someone has to do itWork can’t always be fun, but why do people choose the profession of ‘pit-cleaner’, bailiff or caretaker for the dead? In this series, Dutch people with such a job talk about their work, why they chose it and what makes it so interesting. Today: clinical pathologist Emma Witteveen (36) examines pieces of human tissue, such as pieces of intestine.
When clinical pathologist Emma Witteveen (36) explains what she does every day on a birthday or in the pub, people often look at it strangely. “People think I’m cutting corpses all day long. If the next of kin request an autopsy, I do indeed come into the picture to do an internal examination of the deceased. But in the end that is only five percent of my work.”
In her work it is never about someone who has been murdered, says Witteveen. “Forensic pathologists are involved in murders, we are clinical pathologists. But even a forensic pathologist will not solve a murder. The pathology is very romanticized, perhaps because of all the popular crime series. But that image is not correct.”
In series, pathologists are sometimes covered in blood. Witteveen has to deal with that again. “Of course, blood is involved in an autopsy. Even with a piece of tissue, in a piece of lung, for example, there is still blood. The pieces come to us directly from the operating room. I also get poo. Actually all bodily fluids pass by. That’s part of it and I just wear protective clothing.”
Behind the computer
The tissue used by the pathologists at Symbiant, the company that runs several pathology departments in hospitals in North Holland, is first poured into a kind of candle wax. This is cut into very thin slices which are then placed on microscope slides.
Most of the time, Witteveen sits at the computer, where she digitally examines the tissue and makes a diagnosis. ,,All slides are scanned, so that I can study a nice cross section of the tissue on my computer. For example, I can see how deep a tumor has grown in the intestinal wall. I can also often determine the stage of the cancer. I usually see immediately what is going on, for example, you can detect skin cancer in this way.”
Witteveen has been working as a clinical pathologist for 3.5 years now. Although she now only deals with bits and pieces of people, she did start her career among the patients, as a physician assistant. Before she chose pathology, she didn’t really know the profession well. ,,I only got to know the profession well during my internships in the hospital. During the multidisciplinary consultations, doctors from different disciplines come together, often a pathologist is also present. In the workplace, this medical specialist is fairly invisible, but at the same time very indispensable. A pathologist makes the diagnosis in most cases. I immediately found that very interesting, so I started specializing in pathology.”
Sitting in front of the computer a lot may sound less exciting than being a doctor who spends all day working with patients. Yet the work is anything but boring, says Witteveen. “Being a pathologist also presents the necessary challenge. You have to know something about all diseases, otherwise you cannot make a proper diagnosis. A disease can also occur in a part of the body where you do not expect it. Melanoma, ie skin cancer, can also occur in the gut. So you always have to keep an eye out.”
Intense and confrontational
It is also sometimes a ‘normal’ inflammation or a fat swelling, but cancer is a recurring topic in the work of a clinical pathologist. “Half of my work consists of studying pieces of skin that are suspected of having skin cancer.”
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No one is attached to it anymore, so you don’t build a bond with the patient. In that respect, oncologists have it much harder
Isn’t it hard to be confronted with cancer for a large part of the day? Misery is simply part of working in healthcare, says Witteveen. “If you can’t let it slide off you, then this job isn’t for you. It is of course not the case that nothing touches me anymore. Sometimes I diagnose cancer in an advanced stage in someone who is 30 years old. I find that quite intense and confrontational because it is someone my own age. I have the same with an autopsy of someone about my age. But you have to be able to let it go.”
What does make a difference, according to Witteveen, is that a pathologist only looks at pieces of tissue and does not see patients. “No one is attached to it anymore, so you don’t build a bond with the patient. In that respect, oncologists have it much harder.”
After more than three years, Witteveen can still say that she is completely at home in the pathology department. She absolutely does not think about stopping. “I really like the job. There are also plenty of opportunities for specialization. For example, I could focus on breast pathology, either diagnosing breast cancer or, for example, brain tumors and other brain abnormalities.”
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