I can show you about a variety of diseases in a way you've never heard before.
I hope to provide my unique perspective as a pathologist, but offer no medical advice. By sharing my knowledge with you, I hope you’ll enjoy reading your inside stories, have fun with the gross stuff of humanity, and feel more empowered at the hospital.
A note: I was trained to diagnose all disease, but in practice I focus on the skin, with a variety of other surgical pathology specimens included.
** It’s hard to point to what’s wrong on the slide of a desmoid tumor, also called a fibromatosis. It’s nearly entirely pink, and composed of sheaths of cells that all look the same. There’s no top or bottom, and the infiltration is difficult to demonstrate if you’re not used to discerning amongst shades of pink.
A typical colon involved by a familial polyposis syndrome. The numerous brown and mushroom shaped growths all have pre cancerous potential.