By Lani Kai Clinton, MD, PhD
U.H. Pathology Resident
The click of the switch brings her to life with a familiar hum as the light bulb turns on. The glass is cool and comforting against my fingertips. My heart pounds faster as I bring the glass slide to the stage. As I focus on the image with the powerful assistance of the microscope, a shaded tapestry of deep purple-blue and bright orange-pink dances before my eyes. There they are, the cells that give us life.
Being a Pathologist is akin to being a scuba diver. We explore areas that one cannot access without assistance. The scuba diver uses specialized breathing devices and air tanks in careful combination with weights and buoyancy devices to stand on the ocean floor, to study and to discover new marine life. The pathologist uses a single, simple device, the microscope, to see parts of us that cannot be seen with the naked eye. Over time, the naked eye evolves, and develops action figure-like super powers whereby the conscious part of the brain is bypassed; a diagnosis is produced from lightening-fast neurons. This is “The Eye.” She is a powerful processor, combining the variegated beauty of cellular detail with the precision and rigor of an unrelenting scientist. I love my job.
Some days, we curse “The Eye.” The cells that give us life can also take it away. Although we do not examine patients in the traditional manner, we still see patients. The skin biopsy under our microscope is a very real extension of a living person with his own ideas, dreams, and plans for the future. He just wants this funny-looking mole taken off. The skin biopsy reveals an irregular infiltrate of frankly ugly, pleomorphic cells with cherry-red nucleoli and melanin pigment. I sigh and curse softly under my breath. It is malignant melanoma. It is everywhere. Sometimes, I wish The Eye did not see the melanoma because this diagnosis will change the patient’s life. But I can’t blame “The Eye,” I trained her to do exactly what she did today—to make the correct diagnosis.
The Pathologist is a metaphorical cul-de-sac in medicine. The patient sees their primary care physician with a “funny-looking mole.” The primary care physician refers the patient to a specialist such as a dermatologist who takes a small piece of tissue in the form of a biopsy. The biopsy gets transported in coolers and cars to a central processing laboratory. The piece of skin goes through many processing and staining steps before ending up on a glass slide at the Pathologist’s desk. After the Pathologist makes a diagnosis, the diagnosis is reported to the physician who obtained the biopsy. The physician will treat the patient based on the Pathologists’ report. In our case of malignant melanoma, the patient will undergo surgery to excise the malignancy, a sentinel lymph node biopsy, and possibly systemic therapy with daunting side effects.
As I said, some days we curse “The Eye.”
But we are also grateful to “The Eye.” Without her, we would not be able to give our patients the answers they seek.
About Dr. Clinton
`Iolani School, 1998
Williams College, BA, English and Biology, 2002
University of California at Irvine, PhD, Neuroscience, 2007
John A. Burns School of Medicine, MD, 2011
Born in Kahuku, Hawai`i, 1979
Mother of Charlie, age 2