Andrea Bakker, MD Class of 2017
As I sat, I listened to two residents talk about their love for the specialty. I was even more surprised to hear from a resident who switched from family medicine into pathology. In the medical world this is like moving from Earth to Mars. Nonetheless, these doctors loved so many unique aspects that pathology has to offer: reasonable hours, a lack of challenging (and sometimes frustrating) patient interactions, a wide scope of practice and the ability to make diagnoses. And pathologists were not antisocial, the resident explained, they just didn’t crave the type of interactions one has with patients; instead, they preferred interacting with their colleagues.
This stuff sounded pretty good or maybe I was in a stupor from the food, so I decided to try it out with an elective with Dr. Grynpsan at the Children’s Hospital of Eastern Ontario. For those of you who know Dr. Grynspan, his enthusiasm is infectious; he responded to my email in about 7 minutes.
And so the elective began, first with a brief session discussing neuroblastoma. In class, it can be difficult to comprehend pathology – it tends to look like a whole bunch of pink and purple, however Dr. Grynspan was excellent at pointing out the key features to look for. At the end of the day, once you know what to look for, pathology makes a lot of sense. You are basically looking at the connection between structure and function as is unfolds right before your eyes; for example, cancer cells are overactive, therefore their nuclei are darker.
At the next session, I attended general surgery rounds. These rounds involve surgeons, pathologists, residents and more who review interesting cases from the past few weeks. I loved seeing how pathology interacted with other aspects of medicine. Seeing a case all the way from symptoms, to diagnosis, to treatment, is fascinating and connecting the pathology to the clinical presentation is something that we are not always exposed to in the lecture hall.
At another session, I attended the autopsy of a fetus that had suffered intrauterine fetal demise (IUFD). I have always wanted to attend an autopsy because medical students don’t have many opportunities to do so in medical school. I was a bit concerned as to how I would react to such a young patient, however the experience was very informative. First, we discussed the case by reviewing the charts of the mother and fetus. This brings me to another benefit of pathology – there is always a connection to the clinical presentation. For example, we looked for factors that might have contributed to fetal demise, such as gestational diabetes, slowed growth rate and the presence or absence of screening tests. All of this helped us form hypotheses before starting the autopsy.
The autopsy itself was captivating. We discussed the ways bodies decompose, which allows one to theorize about when death occurred. We started with an external exam looking for fetal deformities and other obvious signs, then we moved on to the internal exam. This was a great opportunity to practice anatomy because one was able to see how tissue layers interact in real life. It was also interesting because we could look for changes that would suggest a certain etiology of the IUFD.
I proceeded to go to several different rounds and what struck me was the huge scope of knowledge that Dr. Grynspan possessed; whether it was urology, general surgery, pediatrics, radiology or oncology, he had a complete understanding of the diseases affecting that population and could talk in detail with his colleagues about the cases. I noticed this phenomenon in class as well – pathologists have a thorough understanding of almost every system in the body. In this sense, I think that completing a pathology elective is a fantastic idea. Learning pathological concepts on real specimens and working with a pathologist to understand the basics makes pathology more interesting and more intuitive. In addition, pathologists have connections to almost any specialty in the hospital, therefore they serve as a great resource to observe other areas for example, Dr. Grynspan suggested that I observe a neurosurgery and then follow the biopsy specimen through to pathology – how cool is that! Finally, pathologists posses a wide scope of knowledge, and are therefore excellent people to chat with to help integrate knowledge learned in various areas. Forget the whole “that’s beyond my scope of practice” – pathologists seem to know it all!
And so in the end, on that seemingly regular Wednesday in February I got much more than I expected from the Pathology Interest Group – not to mention some really good pizza.
Addendum: I wrote this piece in my second year of medical school. I am now coming to an end of my third year and am planning to apply to Anatomical Pathology. Who would have thought that such a coincidence would lead me to my future career? It just goes to show that there is so much out there to discover, so don’t be afraid to follow your gut – or your nose.