Why I became a pathologist and how it affects my writing

In my series of Toni Day mysteries, Toni Day is loosely based on my own career as a pathologist in a small rural hospital in Twin Falls, Idaho. But how did I get there?

It all started when I was six and had my tonsils out. I told my father I wanted to be a nurse when I grew up. The ensuing conversation went something like this:

DADDY: “A nurse?! What for? Do you know what nurses do?”
ME: “Take care of people in the hospital?”
DADDY: “They do whatever the doctor tells them to do. You’ve never done what you were told in your entire life. Why don’t you become a doctor instead?”
ME: “But Daddy, I’m a girl.”
DADDY: “So what?”

This, in 1951, from a man born in 1890, had quite an effect on me. Daddy was clearly a man ahead of his time; and he never stopped supporting me when people asked me what I wanted to be when I grew up and snickered at my answer.

Unfortunately, Daddy didn’t live to see it all come true, because he died when I was ten: but my mother never stopped exhorting me to work hard in school and keep my grades up, to get scholarships, because that was the only way I could ever go to college since she couldn’t afford it on a secretary’s salary.

So I kept my grades up, and got four scholarships that paid for my first year at Occidental College in Los Angeles. During the four years I was there, I had a job as well. Unfortunately, it wasn’t all that easy to keep my grades up, and I graduated with a 3.0 average, 3.3 in my major, not good enough to get into medical school. I watched in dismay as a brilliant girl in the class ahead of me failed to get into medical school with a 4.0 average. Summa cum laude. Phi Beta Kappa. I wasn’t even close.

I took the MCAT and aced it. I also took the Graduate Record Exam, just in case I ever wanted to go to graduate school, and aced that too. Then, after graduation, I enrolled in a medical technology internship at the Long Beach VA Hospital, while going around interviewing at medical schools. My brother, who lived in Virginia, insisted that I apply to Georgetown, and I did just to shut him up.

To my surprise, I actually got into not one but two medical schools, the University of California, Irvine, and …wait for it…Georgetown.

My brother was not happy that I stayed in California, but he had to admit my reasons were good. UCI offered financial aid, Georgetown did not. Besides that, I had a boyfriend and a car, and I wanted to keep both.

So I went to UCI, and worked my way through as a medical technologist at Long Beach Community Hospital, where I met my future husband, John Munro, also a med tech.

One day, a fellow tech who had been hired more recently than I, asked why we did certain things a certain way, when he had been taught differently. As a part-time employee, I wasn’t qualified to tell him that, nor could I do anything about it. In order to do anything about it, I would need to have my own lab, and to for that I would have to be a pathologist.

So I became one. John and I were married in my first year of residency, and when my residency was finished, I got a job at the Twin Falls Clinic & Hospital, a small rural doctor-owned clinic and hospital in Twin Falls, Idaho, and the rest is history. (For more, check out my blog: My inspiration for the Toni Day Mystery series).

As a practicing pathologist, my writing contains realistic and believable medical and forensic information, with the medical jargon softened by Toni explaining it to her husband Hal, much as I used to explain it to John. Most people don’t really know what a pathologist is or what we do, or they think all we do is autopsies. I hope my writing gives them an idea of what hospital-based pathologists do all day.

Actually, hospital autopsies are quite rare nowadays, because of advanced imaging techniques that give radiologists the capability of sampling just about any part of the body with a needle. But when I first came to Twin Falls in 1977, I did quite a few autopsies, in funeral homes because our hospital didn’t have a morgue. All the forensic autopsies from Twin Falls County went to the county hospital, but I ended up doing forensic autopsies for the surrounding Jerome, Cassia, Minidoka, Gooding and Blaine counties.

Luckily for me, that came to a screeching halt when the county hospital bought us out and I joined their pathology group. After that, all forensic autopsies went to Boise, and they still do.

But in the 24 years at the Twin Falls Clinic & Hospital, I got plenty of fodder for my books, and I’ve just barely begun to use it.

Reviews from Heck

I got a couple of bad reviews for Too Much blood this week. I won’t say I’m not upset, because I am. Nobody likes being told that her magnum opus is just so much dreck. I know, I know, everybody doesn’t like the same things, and I can’t please everybody, but I can’t help feeling bad. I know perfectly well that everybody doesn’t hate Too Much Blood, because I’ve got 4 and 5 star reviews too, and I’m glad they got to me first.

I’m not going to post either of these reviews in their entirety, but I feel that certain aspects deserve comment.

First item: HIPAA.

“I found it odd that Toni is able to get information that a typical pathologist probably wouldn’t be able to get her hands (on).”

“Toni looks up confidential medical information on several people who are definitely not in her care (she’s a pathologist for crying out loud, she doesn’t take care of live patients) in
order to “solve the case.” Again, HIPAA laws anyone? That is completely inappropriate and really puts doctors in a bad light, because it suggests that we think this is okay. It’s NOT. People get fired for doing things like that all the time.”

These reviewers are absolutely right; HIPAA is a big deal, and people do get fired for violating it. However, there is such a thing as need to know. Doctors have much more leeway than other medical personnel because they have a need to know about patients, whether they’re taking care of those patients or just providing consultation. Pathologists are consultants.

Pathologists do deal with live people, 99% of the time. They aren’t the primary caregivers, but what they do impinges directly on their care. Every specimen they get should come with adequate medical history, supporting lab data, radiological reports, and any particular concerns the submitting doc might have. But they don’t.  Specimens come to us with no history, or history that isn’t pertinent to that particular specimen. So we have to be able to look that up, or we can’t do our job properly and might not be able to provide the specific information the primary doc needs to know. We might fail to fail to handle the specimen properly for their needs if we don’t know what their needs are, and surgeons aren’t always available by phone. Having access to the electronic medical record is essential for pathologists. When I’m signing out cases, about 25% of my time is taken up by looking things up in the medical record because I don’t have enough information.

Next item: phones.
“In the very first chapter of this book, Toni’s home phone rings in the middle of the night and her husband picks it up. First, what about a pager? A pager on vibrate? A cell
phone? How has this never occurred to her through medical school, residency,
and now her job? If I were her husband, I would have lost it much sooner.”

“How can a medical professional not know about pagers or putting one’s phone on vibrate mode? How can a spouse of a doctor not be used to having the phone ring in the middle of the night occasionally? It would seem to me to be par for the course in marrying a
pathologist who needs to be on-call regularly.”

Pagers make noise. Cell phones on vibrate make noise. A cell phone that vibrates loud enough to wake me up would also wake up my husband, even if it’s under my pillow. Even if it didn’t, my getting out of bed to go out of the room to talk on it would. I know this, I used to have a husband. Even if it didn’t, I would still have trouble getting back to sleep, and for nothing because I wouldn’t be going to do an autopsy in the middle of the night. This seems blown out of proportion as something to condemn an entire novel for.

Third item: Toni’s arrogant and unlikeable.

“Toni Day is extremely nosy and a really unlikeable character. If a character is going to carry a whole set of books named after her, she’d better be someone people want to read about. I
was hoping she would grow and develop over the book, but she was the main reason I couldn’t finish it. She is pushy, arrogant and says the most inappropriate things like she is on the autistic spectrum. I personally would want to divorce her too.”

“Toni uses the excuse that since she did the autopsy on the dead man that this gives her the right to ask all sorts of invasive questions to people she barely knows. In what universe is this okay?”

That hurts. I can’t help taking that one personally, even though I shouldn’t. Toni’s a fictional character. I’m really quite mild-mannered, and not nearly as arrogant as some doctors are. It puts me in mind of a CAP inspection I once did, where the pathology department had seventeen Phase Two deficiencies, which they had 30 days to fix or the entire lab would lose accreditation. At the summation conference, chaos ensued. The techs were bewildered; the pathologists livid. Nothing had changed in ten years, they protested, and they’d been through five other inspections in that time, and nobody else gave them any Phase Two deficiencies. I can’t help it, I told them, I have to call it as I see it, and you are welcome to appeal it. I told them how to do that. I was the epitome of reasonableness. I never raised my voice.

To my utter astonishment, I got slammed for being arrogant and condescending. The regional inspector called me to discuss it. I told him exactly what happened. He allowed as how I did exactly right, and that lab was just going to have to suck it up and fix those deficiencies.

But it didn’t make me feel any better. I still dread doing CAP inspections. Maybe so close to retirement I won’t have to do any more.

But I digress.

Last item: excessive and oddly placed swearing. One reviewer had an issue with swearing in both books.

Guilty as charged. I swear a lot. Nobody cares. Most people laugh. I write the way I talk. In the future, I shall warn reviewers that if they don’t like strong language, perhaps they shouldn’t review the book.

So how did I handle these two reviews? What did I do to make myself feel better? I looked up Lisa Scottoline, who is a best-selling author whose novels feature kick-ass lady lawyers whose language is as strong as mine. She has many many 4 and 5 star reviews, but she also has some 1 and 2 star reviews, and some of them put a lot of emphasis on all the swearing these lady lawyers do.

If Lisa Scottoline gets a few bad reviews, who am I to complain about a couple? It’s life, for a writer, to take the bad with the good and deal.

In other words, suck it up, princess.