Hidden Specialties
Meet the doctors of sleep, images, and microscopes
The process usually takes about a day, but when a surgeon encounters an unexpected mass during an operation, only a near-instant turnaround will tell the surgical team what must be done next. Pathology labs are often situated alongside operating rooms, separated by what looks like a double-sided version of an ice-cream parlor's freezer case in between. "The surgeon opens the OR side and puts the tissue in," says Parslow, "and the pathologist opens the other side" in the path lab. The sample freezes in place, and the pathologist can cut a thin section, stain it, and look at it under a microscope--all contained within the freezer--getting a diagnosis back in 15 minutes instead of overnight. "Crunch time happens about 12 to 15 times a day," says Parslow. "That's what really gets an anatomical pathologist's adrenaline flowing."
No offense intended, but to be certain about the flow of adrenaline--or any other hormone--calls for the expertise of a clinical pathologist. These subspecialists are the doctors who take delivery of the thousands of samples of blood, urine, wound swabs, cerebral spinal fluid, bronchial washings, and other body fluids even less pleasant that are routinely sent for analysis. The heart of clinical pathology at Emory and many other hospitals is the "core" laboratory, a central analytical clearinghouse where the bulk of routine blood and chemical testing is done. Put thoughts of lab-coated chemists pouring fluids from beaker to flask and back again aside; this is a high-tech, highly automated operation.
Expanding world of tests. Samples in safely stoppered test tubes arrive from throughout the hospital by way of a pneumatic tube system, like those used in bank drive-through lanes. Labeled with a number and bar code, the tubes are fed into what looks like a conveyor track from an assembly line. Their journey spans only 30 feet or so, often in under 10 minutes. But in that time, the automated chemical analyzer will retrieve the order for specific analyses from the hospital's database, conduct as many as 41 different tests, and spit the results back into the database, available to physicians anywhere in the building. In addition, says James Ritchie, Emory's associate director of clinical pathology, the hospital has a dozen specialty labs for molecular diagnostics, immunology, high-sensitivity drug testing, and other specialized tests done in small numbers. "There's an expanding world of tests," Ritchie says. "Very rarely does a new one come out so perfect that it does away with previous tests completely."
It's not surprising, then, that the third major arm of pathology is experimental. Pathology, says Parslow, "was born as a research enterprise." In keeping with the specialty's laboratory roots, pathology remains highly academic and research oriented. Because of their day-to-day duties, pathologists have become custodians of large collections of human tissue. Logically, they often take a leading role in studying the diseases that produced the samples in the first place. For example, says Parslow, "we have the tissue, and now thanks to the human genome project, we have the genes as well. It's incumbent upon us to do the genetic research" to find genes that can indicate whether disease is present and what drugs it might respond to.
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