Art From the Heart

There’s no one better placed than a pathologist to understand the connection between art and medicine. From those who find the hidden humor in histopathology to those who see the beauty in bacteria, it’s clear that the people behind the microscope have an eye for the unusual and the visually fascinating. But it’s not just the professionals who see it – the patients do, too. And when Ray Paul, an artist and sarcoma patient at Moffitt Cancer Center, wanted to see what his tumor actually looked like – to “stare his devil in the eye” – it was his pathologist, Marilyn Bui, who viewed it with him and later sent him digital images to enlarge and use as a canvas for his art. This unusual collaboration led to a better understanding of his disease for Paul, a better understanding of her patient for Bui, and a deeper connection between pathologist and patient. Now, along with College of American Pathologists publications committee chair Katherine Galagan, Bui has turned that experience and others into a book. “The Healing Art of Pathology” features artwork and essays about pathology from the perspectives of both doctors and patients – something both editors hope will give each side insight into the other, igniting communication and collaboration.

Bui and Galagan discussed the project and its potential with The Pathologist...

Are patients aware of pathology’s involvement in their care?

Katherine Galagan: When I say that I am a pathologist, people ask me, “What’s that?” They often don’t even realize that we have medical degrees, and they’re even less aware of the different roles within pathology. If you mention television shows like CSI: Crime Scene Investigation or Quincy, M.E., their eyes light up – but all they know is forensic pathology. I have to tell them that forensics is only a small branch of pathology, and that most pathologists work with hospitals or universities to diagnose diseases, run laboratories, and conduct research.

The more outreach pathologists do, the more we will be understood. Before I retired, I spent many years running a Career Day for high school students to help them understand pathology and the different career paths related to the clinical laboratory. That’s one thing our book is intended to do – help patients and others understand the role of pathologists. Jerad Gardner has written a fascinating piece in it about his experience as a pathologist member of an angiosarcoma support group on Facebook. It’s these types of outreach efforts that will help the public understand not only what we do, but also how we can be of help to them.

Marilyn Bui: For most patients and their families, pathologists are silent, invisible physicians. This book approaches patients and families from a unique angle that emphasizes letting pathologists be seen and heard. Once patients have read the book and know what we are capable of doing for them, we hope that they’ll reach out to us and give us the opportunity to better help them. We also hope it will inspire an enthusiastic and talented next generation of pathologists. After all, it’s pretty cool to be a pathologist!

How did the “Healing Art of Pathology” book come about?

KG: The book was Marilyn’s brainchild; she was inspired by the artwork of one of her patients – Ray Paul – created in response to his tumor. After meeting with her to review his slides, he asked her for photomicrographs of his tumor, from which he created the beautiful artwork featured in “The Healing Art of Pathology.”

We gained so much from assembling the book! First of all, I learned a lot about the depth and passion of the human spirit in the face of adversity, challenges, and reflection. Second, I learned about the incredible talents hidden within our patients, colleagues, family and friends. And last but not least, I acquired a deep appreciation for Marilyn’s dynamic energy and vision. She saw the beauty of this book from the beginning and pushed it forward with incredible persistence and resolve.

MB: When I found out that the initial layout of the book had a prohibitive price tag, Katherine uttered the most encouraging words to me. “Don’t worry,” she said, “we will get it done.” By learning a new computer program and doing the entire initial layout of the book, she saved the project and also made it affordable to the readers. She became a partner, a mentor and a friend during the bookmaking process, and I still have so much to learn from her.

We’d both like to thank all of the contributors for letting us share their personal stories. It is a privilege and an honor to be the keeper of their voices. I have learned so much from this experience and everyone involved. I sincerely believe that everyone has the potential to be a pebble in the water, generating a positive “ripple effect” in the world if we choose to do so.

Should pathologists interact more with patients?

KG: Definitely! Not only do we have a lot to offer patients – a unique perspective on their disease without the heavy overlays of treatment options, symptoms, and so on – but we also have a lot to learn from them. If we are insulated from their concerns and misunderstandings, we can’t ensure that their questions are answered from the pathology point of view. Although in many cases the primary care physician serves as the intermediary, the depth of that doctor’s understanding of the pathologic process is necessarily more limited than that of the pathologist who’s actually studying the tumor or disease. For some patients, like Ray Paul (see Sidebar, “More Than a Cluster of Cells”) visualizing their disease can be an important step in understanding and fighting it. In addition, their questions may create new insights and suggest new avenues of study for us.

MB: Absolutely yes! I’m a cytopathologist. Performing fine needle aspiration biopsies at my patients’ bedsides has always been a rewarding experience. By directly communicating with patients and the clinicians while examining fresh tissue samples in real time, cytopathologists play a critical role in patient care. Many patients are wowed by the microscope, my portable “lab,” which reminds them of their high school science classes; others are impressed by the immediate diagnoses we render. Most of us became physicians because we like to help people – and once you meet the patient, you’re no longer just “signing out a case,” but helping a real person. You’re more willing to go the extra mile, so the patient gets our best efforts.

The CAP (College of American Pathologists) Foundation has a signature program called See, Test & Treat (http://foundation.cap.org/get-involved/see-test-treat-program/). Created and led by pathologists, the program directly benefits underserved patients by providing them with breast and cervical cancer screening, education, and a connection to health care. My home institution, the Moffitt Cancer Center, has a Mole Patrol program (https://moffitt.org/molepatrol) that promotes sun safety and provides free skin cancer screening to the public. Its medical director for the past two decades has been a fellow pathologist, who has led the program to great success – screening over 15,000 people. Quite a few pathologists I know volunteer at local and national patient education events on topics like cancer, heart health, or infectious disease. Most of us agree that interacting with patients reinforces why we became doctors and gives us the opportunity to learn from and be inspired by them.

How has open communication helped you and your patients?

KG: I am now retired – and during my career, my options for patient interaction were unfortunately very limited. However, I did review slides (and even gross specimens) with patients on several occasions, and I always found the interactions meaningful and considered them time well spent.

In addition, as a clinical pathologist, I occasionally had conversations with patients in the phlebotomy area, or as part of the transfusion service, especially early in my career. Later on, when I became involved with Lean process improvement, my medical center occasionally had patient team members who invariably provided a unique and useful perspective.

MB: I practice at Moffitt Cancer Center, which has an exceptional reputation in the US. At Moffitt, we put our patient first and work as a multidisciplinary team where pathologists are well respected. The sarcoma surgeons, medical oncologists and radiation oncologists feel comfortable sending people to me with pathology questions, knowing that I’ll have the patient’s best interests in mind and will be supportive of the group. I sometimes get phone calls from the clinic asking, “Could you please explain to our patient what this diagnosis means,” or emails that say, “Can our patient email you about his pathology?” Because of the convenience of the Internet, patients also reach out to me directly. It’s not uncommon for me to be the one helping patients get scheduled and seen by our sarcoma group at Moffitt.

What do you think the book will do for pathology advocacy?

KG: We can only hope this book adds a few grains of sand to the mountain of advocacy efforts occurring worldwide. We hope to inspire pathologists to become even better leaders, team members, and patient advocates.

MB: In the circle of life, our individual roles as physicians and providers are transient. But as human beings, we are connected to each other and to the environment. We hope that “The Healing Art of Pathology” will show readers the beauty and the magnificent healing power of our discipline – so that together, we can make a better life for all of us.

Marilyn Bui is a Senior Member of the Department of Anatomic Pathology & Sarcoma, Section Head of Bone and Soft Tissue Pathology, and Scientific Director of the Analytic Microscopy Core at Moffitt Cancer Center. She is also a Professor and Director of the Cytopathology Fellowship Program at the University of South Florida Morsani College of Medicine Tampa, USA.

Katherine Galagan is an Anatomic and Clinical Pathologist, with subspecialty boards in Cytopathology. Prior to retirement, she was Chief of Pathology and Director of Clinical Laboratories at Virginia Mason Medical Center in Seattle, USA, and has volunteered in various roles for the College of American Pathologists.

“The Healing Art of Pathology” can be ordered at www.cap.org or by calling the College of American Pathologists at +1 800-323-4040 (option 1, request PUB315). Purchasing this book will support pathologists and royalties from the book will be donated to the CAP Foundation, to support their patient advocacy efforts, such as See, Test and Treat.