What is pathology?
The day I announced my choice of specialisation, I was met with these questions.
My family asked the former and my medical colleagues posed the latter. Thanks to
innumerable television shows even a small child is aware that the clinician is an
eccentric genius, the surgeon is a maverick and the emergency physician is a
superhero. Popular culture is yet to discover the rich and varied life of a pathologist
and I was left struggling to answer these deceptively simple questions.
As I began my journey into the world of pathology, discovering the wonders of the
microscope, I made it my personal quest to uncover the answer.
The Science of Pathology
Pathology serves as the bridge connecting bench to the bedside – translating
laboratory data into healthcare outcomes. This also makes pathology dynamic –
what we know changes all the time as scientific understanding deepens.
Pathology overwhelmed me initially. The sheer volume of information – attempting to
learn everything about everything – exhilarated and terrified me. As a novice I
worked hard to add to my mental database – images to my picture atlas, long and
complicated names to my vocabulary, facts and figures, genes and syndromes,
stains and algorithms – learning and unlearning several times.
The aspects of pathology that were emphasised during training were objectivity and
scientific rigor; the pursuit of quality and the importance of being a lifelong learner.
But as I put in the hours, I realised that there’s an art to pathology as well. And that’s
what separated the good pathologists from the great ones.
The Art of Pathology
At its core, pathology is the art of observation. It is approaching each slide with
mindfulness and curiosity. It is the fine art of seeing without preconceived notions. It
is the art of constant vigilance and the awareness that the most routine of specimens
may not be what they seem at first sight.
It is also the art of tidying up. As a beginner I was constantly adding and always
getting distracted by the extraneous. But the art of diagnosis is sifting through the
millions of inflammatory cells to find that one malignant tumour cell. It is the process
of tidying and organising the thought processes of the mind.
Pathology is also the art of contemplation and silent illumination. The path to arrive
at a complicated diagnosis is sometimes impossible to describe. So much of
pathology is the intangible workings of the mind. It is travelling epic journeys while
staying in one place. And perhaps, the most difficult art of all, having the confidence
to ask for help.
We are presented with a tissue snapshot of the patient, trying to make sense of what
exactly is happening and what is likely to happen. We observe and decipher the
minutest of clues while keeping the big picture in sight.
As pathologists we attempt to make sense of the grand scheme of things. Observing
disease trends, trying to connect the dots and predict future outcomes. But always it
is the small triumphs of everyday essential diagnosis that drive us forward.
Distilling Knowledge into Wisdom
Pathology is a lifelong quest to distil knowledge into wisdom through internal
cultivation and practice. The skill of diagnosing effortlessly comes through hardearned experience supported by study and understanding.
In the end, all that pathology has taught me can be encapsulated in two lessons –
approaching every situation with presence and without ego and eliminating the
superfluous till finally only the truth remains. Every day I attempt to apply these skills
in work and life.
Pathology is the Search for the Truth
Today I can answer – pathology is the science and art of perceiving the true nature
of disease for the benefit of all.
To rephrase the words of Albert Einstein – ‘The supreme task of the pathologist is
to arrive at the universal truth that underlies every disease by pure deduction.
There is no logical path to these truths; only intuition, resting on sympathetic
understanding of experience, can reach them.’