The Art of Detection
My Journey to Pathology
by Dr. Nickul Shah Class of 2016
Resident, Department of Pathology
University of Massachusetts/Baystate Medical Center
(Beginning July 2017)
The authors of most published medical research are already well-established MDs. Dr. Nickul Shah published his first book, Hepatitis C Infection and Adverse Hepatic Complications to Anesthesia (Scholars’ Press), shortly after he graduated from medical school. The book focuses on a case he observed during a surgical rotation he completed as an AUA student. In it, Dr. Shah details how he and an anesthesiologist tried to determine whether a drug used during a routine hernia surgery caused or contributed to the death of a cirrhotic patient. Of the eight journal articles he has published so far, two appeared in print before he graduated.
A common thread among all medical specialties is the need to look for correlative factors and trace the symptoms of an illness to the source. This is the essence of pathology. I always knew I wanted to be a doctor, but for a long time, I didn’t know what area of medicine I wanted to pursue. My grandfather, who inspired me to serve my community more than anyone, was a pathologist in India, so I was aware of the field at a young age. I grew up hearing his stories about the puzzling cases he was presented with and how he was able, most of the time, to solve them.
Hints about the specific path my medical career might take were present by the time I began studying at the University of Massachusetts Amherst, but the future was wide open as far as I was concerned. I first gained clinical laboratory experience working as an assistant in the same hospital I’d one day return to as a resident. During my six-year employment with Baystate Medical Center’s Department of Transfusion Medical Services, I got hands-on exposure to various conditions. ABO incompatibility, transfusion-related-lung-injury (TRALI), neonatal jaundice, and disseminated intravascular coagulation (DIC) were just a few.
As a microbiology major, I was able to study fatty acid compositions using elemental analyzers to assess geological climate change. I was also able to study parasitology in a declining bee population using the immunodetection method called polymerase chain reaction-enzyme linked immunosorbent assay (PCR-ELISA), as well as Western Blotting technologies. I felt fortunate to be studying at a place where it was possible to learn how to utilize these techniques.
When I finally entered medical school, I had more than an inkling that I wanted to specialize in pathology. What I knew without question was that my career and even my education had to put me in front of the rarest diseases and conditions. My fascination with the unknown and the power of science to unmask it, along with the desire to help people, drove me.
Between classes and studying for exams in Antigua, I had little time to spare but found myself scouring whatever medical journals I could find for articles about medical anomalies. My rotations were really the first chance I had to work with unusual cases. I made an effort to learn not just about individual patients and their chief complaints, but also about the pathophysiology of their ailments. I took every opportunity to follow up with pathologists at these sites so I could learn more about patients and their cases, especially after a resection, biopsy, or culture.
I was relieved to find that these pathologists were willing and often eager to help me discover that little something extra about a given patient’s history and condition. As I worked hard to complete all of my rotations, I constantly reminded myself to stay alert and recognize any unusual cases in need of closer attention. The more I did this, the more I realized that many of these cases deserved to be explored by others. Apart from the sciences, I had always enjoyed writing in high school and college. It later occurred to me that publishing articles about the rare medical conditions I was observing would be an ideal way to raise awareness and maybe even improve treatment.
My work began to appear in journals. One was about a young woman with colorectal carcinoma. Another was about a man with squamous cell carcinoma, and another, about a patient with neuropathy in the ulnar artery. I co-authored an article on a Central Nervous System infection that was found in a patient who had a compromised immune system. Before long, I was approached to expand an article of mine into a book, something I had never anticipated.
The closer I got to applying for residencies, the clearer it became that I did indeed want to become a pathologist like my grandfather. My interest deepened as I completed rotations in a variety of specialties, even ones that might have seemed unrelated. When I started writing about the cases I examined, that interest became a passion. I would recommend that any clinical student think beyond the immediate scope of the cases they are presented with during their clerkships. They should take full advantage of the wealth of knowledge possessed by supervising doctors and physicians in other departments at their clinical sites. Taking that extra bit of initiative will help them get closer to finding out where their place within medicine is, just as it did for me.