THANKS to the popularity of such television crime shows as CSI:<\p>Crime Scene Investigation and its various spin-offs and <$>and Cold Case Files, forensic patholog> - the investigation into the cause of a death in potentially criminal circumstances - has become the fashionable speciality for medical students to pursue.“Every time we have volunteer students coming into the hospital, that’s all they want to do - C$>,” said Dr. Clyde Wilson, head consultant microbiologist at King Edward VII Memorial Hospital’s Department of Pathology.

“I’ll say ‘let me show you along here’ and they’re saying ‘no, no, no, where are the bodies?’ Take them over to anatomical pathology and they’re in heaven.”

But pathology is not only concerned with investigating gruesome murders and digging up that one piece of medical evidence that will put a killer behind bars.

True, it can involve a certain amount of detective work, but the killers that pathologists at KEMH are tracking down and arresting are medical conditions and potentially fatal diseases.

It’s largely behind-the-scenes work that perhaps goes unnoticed by the vast majority of patients whose only point of contact is their General Practitioner. But for any physician, the department provides an essential diagnostic service, enabling them to pinpoint the condition that is causing a patient’s symptoms.

Laboratory tests can be carried out on blood, body fluids and tissue, and, once analysed by skilled technicians and consultants, the correct course of treatment can be followed.

“Next week is National Pathology Week which is an ideal opportunity for people to get an understanding as to what exactly highly-qualified technologists and lab assistants and pathologists do here,” Dr. Wilson said.

“We are behind the scenes but we’re all part of an integral team of highly skilled healthcare professionals whose common goal is to aid clinicians in and out of the hospital in the diagnosis and treatment of their patients.

“It is different from nursing where you’re on a ward and right next to the patient and the doctor comes in and does their bit and they are constantly there with the patient. In that case the patient can see and understand what they’re doing. In the laboratory we’re behind closed doors and the clients come in and are bled and then that’s it. They see us walking in and out but they have no idea what we do. The role of the laboratory isn’t spelt out by the family practitioner.”

While common or garden ailments can invariably be diagnosed in a doctor’s surgery, more extensive tests are sometimes called for. And trained analysts can learn a great deal about a patient from just a single drop of blood.

“The standard thing to do is for a doctor to tell his patient ‘okay, lets get you up to the laboratory and get a sample of blood’,” Dr. Wilson said.

“Of course they can look at you, see if you look anaemic, take your blood pressure, check your cardiac rhythm and do various in-house sorts of things. But at the end of the day they will send you up here to get some blood work done. If your organs are not functioning properly there will be markers in the form of proteins or enzymes or hormones which may be high. All those standard blood tests will be useful to the physician to help him do his detective work, trying to find out what’s wrong with you.

The clinical biochemistry area has some fantastic machines and a little bit of blood can provide you with a battery of tests.”

The department’s team of 30 laboratory technologists and assistants, along with three consultant pathologists, specialise in different fields, including microbiology, haematology, histology and cytology.

Technologist Leon Wilson specialises in clinical biochemistry - testing blood and body fluid samples to detect chemical and molecular irregularities - clues which will help doctors make a correct diagnosis.

“We can measure all the chemicals and proteins in your body to help diagnose disease,” he said.

“In diseased states things change and the way they change - whether they go up or down - determines if your disease is getting worse or better, if the treatment is working. If somebody has a microbiology infection there’s things in their chemistry that will change, their haematology that will change. If somebody has leukaemia certain proteins are increased.

“We do thousands of different tests - if someone gives one tube of blood we can do up to 120 different tests on that sample. A patient will go to their doctor with certain symptoms and then the doctor will send us a sample because he’s trying to figure out what is causing those symptoms. It’s the laboratory that can help confirm what that cause is. We can say ‘there’s something wrong with your kidneys’ or whatever.”

Dr. Wilson pointed out that, although the process is now largely automated, it still takes a trained eye to analyse any data that the department’s high-tech equipment can rapidly churn out.

“In certain areas such as biochemistry there are some fantastic machines where you can put in a sample, hit a button, and get a wide range of tests,” he said.

“But in microbiology we still have to go sit down, analyse the data and make a lot of judgement calls and decide what’s important and not important. We’re dealing with a living entity - things are there. We have bacteria which are part of normal flora which are living and keeping bad bacteria away from you. We have to interpret those test results. It’s still very much hands-on and requires you to make decisions.

“Sometimes people will call you a ‘tec’ and believe that anybody could come in off the street and push a few buttons. That’s not the case at all because you still need to have the knowledge and the science and the theory behind what you’re doing so that you can interpret what you get off the machines. The machines are very good in terms of the volume they can get through but at the end of the day you still have to do all your training and understand all the principals so that, when those results come off, you can interpret them.”

The department is also responsible for studying results of routine, preventative tests such as annual pap smears, used to detect cervical cancer. It is their analysis of any cell abnormalities that can kick-start early treatment - and a better chance of survival.

Recent technological developments have enabled tests to be carried out far more reliably, efficiently and in far more detail.

And heading the early warning signs can result in a less rigorous course of treatment for the patient.

“With something like diabetes, we can pick up small changes early on now,” Mr Waye said.

“We’re noticing changes in glucose way earlier then we did before. In the old days, if you had diabetes then you had to go in dialysis whereas today, because of the early detection, it can be a case of getting the patient to just change their diet. We’re being a lot more specific and we can do a lot more patients.”

Dr. Wilson believes that, thanks to such innovations as the Internet, the general public are becoming much more informed about their health and might even demand to be tested for a certain abnormality. But economics dictate that the laboratory has to be a lot more selective when carrying out blood work.

“You are people who have read that, if you measure for selenium or zinc or whatever, and if levels are high that is indicative of a something, then that person might go and demand that test. They will want the full works, the Full Monty, and there are laboratories that can provide that testing and if they can pay for it then off they go. It depends on where you are, what the physician wants to do and, increasingly now, what the patient wants. I think sometimes patient involvement can help in a positive way because it’s their body and the more information they can give you as a physician, the better it may well be for you to help solve the problem.”

For Dr. Wilson, the most satisfying characteristic of the department is the fact that it is an essential cog in the island’s medical infrastructure.

Invariably, physicians - be they General Practitioners dealing with everyday maladies, or Emergency Room doctors handling a trauma patient - cannot begin to treat their charges until they know exactly what is wrong with them. Although timely intervention is essential in the effective treatment of disease, medics often have to play a waiting game, unsure of what drugs to administer until the exact nature of an illness has been confirmed and the laboratory can give the green light for treatment to kick in.

“The whole system can become gridlocked,” Dr. Wilson said.

“Do you need to treat this patient? Do you need to isolate this patient? You end up waiting while the doctor tries to work these things out.

“But by using newer technology we are going to be able to get around that, by getting those results out more quickly and freeing up the system. We’re an accredited laboratory and technologically we are on a par with many laboratories all over the world. It is by keeping up with those developments in pathology that will help other departments and make life easier for all parties concerned, including the patients.”