Thoughts of My Pathology Training

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I recently started my residency training in the field of Pathology. It’s another world of adjustment from my premedical course and general practice. If I knew I would be spending my days looking at the microscope, examining body tissues from living and dead people, and diagnosing I wouldn’t have bothered learning a lot of stuff I did back in med school.

A licensed general medical practitioner and a hobby illustrator on the sidelines, I begin blogging on this side account for some organization. The main account posts diverse topics already and it’s becoming an eye sore for me to review my past works.

Premedical courses and medical school will teach you the general stuff. Each time you progress to taking specializations for your career you clip out a bulk of what you previously learned. There’s no use keeping it as you won’t be using it often. It’s the same energy of knowing how to solve quadratic equations and then realizing you won’t be needed it to accomplish your daily tasks.

Pathology consists of two major areas, surgical and clinical pathology. I’m not going to bore you with the conceptual definition but this field deals with studying tissues of the living and the dead to arrive at a diagnosis. We receive referrals for examining specimens from our surgeon friends. By examining the tissues, we can diagnose a disease or monitor response to therapy. My consultant once said that Pathologists are the doctors of doctors.

Because when clinicians can’t arrive at ta diagnosis, they look to pathologist to figure out how to find the missing pieces of the puzzle. Some disease are clinically diagnosed by nature and some requires a Pathologist’s input to confirm. It’s difficult to treat someone without a working diagnosis.

The clinical pathology side covers a lot of laboratory testing, and evaluating test results while taking into consideration the case of the patient. This isn’t the conceptual definition but how I interpret the textbooks I read. This part is more near to what the general practice and other fields can relate to because we all look at the papers printed at by the lab equipment and examine what they mean in the context of the patient’s case.

But we also have to keep in mind the validity of the results and do frequent quality assurance checks on the equipment. We work with our best friends, the medical laboratory technicians for this part. Honestly, there is no better professional to readily consult with than these pros. They practically know more about the how the tests and machines work than most give them credit for. If a clinician works with nurses in the wards when administering care, it’s the same energy as pathologists relying on their medical lab technicians.

Pathologists and medical lab technicians are like the unseen frontliners that often get forgotten. We keep to ourselves in our lab cave all day minding our own business while the entire hospital can get chaotic. The only time we get some semblance of chaos is when lab equipment gets broken or lab accidents happen. But overall our workplace is as chill as it can be.

This doesn’t mean it’s smooth sailing for the resident pathologist. See part of the training includes being tossed by a case that can be anything under the sun. This means you can get cases that can be to the extremes. Some diseases are easy to diagnose while some can take you weeks to figure out what the hell it is you’re dealing with. I find this problem prevalent on the surgical pathology. Each time a tissue specimen gets processed, it takes days for the slides to come out then you got to examine them and make notes. The easiest part of the process is processing the specimens.

The most dragging parts are going back to the literature to figure out what you’re dealing with. Sometimes slides that take days to come out may be of poor quality so you have to cut some samples again and wait another couple of days for rinse and repeat.

Did I mention how much the stench of formalin would be something you get used to? Yeah this carcinogen penetrates your nose even with an n95 mask on and you just got to take in like a champ and cut your specimen right. There’s no fixed way of cutting specimen as each organ requires special handling. It can take us a lot of minutes just to figure out the best approach to take samples on specimens we’re unfamiliar with. Textbook pictures help with the process but not so when the specimen is a giant tumor and then you got to identify the structures of whatever is left looking normal just to be sure you’re doing something right.

At this point I’m just rambling my daily experiences on the job because this will be my routine for the next 5 years. The workload is a dream come true for me than working under different fields of medicine. It’s more mentally draining than physically taxing and that’s perfectly fine. While I’m just sitting on a chair looking at a microscope for hours taking notes and doing the paper work, I’m sure a lot of calories are burned as the mental work piles up.

I wouldn’t recommend this field of medicine if you want a lot of patient contact. And you don’t get to do the stereotypical stuff doctors you see on tv do. You’re that professional everyone relies on behind the spotlight. That’s perfectly fine because you still got an equal say on what goes on operationally in the hospital.

For any interested medical student that happens to come by this blog post, the reference book used would be the latest Robbins and Cotran Pathologic Basis of Disease. Keep in mind that new editions are released almost every year or two and this book is expensive. I think most medical programs use this as a main reference book for pathology but it only covers the surgical pathology part. For the clinical pathology, we use Henry's Clinical Diagnosis and Management by Laboratory Methods, also expensive.

There are plenty of books used as a reference material depending on what organ you’re examining. We also use WHO textbooks as references. It’s frequently a pain to update yourself with the latest diagnostic criteria and methods available as new stuff comes out yearly. Old classifications of benign become malignant and some methods become obsolete. What I learn from this field is how rapid one can become stagnant when they don’t bother attending seminars and conventions.

I’m still crawling my way into getting used to the routine.

If you made it this far reading, thank you for your time. This is a creative footer by @adamada. A Hobby Illustrator.