When I Grow Up:
Becoming a Pathologist.

The following discussion is adapted from an email correspondence exchange between myself and the students of Johnston Middle School, Johnston, Iowa, in February, 1999.
What is Pathology?

      Pathology is the study of diseases that occur in humans (human pathology) or in non-human animals (veterinary pathology).

      Many questions about pathology are answered in more detail if you go to the website entitled, The Lightning Hypertext of Disease, which I wrote in collaboration with four other pathologists. You can reach The Lightning Hypertext of Disease on the Internet at:

           http://www.pathinfo.com/

The Lightning Hypertext of Disease is a commercial website, but you can ask as many questions as you wish for free. WARNING: Many of the answers you will receive are highly technical, and written in the specialized jargon of medicine.
What education is required to be a pathologist?

      Human pathologists must have a Doctor of Medicine (M.D.) or Doctor or Osteopathy (D.O.), plus five years of additional training in a pathology residency program.

      Veterinary pathologists must have a Doctor of Veterinary Medicine (D.V.M.) and additional specialty training.
How did I become interested in Pathology?

      I became interested in biology and medicine research when I was a middle school student. I participated in Science Fairs, which were an opportunity for young scientists to show their work to their peers (that is, among other young scientists), as well as to adult judges.

      I chose to go into medicine, because this is a practical area where you can immediately help other people. I chose pathology because it is one of the most scientific branches of medicine, and because it is one of the few branches of medicine, along with general family practice and radiology, where you can work with diseases of the entire body. Most other medical specialists work with a particular area of the body, like the brain, the eyes, the skin, the chest, the abdomen, etc.
What electronic tools are used in pathology?

      At this moment in history, there are not many electronic tools in the routine pathology laboratory, outside of computers to perform ordinary office functions, like email and fax. There has been a lot of discussion about an emerging area, namely, TELEPATHOLOGY, in which a pathologist in one location looks at specimens under a microscope which is physically located hundreds of miles away. This has been suggested especially for remote, sparsely populated areas, which do not have enough work to employ a full-time pathologist. Right now, telepathology is still very experimental, and many of the problems have not yet been worked out.
How important are autopsies?

      Autopsies have always been very important in societies with a sophisticated medical culture, like the United States. There are many medical questions that you can determine from autopsy studies that cannot be answered any other way.

      There are two basic types of autopsy: MEDICAL (asking why a patient died in a hospital); and FORENSIC (asking why a patient died under suspicious circumstances). You might wish to enter FORENSIC as a keyword in The Lightning Hypertext of Disease.

      In my job, I perform medical-type autopsies. Medical-type autopsies are important in studying the progress of diseases, like heart-disease and cancer, and determining whether certain treatments have helped the patients. There is a Latin saying that every pathologist knows: Mortuí vivós docent. The dead teach the living.

      Most states have a MEDICAL EXAMINER, a group of pathologists who have additional training in forensic-type autopsies, and who perform autopsies on persons who died under suspicious circumstances. Every pathologist, of course, has some training in forensic pathology. In my job, if I think that a crime has been committed, I consult with the medical examiner. In recent years, the number of medical-type autopsies performed in this country has decreased greatly, but the number of forensic-type autopsies has remained steady. I think that the decrease in medical-type autopsies is a mistake, but I am not allowed to decide whether to request an autopsy.
Does it hurt the family to have and autopsy?

      In my opinion, it never hurts the family to have an autopsy, unless the family objects to an autopsy for religious or other personal reasons, or the family is informed of the autopsy results in an insensitive way. For example, in Muslim cultures, autopsies are almost never performed. In my opinion, the doctor who has cared for the patient during life should always interpret the autopsy report for the family. The autopsy report is written in very technical language, and non-medical people might be offended or confused by what they read in an autopsy report.
How do I feel when I do an autopsy?

      Pathologists are usually thinking about the technical parts of an autopsy when they perform an autopsy. Why did the patient die? Was the disease controlled as well as possible by the treatments? Will there be any unexpected findings? Pathologists almost never know the patient that they autopsy, and they become accustomed to the gruesome parts of the autopsy. If you can't get used to working with dead bodies, then it doesn't make much sense to become a pathologist. Still, even pathologists have feelings. The autopsies that bother me the most are the ones on young people about your age who have suffered a great deal before they died. We all have to die sometime, but it seems to me that everyone should have the chance to grow up first.

      There is a joke among pathologists that we think about food when we do autopsies. Many findings seen at autopsy are named after food, probably because food is so familiar to everybody. Examples: NUTMEG LIVER, CASEOUS NECROSIS, BREAD AND BUTTER PERICARDITIS, SUGAR-CAKE SPLEEN, etc. You may enter PATHOLOGY FOOD into The Lightning Hypertext of Disease and see what you get.
What do pathologists do, besides autopsies?

      It might surprise you to learn that non-medical-examiner pathologists do not spend much of their time performing autopsies these days. Pathologists like myself spend most of their time looking at specimens that surgeons and other doctors remove from a living patient. We prepare the specimens and look at them under the microscope, so we can tell the patient's doctor what is wrong with the patient. Most working days for a pathologist are about the same as for other professional people, like lawyers, teachers, and businessmen. It is a long, somewhat unpredictable work-week, but most pathologists do not work at extremely odd hours, like surgeons or emergency-room doctors. There ARE emergencies in pathology, but they don't happen very often. Usually, a pathologist must be called to the hospital if a patient needs emergency surgery, and the surgeon needs to know the diagnosis (that is, what disease) before he/she finishes the operation. In these emergencies, the pathologist quick-freezes the specimen that the surgeon removes from the patient, and makes a diagnosis, so the surgeon knows what to do next. Most routine specimens in pathology take several days to process, sometimes longer if there are special tests.
Does the autopsy always give a conclusive answer?

      Every honest pathologist will admit that at least one in ten medical-type autopsies does not tell us why the patient died. I don't know what the percentage is in forensic autopsies, but it is probably a lot smaller. Still, there are some things so wierd that a criminal can do, that you couldn't figure it out in your wildest imagination. A German-speaking pathologist once told me a little rhyme about forensic autopsies. If you won't be offended by a slightly off-color joke, then you can enter the keyword UMSUNST in The Lightning Hypertext of Disease. (Don't worry; the rhyme is translated.)
How important are findings at the crime scene?

      The crime scene can be very important, depending on the particular case. The pathologist's findings are only part of the puzzle, and the observations obtained at the crime scene are necessary to put together the whole picture, and make sense out of the autopsy results.