Day in the Life of a Pritzker Alumnus
Colin Walsh, MS 2 and Dr. Richard Cote
This spring, the Medical & Biological Sciences Alumni Association sponsored the first Day in the Life program, which gives current medical students the opportunity to shadow Pritzker alumnI in their professional lives during spring break. In the inaugural year of the program, ten students were matched with alumni in the Chicagoland area and California. Our generous alumni opened their homes and work places to our students, providing invaluable insight and advice on the medical profession. Below is an extended account of second year student Colin Walsh's experience with Dr. Richard Cote (MD'80), Professor of Pathology at the University of Southern California.
If you would like to participate in the Day in the Life program, or for more information about other student-alumni programs, please visit: http://bsdalumni.uchicago.edu/students.
Sunday Evening - "My Best Singing Voice"
As Pritzker alumnus and pathologist, Dr Richard Cote, opens the door to his home in Westwood, CA, I'm greeted enthusiastically by the doctor and his two dogs, Hank and Carmella. I focus on making a good first impression while shaking hands and petting the dogs. I step into the foyer and meet his eight year old daughter.
“Who is that?” she asks her father while staring at me from the top of the stairs.
"Well, Gracie, why don't you come downstairs, introduce yourself, and find out?" I would soon realize that Dr Cote has an amazing rapport with all of his children and, when he's not making them laugh, challenges them constantly with questions and observations.
Dr Cote gives me a brief tour of his home before the remaining Cotes return - the twelve year old twins, Nick and Juliet, and Dr Cote's wife, Annette (Annie). After brief introductions, Dr Cote drives Nick to baseball practice, and I'm given time to settle in. And by settle in, of course, I mean that I play backyard soccer with Gracie, who crushes me 16-4.
Denying (wisely) my efforts to help, the Cotes prepare a superb dinner. As they cook, Gracie paces the length of the kitchen with her iPod earbuds in place singing "You're the One That I Want" from Grease in her self-proclaimed “best singing voice.” During dinner, I learn more about the family, how they ended up in Westwood, and how they named their German short-haired pointer, Hank. After dinner, we watch the beginning of a Cote family favorite - the movie, Along Came Polly, before everyone heads to bed.
Monday - "If You Learn Nothing Else..."
I meet Dr Cote and Juliet in the kitchen Monday morning around 7 AM. Before Dr Cote and I head to his office at USC, he drives Juliet to school. She'll be leaving for Joshua Tree National Park on a school-sponsored trip tomorrow. I feel a surge of meteorological envy as I am struck by the cloudless sky and 70 degree heat so typical of mornings in Los Angeles.
After we drop Juliet off at her middle school, Dr Cote immediately lowers the top on his car. "When no one's in the back seat, I always drive with the top down." My jealousy has been replaced by an inability to remember the word ' Chicago' as referring to anything but a style of pizza.
We arrive at the USC/Norris Comprehensive Cancer Center, and I meet Drs Nichols, Wang, and Sherrod along with other office staff,. The University of Chicago connections synapse quickly as I learn that Dr Nichols owes his parents meeting to the U of C law school steps. His son, Peter, is a resident in the psychiatry department at the U of C. His aunt, Dr Nancy Warner, MD '49 (who I'd meet soon - read on!), was the first female chair of an academic pathology department in the country. I ponder small worlds as I enter Dr Cote's office and am struck by two things: the view of the surrounding countryside from his windows and a 1908 lithograph of the University of Chicago campus (football field and all).
Dr Cote and I head into the operating suite to check the surgery schedule and to change into scrubs. Dr Cote receives his first page from the OR, and I begin to understand how those microscope slides that baffle me in CPP come to be. The surgeon has removed cancerous tissue from his patient, and Dr Cote receives the organ. We bring the specimen to the grossing station where Dr Cote shows Sarka, the resident filling in that day, and me how to evaluate the tissue. He begins by orienting the specimen properly, identifying key anatomical features, and looking for any gross abnormalities. He then inks the margins and prepares the organ for dissection. Throughout this process, he's asking Sarka about staging and grading for tumors and about prepping a specimen appropriately for sectioning. He uses the same Socratic, often comedic approach that I came to appreciate the night before while watching him interact with his children. He never condescends to his students but expects them to work diligently and to research questions that they can't answer.
Dr Cote begins sectioning the specimen and examining it for cancer. We return to the OR, and he advises the surgeon on what he's found. At another point, a surgeon comes into the grossing area to ask Dr Cote about his opinion of another specimen removed that day. The patient is still in the OR, and the surgeon cannot end the case until Dr Cote has given him an opinion about the sufficiency of the resection. I was startled by the direct effect that surgical pathologists have on perioperative, even intraoperative, patient management.
Dr Cote fixes sections of the organ for slide preparation, and he asks Sarka if she's comfortable continuing the lymph node evaluation that he has begun. She replies, "I think so, but watching you, Doctor, I think that maybe I don't have as good a technique as I thought." Dr Cote suggests that I observe Sarka as she finishes the lymph node prep. Educated in the Czech Republic, Sarka explains that she normally works at the county hospital across the street. "At County," she describes, "we have 100 cases per day for one pathologist. It's not like here [the Norris Cancer Center], where I can take my time."
Dr Cote and I continue to cover the ORs and work through more patients for that day. He explains his path to his specialty. "After graduation at Pritzker [in 1980], I moved into an orthopaedic surgery residency at the University of Michigan. During my residency, I became heavily involved in research, and it was my research that led me into pathology. I moved to Memorial Sloan Kettering for the next nine years." Dr Cote describes how his interest in immunohistochemistry defined his research, and interactions with his mentors helped him find his way from Ann Arbor to New York. What I retained more than the details in his tale is the idea that he let his curiosity and academic passion guide him to success – a lesson that cannot be repeated too frequently.
High-Yield Guide to Pathology as a Career, adapted from conversations with Dr Richard J Cote, March 20, 2006
| Pros | Cons |
|---|---|
"Great field for research and practice" |
"I have patients, but they don't talk to me" |
"Call is nothing in path" |
"Surgeons may incorrectly treat us like servants instead of specialists, consultants." |
"I hate memorization; I want to understand the process behind my patients' diseases" |
We end the day with a stop in Dr Cote's lab. He will be giving a presentation (two, in fact) on Wednesday, and he wants to review his slides with his colleagues in the lab,. We leave Norris around 7 PM. After we reach Westwood, Gracie shows me her Horton Hears a Who diorama before she heads upstairs to bed. Annie and I continue our conversation about our mutual origins on the East Coast, relocating to California, and much more. I eat dinner with Dr Cote and Nick as we talk about Nick's upcoming baseball game tomorrow night.
CPP = Clinical Pathophysiology and Therapeutics, a rite of passage for second-year medical students at Pritzker for over three decades.
Tuesday - "Not Just a Name on a Slide"
This morning on the drive to Norris, I ask Dr Cote how he balances his obviously frenetic and successful career in academic medicine with such a healthy, active family life at home. "It's always a challenge," he admits. "Balancing with family is never easy. In the beginning of my career, I opted to not have a family. Whatever was asked of me, I did. But now, I place priority on my family. I spend time with them; I won't give that up."
We arrive at Norris and begin looking at the cases that came through the OR yesterday. Dr Cote receives tissues from the surgeons in the OR; margins and measurements are taken; the tissue is sectioned and divided into cassettes; studies and stains are ordered; slides are delivered to the pathologist by the next day. From that point on, it's pretty much like CPP (except with a brilliant pathologist and not just me opening my slide box upside-down).
I appreciate the speed and precision that Dr Cote uses to examine slides. He explains, "What I'm trying to do is understand the process of the disease. The pathophysiology is crucial. Many pathologists will look at a slide looking for a diagnosis. I want to know what's happening with these patients, not just put a name on a slide." As he's speaking, he pauses to demonstrate a mitotic figure or a pleomorphic nucleus. He's slowing down to answer all of my questions and to explain his thinking on each slide. I then realize that if I wasn't here he could go even faster and be just as accurate. The only thing that I do that quickly is eat.
We examine a bladder resection for cancer, and I ask Dr Cote about the transition of p16INK4a and p53 mutations in urothelial cancer (a fact emphasized the week before in class). "Ah yes," he replies, "that was my lab!" Dr Cote's research contributed tremendously to immunohistochemistry in general and in cancer especially. He was not aware that his findings had become so widespread in medical teaching.
In the late morning, Dr Cote introduces me to Dr Nancy Warner, University of Chicago Alumnus from the class of 1949. She began her career at Pritzker (before it was Pritzker) and left to pursue a position at the University of Southern California. At USC, she would become the first female chair of an academic pathology department. She was a member of one of the first Pritzker classes to admit women. We talk about everything from her incredible career to digital cameras. Dr Warner describes some of the challenges that she faced in her career as a female advancing so rapidly on an academic track, and she comments, "As for Pritzker now, it's a different world."
Day in the Life Impressions
Around 2 PM, Dr Cote and I move from his office in the cancer suite to his office in his lab. He has a conference call regarding a patent application for technology developed in the lab. At the end of the phone call, I ask Dr Cote about his experience with patents and technology development in his research. "You have to plan for it," he replies. "While you're working with new technology, you ask yourself, 'does this have a commercial application? How can I develop this? What direction can it take?' "
We leave Norris around 5 PM because Nick has a baseball game at 6 PM. The teams are warming up for the game when we arrive at the Bad News Bears Field. Soon Gracie and Annie arrive to add to the cheering section. Gracie finishes her In-n-Out burger and grabs me to play "Now You Make Me Laugh!" In fact - amusing an 8 yr old with a normal energy level somewhere between a tornado and the sun is not that hard. In the meantime, Nick reaches base in every At Bat, bats in 3 or 4 runs, and scores no fewer than 3 times. Nick, Dr Cote, and I go out to dinner to celebrate.
Wednesday - "10 years of work in one slide"
We begin the morning at a Pathology Conference in the medical center. Dr Cote is delivering a talk on his study of occult metastases and improved detection techniques. He mixes theory, data, and humor throughout his talk. I've known Dr Cote for three days, and I'm already starting to take for granted his entertaining didactic style.
I spend the remainder of the day in the research lab. I spend some time with Anirban, a graduate of medical school in India now pursuing his PhD. "This lab is almost purely translational research," he says, "Dr Cote and Ram allow us to have the freedom to try something new - not many PIs are like that. I really like this environment." He's very curious about medical education in the US as I'm interested in medical school in India. We're still comparing the two systems as the lab migrates to the USC Faculty Club for lunch courtesy of Dr Cote. The entire lab enjoys both the food and Dr Cote's comedy
After lunch, we head to a meeting of the PPG - a consortium of three major USC labs (that collaborates on large-scale research endeavors. The director of each lab presents recent developments and suggests directions for the future. Dr Cote's second presentation of the day runs as smoothly as the first.
At the end of our third day together at Norris, Dr Cote and I approach his car in the parking garage. He asks, "So you want to drive home?" I buy time with a forced, "Are you serious?" Then I look at his Mercedes convertible, think “maybe I shouldn't,” and shout, “Absolutely!”
As I drive with concentration normally reserved for final exams, Dr Cote leaves me with some final advice about success in medicine: "There are no secrets. It's hard work. Medicine takes sacrifice no matter what anyone says. I made choices in my career, and everyone needs to make their own. What makes me happy now, like that game Tuesday night, may not be the same as what once made me happy. I enjoy every minute with my family now. And I don't seek to tell my children what to do; I want them to find their own ways. But one thing I do know - parents can show their children the benefits of a fully-lived life."
