The Art of Medical School

This week will have limited amount of posts. Why? I have 16 hours of testing on the past 12 weeks of medical school. This test will contain an insane amount of information. It covers the entirety of four major organ systems: hematology, nephrology, pulmonology, and cardiology. I thought it would be fun to share one little slice of what I will have to do tomorrow on my first day of testing.

Remember that time you went to an art museum? Like the Metropolitan in New York, or the new Broad in Los Angeles. You saw a beautiful painting like this Picasso below. Instantly, you were like, “this is cool but what am I looking at?” You read the little side card and it explains how Picasso implement XYZ technique to make a political statement against that fascist jerk Franco. Total BS, its just a bunch of shapes that kinda look like people. Then you saw an Miro and became perplexed that abstract shapes could be considered fine art. AND then you saw a giant Koons statue, became awestruck but contemplated its value to society. I think I’m not alone in feeling this confusion when confronted with modern art.

Cool Stuff Pablo, I see a lady…. and some other ladies
Is this an abstract interpretation of a long island ice tea, Miro?
This is what people call art these days?

That experience is incredibly similar to histopathology lab. For this block, we are expected diagnose kidney diseases based almost entirely on pictures. I have included some photos for everyone else to give it a shot. Below we have a photo of glomerulus (the filtering apparatus of your kidney). What the heck is going on with it? Well, I see some pink looking cells and some purple looking cells. How am I supposed to get anything out of it? Well the first step is to recognize that this is not a normal glomerulus. The glomerulus should be empty like your brita filter at home. Instead, it is gunked up with some fluffy cotton candy material.

H&E Stain of Abnormal Kidney. Doesn’t it look like a Picasso?

If we were to look at this biopsy at even higher power, it would look like the picture below. Now what do we see? Something that resembles a Miro, just a bunch of lines. In reality, it is a kidney tissue filled with these little teeny tiny protein fibers.

EM of Abnormal Kidney- Miro couldn’t have drawn this better.

With the cotton candy appearance and the small reticular fibers, we would diagnose this patient with amyloidosis. The patient has either a familial mutation that underlies this disease, multiple myeloma (a type of blood cancer), or a chronic infection. This patient will have a nephrotic syndrome. In English, this means that the patient will pee out lots of protein, appear swollen, have incredibly high cholesterol and be prone to clotting. Not a fun set of problems to have. Look how much you can get from just two slides!!!!

Why don’t we give it another shot? Below we see nodular pattern and a thick basement membrane ( it kinda look like all the shapes are traced with a felt tip purple marker). This patient has a classical presentation diabetic nephropathy and must do a better job to lower their blood pressure and monitor their insulin to prevent chronic kidney disease.

Kimmelstiel Wilson Nodule (say that 5 times fast). This is a hallmark of diabetic nephropathy.

So ultimately just like those museum explanations for all those painting, there is some underlying meaning to every abstract tissue you see. But what they don’t tell you is that it takes a lot of time and incredible amounts of energy to ultimately uncover it. Honestly, It’d be much easier to scribble some lines and call it modern art.

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