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

Nadler, Spencer

Hardcover

ISBN 10: 0375504168 ISBN 13: 9780375504167

Publisher: Random House, 2001

Synopsis

With this beautiful 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.

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 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; an obese woman who must learn to get along with her fat cells as she copes with bariatric surgery; two people with early Alzheimer’s disease who fall in love and decide to live together despite the microscopic changes in their brains. In The Language of Cells, Spencer Nadler illuminates in lyrical prose “the quiet heroics of everyday people” as cells and the spirit contribute to the beauty of the human continuum.

About this title

About the Author

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

From the Inside Flap

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;

Reviews

As a surgical pathologist, Nadler has little patient contact, but in this collection of essays he focuses on the rare interaction between his specialty and the patients whose diseases he has diagnosed under the microscope. Nadler maintains that disease is more than a set of facts, while illness is more than a diminished way of life. In these stories, he focuses on patients learning to manage adversity: a woman coping with breast cancer, an obese patient undergoing bariatric surgery, a well-known conductor living with cardiac arrhythmia, a young boy and his family struggling with sickle-cell disease. In other passages, a veteran tells of his paraplegia and the shortcomings of the V.A. hospitals, another patient faces Alzheimer's Disease, and the terminally ill adjust to hospice care. Like F. Gonzales-Crussi (There Is a World Elsewhere, LJ 9/15/98), Nadler writes as a man first and a physician second. One concludes these essays glad to know that there are physicians such as Nadler and Neil Skolnik (On the Ledge, LJ 3/1/96) who truly seem to care. James Swanton, Harlem Hosp. Lib., New York
Copyright 2001 Reed Business Information, Inc.

A surgical pathologist who spends most of his time looking at cellular and tissue materials, Nadler generally has little to do with patients as individuals. In the thoughtful pieces in this book, however, he considers his typical daily work and a few experiences with patients either in his lab or on "house calls." Those patients' problems include breast cancer, obesity, brain tumor, and, in highly personal accounts of conductor Mehli Mehta and his own cardiac complaints, heart disease; and Nadler shows profound understanding of them and their medical, surgical, and personal difficulties. His invitations to a breast cancer patient and to a child with sickle cell anemia and his mother to come to the lab to explore microscopically their tissues and blood spur him to excellently descriptive and sympathetic writing, and his account of his father's Parkinson's disease describes both a lively case history and a loving father-son relationship. William Beatty
Copyright © American Library Association. All rights reserved

Excerpt. © Reprinted by permission. All rights reserved.

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 rise to her illness.

She listens quietly as I move the pointer across the microscopic landscape. "These clustered islands of glands are the lobules," I tell her. "Milk is produced here in the lactating breast."

"They look more like pink hydrangeas to me," she says, "a sprawling garden of them." She talks excitedly, asserting interpretive authority over her own cells. I can only imagine the variety of forms a cellular array such as this might suggest to an uninitiated eye.

"And these?" she asks. "What are they?"

"Ducts," I say. "They transport lobular milk outward to the nipple."

"My God. Look at them," she says. "Ponds, lakes, rivers, estuaries that carry milk. It all looks so peaceful." With her legs braced in the chair, she hoists her torso onto my desk and hunches over the microscope to get a better view.

There is little need for pedagogy; she is finding her own truths with metaphor. I switch from the four-power objective, the scanner (a magnification of forty), to the forty-power objective (a magnification of four hundred), and individual cells take prominence over cell patterns.

She clasps her hands together. "It's as if all the planets in the universe have come together here."

"See the uniform cells lining the lobules and ducts?" I point out the blue nuclei, the pink cytoplasm, the discrete nuclear membranes.

I switch back to the scanner and we pass over fields of ducts and lobules. I suspect it is a whimsical leitmotif she sees, hydrangeas, ponds, rivers suspended idly in fat and fiber, floating serenely.

I wait a few minutes, allowing her to absorb the beauty of her own cells. Sitting perfectly still, crooked like a pliant ballerina, she inspects her cellular self.

Reluctantly, I replace the slide of her normal breast tissue with one of the cancer.

"Whoa," Hanna says.

She stares into the microscope, transfixed by the disarray of her malignant growth, a raw view of her life spread out before her. "These cells look like distorted hula hoops," she says. "It's all damage...

Edition details

• Publisher: Random House
• Publication date: 2001
• Language: English
• ISBN 10: 0375504168
• ISBN 13: 9780375504167
• Binding: Hardcover
• Edition number: 1
• Number of pages: 224