The Language of Cells: Life As Seen Under the Microscope - Hardcover

Nadler, Spencer

 
9780375504167: The Language of Cells: Life As Seen Under the Microscope
Hardcover
ISBN 10: 0375504168 ISBN 13: 9780375504167
Verlag: Random House Inc, 2001

Inhaltsangabe

A surgical pathologist journeys into the microscopic world of cells as he explores their sometimes deadly influence on the lives of people affected by them, describing the implications of sickle cells on a young patient and his mother, the effects of breast cancer cells for Hanna, and the cells in the brain of a patient with Alzheimer's. 25,000 first printing.

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Über die Autorin bzw. den Autor

Spencer Nadler, M.D., has practiced surgical pathology for more than twenty-five years in Southern California. His essays have appeared in <i>Harper's, The Massachusetts Review, Cross Currents, The Missouri Review, The American Scholar</i>, and <i>Reader's Digest</i>. <b>The Language of Cells</b> is his first book.

Aus dem Klappentext

autiful book, Spencer Nadler takes us into the remarkable world of cells–and into the lives of people whose behavior is affected by the cells seen under his microscope. After twenty-five years as a surgical pathologist, Nadler began to miss interacting with the people whose cells he studied. And so, he came out from behind his microscope and as a writer began to focus on people as well as on their cells, examining in this unusual book how a person’s life and spirit–and cells–coexist.<br><br>In the diminutive landscape of the microscope, a young patient’s sickle cells look like harmless apples and bananas, but the impact they have on him and his mother is acute. Under Nadler’microscope, normal breast cells look like pink hydrangeas to the remarkably spirited Hanna and her breast cancer cells like<i> </i>distorted hula-hoops. Among the other people we meet are an orchestra conductor who must choose between the rhythms of his music and those of his heart;

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CHAPTER ONE

Working Through Images

My work, as an interpreter of human-tissue biopsies, is largely an art. I carefully observe changes of color, delicately feel for variations in texture, and, with my microscope, peer in on the cells to study their form and tableau. The impact of disease can be very subtle.

The need for my diagnoses to be free of error can provoke unwanted stress. Often the image of a challenging biopsy stays with me for hours, even days. These cells, floating freely in my mind like anxiety, play their tricks, show me their elusive faces, their phantom patterns. They seem to conspire to confuse me. Through the years I've developed tricks of my own-serial sections, step cuts, a host of special tissue stains-designed to counter their deception. When nuclei are marred by craggy clumps of chromatin, and cell patterns appear baroque or abstract, I cull from memory similar compositions and interpretations. After many years at my microscope, the number of different cells and patterns that I recognize, the blueprints of disease, seems infinite. I rely on this experience. And although the majority of biopsies are no longer diagnostic challenges for me, interpretation can, on occasion, be tortuous-but never so formidable as living with the disease itself.

My surgical pathology office is within the hospital histology lab, appended to the surgery suites. A sliding glass window separates me from ten operating rooms. It is twenty-five steps from my desk to that window. A biopsy, if it is to be interpreted during surgery, is processed within minutes of its arrival. I am mindful that the patient is under anesthetic and that time is of the essence.

When I arrive each morning, I scan the operating-room schedule for surgeries with biopsies that will

require rapid, frozen-section interpretation. Then I have my coffee in the surgery lounge and listen to the surgeons' stories. A surgeon's demeanor-anxious, diffident, vague-might stir me to anticipate problems, to consult the patient's X rays and chart prior to receiving the biopsy. I am most comfortable with surgeons whose judgment I feel is beyond reproach; they tend to be meticulous, obsessive.

An accomplished surgeon I have practiced with for years tells me about a thirty-five-year-old patient I'll call Hanna Baylan. She has a palpable mass in her left breast; on the mammogram it looked suspicious for malignancy, and the core needle biopsies of it I interpreted a week ago showed infiltrating carcinoma that originated in her breast ducts. This morning she is having a lumpectomy to remove the cancer-containing portion of her left breast as well as a lymph node resection in her left axilla. These nodes are markers for tumor spread beyond the breast. She is worried, the surgeon tells me, that she will not live to see her three small boys grow up.

preoccupied with cancer cells, I have no social or psychological sense of a cancer patient. I retrieve Hanna Baylan's core biopsy slides from the file and review them in my office. I fix on elements of function, not form: milk-producing lobules, milk-transporting ducts, nipples, fat, connective tissue. I fix on cancer. After her surgery, my responsibility will be to classify the cancer, grade its aggressiveness, and determine the extent of its local spread. I will glean the facts that are pertinent to any use of radiation or chemotherapy to help her physicians mount their therapeutic blows.

"Biopsy, room two," the operating-room nurse shouts.

I walk through the histology lab, which smells of formaldehyde. The counters are crowded with vats of tissue-processing chemicals-alcohol, formalin, xylene, paraffin-and glass vessels of vivid red and blue tissue stains. A cryostat-the frozen-section machine standing in the corner-hums like a fluorescent lamp.

Hanna Baylan's lumpectomy tissue, swathed in gauze and labeled, sits on the counter beneath the sliding glass window. With gloved hands I unveil a round fatty mass, its yellow surface smeared with fresh blood. It has the look and consistency of a ripe nectarine. I bisect it with a knife and see a mass the size of a pit at the center, white and gritty as sandstone. Its retracted, deep-rooted look and rock-hard feel imply carcinoma.

The axillary lymph nodes arrive buried in fat. There are twenty-two in all-soft, oval, encapsulated like beans. Two of the beans are hard and white, gritty when cut. The cancer has exceeded its breast of origin. I pass on this information to the surgeon.

At 6:30 the following morning I remove the plastic cover from my microscope and continue my examination. I stare at the sprawl of Hanna Baylan's tumor. The foreboding bulkiness of the cancer cells, the scowl of their thickset nuclear faces looms through the lenses. They are gathered into inane configurations that crudely mimic breast ducts. Although this cancer splays out garishly into adjacent breast tissue, the biopsy margins are free of malignant cells: the local cancer has likely been entirely removed. Eleven of twenty-two axillary lymph nodes bear cancer cells, however, and the probability of spread to other organs is high. I classify this tumor as an infiltrating, moderately differentiated carcinoma arising from breast ducts.

I have completed my evaluation of Hanna Baylan. I await two more breast biopsies, a lung biopsy, and three skin biopsies. All are suspected of being malignant. By tomorrow Hanna Baylan will become a memory for me, a name on yesterday's surgery schedule with tumor cells attached.

By confining myself to cells, I stay clear of the fiery trials of illness. I remain detached; I can render my diagnoses with a cool eye. My fascination with the microscopic form, color, and disposition of cells drives me like a critic to interpret, to applaud or decry them for others. Paradoxically, observing so much of life through a microscope all these years has left me feeling, lately, that I've sampled too little, that I've missed the very warp and woof of it.

"Dr. Nadler?"

A young woman is standing at my office door.

"Sorry if I'm disturbing you, but no one was at the reception desk so I walked right in," she says. "I wonder if I can see the slides from my breast tumor?"

"Now?" It's six o'clock, the end of a long day.

She enters and sits in the chair by my desk. "You don't remember me, do you, Doctor?" she says. "I was at the lecture you gave at the Wellness Community last month."

Her cropped blond hair has a uniform thinness that suggests chemotherapy; her face is gaunt and pale. Still, she seems valiant somehow, undaunted, her self-esteem intact. During the lecture I had used a projecting microscope to show on-screen what the cells and patterns of different tumors look like.

"I'm Hanna Baylan. You diagnosed my cancer forty-three days ago."

I don't recall seeing her at the lecture, but I do remember, in vivid detail, the nectarine lineaments of her lumpectomy tissue. I'm like the surgeon who selectively focuses on the organs he's rectified or removed. My work lies apart from Hanna's face, among the tiniest kernels of bodily things; my work lies in her cells.

"It's pretty late," I tell her.

"Yes, it is," she says. "Maybe it's already spread to my bones."

This is not what I meant. "Why don't I see what I can do." I wish she had called ahead, given me a chance to review her slides.

I retrieve all her breast and lymph-node slides from the file and move her chair opposite mine. With effort, pain maybe, she leans across the desk to peer through the alternate set of eyepieces on my two-headed microscope. Resting her elbows on the desktop, she looks in on the events of her body-cells long dead, now fixed and colored-that have given...

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Verlag
Random House Inc
Erscheinungsdatum
2001
Sprache
Englisch
ISBN 10 
0375504168
ISBN 13 
9780375504167
Einband
Gebundene Ausgabe
Auflage
1
Anzahl der Seiten
196
Kontakt zum Hersteller
Nicht verfügbar
Verantwortliche Person
Purmerul LTD
https://strengholt.nl/en/

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