A Day in the Life of Consultant Pathologist - Dr Máire Lavelle
I am the Lead Breast Consultant Pathologist in University Hospital Limerick (UHL). When I tell people that I’m a pathologist, it is sometimes assumed that I attend crime scenes and solve murders. When I explain that I’m not a forensic pathologist, I’m a hospital pathologist, I am often asked: “but what do you actually do?”
Pathology is the study of disease. As a breast pathologist, I diagnose breast disease under the microscope.
When a patient comes to the breast unit with a problem, they see a surgeon who takes a clinical history and examines them. If necessary, the surgeon may request a scan. If the radiologist performing the scan sees something abnormal, they will take a biopsy, a tissue sample of the abnormal area of the breast, place it in a container of fixative and send it to the Histopathology laboratory.
We can’t just put the biopsy straight under the microscope. The microscope light must pass through the sample to be seen, so the sample must be cut very thinly before it can be assessed.
To achieve this, the tissue sample is fixed in formalin in its container. It is then embedded (either by a pathologist or a medical scientist) in a small cassette and covered in paraffin wax, creating a wax block.
The medical scientist then uses a machine called a microtome to cut the wax block into extremely thin strips, which are placed onto a glass slide. At this point, the cells are still difficult to see, because they are very transparent, so the slide goes through a staining machine where tissue dyes are applied to the sample which colour the cells so they can be seen. The dyes used are haematoxylin and eosin, which dye the tissue in pinks, blues, reds and purples.
The glass slide is dried and then a glass coverslip is glued onto the top of the sample, so the sample is trapped firmly between two slides of glass. This is the point when I can put the slide under the microscope and make an assessment.
Sometimes I can make an immediate diagnosis. Sometimes the interpretation is more complex and I might need to perform more chemical tests on the sample to establish a diagnosis.
Even if the sample is clearly cancerous, I may still need to perform more tests to establish the subtype of cancer and what hormones it expresses. All these extra tests allow decisions to be made on potential future surgery, chemotherapy and radiation therapy.
The pathological diagnosis under the microscope is not the end of my duties for this patient. Each breast sample is discussed at the breast multidisciplinary meeting. Surgeons, radiologists, pathologists, oncologists, radiation oncologists and breast care nurses all attend this meeting and we each discuss our findings to establish the diagnosis for the patient and discuss the treatment options for each patient.
My job also involves cancer research as well as education and training of medical students, junior doctors and medical scientists. The smooth running of the laboratory requires a lot of work from the entire laboratory team of which I am a part.
What is my favourite part of the job? That is a difficult question! Pathology is often described as “the bridge between science and medicine” and I really enjoy having a hand in both fields. There is huge job satisfaction in being part of the breast team to treat patients with breast cancer. That is why I became a doctor: to help people.
Note: October is Breast Cancer Awareness Month, and at UL Hospitals Group, we're taking the opportunity to spotlight our Breast Services at UHL and the care our team provides.
A day in the Life of RANP, Symptomatic Breast Unit - Nichola McNamara
My name is Nichola McNamara. I am a Registered Advanced Nurse Practitioner (RANP) in the Symptomatic Breast Unit at University Hospital Limerick (UHL). I started my career working in cancer services, mostly administering chemotherapy in the Haematology Oncology Day unit, before transferring to the Breast Unit in 2018. I have two young daughters, so life outside of work is busy, mostly spent in the car driving to children’s activities and parties. I love music and getting to live gigs whenever I can. I think it’s important for us all to take time to mind ourselves and do something we enjoy out of work.
What a typical working day involves
The Symptomatic Breast Clinic is an outpatient-based service and we review over 9,000 patients every year. I have a fantastic working relationship with my colleagues, including the Breast Clinical Nurse Specialists, Clinical Nurse Manager (CNM2), Consultants, Surgical team and Administration staff. We run approximately seven clinics per week. My duties as an ANP include reviewing patients in clinic with benign and malignant breast disease.
My typical day involves meeting patients, taking a clinical history, performing breast examination, requesting imaging and liaising with GPs. Health promotion is a major part of my role; educating every woman I review on the symptoms of breast cancer and how to perform monthly self-breast examination. This empowers women to confidently take control of their own health and not be over-reliant on clinicians.
What I enjoy most about my work
I have a strong interest in hereditary breast cancer and genetics and I am a member of the National Family History Steering Group. My main cohort of patients are women at risk of hereditary breast cancer, either due to genetic mutation or high family prevalence. What I enjoy most about my work is getting to know my patients. With genetic carriers, I often meet multiple members of the same family every year and they like to have that continuity of care. Women with a genetic mutation often must engage in difficult decision-making, such as risk-reducing mastectomy, and require a lot of support and guidance. I have developed a good and trusting relationship with these patients and it reassures them to know they can pick up the phone to me at any time if they have a breast problem in between clinic visits.
My favourite part of my working day…
My favourite part of my work is when I make a difference to the lives of patients and their families. This might involve doing something small for a patient, like referring them for a complementary therapy and it’s nice to get feedback that it helped them. Women who are on five-year follow-up care plans can really struggle psychologically after treatment for breast cancer. My role is to listen carefully to their experiences, and advise them of what to expect during the follow-up plan. It’s important that these women are aware of survivorship programmes and are offered health promotion advice as they begin the survivorship journey.
My most exciting career moment to date..
Graduating with an Advanced Nursing Masters in NUIG was my most exciting career moment to date. It wasn’t easy being a working mother and studying for a Master's so it meant a lot. I really enjoy learning and have recently started a Postgraduate Certificate in Cancer Genetics and Genomics with RCPI, so I’m not quite finished studying yet! Overall, I feel it’s worth it as the ANP service has positively impacted our unit by improving the patient experience, reducing waiting list times while also promoting the evolving role of the nurse.
A key focus
We are now looking towards commencing virtual clinics for patients at risk of hereditary breast cancer. Currently, a new GP referral electronic form is being compiled by the National Cancer Control Programme. This means a patient who is concerned about family history of breast cancer can be referred by the GP to the virtual breast clinic, and will not have to attend in person unless there is a clinical concern. To facilitate these new clinics, a Clinical Nurse Specialist in Hereditary Breast Cancer, Lynn O’Brien, has recently been appointed in the breast clinic. Lynn and I will be working closely with the Consultant Breast Surgeons to decide the appropriate care for these patients and roll out these new nurse-led virtual clinics.
October is Breast Cancer Awareness month, so just a reminder for women (and men) to check their breasts every month. For women, a week after menstrual cycle is best. Any concerns should be relayed to their GP. For further advice on breast examination, see link: https://www.cancer.ie/cancer-information-and-support/cancer-types/breast-cancer/how-to-check-your-breasts
A Day in the Life of Noreen Murphy, HCA
My name is Noreen Murphy and I am a Health Care Assistant (HCA) in the Symptomatic Breast Unit in University Hospital Limerick (UHL). I have been an HCA for 23 years, and have worked in the Breast Unit for the past seven years. I work opposite my HCA colleague NicolaMcNamaraas part of a multi-disciplinary team that includes the Breast Unit Co-Ordinator, Data Manager, a Clinical Nurse Manager (CNM2), Advanced Nurse Practitioner (ANP), five Clinical Nurse Specialists (CNS), an attendant and secretaries. Prior to UHL, I was an HCA in Mallow General Hospital and Castletownbere Community Hospital. I have three children, with one still in school. Outside of work I love social dancing such as jiving and rock & roll dancing. I also enjoy playing Gaelic for ‘mothers and others’ and going on long walks with my dogs Buddy and Buster.
My working day
Work starts at 8.15am, but my day begins a lot earlier, as I commute from Mallow and need to get on the road early so I can get parking at UHL. My role varies from day to day. In the busy clinic, I bring patients in from the waiting room to the clinical room to see the doctor or Advanced Nurse Practitioner (ANP), and also chaperone for breast examinations. I will often meet patients and their relatives again at the end of clinic, and some of them may have received bad news. At those times, I find a comforting word and an offer of a cup of tea is a kind and compassionate gesture that many patients appreciate.
I also work as a Fitter in the Breast Unit, which involves measuring women for fitting with a prosthesis and bra eight weeks after mastectomy. I trained for this role in Dublin several years ago and attend refresher courses regularly to keep up with developments.
What I enjoy most about my work
I really enjoy working as part of the breast team. We all have our own roles, and all our contributions are valued. I enjoy supporting patients, from diagnosis to survivorship, listening and chatting to them, and helping them to feel at ease as they make their way through the clinic. Many patients attend for check-ups on a yearly basis, so you really get to know them and their families.
My favourite part of my working day is…
My favourite part of my work is fitting patients after mastectomy. For women, having a breast removed is life-changing for your femininity and sexuality, so I allocate an hour for each patient, to ensure they will have time to try on different bras and prostheses and feel comfortable and more confident when they leave. A prosthesis does not replace their own breast, but it makes them feel good and (a term that many patients will use) ‘normal’ in their appearance.
My most exciting career moment to date
The most exciting moment in my career was becoming involved in the ‘world first’ 3D Breast Prosthesis Pilot Programme to create bespoke breast prostheses for women post-mastectomy in Limerick. State-of-the-art 3D manufacturing is used to scan the chest wall and provide a custom-fit prosthesis for each individual woman. This exciting programme is run between the Symptomatic Breast Care Unit in UHL, Mater Private Radiation Oncology UHL, and the Rapid Innovation Unit in University of Limerick. I will be trained in using the technology that will allow me to fit these bespoke 3D prosthesis for women who have undergone mastectomy in UHL.
I really enjoy working as a Health Care Assistant as I am a people person. I enjoy the one-to-one service I am able to offer patients as a fitter. It gives me great job satisfaction to see the difference that particular service can make, giving confidence back to women who have been through life-changing surgery.
October is Breast Cancer Awareness Month, and we're shining a spotlight on our dedicated Breast Services team at the Symptomatic Breast Unit, UHL, and the care they provide to our patients.