A Trilogy of Food, Fun, and Facts: Musings of a Pathologist-in-Training

Pathology is a perfectly blended specialty filled with food, fun and a whole range of factual morphological descriptions!

As a pathology resident, one of the first things that got me intrigued by the specialty was its strong association with many food epithets. From the almond-shaped ovary,¹ to the blueberry muffin baby,² to the coffee bean nuclei in the thyroid,³ fried egg appearance of mast cells,⁴ grape-like lesions seen in molar pregnancy⁵ to the flat cake placenta⁶ and even to the strawberry cervix!⁷ The list is endless. I found these descriptions so interesting that I kept asking myself, “why do pathologists have to make associations with food for many normal and pathological disease processes we see around?”

Aside from the fun association with food (which I happen to like a lot), getting to learn and understand the pathology of disease processes, genetic and syndromic associations have been a fascinating, humbling, and altogether nerve-wracking experience for me.

It has been fascinating because I totally enjoy learning about the underlying processes that get some people sick while others stay healthy. At the same time, it has also been humbling, because, then I realize that so many disease processes are genetically determined and so out of our control. Along the same lines, the experience has also been neck-wracking, because of the detail and efficiency that goes into mastering different disease morphologies and preparing a comprehensive pathology report. The ability to tell the difference between two very similar disease entities but with different morphological features can drive one crazy, because, sometimes everything just seems to look the same!

I remember my early days as a resident. The first week in residency training to be precise. Then, I got reintroduced to the microscope, which is the power of the pathologist. Looking into the microscope and feigning to see what the senior residents and attendings were seeing felt like outright torture to me. You know why? It’s because everything under the microscope was either blue or pink.

In my few years of training as a resident, I have come to learn that in order to be successful as a pathologist, one must be adept with every single detail. As Pathologists, we deal with the facts. We do not make things up, and strive to present the facts of every case which ultimately supports our rendered diagnoses.

Unlike when I first started my residency training, I now know that not everything under the microscope is just blue and pink, and even if they are indeed blue and pink, the degree of their “blueness” or “pinkness” varies. And the intensity of the hematoxylin and eosin (H&E)/immunohistochemical stains may sometimes tell disease entities apart from one another. So, sometimes when people ask me what type of doctor I am training to be, I tell them, “I am a doctor of colors,” which of course often leaves them confused!

I also tell people that I am training to be a doctor who works from behind the scenes, to make sure they get treated right all the time. And this realization I believe is what has created the greatest impression for me. Realizing that a patient’s choice of treatment may totally be dependent on the pronouncements I make on their disease process, is something that gets me motivated to keep putting in my best into my training in order to become one of the best in my field. Therefore, even though we operate as doctors from behind the scenes, our professional judgments often go a long way in impacting the welfare and outcomes of patients whom we never get to see, which is one of the aspects of the specialty that I truly love.

So, pathology as a specialty has given me a more robust meaning to life. I have learned to value and appreciate the time I spend with those I love, and to make special moments with them count. It has made me realize that there are certain things about life such as genetic diseases, that I have no control over and therefore should only be concerned with giving my very best all the time. Pathology has also made me more detail oriented, by learning to distinguish benign from malignant processes. It has reinforced for me, the importance of being the best person I can be to both my family, neighbors and my community in general. And I would also add that pathology has further reignited my love for good food. So, let the party begin!!!

References

1. Ignatavicius DD, Workman ML. Medical-Surgical Nursing: Patient-centered collaborative care. Elsevier Health Sciences; 2015. 1735p.
2. Mehta V, Balachandran C, Lonikar V. Blueberry muffin baby: a pictoral differential diagnosis. Dermatol Online J. 2008;14(2):8.
3. Oertli D, Udelsman R. Surgery of the thyroid and parathyroid Glands. Springer Science & Business Media; 2012. p. 620.
4. Bolognia JL, Jorizzo JL, Rapini RP. Dermatology. Gulf Professional Publishing; p. 1438.
5. Daftary. 100+Clinical Cases In Obstetrics. Elsevier India; 2006. p. 478.
6. Power ML, Schulkin J. The Evolution of the Human Placenta. JHU Press; 2012. p. 278.
7. Swygard H, Seña AC, Hobbs MM, Cohen MS. Trichomoniasis: clinical manifestations, diagnosis and management. Sex Transm Infect. 2004 Apr 1;80(2):91–5.

-Evi Abada, MD, MS is a Resident Physician in anatomic and clinical pathology at the Wayne State University School of Medicine/Detroit Medical Center in Michigan. She earned her Masters of Science in International Health Policy and Management from Brandeis University in Massachusetts, and is a global health advocate. Dr. Abada has been appointed to serve on the ASCP’s Resident’s Council and was named one of ASCP’S 40 under Forty honorees for the year 2020. You can follow her on twitter @EviAbadaMD.