There are still people around him who don’t know what he does, even though Sagrario García has only a few years left to retire. She directs the Pathological Anatomy service at the Infanta Sofía University Hospital in Madrid, the place where specialists like her dedicate themselves to naming diseases. They are invisible doctors in the eyes of the patients: they do not give them a face and will never deal with them, but they know them by what they tell small pieces of their flesh: a small piece of breast to biopsy, a completely removed thyroid, a part of the intestine.
Pathologists, says García, are the best witnesses of how bodies become ill and those responsible for writing the most relieving words – “it is benign” –; also the most feared. So far this year, samples from 20,100 people have arrived at its service, passing through different rooms, hands and machines. The organization is scrupulous and, above all, manual. The fabrics are cut in the carving room. Those portions should be selected, if it is a complete organ, that will give the best information. On the operating tables there are scissors of all sizes, tweezers and fans to ensure that odors do not invade the space.
The water inside is then extracted and exchanged for paraffin to create a block of wax where they are inserted. Like a fossil. To look at it under a microscope – or through a screen if it is scanned – you need to have very fine sections. Three microns wide that are sectioned one by one. A minority of hospitals, the largest ones, have machines that have automated this craft, but they are still expensive and the majority cannot make that investment. The last step before García and the other pathologists take action is to stain the samples. They all take on a violet color.
“The patient’s prognosis and treatment will depend on our diagnosis,” says the head of the team, made up of nine other doctors, 12 technicians and two secretaries. She is a head and neck expert; Others of her colleagues know more about hematology, or gynecology, or kidneys. They see many suspicions of tumors, what more; but also eczema and psoriasis, kidney failure or cytology samples. The service also performs autopsies on fetuses that have died.
“The other day they put me here – he points to the upper part of his neck – because there was a metastasis in a lymph node that came from thyroid cancer and I couldn’t see where it was with the naked eye, when removing it,” he admits. Sectioning better, it appeared before his eyes. “This patient is going to be cured,” she says – very confident – immediately afterwards, looking at a screen that to the outsider’s eye is completely incomprehensible.
The sample draws geometric shapes under the microscope with a white portion in the center. That’s the problem, he points out. The doctors’ knowledge, together with the information that can be automated with machines, allows us to explore whether the tumor has this gene or this other – that marks a certain surname and directs towards the type of treatment – and also determines the stage.
Pathologists have begun to vindicate themselves from outside the laboratories. The Spanish Society of Pathological Anatomy (SEAP) presented a status report a few months ago, based on surveys with professionals. “Without us many diseases cannot be diagnosed, we are the notaries of medicine,” said its president and head of service at the Vall d’Hebron University Hospital, Santiago Ramón y Cajal.
There are inequalities in “quality of diagnosis depending on the communities” and there is concern about the generational change “due to the little exposure and visibility despite the relevant role they play.” In the last specialized training offer (MIR), there were 133 places in this specialty out of a total of 8,722. They all covered themselves. “Ignorance of this medical specialty is due, fundamentally, to the fact that pathologists have practically no relationship with patients; it is usually other doctors (oncologists, dermatologists, gynecologists…) who share the diagnoses, so it is complex to know their work”, they assume in the SEAP, which estimates that 20% more specialists would be needed in Spain to assume the increase in surgical activity.
Specialists and technicians, mostly women, take between two and four days to reach a diagnosis, although in urgent cases it can be resolved in 24 hours. On the contrary, if many samples have to be looked at or rare cases are encountered, the process can take up to two weeks. “We work with this,” says García, placing on the table a thick volume that is his particular encyclopedia. “And with calls to colleagues,” he adds. Asking for a second opinion, from a colleague at your own hospital or another, is part of everyday life. At the weekly tumor commissions, where they meet with professionals from gynecology, oncology or neurology, García has to arrive with a diagnosis that refines as much as possible what is happening to the patient because the rest will depend on that first step.
When this medium is about to leave the facilities, a package arrives at Dr. García’s office with an envelope. It’s from a patient who sent some sweets to thank him. “And I’m telling you that they don’t know us. “I promise you – he laughs – that this will never happen.”
#doctors #dont #illness
