Dr Caroline Gannon, paediatric and perinatal pathologist
Tell us a bit about what your job involves.
I am one of two paediatric pathologists in the department and my colleague and I arrange our rota so that we spend one week doing laboratory work (surgical biopsies, paediatric tumours, frozen section diagnoses and placentas) and the next on autopsies. When my week involves autopsies, the first thing I do is check with the mortuary to find out what cases we have, or the hospital staff will contact us to make sure we plan our working day and can give the family a specific time when their baby will be returning to them.
We provide a service to the whole of Northern Ireland so cases are sent to us from considerable distances. We undertake around 270 autopsies a year, most of these are at the request of the parents. Autopsies are important because they help the parents understand why their baby has died. But we have around 20 cases a year from the coroner, usually babies who have died at home unexpectedly, or occasionally following medical or surgical treatment.
Afternoons are generally dedicated to looking at slides from post mortem histology. Histology is the microscopic examination of cells or tissues. For each case, we aren’t just looking for disease processes; we are also looking to confirm that the baby was developing normally. Once I’ve looked at the histology, I gather all the results of all the investigations together and formulate my final report.
When my work involves biopsies, I will generally liaise with the laboratory. We may have urgent biopsies or intra-operative frozen samples (samples prepared during the course on a surgery by freezing and slicing the tissue sample). A paediatric tumour biopsy is always sent fresh (without formalin fixation) so that we can send samples (with consent of the family) to genetics and biobank. This requires coordination with theatres and the laboratory staff.
I will also see what formalin fixed specimens have arrived for me and then perform a surgical cut-up – the process of examining a specimen, formulating a differential diagnosis, and then taking appropriate representative samples for microscopy. We also receive large numbers of placentas to examine from pregnancies that have been complicated either by fetal disease, maternal disease or pregnancy related issues, and so examination could give us some useful information.
Why did you choose this specialty?
I was lucky at the very beginning of my training in histopathology, in the department where I trained, we had a consultant with a special interest in paediatric and perinatal pathology, and he took the time to help me develop my skills in the specialty. At the time, it was customary in the department for trainees to undertake the perinatal autopsies as well as the adult cases, and I found that I preferred the paediatric cases particularly those in which there were abnormalities. It is like detective work, piecing all the information together to form a cohesive diagnosis.
What do you enjoy most about your chosen specialty?
We are quite a small specialty; there are only about 60 full time paediatric pathologists in the United Kingdom and so we all tend to know one another. If I have a difficult case, I know who to send it to for an expert opinion. Most of us in paediatric pathology have attended the international advanced courses run by the International Paediatric Pathology Association, and this puts us in touch with colleagues throughout Europe and the rest of the world.
We work with families at what is an extremely difficult time in their life, but any information we can obtain will be used for the benefit of that mother and family for the future, and we can ensure that future pregnancies are managed optimally. Personally, I regard it as a privilege that families are willing to trust me to do the best job I can for them, and it is very satisfying if I can give them some information to explain what has happened and why, and that will help guide the clinician in any future pregnancy.
What's been a highlight of your role?
The nicest thing that has ever happened in my career, I was phoned one day by a father – his wife had been admitted to hospital and their baby was stillborn. He wanted to discuss some aspects of the autopsy with me before they made their mind up. This isn’t that unusual - my colleague and I are frequently contacted by parents for various reasons, such as providing a parent-friendly version of the report. I went to the ward, met with them, obtained the consent for the autopsy and met with them again afterwards.
About 18 months later, the mother visited me at my office to show me her new baby. She said without knowing why her first baby was stillborn, she would never have had the courage to go through another pregnancy. Knowing that my job makes a difference is immensely rewarding, and I guess it’s the reason why a lot of us go into medicine in the first place.
Are there any particular challenges that you face?
In Northern Ireland, we have a cultural tradition of being buried very quickly after death, most people are buried within 3 days of death and parents expect that the examination of their baby will take place to facilitate this. For babies coming from a distant hospital (our furthest is 120 miles away) we will ask the funeral director to wait, perform the autopsy immediately and then send the baby back the same day to ensure that they aren’t away from their parents for too long and we don’t delay the funeral.
What advice would you give to students looking to enter your field?
After medical school and foundation years, you need a good, broad based pathology training to begin with. Knowledge of paediatrics or obstetrics is also very useful. Once you make it known that you are interested in paediatric pathology, your local paediatric pathologists will fall over themselves to help you, including advice about applying for entry to the specialty. We’re all keen to get more people interested in what is a superbly rewarding job.