Please describe your typical day
My name is Mike Watson, I'm a histopathologist, and my interest is paediatric pathology. My usual working day runs from about 0830 to 1730, and my time is divided between the cut up room where the specimens are handled, and the microscope. In a typical day I will spend some time in cut up, supervising registrars dissecting specimens, doing so myself, and selecting tissue for frozen section. Most of my time is spent at the microscope reporting histology, and teaching registrars. I thought it easiest to illustrate typical activities in my day with a couple of examples.
What are the types of cases you typically see?
A brain tumour is a common frozen section consultation. When the specimen arrives in the laboratory, I prepare a smear from it, and select tissue to be frozen. The gross appearance of the tissue and the way in which it smears give me important information. While the scientist prepares and stains the sections, I review the MRI, and by the time the slides arrive, I have a considerable amount of information to help formulate a differential diagnosis. I will then examine the smear and frozen sections and ring theatre with a diagnosis or differential diagnosis. If the case is difficult, I will show colleagues and discuss the case with them, before ringing the clinician. One of the things I like about my job is the collaboration within the department, and the fact that my working environment is supportive and educational.
The other example I thought I'd use is the receipt of a Wilm's tumour nephrectomy. Because these specimens are nearly always semi-elective, I am usually familiar with the imaging, and other clinical aspects of the child's presentation (associated syndromes etc) beforehand, because the case will have been presented at the Starship oncology meeting, and discussed by representatives of the different specialties involved. When the specimen arrives, I examine it with the paediatric pathology registrar and she obtains photographs. Next the specimen is inked so that we know where the resection margins are on the histology slides when we obtain them (because the ink is visible in the sections). Then we make an incision in the specimen to obtain material to freeze for tumour banking and molecular studies. Following fixation in formalin, the slices of the specimen are sampled to show the variation in tumour morphology and extent of spread, using blocking maps drawn on the specimen photographs. These enable return to the specimen for further sampling of a particular area when indicated from review of the slides. Typically a Wilm's nephrectomy will generate 20 to 30 slides and it takes a few hours to properly examine them before writing a report describing the tumour including such things as the presence or absence of anaplasia, extracapsular invasion, vascular invasion, lymph node metastasis, and so forth. I will then present the pathology at the oncology meeting the following week to enable therapeutic decisions to be made.
In a typical working day I will get several calls from surgeons, oncologists or radiologists about cases. Most of these are paediatric cases, and I enjoy my relationship with the other specialists I interact with. Other things that form part of my day are administration which I don't particularly enjoy but regard as a necessary evil, and teaching which I enjoy. This is nearly always in the context of current cases, either in the cut up room, or at the microscope, reviewing cases reported by the registrar. In anatomical pathology, our registrars also have more formal teaching on a Friday morning which usually comprises a workshop on a particular topic (salivary gland tumours for example), followed by a review of interesting recent cases. All five laboratories in town contribute to these teaching sessions, so my turn usually only comes up about once a year. The registrars themselves work out what topics they want, then approach the relevant consultants. Pathology training is quite exam-focussed.
I am on call for one week in seven, and in a typical week, I will get half a dozen phone calls and have to come in once for an hour to look at a frozen section, or other urgent biopsy. This is usually not in the middle of the night, so it's hardly a burden.
What do you enjoy about working in Pathology?
Some of the things I like about my job are the intellectual appeal of problem solving, the collegial environment I work in both within and outside my department, and the fact that I get to integrate information from the other parts of the laboratory when coming to a diagnosis (genetics, haematology, microbiology etc). I find the science behind what I look at fascinating, and it's exciting to work in a field where the pace of accumulation of new knowledge is so considerable. This is what attracted me to pathology in the first place.
What do you enjoy about working in the Auckland Region?
I like working in the Auckland region because in a centre of this size, I can focus on histopathology alone, (whereas in a smaller centre I might have to do cytopathology and autopsy pathology too), and I can do paediatric oncology which is not really available elsewhere except Christchurch.
What do you enjoy doing in your spare time for leisure activities?
In my spare time I enjoy tramping. I grew up in the South Island, and the mountains and valleys of Aspiring national park in particular are very dear to me. My children are at an age now where they can enjoy tramping too, and for me at least, this is the ideal family holiday. Unfortunately, one of my teenagers doesn't agree.