A Storied Career

What led you to medicine – and to pathology in particular?
In high school, I was very interested in biology. Alongside a small group of friends with similar interests, I even built a lab in the woods behind our house where we lived in Paraiso, Panama Canal Zone. We operated on frogs and other animals to learn more about their anatomy and physiology. We even got interested in taxidermy under the guidance of one of our biology teachers and would taxidermy sloths and smaller mammals. In college, medicine was the next logical step from biology – and my love of microscopes and biological concepts led me to specialize in pathology.

I was in the MD/PhD program at the University of Wisconsin–Madison. My major professor, W.H. McShan, was an endocrine researcher who spurred my interest in the subject. When it came time to subspecialize, endocrine pathology seemed like a logical choice.

You’ve written a comprehensive textbook on endocrine pathology and served as Editor-in-Chief of the journal Human Pathology. What did you learn?
The book on endocrine pathology was one of several that I wrote over the years. I was always interested in pulling knowledge together and conveying major concepts to students and to my colleagues. That same impetus made my 13-year tenure as Editor-in-Chief of Human Pathology an enjoyable experience. I learned to admire and respect original observations even more than I had before. I also learned that being editor takes a great deal of work if you want to do the best possible job. The two things that I am most proud of from that time in my life are having encouraged younger colleagues to get more involved in academic pathology (by introducing novel aspects to the journal, such as the section on “Being a Pathologist”) and having stimulated residents and young faculty to participate in both writing and reviewing manuscripts for publication.

The “On Being a Pathologist” pieces invited outstanding pathologists to write about their careers in pathology. For instance, Leopold Koss wrote a very dramatic summary of his struggles to complete medical school during World War II while escaping Nazi persecution.

To encourage interest in academic pathology, we invited residents and fellows to review articles for the journal. The invitations were directed at specific people (mostly residents and fellows I knew from Mayo Clinic, the University of Wisconsin, or grand rounds elsewhere in the country) and I can’t recall a single one who declined.

You’re heavily involved in research as well as clinical work – how do you balance the two?

It is often challenging to balance the practice of pathology with research. You end up spending more time than you should in both areas, which is not good for a well-balanced family life. However, in my situation, some major rewards resulted from hard work in both areas – for example, in the 1980s, our group developed the chromogranin A monoclonal antibody (LK2H10) that is used by pathology laboratories around the world today. We also recently published a new pan-neuroendocrine marker, insulinoma-associated protein 1 (INSM1), with one of our former residents, Jason Rosenfeld; INSM1 is now rapidly becoming a highly specific, broad-spectrum marker for neuroendocrine tumors.

It has been tricky to focus enough attention on every area of my professional and personal life – but, if I had to do my career over again, I would probably do the same thing.

What has been the most impactful moment of your career?
Two moments in particular stand out. The first is becoming President of the USCAP in 2004.  The second is presenting the Maude Abbott lecture, one of the highest USCAP honors, in 2015 and receiving a standing ovation after the presentation. But I’ve been fortunate enough to have a career full of highlights, including serving as one of the editors for the WHO Blue Book on Endocrine Pathology in 2004 and in 2017.

Being president of the USCAP was a unique experience. The president usually selects the speaker for the Timely Topics Lecture and I had the privilege of inviting Nobel laureate Phillip Sharp to deliver the 2005 lecture. It was also exciting to learn about the history of the Academy and to interact with all of its senior leaders.

What are the main obstacles you’ve had to overcome in your career?
I am very introspective and somewhat shy, which at times has been a major obstacle. I’ve managed to overcome those feelings by convincing myself to keep pushing ahead, no matter what. I am a mentor to many young pathologists in training, including one in the USCAP Mentoring Academy, and I usually emphasize the difficulty of pushing oneself to the limit (which often carries career advantages) while trying to maintain a balanced life with one’s family. To me, this is one of the major obstacles to a successful career in pathology – there simply isn’t enough time for everything.

What are your next goals for yourself?
My major goal is to inspire more undergraduates and medical students to pursue a career in pathology. After all, pathologists are some of the most satisfied medical professionals, even after many decades of practice. But that’s not my only goal; I also want to make one more major discovery before I give up the practice of pathology.