Peering Down the Microscope

^{By Michael Gordon, MD, MSc, FRCPC}

Ever since I was very young, I wanted to be an engineer like my father. He worked as a civilian for the department of defense, and during the war was involved in writing maintenance manuals for trucks and tanks. We had a lot of catalogues of military vehicles at home and my friends loved to visit and look at these books. But the most attractive thing about being an engineer, I thought, was my father’s talent and joy from fixing almost anything. It was from him I learned the wonders of duct tape.

When it came time to choose a high school, I was lucky enough to have grown up in Brooklyn, New York where the famed all boys Brooklyn Technical High School was one of four public high schools. I became a student at “Tech” as it was colloquially called in the early 1950’s. It was a huge building in downtown Brooklyn that had become a Puerto Rican enclave. I needed to take a subway to school, and on the way, I passed the wonderful Brooklyn Academy of Music where I saw my first live concert with the famed pianist Arthur Rubenstein. Passing up the street to shouts from the local children of “mira mira” (look, look) I entered the school.

The curriculum was amazing—New York regulated normal classes from 9-3, and then from 3-5 it was various engineering subjects and so-called “shops.” I carried a T-square around with me for drafting class and learned the nuances between a HB, 1B, and 4B pencils. My father gave me a gift of the ivory faced slide rule he used during his engineering studies at Cooper Union in downtown Manhattan.  I especially loved the woodshop where I learned to use industrial sized and hand tools. My instructor was marvelous craftsman and expected the best. If a student showed dexterity at using a chisel or a plane, he would reward them with a beautiful African Violet which he grew in abundance as a hobby—the window sills were home to them with the large windows that provided ample sunlight. It was an honor to receive one and walking through the corridors of the school with one in hand was a sign of achievement that after first year every study recognized. I developed my photography interests at Tech, and by this time had a full darkroom in my basement. I became the photographer for the school newspaper and the yearbook.

In the last year of high school with industrial processes, metal work, foundry, and excellent math and physics skills under my belt, I started looking at possible universities. It was before the digital age so all the research was done in the massive library that Tech had. I tentatively decided on a major in Engineering physics at one of the finer universities hoping I would qualify for a scholarship as my family did not have money for a private university. In the end, I decided that I would go to our local branch of the City University of New York, Brooklyn College. It was a short subway ride away and had a very good reputation. It was a true liberal arts college with a splendid campus in a residential community in Brooklyn.

I loved university, and loved the diversity of subjects that I did not have at Tech. I was captivated by my English courses, which were mandatory, and enthralled by history, classics, and social sciences. I postponed physics and chemistry as I had covered the well in high school. My social science teacher Edgar Z. Friedenberg, a renowned Educator, engaged me to help edit his famous book, “The Vanishing Adolescent.” He also awakened my curiosity to travel, as one who had done it a great deal. I can thank him for a decision that I made with the wonderful and generous concurrence of my parents to allow me to take six months in my third year of Brooklyn College to travel around Europe. They funded a small delightful Renault Dauphine. I left Brooklyn right after the term ended and flew to Paris where I met a classmate and picked up the car. I drove to Lausanne Switzerland where I had enrolled in a summer course in French.

Somewhere along the way in my travels I picked up a paperback book written by Paul de Kruif an American anthropologist, called Microbe Hunters (the Classic Book on Major Discoveries of the Microscopic World). I read it while I was travelling and it mesmerized me. I had never read anything so enthralling. I had also acquired another book to which I attribute my choice to change my future studies from engineering to Medicine: The Citadel by A.J. Cronin.

When I got home I changed my major at Brooklyn College to what was called “pre-Med,” which had little impact on the courses I took with chemistry being my major course program but there was plenty of room for the liberal arts courses which I loved. I told my parents I wanted to go into medicine rather than engineering and they seemed pleased with that. I was concerned about the cost of medical school and also knew that if possible I would like to study “overseas” and therefore applied to European and British medical institutions. As it turned out I was accepted to schools in Switzerland, Belgium, Sweden and a number in Scotland, all beginning a year after my return, which would have allowed me to finish my undergraduate degree.

It was early September, which was still warm enough for the beach that was two blocks from my home. As I walked up my front steps, someone behind me called, “Telegram,” which I turned to receive. While still dripping water from my swim, the towel wrapped around me, I opened the telegram that offered me a place that fall at the University of St. Andrews in Scotland. I had to let them know within 48 hours. I was too excited to think but knew enough to enquire at Brooklyn College what would happen if I started Medical School that fall and was told to my joy that the first year of medical school would be counted as the last year of my undergraduate degree. I sent the Telegram within the 48-hour deadline and was soon notified of my acceptance with the site of my studies being in Dundee—the clinical site of the medical school.

The bus ride from Glasgow to Dundee was a unique experience. I took the local route not realizing that the normally 1-hour drive would take 3 hours with the bus entering each village on the way to pick up passengers and parcels. The conductress could not believe that I was taking that bus all the way to Dundee and every-time she passed me she would mutter “Dundee.” I asked a police officer where I might find a bed and breakfast and he pointed me to an office building whose second floor was a very modest but decent B&B. The next morning after a typical high cholesterol breakfast I went to the University. I was a month early but wanted to find “Digs” (accommodation) before I left for a month visit to Copenhagen. I was shown a few flats which I knew I could not live in and after going back to the office was asked if I would accept living in a house with a landlady—I decided why not: I ended up with the loveliest of lovely landladies who doted over me for the whole academic year—I kept in touch with her throughout my studies and was there in the recovery room when she recovered from hip surgery.

I returned to Dundee after my month in Copenhagen where I visited the young medical students who had taken me in to their flat during my first visit to Copenhagen and were partly responsible for my choosing to study overseas. I walked up the stairs in the ancient-looking medical school building and entered the classroom which had a high incline for the desks which were all connected. The professor came in—it was anatomy class. I sat close up because I could hear and see better. Halfway through the lecture I raised my hand for a question and could hear the shuffling of feet from my classmates. The professor looked at me with disbelief—I learned from my classmates that asking a question was just not done (I had asked not just one but two, accompanied by the shuffling of feet). I went out and bought the massive Greys Anatomy, when I met two of my local Dundee classmates, they looked at me and said, “the exam is not for a year and a half”. I went from class to class trying my hardest to understand the Scottish accents—almost a foreign language!!

I loved the courses with a special excitement over the first year and a half of pre-clinical studies: with a special affection for physiology, microbiology and pathology—with an attraction to the use of the microscope. My first spring break was spent skiing with a few university mates in Switzerland. I walked into a shop in Zurich that sold Ziess microscopes—the company having been founded in 1846. I was staying overnight in Zurich before return to Dundee. I telephoned my home and asked my father if I could buy a microscope for my studies—money arrived the following afternoon and I purchased a basic binocular instrument which was head and shoulders more sophisticated than the scope provided by the medical school. I carried it though Europe and placed it on my desk in Dundee. I borrowed a teaching set of Pathology slides and started my wonderment of that microscopic world.

I finished my medical schooling and started my six-month internship at the Aberdeen City Hospital. Within a few hours of entering the ward to which I was assigned there was a clamor in one of the rooms: a woman had been brought in (we had direct admissions requested by the family doctor as we did not have an emergency room) with a high fever, a total body red rash and a stiff neck. As the sister (head nurse) watched my examination I said, “I think it is meningitis” to which she responded with the one word, “aye” and instructed the staff nurse top bring a lumbar puncture kit. Meanwhile, I inserted an intravenous line to help with hydration and to give a portal for medication if necessary.  As the nurse opened the kit and helped me on with the gloves and then positioned the patient in a curled up position thus exposing her vertebral spines I whispered to the sister, “I have only done this once” to which she said, “You’ll be fine.” The needle pierced the spinal ligaments and then there was the quiet pop as it entered the subarachnoid space: as I pulled the stylet out, fluid gushed with such a pressure that I was not able to measure it with the supplied manometer. I filled a couple of test tubes and put some fluid on a couple of glass slides and sent the sample to the laboratory. I went to the side room that had a basic microscope, stained the slides with H & E (hematoxylin and eosin) stain. As I peered down the microscope, I saw the tell-tale small round strings of darkly stained organisms typical of streptococcus.  I asked for intravenous penicillin which was put into the intravenous medication port and ordered the speed of the “drip”. By the next morning the temperature was down and she was awake and alert.

That afternoon a three-month-old was brought by her mother, begging us to “save her, she will not eat or drink and is burning up”. The charge nurse took the “bairn” (Scottish for child) into a room and after a short examination I said to her “I think she has meningitis” and then asked for a scalp vein intravenous set. I had enhanced my scalp vein size needle insertions working that previous summer in a Copenhagen government standards lab by taking blood from the tail veins of mice to test for pathogens in intravenous fluid sets. The nurse curled the infant into almost a ball, the needle went in, the quiet “pop” was heard and the fluid came out with a high pressure that I could measure with the manometer. As the previous day, the sample was sent to the lab and I took two slide samples: which showed H. influenza. I asked for chloramphenicol to go into the antibiotic chamber in the IV. By morning she was cooing and looking for food. The mother came early in the morning and was beside herself for joy. I realized that in the first two days of my first internship I had actually been instrumental in saving two lives—I was on top of the world.

I had other experiences where the microscope was key to my diagnostic ability and unlike the situation when I did my next house-job in Boston, I had one available to me on the unit so I did not have to wait for the specimen to be sent to and reported from the lab. One day we were told we were getting an elderly woman transferred from the Outer Hebrides, the collection of islands off the west coast of Scotland. She was, a bit delirious and very pale. There was nothing specific on her examination and blood was sent to the laboratory. Because of her very pale appearance I took a blood sample to look under the microscope. I was surprised by the appearance of hyper-segmented leucocytes and the large red blood cells. I remember that the white cell appearance was characteristic of pernicious anemia but the white cells had also those suggestive of an infection.  When her vitamin B12 level came back it was very low, and her blood culture was positive for streptococcus. With Antibiotics and large doses of vitamin B12, her condition gradually improved with anemia taking a bit more time than the infection. She turned out to be a spry elder with a marvelous accent which I could hardly understand: what I learned from her was the power of the microscope.

Later on in the internship, I admitted a teenager with a very sore throat and high fever. Her tonsils were full of white patches and her neck lymph nodes were enlarged and tender and her spleen was enlarged and she had a rash.  Because of the throat appearance and fever her physician had assumed it was strep throat and treated her with the new broad spectrum antibiotic ampicillin. I took blood samples for the lab and also but some on a couple slides for a look under the microscope. There was the typical appearance of large monocytes seen in mononucleosis, the many lobed leucocytes: the rash was typical of what became known in such patients treated in particular with ampicillin. My time in Aberdeen was ending. The microscope experiences had served me well. Knowing I could not carry it around with me I sold it to an Aberdeen medical student, with the hope that it would serve him as well as it served me.

After 6 months of pathology at the Hadassah Hospital in Israel where I moved after my time as a medical resident in Montreal I entered the Israeli Air Force as a physician-officer. I served for a year and a half with the preceding 6 months being spent looking down a microscope for most of each day. On the air base where I served there was a medical clinic which other than basics had an old but usable microscope. Its most dramatic use came from examining the genital sample of a higher-ranking officer (I was a second and then first lieutenant) who complained of a “drip.” He came to see me at a very early in the morning meeting at the clinic. I could see as he pulled his pants down the stains from his secretions on his undergarment and put a sample on a slide which I stained with H&E and looked down the scope. My two medics were waiting patiently to look down the microscope where I showed them the gonococcus. I then explained to the shock of the captain that one of us would have to tell his pregnant wife and that she would have to be screened by public health and that he had to refrain from sex while he completed a course of penicillin, He was mortified and at one point used the term “that slut” to describe the female soldier from another base who also had to be referred to public health. The two medics where exhilarated by their microscope experience.

I finished my military service and entered my medical residency in Jerusalem: I was known as the resident who was often in the lab to look down the microscope at samples such as gram stains of sputum. My first medical paper was on the use of the gram-stain as a diagnostic tool in deciding on antibiotic choice in lower pulmonary tract infections.

Peering down the microscope was and has continued to be an exciting thrill for me.

Dr Gordon is a geriatrician and ethicist; formally medical director and head of geriatric medicine at the Baycrest Health Science Centre in Toronto. He trained in medicine at the University of St. Andrews in Scotland and in medical ethics at the University of Toronto. He has traveled and lectured widely and is a medical writer having published a number of books the most recent ones being Parenting your Parents: Straight talk about Aging in the Family—co-authored with Bart Mindzenthy.