Monday, October 31, 2011

Fan Mail

I've had a handful of readers over the past couple of years e-mail me to ask me questions about pathology and advice about medicine but no one, until last Thursday, has ever prefaced their question as "Fan Mail." I was tickled pink. A first year medical student from a far away institution asked this, and kindly allowed me to answer in a post:

"My question for you is, are there times when you wished non-pathologist physicians remembered more about histology? What would you like them to know?"

The short answer is this: NOTHING. That's job security, right there, in an age where everyone is stepping on everyone else's toes. Radiologist doing surgeon's jobs, interventional cardiologists threatening the cardiothoracic surgeon's lifestyle, general surgeons delving into plastics, etc. etc. Nothing makes me happier than when a radiologist peers into the scope while I am doing a wet read on a lung biopsy and acts like it is all voodoo. Or when a gastroenterologist comes to the lab to look at a biopsy and I can tell, even when they act like they understand what I am describing to them, they really haven't a clue. I'm certainly not claiming superiority, here. When a patient starts to hemorrhage during a lung biopsy, or when it comes to treating the many diseases that I diagnose, I haven't a clue. That's not my job, and I am not interested in any of it unless it helps me help the patient. I like to know the implications of my call, that is very important - if I upstage this cancer what will it mean for the patient? Extra chemo? A grimmer prognosis? But beyond that, I have little interest in the details, I have my own wide scope of practice maintain current knowledge in, and that already stretches me to the limits.

In a subsequent e-mail the first year is lamenting over an upcoming histology test, but simultaneously pleased with her status as a first year med student - we were all happy miserables, in med school. I hated first year histology. It was one of my few B's in medical school. Those old neck-breaking 1960's scopes with blurry eyepieces staring down onto old, overused slides - that was a nightmare. My first month of pathology residency confirmed that I retained nothing - I used to take random slides from my autopsy cases to test myself on normal histology. I still remember mixing up the pancreas and the pituitary gland. I think the first couple years of med school are important - but especially the first year seems to be a test of endurance, much of it is not really applicable to daily practice. Biochemistry about did me in, especially since I was a psychology major in college. Since I have graduated from my med school, they have re-vamped the curriculum to a systems-based approach, which I hope is less abstract than our disjointed basic science review.

My second year of medical school was better - everything seemed more practical. That is where I realized I had a talent for pathology. I was an "upper quarter" student, but was rarely at the top of the class. This changed when I took pathology - a two semester course. There was a bulletin board where all of our grades were posted next to our "super top secret" numbers that designated us, a number known only to the individual. The Wailing Wall. I still remember how long it took me to find my own number on the first pathology test - searching for my grade. After many frustrating, anxious minutes I finally found it - at the top. I was standing in a throng of med students. Someone said, "Who is that? Who made the highest grade?" I smiled quietly, still in utter shock and amazement, and slipped away. I was never at the top before, but it was consistent for me, in pathology. So although my route was circuitous - I had an ophthalmology residency in the bag, I was glad that I came to my senses because this is clearly my calling, and I am happy.

Thanks much for the "Fan Mail." It made my day! And good luck on your histology test, J! It is a means to a, hopefully wonderful, end. You never know. You might have a knack at it.

11 comments:

rlbates said...

You deserve such good fan mail!

Happy Halloween!

Thatgirl said...

I love your attitude :-)

In good news, at least at Duke, we have virtual microscopes so our histology/microanatomy slides are all on our computers. There are microscopes available but I've never seen anyone use one...

Gizabeth Shyder said...

Thanks, Ramona!

How funny! You know, come to think of it all the second year path was virtual. We were during the transition. By second year, most of our tests were on the computer. Gosh, my post dates me!

Liana said...

Of course you should be getting fan mail!

Part of my tropical medicine training involved a day in the lab each week (the assumption being that wherever we're going, there might not be a pathologist to diagnose stuff for us). It was stuff that is probably ridiculously easy for you, like malaria in the spleen or leishmaniasis in the spleen or trichuris in the gut but it turned into one of my favourite days of the week!

We still had to use microscopes and glass slides, and eventually everything got slightly greasy from people using the oil immersion lens and not cleaning things off. Ew.

Gizabeth Shyder said...

I'm with you on the oil - was so nice to finally get my own scope that wasn't swimming in dirty oil from a lazy resident.

We see those diseases so rarely that it is good to brush up on them now and again - I occasionally get a smear to look for malaria or leishmeniasis and I always have to open the books.

The Duchess of Cookies said...

You receive fan mail because you ROCK!!!

Ugh, I hated sharing scopes...

Kyla said...

The only part of A&P that I didn't do extremely well in was the lab practicals involving microscope identification. Blech!

History Doc said...

(formerly "the mother")

I nearly failed my first pathology practical in medical school too. But I got better. Really.

rlbates said...

Hoping all is well with you and yours. Happy Holidays!

Anonymous said...

Hello: I am a pathologist and love your blog. Can I get your email address so I can write about my experience? I would like to do it privately. Thanks

Gizabeth Shyder said...

Hey anonymous - I just saw this - just blogging again after a long hiatus. It did not come to my inbox for some reason - got hung up in a pending comments area I have not seen in a long while. Hopefully my comment will trigger something in your e-mail. I would love to hear from you if you are still interested in chatting. Sorry for the late reply.

gizabethshyder@gmail.com