Photo Essay: 6 reasons why Pathologists should read Classic Literature

 

“Classics are books which, the more we think we know them through hearsay, the more original, unexpected, and innovative we find them when we actually read them.
Italo Calvino”

 

I made up this blog post in my mind , discussed it with my friends and retained it in my mind. This is a very old tradition known as  “oral literature” spoken, not written.  Now I am writing it after 10 days.

6 reasons why Pathologists should read Classic Literature:

1. Reading literature  keeps your brain sharp and agile. Mental exercise can improve one’s chances of escaping Alzheimer disease. As you grow older you may forget little things. This is not dementia, it is natural process of aging.  Pathologist are constantly using their brain. One has to promptly remember differential diagnosis of every case, order for appropriate special stains, issue reports  as soon as possible. If you are practising medicine for a long time, it is expected you have read most of the medical books in your subject.  For active, healthy brain try reading classic literature by authors of different race and culture.

A scene from Iliad during battle between Achilles and Hector before the walls of Troy. Homer’s epic poems the Iliad and Odyssey deal with the 10 year’s seige of Troy by Greeks and return of hero Odysseus ( or Ulysses) from the war, in which he has marvellous adventures.  Image –  Image collection of Dr Sampurna Roy MD.

 

2.  You are an academic and working with people from different countries, race and religion.  To know your colleague better read a famous novel from his/her country. It is the best way to know the culture of a different nation. Your colleague will be delighted if you recite few lines from a book of his native country.

The Arabian Night’s Entertainment is a collection of old stories written in Arabic which were first translated into English in 1840. Some have become very popular, like Alibaba and Forty Thieves, a scene from which is illustrated here. Image –  Image collection of Dr Sampurna Roy MD.

3. Your research is successful. You have made a great discovery !!  You want to name a disease or a new tumour, which only you have diagnosed. You can put your own name to a Tumour  or a Syndrome   (Eponym). It is more fun if you use the name of a popular literary character. If you are well-read and familiar with the characters of various classic literatures, the naming procedure will be much easier. Example : Alice in Wonderland Syndrome and Pickwickian Syndrome.

One hot summer afternoon Alice chased a white rabbit down a rabbit hole and began her strange Adventure in Wonderland. This story by Lewis Carroll is one of the most famous children’s books ever written but it appeals to people of of all ages. Carroll’s real name was Charles Dodgson. (1832-98). and he was a lecturer in Mathematics at Oxford.   Image –  Image collection of Dr Sampurna Roy MD. Read:  Alice in Wonderland Syndrome ; The disease and the story of Alice’s Adventure.

4.  Some great authors like Charles Dickens , Sir Arthur Conan Doyle, Shakespeare have described many medical conditions in their novels.  If you are familiar with their writings, you can spice up your lecture by quoting from their books, write medical articles and blog posts.

Read: 14 things Pathologists can learn from Sherlock Holmes

Some of the best known characters from the works of Charles Dickens are grouped together in this drawing.   Image –  Image collection of Dr Sampurna Roy MD. Read: 7 things Doctors can learn from Novels by Charles Dickens

5.  If you are blogging on a serious medical subject, knowledge gained from literature will help you to be more creative. It will help you to make a boring subject more exciting.

6.  Read classic literature to avoid digital distraction. After a busy day a beautiful novel can have a relaxing effect on your mind. You will get a   good night’s sleep and be more productive in the morning.

Enjoy images from some timeless classics from my personal  scrapbook collection:

The famous episode from Miguel de Cervantes’s Don Quixote when the hero is about to tilt at windmills, imagining them to be giants. Don Quixote is about the adventures of a foolish and charming knight who wanted to achieve world wide fame.  All kinds of everyday things are seen by him as fearsome and exciting. The book was written as a satirical romance on tales of chivalry. Image –  Image collection of Dr Sampurna Roy MD.

A scene from Beowulf, the epic Anglo-Saxon poem of the 6th century, which shows the hero Beowulf about to be confronted by Grendel – half monster and half man, in the castle of Hrothgar, king of Denmark. Beowulf eventually kills the monster which had terrorised the castle and its inhabitants. Image –  Image collection of  Dr Sampurna Roy MD

The scene from Gulliver’s Travels where Gulliver is captured by the Lilliputians. Image- Image collection of Dr Sampurna Roy MD

The songs of the troubadours originated in Provence – South France. Image- Image collection of Dr Sampurna Roy MD

The wars between the Greeks and Persians, which Herodotus recorded in his celebrated history, included the famous sea battle at Salamis. This was fought in 480 BC between a Persian fleet which is said to have numbered over 800 ships and a much smaller Greek force. Despite the odds against them the Greeks won a great victory and destroyed or captured a large part of Persian fleet. Image- Image collection of Dr Sampurna Roy MD

Fennimore Cooper’s Last of the Mohicans is an exciting tale about the American west. Image – Image collection of Dr Sampurna Roy MD.

A scene from Tom Thumb, one of the fairy tales by the Grimm brothers. These two brothers were learned professors of the German language and literature but they are remembered today for their folk and fairy tales. Image –  Image collection of Dr Sampurna Roy MD.

 

“Where the mind is without fear
and the head is held high, where knowledge is free.
Where the world has not been broken up into fragments by narrow domestic walls.
Where words come out from the depth of truth,  where tireless striving stretches its arms toward perfection.
Where the clear stream of reason has not lost it’s way into the dreary desert sand of dead habit.
Where the mind is led forward by thee into ever widening thought and action.
In to that heaven of freedom, my father,
LET MY COUNTRY AWAKE!”   

by  Rabindranath Tagore, Gitanjali

An Illustrated Guide to a Pathology Quiz Case

History of the case: Poster 1

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Poster 2

Poster  3

Final Diagnosis:  Granulomatosis with Polyangiitis (formerly known as Wegener’s Granulomatosis)

Pathology of Wegener’s Granulomatosis (Granulomatosis with Polyangiitis)

Pathology of Wegener’s Granulomatosis (Granulomatosis with Polyangitiis) of the Ear

 Image Courtesy: pixabay.com

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Want to be a great Pathologist? Think like Sherlock Holmes

14 things Pathologists can learn from Sherlock Holmes

By  Dr Sampurna Roy MD

“Nothing is more deceptive than the obvious fact” – Sherlock Holmes

I have been a fan of Sherlock Holmes since the age of twelve. If  I didn’t understand something I would ask my Dad to explain. He seemed to have an answer for all my questions. My father would often laugh and say, you can also be a detective like Sherlock Holmes. As a child I thought he was joking and I would giggle and go back to reading. My father was not joking.

A few years later I visited London with my parents. I was thrilled to visit 221B Baker Street, the London home of Sherlock Holmes. My parents were amused to see my excitement during sight seeing. I remember frantically collecting souvenirs from the gift shop to make the visit memorable. I was enthralled by Baker street metro station with pipe-smoking, deerstalker cap wearing silhouettes of Sherlock Holmes covering the walls of the station. My father quietly said, you can be a very good detective if you work hard. He gave me a book which he bought in London. It was an autobiography of Sir Arthur Conan Doyle.
After reading the book I knew I wanted to be a doctor, a pathologist and a writer. There is a vast difference between wanting and achieving something. “I am still not an author of a best seller.”

I finally became a doctor and a pathologist. Life brought me right back to Baker Street. I rented a flat in Bickenhall Mansions in Bickenhall Street, located just off Baker Street. The nearest tube station was Baker Street tube station which was 5 minutes walk from the property. The tube station soon became an everyday, crowded place for me. I was no longer a tourist. I was on a mission to learn to be a “good detective” in the land of Sherlock Holmes.

14 things Pathologists can learn from Sherlock Holmes.
1) A pathologist should have an excellent mentor – Sir Arthur Conan Doyle created the famous detective Sherlock Holmes.  He was graduate of the University of Edinburgh Medical School. Doyle  spent nearly ten years practicing general medicine. Later, he specialized in ophthalmology. Doyle was motivated and mentored by legendary teacher, Dr. Joseph Bell, under whom Conan Doyle had studied medicine. Dr Joseph Bell was well known for keen observation of facts and power of deduction. He could reason out other facts from the one he knew. Doyle was fascinated with the incredible abilities of his mentor. Doyle admitted that Sherlock Holmes’ character was based upon Joseph Bell’s way of practicing medicine. It was Sherlock Holmes’ powers of deduction that made him the most famous detective in all fictions.

2) A pathologist needs a trustworthy, not too clever friend – A loyal, helpful friend is a blessing for a busy, ambitious doctor, to discuss his cases and brag about his successful diagnosis. Sir Arthur Conan Doyle created Dr Watson a faithful companion of Sherlock Holmes in every case.

3) A pathologist should be completely dedicated to his profession. “I cannot live without brain-work.”

4) There is a difference between seeing and observing – Pathologist should have the power of observation: “I see no more than you, but I have trained myself to notice what I see.” 
Just think of the quotation when you diagnose a case of Leishmaniasis, Malakoplakia or any case of “invisible dermatosis” on Hematoxylin and eosin and later confirm with special stains. It can give you a tremendous sense of achievement.

5) Pathologist should have the power to observe and to reason:  “Never trust  general impression”.
“On the contrary, Watson, you can see everything. You fail, however, to reason from what you see.”
These quotations reminded me of a second opinion case I reported few years ago. He was a young Indian boy who presented with a small superficial nodule on the finger. It was reported as benign granuloma annulare. I didn’t like the look of the oval and spindle shaped cells around the necrotic areas. There were little vacuoles and areas of hyalinization. I ordered for cytokeratin, vimentin and epithelial membrane antigen. The lesion turned out to be an epithelioid sarcoma – a malignant tumour in a young 20 year old boy.

6) Pathologist should thoroughly see the slide in a systematic way, from one end to another –  “Not invisible but unnoticed, Watson. You did not know where to look, and so you missed all that was important.”
Whether it is skin biopsy, soft tissue tumour or gastrointestinal biopsy it is easy to miss a small area of malignancy, mitotic figures, or microorganisms hiding behind dense inflammatory cells.

7) Pathologist should not only have power to observe and reason, he should also learn to think backwards and take past clinical history – “In solving a problem of this sort, the grand thing is to be able to reason backward.”
There are dozens of examples where previous history of malignancy has been omitted from the request form. A patient with a metastatic skin nodule with previous history of colonic carcinoma or renal cell carcinoma can completely change the diagnosis.

8) Collecting important data of the patient – “Data! Data! Data!” he cried impatiently. “I can’t make bricks without clay.”  A pathologist should get as much information of the patient as possible. Pathologist should know what  he is looking for and what investigation and special stains will help in reaching the diagnosis.He should talk to the patient’s family interact with clinicians and take help from the radiologist, if necessary. It is a complete team work. Facts should be gathered in details , gross and microscopic features should be correlated, extra blocks should be taken if necessary. Every detail must be scrutinized and described as accurately as possible. A systematic approach reduce diagnostic errors.

9) View of an expert Consultant – An expert in a field with several decades of experience should not take a long time to reach a diagnosis. Sorting out unimportant facts from important facts is possible by experience. “As a rule, when I have heard some slight indication of the course of events I am able to guide myself by the thousands of other similar cases which occur to my memory.”

10) Importance of Differential Diagnosis – “One should always look for a possible alternative, and provide against it. It is the first rule of … investigation. … you should never lose sight of the alternative.” All pathology residents have been warned about this important basic error.  It is a common mistake to have preconceived idea about a particular diagnosis , and then trying to fit in the facts. Many  newly qualified pathologists with limited experience in the diagnosis of wide range of pseudoneoplastic lesions try to match pictures from standard text books. Not all tumours look same. Many benign lesions can mimic  cancer and vice versa creating a diagnostic dilemma. “It is a capital mistake to theorize before you have all the evidence.” Think like Sherlock Holmes and solve the puzzle.

11) Approach to final diagnosis in a complicated case – “How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?”
Sounds familiar ? Yes indeed, in many rare cases pathologists often have a long list of differential diagnosis and reach the final diagnosis by process of elimination. It is important not to ignore the result even if initially it seems unlikely.

12) Pathologists should constantly update their knowledge – Read latest journals and books. Sherlock Holmes had vast collection of books, got evidence based information from local library or other reliable sources.

13) Pathologists should show empathy – Sherlock Holmes was warm, kind, attentive and committed to his clients. He treated member of the royal family or a poor governess with equal respect, kindness and sympathy.

14) Pathologists, in any part of the world, should have knowledge about Tropical Diseases – Sherlock Holmes described many tropical diseases in his adventures, like  tetanus, septicemic plague and leprosy. The origins and routes of transmission of tropical infections were subjects of investigation in many of his stories. He introduced the term “tapanuli fever” in ‘The Adventure of the Dying Detective’ which is probably melioidosis.
A Scientific Detective’s Approach to diagnosis in Pathology:
– A methodical and logical approach to the slide
– Aware of clinical history and other related information
– Necessary investigations including special stains and immunohistochemistry which finally lead to the correct diagnosis.
– Final conclusion is based on correlation of data and observation of minute details of the case.

Sir Arthur Conan Doyle was a medical doctor, creator of Master Detective Sherlock Holmes, author of best sellers. He is an inspiration to doctors who enjoy writing.

 Image Courtesy: pixabay.com

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