Mary Ann Rutkowski remembers the day she chose her future career – at the mall.
As a high-schooler, she was at a career day event when someone handed her a flier about the field of cytology. Intrigued, she read about microscopes and cancer detection, picturing herself behind a 'scope someday.
A native of the Utica region, she graduated from Upstate Medical Center and went on to complete a clinical semester at URMC to become a certified cytotechnologist.
It was the summer of 1978, and she was 20 years old when she was offered a job in the URMC Department of Pathology and Lab Medicine. She hasn't looked back since and on May 6, Rutkowski will retire from that same position after 38 years.
Here, she shares some reflections on her long and successful career.
Do you remember your teachers from your clinical semester at URMC?
Dr. Stanley F. Patten, Jr. wrote the textbooks. He laid the groundwork for how you not only diagnose cancer but the pre-cancerous conditions, which are so important. I have had so many wonderful mentors throughout my tenure here. Many were really pioneers in the field. Drs. Bonfiglio, Wilbur, Stoler are just a few that come to mind. Florence Patten also had a major influence on my formative years as a cytotech.
I still find it kind of frustrating when we get a case of cervical cancer which should be 100 percent preventable. It’s usually in people who may not have insurance, or something prevents them from getting annual screenings.
How has microscope technology changed since you started?
We used to look at a lot of conventional slides where you smear the material onto the slide, and it was very difficult to see. It was thick, not well stained, and air dried, so there were a lot of technical problems. It was challenging in a fun kind of way to decipher what was going on in these conventional smears.
Probably in the early 1990s, liquid-based technology really revolutionized cervical cancer screening and took that element of poor quality out of the picture. It was definitely a much needed advancement. That’s where we are today placing a pap sample in a solution and removing error the doctor may make in making the slides.
What has been your favorite part of the job overall?
The part I enjoy most is when we go out on our aspiration biopsy procedures because we get to see the patients and we’re reminded that it’s not just a piece of glass that we have on a microscope. We may see their family, friends – their support personnel – with them. Even though we can never get to know them personally because then you lose your objectivity, I’ve always enjoyed going out and playing an “active” role in obtaining diagnostic material. The first step for our patients towards treatment is getting the answer; that is the role we play.
Do you think some people choose this profession because it’s not patient-facing?
Perhaps. That’s what attracted me to it – it has some patient contact but not an extreme amount. I admire people who take care of people who are quite sick. It’s a tough job. We are the people who are behind the scenes.
In addition to patients, what has it been like to work with partnering agencies?
We have had some wonderful clinicians who get referrals from all over this part of the state. I think we take it for granted because we’ve worked with them for so long, but these people come from Buffalo and the Southern Tier because they don’t have access to people with the expertise to do endoscopies or the various invasive procedures. For me it’s rewarding that we’re on the same team. They’re trying to stick a needle in a target and we’re trying to interpret that material accurately to the best of our ability.
How do you plan to spend retirement?
Life’s a gift and when you’re around people who have a lot of health problems you’re reminded that if you have your health, you should enjoy it and not complain. I hope to travel and I enjoy photography (an amateur shutterbug). My husband and I have a little cabin on 30 acres in the middle of nowhere on the top of a mountain in Naples that we’ve nicknamed “the bungalow.” I suspect I will be there more often.
Rochester has been our home for 30 years … When you’re here this long, this becomes your home and we have friends here. We live right in the Highland Park area and love city living, being close to things, and that park is so unique. That was my goal: to be retired before the Lilac Festival (laughs).
It’s rare these days to hear about someone sticking with the same job for 38 years. What has kept you around so long?
I never really wanted to leave, (and) even now it’s bittersweet. I feel like I have friends here, not just coworkers. We’ve always worked as a team and that’s what has allowed us to survive, helping each other out. That’s what I think has kept me here as long as I have. It can be stressful some days but we help each other out. The days go by fast and the weeks go by even faster. And the years! I blinked and here I am 38 years later. I truly have had the time of my life here at the U of R.
Do you have any advice for young people starting their careers?
Make sure you set your goals and do something you enjoy doing. You may not stay as long in one place, but no matter what, make sure you enjoy it and appreciate what you have instead of looking at the glass as half-empty.
It’s 9:05 on a Wednesday morning and a group of apron-clad pathologists' assistants (PAs) are gathering for morning rounds.
This is a daily meeting during which the pathologists, PAs, and residents meet on the floor of the gross room at the University of Rochester Medical Center.
Raman Baldzizhar, a resident doing his Surgical Pathology rotation, reads the schedule aloud for the group. He states the age and gender of each patient along with their procedure and the name of the doctor doing the surgery.
Today’s agenda includes a prostate, a pancreas, a kidney, a spleen, esophagus, and two stomachs.
After hearing the schedule, the team decides how they’ll divide up the day's work. Moments later, a colleague walks through the door carrying a frozen section specimen. It's a dark brown piece of tissue that was removed just moments ago from a patient's thyroid.
The team has to move quickly: A frozen section specimen is sent for immediate analysis while a patient is in the operating room (OR) under anesthesia. A diagnosis must be made within 20 minutes, which will help the surgeon make a decision during the procedure.
For this procedure, the tissue is literally frozen in a chamber called a cryosat. Once frozen, it is cut into extremely thin slices. A section of the tissue is placed on a glass microscope slide and stained with dye. The pathologist will examine the tissue under a microscope, render a diagnosis and report the results to the surgeon in the OR.
Each day, the PA team works against the clock; tissue specimens start to deteriorate soon after it is removed from the body and deprived of oxygen. For instance, breast tissue has a one-hour window before it must be submerged in formalin fixative to help preserve it.
The hospital’s Accessioning Unit is responsible for transporting specimens between the OR and the gross room. Technicians use an air-powered tube transport system similar to outdoor teller stations used at banks. Or, if the specimen is too large, it will be hand delivered to Surgical Pathology.
On this particular day, Dennis Dening, a PA, is examining a portion of tissue removed from a heart. I ask, What made you want to become a PA in the first place?
“I knew I wanted to do something medical, and I always enjoyed dissection,” he said, keeping his eyes fixed on the specimen.
Specimens come in all shapes and sizes. On average, the Surgical Pathology unit at URMC receives an average of nearly 500 specimens a day. They may be malignant or benign and can vary from small biopsies, such as an atypical mole removed by a dermatologist, or polyp removed during a colonoscopy. Other times, a specimen will be an entire breast or lung removed.
The PAs are responsible for dissecting and describing the specimens, in a process known as "grossing." A detailed gross examination includes information about the appearance of the specimen such as size, shape, color and consistency.
In cancer cases, the PA must identify the tumor and describe the relations of the tumor to the surrounding normal tissue. Once the gross description is completed the PA will determine what sections of the specimen will be examined microscopically by the pathologists.
Laurie Baxter was hired as URMC's first PA 21 years ago and now serves as the supervisor for a team of eight full-time PAs. During her time, has seen a lot of changes in the gross room as more people have shown interest in the profession.
"Once people come here to shadow and realize this is what they want to do," she said.
Since Baxter started her career, she's seen a greater number of students choose to go into the field. She has had four employees that started as biopsy technicians and returned to school to become PA's - and expects more will follow suit in the future.
Currently there are 10 PA training programs in North America with all but one culminating in a 2-year master's degree.
“This is a pretty satisfying job,” said Baxter. “Although we never come face to face with patients, PAs play a critical role in patient care. What we describe and submit for diagnosis directly impacts future treatment options for the patient."
In addition to grossing, PAs train residents and sometimes assist in autopsy procedures. The workflow in the gross room is steady, so the team must work together productively.
Biopsy specimens have the quickest turnaround time (one to two days) but larger specimens can be more work intensive and take several days to complete.
“Every specimen represents a patient," Baxter said. “We can't ever forget that."
And don’t be fooled by the term “gross.” The human body is amazing, after all, she tells me with a laugh.
"Who says it's gross?"
In photos (from top):
Dennis Dening, a PA, dissects a ventricular core (a heart tissue specimen).
Trista Skedel, a PA, checks dictation reports in the gross room at URMC.
A frozen tissue sample that will be cut, stained, and examined under a microscope by a pathologist.
Hilary Haefner, a PA, grosses a breast specimen.
Elizabeth Sharratt dissects a uterus at the grossing station in Surgical Pathology at URMC.
Behind many patient diagnoses is a process that starts in the operating room and ends under a microscope.
UR Medicine Labs has a team of histotechnicians (HT) and histotechnologists (HLT), often referred to as "histotechs," who work around the clock to complete the steps leading up to patient diagnoses for cancer and other diseases.
Histotechs are responsible for taking human tissue to prep, cut, and stain before it's examined by a pathologist. We recognize this important work in honor of Histotechnology Professionals' Day on Thursday, March 10.
"I think most people have never heard of histology," said histotech Wally Pryjmak, who has worked at UR Medicine Labs for two years. He didn't even know what a histologist was when he became a certified medical lab technician. Nevertheless, Pryjmak wants patients to understand the link between his work and their treatment. As he says, "We create the slides your diagnosis is based on, so without us it would be a lot harder to get diagnosed."
The tissue prep process starts after a patient has surgery to remove tissue from the body, often in a biopsy. This tissue is brought to the Surgical Pathology area (located on the ground floor of SMH) and is most often examined first by a pathologist's assistant (PA) who dissects the tissue at a grossing station.
The tissue sample then goes into the hands of a histologist who processes it through a series of alcohols to remove any water, clears tissue in xylene and infiltrates it in paraffin wax. The tissue is then embedded into a paraffin block and the histologist cuts it into paper-thin slices.
Wax slices of tissue then go into a warm water bath to stretch them out and prevent wrinkles before carefully placing the tissue onto a glass microscope slide. The histologist gently scoops the section of tissue onto the slide to dry. He or she then treats the slide with a basic stain (hematoxylin and eosin) to make the sample is easy to see under the lens.
There are up to 75 different stains that reveal certain tissue elements, fungus, or bacteria. A pathologist can request any combination of stains be added before viewing the slide close-up.
In this way, the histologist is part artist and part chef: they must follow a "recipe" of stains to yield a proper reading. Even a small misstep can compromise the diagnosis. Once the slide is treated with the proper stains, it goes to a pathologist who examines it and issues the diagnosis.
The work of a histologist requires careful attention to detail and physical stamina. On average, the histology team at Strong prepares between 800 and 1,200 slides each day.
Diana Scott is the supervisor for histopathology at Strong. To her, the work of a histologist is like an art form. And while patients don't see or speak with the lab team helping behind the scenes, the connection is still very meaningful.
"We care about the production side of things and the quality of the slides," said Scott. "We treat every specimen like it belongs to one of our family members waiting for their test results to come back."
(Top) Histologist Lisa Torregrossa embeds a tissue sample into paraffin wax. Once the wax hardens, the block can be sliced for examination. (Top right) Elizabeth Pilon uses a microtome instrument to slice a piece of human breast tissue that has been embedded in wax.
(Above right) There are more than 75 special stains used to dye tissues so they can be viewed clearly under a microscope. The stains highlight specific tissue components (nuclei, muscle, etc.) or microorganisms (bacteria, fungus) and a combination of stains is often necessary.
(Right) Tissue blocks, or cassettes, are preserved and filed for at least 20 years after a diagnosis is given.