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Pondering Pathology WEB ONLY

By William Fleet, M.D., MD 58
January 2010

If gross anatomy class in our freshman year was boot camp, pathology in the second year was air-born/ranger training. Dr. John Shapiro, the chairman of the department, prided himself in knowing every student by name on the first day of classes. He had survived a severe leg wound in World War II, walked with a stiff knee and demanded military-like discipline from his students. We were required to wear a clean shirt, a tie, polished shoes, a clean white lab coat and our well-cut and short hair. If a student failed his dress code, the poor fellow was summarily dismissed from class. (None of the three women in our freshman class had survived the first semester.) One day he met one of my less fastidiously dressed classmates in the hall and, as he passed, remarked, “The pool hall must have closed early today.”

We were expected to stand when he approached our desk in lab and to stand when answering questions during lectures. He was caustic, arrogant and imperious. Although he was the major terror of the second year, to the upper classmen, he was the faculty member to be called if they were in trouble with girls, family or the police.

There were only two scheduled exams for the entire semester-and-a-half course: the mid-term and the final. All other exams were unannounced and unexpected. After a few weeks I adjusted to the routine. I even liked it; I kept up to date, took the tests as they came and did not have to sweat out all-night study sessions preparing for a scheduled test.

Dr. Shapiro’s lectures were peppered with questions. Since pathology involves both gross and microscopic examinations, most lectures were given in a darkened room while slides were projected. There was no doubt that he could see through the back of his head and in the dark because every few minutes he would spin around on his stiff leg, point to one of us, call us by name and fire a question. Any incorrect answer evoked a caustic, demeaning retort. An incorrect guess invited a third degree oral blistering. Almost no one finished the course without being “Shapped”. Once, in order not to give an incorrect answer, a classmate answered every question with, “I don’t know, Sir”. After several such answers, Dr. Shapiro spat out, “My God, don’t you even suspect something?”

One of my classmates was so terrorized by Dr. Shapiro that he could not walk past the entrance to the wing housing the Department of Pathology. When approaching the third-floor wing, he would descend to the second floor, walk past the frightening area and then climb back to the third floor again. His dormitory suite-mates swore the following story is true: The day before our Christmas holiday, Dr. Shapiro called him to his office. He growled, “You need a break. Do not take a book home! You will not fail pathology. I will see to that!!” According to my sources, Jack set his alarm clock, arose at 2 a.m., slipped his pathology text into his suitcase under all his clothes, hid the suitcase in his closet and went back to bed. He arose again at 5:00, slipped out of the dorm, and took a cab to the train station where he hid until his train left in midmorning.

One of my friends was a bit more casual toward school than most of us. During a lecture one day, Dr. Shapiro turned on the lights, stared at Tom and, in a stern voice asked, “How do you spell ‘syphilis’?” Tom quavered, “S-e-p-a-l-i-s?” Dr. Shapiro fixed him with a withering glare and roared, “That’s how you spelled it on your test yesterday. Just spell it correctly anywhere on your next test paper I will give you an extra five points. God knows you need them.”

My approach to Dr. Shapiro was: never ask questions and change seats often. It didn’t work.

If the never-ending volume of facts to memorize, the constant stress in class, the military-like requirements of dress and behavior and the ever-present atmosphere of fear were difficult to endure, they paled compared to “Organ Recitals”. An Organ Recital bore no relation to music. “Organ” referred to hearts, livers, spleens, etc.

Our class was divided into groups of four to attend autopsies in rotation. There, we observed the resident’s examination and performed minor tasks. However, the next day was a different story. The class assembled in the autopsy room and stood on movable stands close to the autopsy table. The unlucky four stood beside the autopsy table while the resident presented the patient’s internal organs to Dr. Shapiro. After several cogent comments on the pathologic findings, he began to question one of the four students standing across the table. His questioning was brutal and, with almost savage glee, he exploited any weakness in a student’s knowledge. Occasionally, with fierce expletives, he expelled a particularly unprepared student from the room.

Eventually, my turn arrived. Our patient had died of complications of diabetes. Knowing that I would be in Shapiro’s sights the next day, I spent the entire rest of the night reading everything I could find about diabetes. If the library had been open a 5 a.m., I would have read a monograph on the disease. The next morning, I stood nervously in the pit across the autopsy table from Dr. Shapiro. He asked question after question, and I answered every one. Finally, he limped around the table, leaned down until we were nose-to-nose and rumbled, “Mr. Fleet, what have you been reading?” I assumed I had violated some rule but, knowing he could read minds, see in the dark and leap tall buildings in a single bound, I was afraid to lie. I quavered, “Only my pathology book, my physiology book, and a textbook on internal medicine.” He paused, cocked his head to one side and said, sternly, “Sit down.” He directed few questions toward me for the rest of the course, a circumstance I could live with very easily.

The pathology final exam was traditionally an oral ordeal and, in a medical school-ending, life-ending stroke of horrible luck, I was assigned to Dr. Shapiro as my examiner. Before the exam I virtually memorized my 1,200 page textbook, all of my three-inch stack of lecture notes and looked at almost every microscopic slide in the entire medical school. Promptly at the appointed hour I timidly opened his office door. “Knock before opening a door! You never know what’s happening on the other side!” erupted from behind his desk. I went out, knocked and re-entered. It was not a good start.

The questions began. His first question was, “Describe the bacterial flora of the duodenum.” (The duodenum is the short segment of small intestine just distal to the stomach. It receives the contents of the stomach, bile from the liver and digestive enzymes from the pancreas.) I was certain that nowhere had this fact been mentioned in my medical school career. I replied, “I don’t know, Sir.” He roared, “I will not accept that as an answer. Try again.” I sweated, squirmed and thought. I mulled over the fact that the chemical composition of that area is inhospitable to bacteria. Coupled with the rapid transit of fluids in that segment, it just might result in a sterile fluid. I took a gamble and said, “sterile”. I had guessed right! I had a temporary reprieve.

The next question was similarly couched. During the entire exam, none of his questions related to any lecture or text I had ever heard or read. Instead, every question required me to integrate my knowledge of pathology, microbiology, anatomy and physiology that I had acquired during my first two years of medical school. After the shock of the first question had abated, after I realized that all subsequent questions would be of a similar nature and knowing “I don’t know” was outlawed, I relaxed a trifle, thought through each question before I answered, and survived the remainder of the hour with a manageable level of anxiety and fear.

For a second time I had passed through the fire. My swagger was disgustingly obvious as I walked to my classes in physical diagnosis and other clinically orientated subjects in the second semester. Now, I was learning to be a clinician!

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