Guest Articles

Moments in a mother’s medical career in pathology

Professor Catriona McLean

I am 20. At a social barbecue I talk with an obstetrician about careers in medicine. She tells me that there is no point becoming an obstetrician if I want to have a family. I remain quiet.

I am 22. I compliment my favourite aunt on her new hairstyle. Her look is blank. It is a wig. I am so naïve. She dies the night of my fourth-year final exam. I forget to go to my exam.

I am 24, an intern in my first term. I am looking after Ian, who is having the first bone marrow transplant in my hospital. I am fascinated by the science. I see Ian remain positive and friendly at all times despite what he is going through. He has a lovely family. I don’t want him to die with this brand new treatment. I remain vigilant and work to my capacity; to my great relief, Ian lives.

I am 27, a senior resident medical officer. I have offers to continue training in oncology, cardiology, or neurology. I am unsure which direction I really want to go. I am pregnant. There is no maternity leave in the medical officer award in 1987. I am forced to resign. I let all three physician training offers go. I lose my entitlements. My little boy eclipses medical study.

Choosing what you should do with your medical degree, and balancing this with your personal life may not be clear to you early in your medical career. A single event, person or patient may inspire you in a direction. Your career choice may not evolve as you wish it to. You may need to make compromises. You may face hurdles that you never thought would occur.

After some deliberation about which path I should take I chose to become a pathologist. At the time I also thought it was going to be more practical for me and my young family. I’d always been fascinated in pathology and I remain fascinated by pathology. Whilst there is disease, there is the need to diagnose, understand pathogenesis, and find effective treatments. Even today, I often see something new down the microscope. It could be something I’ve overlooked every other time or an extremely rare disease. I’ve learnt to keep my eyes and my mind open.

Often I get questioned by junior doctors about moving into pathology and moving away from the patient. I do not see it that way. I feel that the patient is very central to our role. We want to make sure their diagnosis is correct, that we offer them accurate information about their disease. We are not disconnected from them.

It has not always been plain sailing trying to juggle fellowship exams, consultancy, and being a mother. I did, however, create a rule for myself very early on. This rule was to never study once I returned home after work. If I could not keep family and work separate it would not work for me in the long run. So, I learnt to concentrate super hard. If I read something once, it had to stick. If I saw something down the microscope, I had to be able to recognise it the next time. I still abide by this rule today.

Once I’d completed my fellowship, there were very few public hospital jobs around so I started a doctorate and received some sessional work. It was a 56 kilometre round trip to the hospital for one of the sessions. Sometime later I was pregnant again. I chose to resign from the distant workplace, took eight weeks off, and continued to work on my thesis at the university. Fifteen months later I was pregnant with twins. I took annual leave. I’d finished my experimental work so I wrote my final thesis when my twins were three months old. They’d sleep and I’d write. They’d wake and I’d feed them. Don’t ask me details about this time of my life.

Following my doctorate, I found a consultant job close to home. I also decided early on that collaboration would offer me more scope for research than trying to juggle full time service work and leading research. Some colleagues choose to become the leaders of research laboratories. I choose to contribute my skills and knowledge to research. Everyone is different.

I am 44. I have four children. I am offered a job as professor and head of anatomical pathology and I take it. The children can all walk to school and I never make or find time to wash my car. Time is of the essence.

I am 57. I am still head of anatomical pathology amongst other new titles and fellowships I’ve gained. My special interest is in brain and muscle pathology, particularly rare diseases. My world-ranked expertise is shared with medical science via more than 350 research papers in which I am a co-author.

What will the future be for certain specialties in medicine? Will algorithms and robots overtake large aspects of our work? It is important to look to the future but also to remain optimistic and to be prepared to change. One aspect of my field, rare paediatric neuromuscular diseases, has seen a great deal of change in the past five years. Next generation — and now whole exome — sequencing has resulted in many genetic diagnoses being made. What about those children who remain without a genomic resolution? What happens to those in whom a specific mutation has been found? Is there a specific treatment available based on this new information? Not usually. Not yet. What then?

Knowing the gene mutation does not mean that the mechanism of pathogenesis is known. Without a good understanding of pathogenesis, specific treatments remain unknown. It is a group effort to solve these unknowns with input required from multiple specialties. I’ve been involved in several recent cases looking at new gene mutations and how they affect muscle. There has been much for me to learn from using this new information to help interpret future cases and to aid in understanding the pathogenesis of a disease. This new genomic information adds to the new information provided in the seventies by electron microscopy and in the nineties by immunohistochemistry — each of which was revolutionary in its time.

Making each career decision, each medical decision, requires adaptation and use of your knowledge in new ways. At the same time, it is important to remember that your career should always be fun. It should always be challenging. You will always be learning.