The Laboratory 4

“Today we’re going to visit Pathology, Jaded Julie. One has to be impressed with what they do here, with the pathologists dealing with life-or-death issues on a daily basis.”

“C’mon, Curmudge, you know it’s not strictly life or death. The ultimate mortality rate is 100%; everyone dies eventually. It’s more correct to say, ‘death sooner or death later.’ “

“Thanks for making my day brighter, Julie. Shall we continue our tour of the laboratory with Mary Dikeman?”

“The next three rooms are the offices of our pathologists, each with a microscope on the desk. They work closely with Histology and Cytology, and they oversee the technical aspects of the entire lab. Their normal day includes examining and describing each tissue specimen, examining slides prepared from the tissue specimens for evidence of malignancy or disease, performing analysis of frozen sections of fresh tissue sent from the operating room, conferring with surgeons and oncologists about reports, reviewing Pap smears, reviewing new and changed technical procedures. They also perform autopsies when required.

Now we will walk into the histology department. Histology is the study of the microscopic structure of organic tissues. A tissue sample, such as a gallbladder, is removed during surgery, put in a fixative and send to Histology. There the next day the pathologist examines it and describes its appearance at the large stainless steel grossing station in Histology. Then he will cut portions of it to have microscopic studies. These sections are processed overnight in two instruments that move the tissues through various solutions to prepare them to be cut into very fine slices and put on a slide. There are four microtomes at the center table in this area that are used by the histotechnicians and histology assistant to cut the tissue into fine slices for slides. Once they are affixed to the slides, they are moved to an instrument where they are stained and a glass coverslip is put over the tissue. These are the same as the bright colored tissue slides they show on the CSI or Medical Examiner TV shows. Then they are taken to a pathologist for him to examine. They look at what kinds of cells and structures are present on the tissue slide and what characteristics they have. When fresh tissue is sent to Histology for a frozen section during surgery, a portion of the tissue must be quick frozen in a cryostat and then thin slices are cut and placed on a slide. After it is stained, the pathologist examines it and calls the results to the operating room. The surgeon will then decide how to proceed with his surgery. You will notice that there are two cryostats, so there is always one available in case one is in auto defrost at the time it is needed. The histotechnicians also perform other special stains and immunohistochemical stains on tissue to help the pathologists make disease diagnoses from these slides.

Now let’s go across the hall to the Cytology processing area. Here is another laminar flow hood to protect the users when they set up possibly infectious samples. Watch the cytology assistants take the Pap smear vials and run them through the processor to make a thin layer of cells on a slide. Then they spin down body fluids in the centrifuge and process them to make a slide. The slides are stained and coverslipped on the instrument in Histology. Then the slides are put on the computerized imaging system that will survey the slides and pick out 22 fields of interest that need to be reviewed. In another room with microscopes at 3 work stations, the cytotechnologists look at and determine if there are suspicious cells present on the 22 areas or anywhere on the slide. This uses both computerized and human expertise to provide a high level of detection. Any slides that have suspicious cells are taken to the pathologists to review and diagnose.”

“I remain totally impressed, Julie. So much of this requires painstaking work by the technicians and experience and judgment by the pathologists. Diagnosis of diseases by microscopic examination of tissue specimens can be very difficult, as is the case with interstitial lung disease. Different areas of the same specimen can look different, and even experienced pathologists can disagree.”

“With your poor eyesight, Curmudge, it’s a good thing that you didn’t become a pathologist. ‘It looks as if we are nearing the end of our tour, Mary.’ ”

“ Almost, Curmudge and Julie. Across the hall is a room where there is an industrial dishwasher, large sinks and an oven. Here the lab glassware is washed and equipment kept clean by the lab aide, who also orders supplies and fills orders for lab supplies.

Near the main lab is the Point of Care office. The POC staff maintain and oversee all the bedside testing that is done across the system. Also located in this area are the MT school coordinator, the student lab and classroom. Our technologists and pathologists support a school to provide a clinical year experience for 4th year medical technology students. They receive lectures and training in the student classroom and student lab, and then are integrated into the laboratory to learn about performing tests in most areas of the lab.”

“Although our formal tour is over, let’s get together next week and do a post mortem (oops, that might not be the best term to use here) on what we have seen.”

Affinity’s Kaizen Curmudgeon