This will seem incredible and surprising for the layman, but no specialist of any profile can do without a pathologist - therapists, oncologists, gynecologists, ophthalmologists, surgeons, and other doctors. The fact is that in the pathology department of the Nizhnekamsk CRMH, not only autopsies of bodies are carried out, but also histological studies of various tissues, starting with moles and papillomas and ending with the stomach, uterus, and intestinal fragments.
Today marks the Pathologist Day. In the pathology department, NCRH employs two doctors, six laboratory technicians, and two orderlies. And on the eve of their professional holiday, we talked with the department head Anatoly Spiridonov, who founded and has been heading his department for 44 years.
About the job
"I love my job very much. When people find out that I work in the morgue, many people are surprised: "Oh, how do you work there? It must be terrifying out there." But, in my opinion, this is a regular medical work - exciting and essential. During the autopsy, we check the correctness of the attending physicians' diagnosis, help them understand the pathological process when there are doubts about the mechanism of death.
Of course, one of our main tasks is in vivo diagnostics. Now no doctor can do without us. For example, the therapist directs the patient for an endoscopic examination to check some digestive tract part. Endoscopists take a small piece of tissue, send it to us, and we make a diagnosis. That is, the priority direction in our work is to help identify the disease, especially cancer."
About helping the doctor and patient
"I have always been interested in the essence of the pathological process. How does the disease proceed? What changes in the internal organs did it lead to? What does it look like in its finale? Why did death occur? An equally interesting process begins when biopsy material is sent to us. For example, they send material without suspicion of cancer pathology, and we detect cancer at an early stage. It also happens the other way around. They send us material with suspected cancer, and we remove the diagnosis. Previously, we sent patients for research to Kazan. Now we are sending them to the capital with a ready diagnosis for the appointment of a certain specific therapy such as chemotherapy or radiation, for example. Sometimes there are complex, dubious cases where cancer cannot be detected by the eye. In such cases, we send for additional immunohistochemical studies to exclude or confirm a malignant neoplasm's growth. If the diagnosis is confirmed, then again the factor of early detection plays a big role. This guarantees that a person has time to be operated on timely and has a chance to live to a great old age. And if the diagnosis is removed, this is even more joyful. And then I get the greatest satisfaction from my work. This is the way how we help the attending physician and the patient."
About the research
"Tissues of various volumes are delivered for research. For example, during EGD, the endoscopist detects an ulcer, plucks two or three tiny pieces from the ulcer walls, and directs them to us. Also, doctors send areas of skin or papillomas with suspected cancer, part of the intestine from a few centimeters to a meter or more, stomachs, fragments of the liver, gallbladders, appendixes, kidneys, uterus, ovaries, fallopian tubes, pieces of lung tissue, mammary glands, and so on. For example, an oncologist operates on the mammary gland and finds a tumor. They call us, warn us that we need to check the specimen urgently, and within 20-25 minutes, we give an answer. This may be a benign or malignant formation. In the case of a malignant neoplasm, the doctor removes the mammary gland with adjacent lymph nodes. This shows the degree of liability we deal with: during the operation, we make conclusions and take responsibility for the patient's health."
About the autopsies
"We open the bodies of patients who died in the hospital, in Cardiology, Surgery, Primary Vascular Center and other departments. Exceptions are those cases when the doctor understands the disease's mechanism, causes of death, and no doubt about the diagnosis. If the relatives do not mind, then they take the body without an autopsy. If there are doubts about the diagnosis and interpretation of the mechanism of dying, an autopsy is mandatory. We must also open the body of a patient who has been in the hospital for less than a day.
We often give the body to relatives without opening those who suffered from malignant neoplasms and histological confirmation of the tumor. If there is no confirmation, an autopsy is mandatory."
About the first autopsy
"It is forever etched in the memory. At the Department of Forensic Medicine, I dissected a young man. He was 26 years old. He escaped from prison, and this was his fourth conviction. The body was like an art gallery, all tattooed from the forehead to the feet. On one eyelid was written "Paradise," on the other - "Glory of the CPSU," tattoos were on the chest, stomach, limbs, buttocks, and penis. He had the dates of his incarceration tattooed on one foot and his release dates on the other. There were four dates on one foot and only three on the other.
The guy was in a high-security prison; he ran and managed to get through three fences under the alarm and an electro-current. Only the fourth fence worked. The guy ran towards the forest, but the sentry fired a machine gun from the tower after warning shouts. One bullet hit the small of the back, went through the stomach, and tore the intestines in three places. The second one hit the gluteal region and broke off the head of the femur. The fugitive was taken to a prison hospital, where he died."
About the clean and red zones
"Because of the coronavirus, our work has also changed. In the first building of the morgue, we dissect the bodies of patients who died in the inpatient departments. The second building of the morgue is divided into clean and red zones, where autopsies are carried out on the bodies of patients who died presumably from viral pneumonia. Pathologist Dmitry Alexandrovich Klimenko and two nurse aids work there fully equipped in protective suits.
We have never experienced such changes in internal organs, mainly in the lungs, as in coronavirus. In ordinary pneumonia, the lungs are dense, and pus-like fluid flows out of them when cut. In cases with COVID, the lungs are like rubber – viscous, elastic, with focal hemorrhages and fluid-clogged alveoli. The lining of the alveoli changes so that it interferes with gas exchange – this is what destroys a person. Coronavirus also differs in that it occurs with thrombotic syndrome – blood clots form in the vessels, circulating throughout the body, causing secondary damage to internal organs. And because of blood clots, circulatory disorders can occur, causing a heart attack and stroke."
"A living person can't get into the morgue; that's out of the question. I also heard and read these stories and anecdotes. After the onset of clinical death, doctors fight for the patient's life for at least 30 minutes. This means that when there is no breathing, heartbeat, reflexes, the doctor still spends half an hour resuscitation. Artificial ventilation, heart massage, defibrillation, intravenously administered drugs that are used in intensive care. And suppose after half an hour, there are no signs of life. In that case, the resuscitator draws up a resuscitation card and signs that biological death has occurred, that is, irreversible changes have occurred in the patient's body, and the person will not return to life."
"We always feel sorry for people who come to us. So I'm surprised how easily some people manipulate their health. Often we provoke our diseases by smoking, excessive alcohol intake, drugs, or overeating. I do not understand extreme entertainment, which is popular with young people: they climb the walls of houses without insurance, ride on the roof of an electric locomotive. I am very sorry when a young man or a young woman gets on a dissection table, in whose anamnesis "drug addict," " alcoholic, "or"HIV infection" is written. You live once, and it can all end instantly. But the person is somehow sure that something will happen to others, but not to them."
About the most difficult
"Sometimes there are difficulties with the diagnosis, with the establishment of the cause of death. I have a medical history on my hands, and I know the clinic, but something does not fit into history, so I have to wrestle with the subject. But these are working moments. The main difficulty of the ethical plan is talking to relatives. Often, thanks to negative information in the media directed against doctors, people come angry, with preconceptions against us, and confident that their relatives were treated incorrectly and the diagnosis was also made incorrectly. Some even said: "You work in the same hospital and still do as the doctor says." What's the point in doing so? Relatives can apply to the prosecutor's office, which will appoint an exhumation. And the fact that we allegedly changed any data will qualify as official forgery. Such distrust is very unpleasant and offensive; it feels like being spit on."
About the most important thing
"The most important thing I've learned over the years is that life is beautiful. No matter how it develops, no matter what happens, you need to enjoy every day. Someone said that the past is no longer there, the future is unknown to us, and we live only in the present. I fully agree with this. It is necessary to love life as it is, and it is necessary to live in the joy of yourself, your loved ones and friends, which is happiness. And the reward will be life expectancy and the love of our relatives."
"Our team consists of two doctors, six medical laboratory technicians, and two nurse aids. Medical laboratory technicians, or as they were called before – laboratory assistants are women of different ages, but they are all distinguished by hard work and responsibility for their work. There is a certain standard of workload for medical workers, including for employees of the pathology department. Our employees overwork this limit thrice, even four times, and they work responsibly and with a soul. I am very grateful to them for their work ethic, and I wish them health, happiness, success, and family well-being!"
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