"Because we don't have direct patient access we are considered the backroom boys," says Dr Mary Sheppard, while sipping coffee in the Royal Brompton Hospital cafe. As a consultant histopathologist it is Sheppard's job to analyse human tissue from the living and the dead in order to make a diagnosis of disease. Concealed from public gaze, her work is far removed from the television-driven image of pathology; moody, blue-lit rooms with corpses on mortuary slabs and hard-bitten detectives lingering in corridors.
Sheppard herself looks nothing lack a "backroom boy." Smart, elegant and tanned from a recent foreign holiday, her appearance belies the many hours she spends hidden behind the scenes in the pathology lab.
"The majority of my work on a daily basis deals with biopsy material; tissue removed from living people who are looking for a diagnosis," she explains, in her mellifluous Irish accent. A fast-track procedure has evolved, whereby Sheppard and a surgeon work in tandem. Once a patient is in the operating theatre, a surgeon is able to remove a suspect lump and send it straight up to Sheppard in the pathology lab for examination."
"Operating theatres are just above pathology labs and the lump comes literally by tube, like a little lift. Staff freeze it immediately in order to cut it, and put in on a glass slide under a microscope." Shepard then delivers her verdict to the surgeon within 10 minutes. When operating on a tumour, a surgeon may continue to remove tissue until Sheppard gives the all clear, via intercom.
"All histopathologists do frozen sections on a daily basis, it's one of their most challenging jobs because if you get it wrong you're in deep trouble – someone will have a breast or lung removed on your opinion., It's a constant worry and a constant stress. I have occasionally got things wrong….we do make mistakes. But that is why we have a Royal College of Pathologists, who supervise our training and professional development. A certain percentage of my work in reviewed by another pathologist,."
Sheppard is an expert cardiac histopathologist specialising in sudden cardiac-death syndrome in people under the age of 35 years. Her research into heart and lung disease is recognised by consultants across the UK, who send her tissues from autopsies for examination. Since the Alder Hey organs scandal and the resulting Human Tissue Act, it is illegal to remove tissue without the family's consent. A small percentage of people withhold their consent. "They can be the very same people who come back two months later, but by then it's too late – the tissue has been disposed of."
Each week, seven to eight people under the age of 35 suffer a sudden death linked to cardiac disease in the UK. Often these diseases are genetically inherited and the rest of the family will need to be screened. Sheppard explains this, and the causes of sudden death, to the bereaved families confused by complex medical terminology, such as "hypertrophic cardiomyoptahy."
"Most people haven't heard of it before and are stunned to hear that their family has this entity that may be inherited by other members of the family and passed on to future generations."
As a mother of four, Shepard says she can empathise with the intense bereavement of the families she meets.
"There's nothing more devastating that can happen than waking up one morning to find your child dead in bed. It's appalling for families."
Being a consultant is virtually incompatible with being a mother, says Sheppard, who believes she is the only woman in the hospital to have four children.
"Medicine doesn't encourage breaks….and is unforgiving if you take time out for children."
But that hasn't dampened Sheppard's love for the discipline, having returned to work only a couple of months after giving birth to each 0of her children. Her husband, who works in property, is very supportive.
"As his own boss he can do the school runs, which frees me to concentrate on making the right diagnosis."
It was partly her desire to combine a career with a family that prompted Sheppard to specialise in histopathology. As a young medic she worked an "outrageous" 120-hour week on average.
Histopathology "allowed me to have relatively regular hours, though admittedly we're on call….and I loved the subject as a medical student," she adds.
The eldest of 11 children, Sheppard was raised in Cork. She was lucky to have been one of the first generation that benefited from government investment in university education, transporting her and her siblings into a different world from that of their parents.
"My father was a policeman, my mother a full-time mother – all her generation were."
She remains an active Catholic, and says her strict upbringing provided "my family and moral values."
I wonder whether her religious beliefs affect her work. particularly when conducting autopsies.
"Once the body's there, the spirit has left. You're not worried about the spirituality of the person. It's a job, you analyse it dispassionately."
And yet, working with death on a daily basis hasn't made her immune from worrying about her own demise.
"I'm very put out by the idea that I'm going to die," she says.
"I don't look forward to in in the least. I'm hoping that there might be such improvements in medicine that I might live until I'm 120."
Later, however, Sheppard bemoans the "demands by the public for perfection. People are now expecting everybody to live forever with complex abnormalities."
This makes her life tremendously stressful. Obsessive compulsive tendencies, she says are a prerequisite for the job.
"You have to get it right. It's a matter of life and death. We're the only profession where we're expected to be perfect, and if we're not we're going to be sued."
Most cardiac and thoracic (lung) surgeons pas through the National Heart and Lung Institute at the Royal Brompton Hospital. It's a busy teaching hospital and it's part of Sheppard's job to train students and other pathologists.
"I love that. It makes my job varied. During the day I can be giving a lecture, having a multidisciplinary meeting with surgeons, looking down the microscope, training a junior doctor and maybe talking to a bereaved family. That's why I stay late some evening's it's quite hard to drag yourself away."
Consequently, she is rarely home before eight o'clock.
"When I go home I cut off. My brain goes in a totally different direction." An ability to compartmentalise life is probably essential for a successful consultant.
Performing autopsies has never upset Sheppard and she doesn't find them ghoulish. As a child growing u in Ireland she would often attend wakes, where the dead body was laid out.
"It was part of my culture and it wasn't morbid, there was a respect for death. In the modern western world we are protected from death. People are terribly frightened, particularly now when few believe there is an after-world, and everyone fears oblivion." She adds that if this fear and revulsion had been our attitude towards death throughout history, there would have been no medical advances. "All medicine evolved around pathology. to me it's the cornerstone of medicine.
Families affected by sudden cardiac death require an enormous amount of counselling. But with a "massive financial shortfall in the NHS at the moment extra funding is out of the question." Instead, charities such as Cardiac Risk in the Young (CRY) are left to pick up the pieces. Created bottom up rather than top down, CRY was initially formed by bereaved families desperate for more information. Sheppard is diplomatic about the issue; with so many urgent cases vying for funding "it's a difficult call, because the government has to prioritise." She does, however, speculate whether Gordon Brown's son recent diagnosis of cystic fibrosis will leader to greater funding.
"We would hope so," she says – it is a disease the Royal Brompton Hospital specialises in treating.
Sheppard's laboratory work remains very much a patient relationship with a microscope. She leads me into the bowels of the hospital, along hard, shiny, off-white floors and down a corridor lined with white coats on pegs at the entrance e to each room. I am assailed by a strong smell of disinfectant. The heat is oppressive. Sheppard explains this is because we are above the boilers and the area is not insulated. Finally, we enter her office . Much like any other, it contains computers and personal photos. On her desk is a microscope and surrounding it are glass slides containing small pink and purple stained specimens. This, I learn, is tissue sent to her for examination, taken from a 26-year-old man who suffered a sudden cardiac death. It is the only contact she or I will ever have with this man, someone we have never met and who is already dead.
I realise Sheppard's mind is a visual library of myriad cellular patterns,. As she analyses the cellular structure of a slide under the microscope. she automatically compares it to hundreds of other patterns logged in her memory, scanning for an deviation from the norm that might indicate disease. In contrast , when it's time to leave, I have trouble remembering which corridors will lead me back towards the exit. Sheppard patiently explains the way, before disappearing back to her microscope.
Curriculum vitae
Current position
Consultant histopathologist at the Royal Brompton Hospital, London
Qualifications
MB (Medical Bachelor)
MD (Medical Doctorate)
MRC Path (Member of the Royal College of Pathologists)
Career high
"Meeting family of someone who has had a sudden death , and being able to explain what has happened. This helps the family come to terms with it and encourages other family members to get screened."
Career low
"When you make a misdiagnosis. But with our audit systems we are required to double-check, which helps to prevent inappropriate operations."
