All the Living and the Dead, Hayley Campbell

 I finished reading this book last week and I am disappointed that although there is a reference to a 'technical' assistant, the author is apparently unacquainted with the profession of Pathologists' Assistant.  The author is a journalist from the UK.  I'm  left to wonder whether or not PAs are even a 'thing' there (I confess that I assumed that PAs would be distributed everywhere across the developed world - exposing my naivete I suppose.  She also apparently did not interview an anatomical pathologist or a forensic pathologist to get an understanding of what the overall purpose of an autopsy might be.  I plan to attempt to contact the author so that, in the event of a 2nd edition or a reprint, a mention of the totally wonderful work that PAs provide in North America is mentioned.  Not only do we provide energetic, high quality  work in surgical pathology and autopsy pathology day to day; doing the hands-on stuff that pathologists prefer to not involve themselves with, but we also teach pathology resident doctors in not just the nuts and bolts of how to handle certain surgical or autopsy specimens, but also in medicine and pathology.  I also want to take the time to clarify a few things with the author regarding forensic versus hospital (aka 'medical') autopsies; how they [significantly] differ and who is, or may be, involved.  The roll of the Autopsy Attendant (aka "Autopsy Assistant"  or "Morgue Attendant" - also sometimes, and unfortunately, referred to as "Pathology Assistant") also should be clarified for the sake of the accuracy of the book.

By way of an overall review of the book however, I'd say that I very much enjoyed the results of the in-depth research that the author did, far and wide, in casting a light on the occupations of those who work largely behind the scenes when it comes to the handling of the dead.  A good read; entertaining.  Recommended.

New read...

 I'm about half-way through a new (2022) book entitled All the Living and the Dead. From Embalmers to Executioners...,  by Hayley Campbell.  I'm quite enjoying it so far.  It's the sort of read which will probably appeal to those of us who are familiar with this sort of thing (the sort of topics that may not be fodder for what would be considered acceptable dinnertime discussion).  I think you'll like it if you're anything like me.

A little history...

Being among the first PAs in Canada, if not the first [surviving] Canadian PA, now that my career is over, I can do a bit of a retrospective...

At the beginning of the 1970s, when PAs were foreign to almost all Canadian hospitals, those in eastern Canada who hired me as their first PA, went out on a limb.  They took a risk initially, but they supported me as I learned medicine and pathology, dissection techniques, and of all methodology around handling surgical pathology specimens and creating a competent gross description.  I became the best Pathologists' Assistant that I could be and became an asset to the department; so much so that within the ensuing 30 years, over a dozen more PAs were hired at that site.  I eventually rose amongst the ranks of the department of Anatomical Pathology and became the Manager of the department.  This all occurred many years before the second phase of my career on the opposite side of the continent, closer to the left coast.  Again, those who hired me as their first PA took a risk.  I learned after I arrived both the reason why I had been hired and why for 30+ years, PAs had not been part of the fabric of the healthcare system in this area.  My new boss at that time was very unpopular and took a ton of flack from many corners of the area, mostly from the pathologists, a lot of whom were soundly against PAs.  I was re-reading some of the Comments to this blog recently.  I was reminded of the toxic climate that was present in the area at that time.  I feel very fortunate that I was shielded from much of it as I was working very long hours in those days (yes, I worked seven days a week at first).  It was comparatively easy to focus on my work; to do the best job that I could for the local patients.

That was 18 years ago.  Whereas I was the only PA at this site for a while, relatively soon, another PA was hired, then another.  The PA compliment at this site is now four and I predict that a fifth PA position will be justified within the next five years or so.

Among the older Comments that I was reading recently were a few (from someone who would not give her/his name) stating that s/he would never recommend hiring a PA as part of the healthcare team; that they were 'more trouble than they were worth.'  As the Comment was anonymous, I did not respond.  I know however that the PAs in this region all do a fine job of grossing surgical pathology specimens; that they abide by grossing protocols, written using current best international practices, and which have been approved region-wide by senior pathologists.

I have known many pathologists throughout my lengthy career; some very good and some not quite as good.  A few of them were more trouble than they were worth.  I know that their bosses felt similarly.  How it is that some people feel that, when making anonymous statements, that they can be so outspoken and hurtful escapes me - but it is a characteristic of some humans unfortunately.  At the other end of the scale are those who appreciated the hard work that the Technologists, Cytotechnologists, Technicians, clerical staff and PAs did with them and/or for them.  While we all know that nobody, including so-called 'professional staff', is perfect, we all need to be open to change and to improving our practice.  All of us.  We need to be receptive to suggestion and we all have to speak up.  All of us.  In this age when information is increasing and changing at a furious pace, we must keep an open mind to change.  If we insist on attempting to maintain the status quo, our practice will suffer.

End of rant.  Sorry.  I am sure that for most of you, this is old news and that you agree completely.

Another Comment was from an American PA trainee who hoped to get employment in Canada.  I want to apologize to that individual for not responding promptly.  I had been 'convinced' years ago to not post to this blog by my brow-beaten and harassed boss.  I hope that you are by now enjoying a PA job somewhere in Canada as it sounded as though you might have had a less than ideal experience in the USA.

Yet another Comment from someone (anonymous of course!) who said that they knew me and had worked with me stated that I was being disingenuous (my word, not hers/his) - that I was a different person in my blog than I was in person.  'Not so' is all I have to say to that.  End of story.

More to come.

RETIRED!

I am pleased (and somewhat amazed!) to report that I have officially retired!  I was reluctant at first but I'm glad that all has worked out well so far.  I recently learned from a colleague who has also recently retired that the first three months of retirement are the most challenging; that a great deal of flexibility is required during this time and that one needs to learn to NOT be busy all of the time.  I agree that, so far, if I'm not doing something all of the time, I feel un-productive and hence unfulfilled.  I'm already getting closer to the three-month point and I think things are improving in that respect.  Wish me luck.  I still miss work and I feel as though I have abandoned the other PAs.  I hope that they're doing OK.  I understand that another position has been posted. I'm hoping that the new employee will work out well with the team.

It has been forever since I've posted to this blog.  I hope readers didn't think that I had died! 😊

I realized recently that I had neglected to post the fact that I had authored what is something of a rarity for the department for which I worked recently (2005-2022) and that is to publish a peer-reviewed case report.  Even more rare is a paper that is based on findings found at autopsy (and we all know how increasingly rare autopsies are!).  The paper was published in the Canadian Journal of Pathology vol. 10 no. 3 and is entitled Unsuspected Coronary Artery Giant Cell Arteritis - a reminder to clinicians and pathologists to advocate for autopsies. Fradet, Wenzel, Stinson.  The Can J Pathol is open source (so anyone can read the article by going to the Archives section of the CAP-ACP website. GCCA CanJPathol 10:3).  The incident dealt with in the case report was something of an error in judgement and communication wherein a patient  who was believed to be suffering from atherosclerotic coronary artery disease was referred from cardiology to cardiac surgery for surgical revascularization.  She then underwent coronary artery saphenous vein bypass grafting.  Intraoperatively, the surgeon recognized the diffuse nature of the disease; realizing that good quality bypass surgery was not possible.  Nevertheless, he managed several anastomoses very distal on the native vessels.  Despite initial adequate flows, the patient arrested intraoperatively and ultimately did not survive.  The autopsy showed minimal atherosclerotic coronary stenosis and severe GCCA.  The article has some pretty good illustrations of multi-nucleated giant cells in severely stenotic arteries.

More on the subject of retirement...I've been training almost daily on my indoor bicycle trainer and I am looking forward to racing my 12th Granfondo in July with friends, including a good friend/colleague from Ottawa who will be visiting specifically to race with us.  I'm trying very hard to avoid injury!

I just noticed that my email address at the bottom of the blog is incorrect.  I will attempt to correct that forthwith.  If I fail however, it's billstinson90@gmail.com.  Please use that address going forward.

Happy trails!

Most hated

I was sought out via email by a PA MSc trainee recently and we exchanged several emails on the subject of quality assurance.  As someone whose job it is to advocate for the patient (my title is PA Quality Coordinator), I provide support for the PAs.  I told the trainee that I had written the grossing manual (she informed me that the centre at which she was being trained did not have a grossing manual!) and that I regularly critiqued the PAs' work.  In a subsequent email, she told me that one of her supervisors said that I must be the "most hated PA in the country".  Maybe I am.  Thankfully (for me and, more importantly, for the patients) this is not a popularity contest.  Egos can't get in the way of ensuring the proper handling of surgical pathology specimens.  Anyone who takes a suggestion or a criticism personally needs to think less about him/herself and more about the patient.  Even more, anyone who forges ahead without being absolutely certain of how to approach a specimen -- thus potentially jeopardizing the patient's care -- hoping that s/he doesn't make a serious error, had better re-think their approach.  This is no game.  Peoples' lives are at stake and there is no room for error.  There is most definitely no room for ego or personality.  The pathologists who we assist must be able to depend upon us consulting if/when there is any doubt (including uncertainty about the medicine or the pathology or the manner in which a specimen should be handled).

Still to come:  inadequate PA training.

The Interrogation Room

I watched The Fifth Estate on Friday evening (CBC, May 15, 2015), an episode entitled, The Interrogation Room.

The event around which this episode centred had to do with the birthday party of this guy who had, it seems, some unsavoury acquaintances in attendance.  One of these was murdered by others on the lawn outside the building in which the birthday party was taking place.  The birthday boy's best friend was standing beside him (there was video to prove it) in the building, both enjoying listening to an acquaintance singing, when the murder took place and, when asked (in the interrogation room) afterwards, he stood up for his friend (who the police believed had perpetrated the crime) saying that there was no way that he could have murdered the guy.  The cops had a different idea of how things went and proceeded over the course of the next day (many non-stop hours without food or drink), all in the interrogation room, to get the friendly witness to admit, just so he could get the hell out of there, to their way of viewing the crime (ie. he 'ratted' on his best friend).  Does this sound at all like Omar Khadr's experience to you?  Omar, at the age of 15, admitted to killing the American serviceman and was, as a result, incarcerated until very recently.  Both interrogations used similar tactics.  There's a method used by the police called the Reid Technique (http://en.wikipedia.org/wiki/Reid_technique)  wherein one can eventually get anyone to admit to anything.  The friend was an innocent and he was treated like a criminal.  It doesn't have to be physical torture; it can by psychological.

So, the birthday boy was accused of murder and eventually the case came to trial.  He had been  incarcerated during all of this time (years).  His friend, the witness who had been coerced into admitting that he saw his friend murder the guy, admitted under oath that he had been bullied by the cops into saying whatever it was they wanted him to say.  So, his testimony was worthless.  He and another previously-friendly witness (also 'interrogated') were the only witnesses for the crown's case against the birthday boy.  Obviously, the birthday boy was not convicted.  He however spent YEARS in jail.  All of these individuals' lives were changed forever by the harassment inflicted upon them by the police.

I hope you're getting the context vis a vis that which befell me a couple of years ago. You've probably heard of 'blame the victim'?  The shoe fits.

I am encouraged that the Globe and Mail has weighed-in on the subject of police brutality (and they intend to continue to voice their opinion in a rare 2-part editorial).  Lending their voice to the public's might be helpful.  The excessive use of all-too-often lethal force by police against innocents must end.  There must be better training and much better supervision and accountability of those who become police. Hiring criteria should also be examined.

Stay tuned:  Next post will deal with inadequate training of PAs.