The Evolution of a Lab Hero

Medical laboratory professionals are at the heart of the laboratory and at the diagnostic crux of healthcare. I am a part of the medical laboratory professional team; I am a pathologists’ assistant (PA). It has been my honor and privilege to serve patients and fellow healthcare professionals alongside pathologists for over a decade. In that time, I have watched our profession become an integral role within the healthcare team as the “unsung heroes” of the lab (1).

My first synoptic report

My journey as a PA has been less than traditional. In fact, it began in an elementary school gym. I can still smell the freshly polyurethaned floor as I perused the annual school science fair exhibits. My own submission wasn’t particularly innovative or award-winning; however, I found it both fascinating and exquisite. You see, I had stumbled upon a model brain at the local hobby store – one that could be dissected and colored – and decided to feature it in my science fair submission. The model was accompanied by a nine-year-old’s version of a synoptic report correlating anatomy with neurologic function, albeit in a very rudimentary way. I recall being mesmerized by this anatomic structure: its splendor, beauty, and complex functionality. It was then I knew I wanted to be… a brain surgeon.

Fast-forward many years through high school, with university decisions looming. I faced an inner dilemma between my technical and creative ability as an artist and my passion and intrigue for the biological sciences. Sadly, neurosurgery didn’t make the cut – but I was able to find an acceptable marriage by attending the Rochester Institute of Technology, from which I graduated with a degree in medical illustration. My initial post-undergraduate years of employment were as a full-time, in-house, contract biomedical illustrator and animator at Pfizer Global Research and Development, where I developed content for clinical trial patients, clinicians, and researchers. Although rewarding, the work was very much removed from both the patient experience and the pathology that deeply intrigued me – a disconnect that weighed heavily on my creative juices.

But, as fate would have it, the ever-changing dynamics of the biopharma industry caused my entire creative services team to be “reassigned.” This left me out of a job and, out of desperation, I ended up taking a position as a technical illustrator at Dominion Nuclear Power Plant. I spent my days illustrating turbines and regulatory commission datasets which, although important, was less than fulfilling. But it did make me realize that I needed to get back to the drawing board and reconnect with the passion that so deeply influenced my undergraduate studies. Those curiously blissful moments of dissecting a human cadaver in gross anatomy and investigating the disease mechanisms behind said cadaver’s demise was what drove my research.

Finding a new path

Thanks to Dogpile (an Internet metasearch engine), the keywords “human dissection” + “pathology” + “master’s degree” pointed me in the direction of a profession I hadn’t even heard of: the pathologists’ assistant. It offered a career leveraging my technical ability and passion for biomedical sciences, with the added prospect of being able to focus exclusively on dissection while nevertheless serving patients and the healthcare community. A perfect match!

As a Connecticut native, Quinnipiac University – one of eleven NAACLS-accredited “PathA” training programs (2) – was in my backyard. Without hesitation, I applied and was accepted into the class of 2007. PA school was intense and certainly not for the faint of heart. Our first year was entirely didactic. Courses were stretched out over a 12-hour span, Monday through Friday (and even Saturdays during the summer), so days on campus were long. Sleepless nights ensued as my classmates and I scoured endless pages of notes from courses such as Human Microscopic Anatomy, Basic Human Pathology, Clinical Pathology, Laboratory Management, and Embryology.

The second year consisted of intensive clinical rotations in places like Yale University School of Medicine, the Connecticut State Medical Examiner’s Office, Hartford Hospital, the VA medical center in West Haven, Crouse Hospital in Syracuse, and many more. We trained alongside residents and other PA students. Our preceptors, to whom I am eternally grateful (thank you all for your patience and commitment to the profession) served as models for how to be successful behind the gross bench and in the autopsy suite. Overall, the Quinnipiac program prepared me with “comprehensive knowledge in the practice and operations of the anatomic pathology laboratory” (3).

Upon graduation, I sat for the American Society for Clinical Pathology (ASCP) Board of Certification and passed. I was now a bona fide, ASCP-certified PA – I was a PA (ASCP)^cm.

The next step – a job

As a resident of Connecticut, I was warned that Quinnipiac’s presence caused the market there to be somewhat saturated – so it would be difficult to obtain employment locally. This didn’t deter me. I wrote letters to every hospital in the state that didn’t have PAs, offering my services as an eager and emerging PA. Much to my professional satisfaction, I was offered a position at my birthplace, the William W. Backus Hospital, with University Medical Group (later University Pathologists, LLC).

This first job out of school was one of evolution. For several years I served as not only the PA, but also the histology supervisor. You see, the scope of practice of a PA is vast, as I quickly discovered during my time at Backus. Grossing surgical specimens, prosecting autopsies, accessioning, cutting frozens, specimen photography, intraoperative consultations for specimen adequacy, negotiating service contracts, participating in annual reviews, managing chemical inventory – you name it, I did it, in collaboration with an excellent team of pathologists and medical laboratory professionals.

After a transition to a new and equally diverse role at Kent Hospital, where I again served as both PA and technical histology supervisor, I finally felt I had the experience to spread my wings and leave Connecticut in 2015. I relocated to southeastern Virginia, where I initially worked at Bon Secours Maryview for a year and then moved to a position close to my home. To this day, I am employed at Chesapeake Regional Medical Center with Hampton Roads Pathology.

Making our mark

What sets those who choose the PA profession apart is our variety and versatility. My professional evolution highlights the infinite variability among our journeys to becoming PAs. In fact, medical illustration wasn’t the only unconventional first career I encountered in PA-dom; this eccentricity is a common thread among PAs, with previous professions including: boar laboratory technician for artificial insemination, professional dancer at Walt Disney World, Spanish translator, and mosquito colony research tender. Certainly, there are those who follow the natural progression within the lab – histotechs, cytotechs, or clinical laboratory scientist (according to an informal Facebook pathologists’ assistant group poll and discussion). But this is precisely what makes us unique – the vast diversity of experience we bring to the proverbial grossing bench.

The versatility we offer relates to job responsibility (supervisory versus non-), type (community hospital versus academic), and genre (surgical versus autopsy). In my humble opinion, we are not just pathologists’ assistants despite our official job titles; in actuality, we bridge the gap between all aspects of the preanalytical, analytical, and post-analytical stages for every patient who comes through the door of our laboratory. Our scope of practice is beyond what I can describe through my own personal experiences but, to say the very least, we are “academically and practically trained to provide accurate and timely processing of a variety of laboratory specimens” and, as such, we are “key partners in assisting the pathologist to arrive at a pathologic diagnosis (4).”

Aside from my day job grossing, I have never been particularly satisfied with the status quo; I have always sought ways to keep my creative juices flowing. As a result, I have taken advantage of every opportunity to serve the profession – and I’ve found it amazingly rewarding. I have teamed up with both the ASCP and the American Association for Pathologists’ Assistants (AAPA), working on a vast array of programs and projects. Shortly after graduating from Quinnipiac, I applied to serve as an ASCP Career Ambassador, which really served as a catalyst for my volunteer roles within the organization.

With a significant workforce shortage looming over the laboratory, ambassadors visited area high schools to present on careers in the laboratory. I happened to have access to the Yale University autopsy organ teaching collection, which was a huge hit with the students. This experience evolved into a role on the Council of Laboratory Professionals, where I currently serve as the Immediate Past Chair (2018–19). I now also serve as a Member-At-Large on the Commission on Membership (2019–21). These roles have given me the opportunity to keep my finger on the pulse of our profession and stay closely in touch with our members – the entire medical laboratory professional team. I am deeply committed to ASCP’s mantra: we are indeed stronger together.

In 2012, the AAPA embarked on a journey to create the “Grossing Guidelines,” more officially known as the “AAPA Macroscopic Examination Guidelines: Utilization of the CAP Cancer Protocols at the Surgical Gross Bench.” As a classically trained medical illustrator, I was invited to be a part of this immense project – and it is with pride and satisfaction that I now fulfil the role of Art Director/Illustration Liaison and contributing illustrator on this wonderful practice aid and teaching tool. The Grossing Guidelines aim to lead the entire pathology community through the macroscopic examination of cancer resection specimens. What a labor of love and commitment – and a true marriage between my passions and professions as a medical illustrator and pathologists’ assistant.

Words of wisdom

If I had a message for all PAs out there, it would be to value your amazing career opportunity and be the best you can be. Pathologists, value your PAs; we have much to offer. And to the rock-star medical laboratory team: leverage what you may already have in your lab toolkit and look to the PA, a multifaceted part of your team.

My message for all laboratory medicine professionals, from phlebotomist to pathologist, is this: get out there and do something great! Your professional value goes far beyond the walls of a hospital – for instance, with volunteer roles that are critical to our field as well as to your growth and development. Why keep those unique qualities we bring to the grossing bench to ourselves when we can be a part of a diverse team for the greater good of our healthcare profession? Volunteerism has pushed my career forward in more ways than I can describe, allowing me to network with a vast group of medical laboratory professionals and participate in challenging – yet rewarding – projects. I’ve soared farther than I could have ever imagined, and I’m sure the best is yet to come.

I’m telling my story in response to an editorial in a previous issue of The Pathologist, in which my colleagues and I were described as the “unsung heroes of the lab (1).” That editorial called upon us to tell our stories as non-pathologist laboratory professionals. If I had only one goal in doing so, it would be to inspire all of you to truly be lab heroes. I am an ordinary person, with unusual but simple beginnings, who has embraced the journey. I challenge every reader to commit to some form of volunteerism – something that gets you one step closer to becoming the best you can be. Your patients deserve a better you. They deserve a lab hero.