Francisco Gonzales-CrussiRetired Professor of Pathology, Northwestern University Medical School; Head of Laboratories, Children's Memorial Hospital, Chicago, USA

Interview location: His Chicago apartment overlooking Lake Michigan
Interview date
: 14th November, 2007

Key Themes: Attributes of a Pathologist, Autopsy, Children,  History of Pathology, International Perspective, Life, death and the hereafter, Mentors and Influences, Motivation, Relationship with clinicians

Profile | Transcript Summary | Full Transcript


Section 1

  • Talks about his origins in a poor neighbourhood in Mexico City.  Relates how inspiring teachers at school, and later university, encouraged him to study medicine.
  • This was at a time when pathology was in transition between the European approach and that of North America; two major ‘role models’ at his medical school embodied this shift.  He appreciated the erudition and knowledge of the first, and the challenging and enquiring mind of the second.  “All of a sudden I saw that there were two worlds: one, the old world of the erudite, complex classifications...very elegant, very impressive; and another which saw through this tangle of things into what was more essential.”
  • Relates how his father died when he was 10; his mother, as he acknowledges, “sacrificed herself” for him.  Credits another episode in his life with opening his eyes to a world beyond his neighbourhood: he won a French government competition that took to Paris for a few months. “Never having left my neighbourhood of Mexico City... And all of a sudden finding myself in France -- it was an experience I will never forget.”
  • Describes being befriended by a Jewish family recently arrived from Poland, who introduced him to the riches of reading.  “They brought with them this tradition of 'you respect the man who knows'."
  • Besides these outside forces, he acknowledges how his own personality influenced his path in life.  “I wanted to study medicine, but at the same time I was a little bit afraid of practising medicine.”  He found the responsibility of direct care and responsibility for patients “an unbearable emotional burden”, so he decided to go into pathology.
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Section 2

  • Starts as a pathologist in Mexico City:  “It was the pathology of poverty.” Makes the point that many of his colleagues and teachers had been trained in North America,“ so the systems were very good.  The resources of the institutions were more limited because of the poverty of the third world.”
  • Despite the impressions that his writings have given his readers, a preoccupation with death played no part in his decision to become a pathologist.  “[Pathology] is intrinsically very interesting and… it is really the foundation, one of the sustaining pillars, of medicine.”
  • He then reflects upon what he has learned from working with the dead.  In his view it gives one more than a purely intellectual understanding of death; it is “the understanding that touches the heart.”  As he says, “It perhaps gives me a greater sense of the fragility of life…  But having said that, I, like every human being, tend to forget about it!”
  • Remarks that although he has written on many topics, including love, the topic that he is so often asked about is his view on death.
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Section 3

  • Outlines some of the avenues a pathologist’s career can take.   First, he can become a diagnostician, “which in itself takes a whole life because the explosion of knowledge has been so great.”  This is mainly what he did: “If one becomes proficient at diagnosing, adept at reading biopsies, it is very satisfying, and you know that you have done something for the patient.”
  • Another avenue is teaching, which he also did.  Discusses at length the whole issue of developing a ‘good eye’ in trainees, but much of this cannot be taught:  There are “people who may have tremendous abstract reasoning… excellent memory and be excellent in many aspects, but don't have a 'visual intelligence' and so they don't become very adept at the microscopic interpretation.”
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Section 4

  • Describes how when he came to the USA, opportunities opened in paediatric pathology, which was at the time a developing field.  One reason why it had been slow to develop as a sub-speciality was that people thought that children “were just adults in miniature”.  The pioneering work of Edith Potter in the 40s and 50s put paediatric pathology on the map.
  • He focused particularly on tumours in children and teenagers, and discusses in considerable detail the phenomenon of teratomas, on which he wrote “a text atlas, sponsored by the Armed Forces Institute of Pathology”
  • Discusses how, had he taken up the third avenue for pathologists, research, he may have looked into the root causes of teratomas.  But this was not his field.
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Section 5

  • Talks about how advances in technology, such as genetics and fetal surgery, have raised the profile and significance of paediatric pathology.  “There will be some diehards who say they… can do everything, adults and children.  But the right thing to do is to have people devote all their attention so that they can see the singularity of paediatric pathology.”
  • Describes how, throughout his years in practice, he worked alongside the surgeons during operations.  Expresses some regret at changes in practice whereby pathologist and surgeons today are often not even in the same building, but communicating by computer.  “Somehow I think that when you lose the personal contact you lose something else.”
  • Mentions that one of the things he appreciates about pathology is that there is often time to consult with colleagues in reaching a diagnosis. “The pressure is not as great as for the surgeon who has to make an instant decision… and the wrong decision may have disastrous consequences.”
  • Expresses regret that at the end of his career the balance between administration and practice of pathology shifted to the former to such an extent that he decided “it was better for me to quit.”
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Section 6

  • Discusses the various reasons for the decline in autopsy rates in the US.  Chief among them he believes are financial considerations.  “The health scene [in North America] has become a health industry…It’s become like a business.” The situation is less critical in paediatrics.  “There are so many things that are still unknown that even the physicians feel the need to request autopsies.”
  • Believes this decline is a “negative” development.  For one thing, “there are new diseases that can only be known by securing tissues and doing all the studies that an autopsy allows.”
  • Other factors in the decline of autopsies he cites are fear of litigation, the “arrogance” of physicians who believe that new technology gives them all the answers, despite studies which show this to be erroneous.  Furthermore, the autopsies tend to be delegated to the least experienced pathologists and the quality of reports can sometimes suffer. “In some institutions there is a multi-tiered structure of pathologists.  Number one is the researcher, then of course the prominent service people, and the autopsies are way down.”
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Section 7

  • Discusses how the system of internships has developed over time and his particular experience as an immigrant to the USA.  Describes the ups and downs of his early career.
  • Talks about his family’s shop in Mexico City that his mother took over after the death of his father.  “It was like the ancient apothecary shops, a tiny little thing in a corner where we sold all kinds of traditional medicine.”
  • Reflects on the poignancy of emigrating.  “It's a difficult thing to leave your home, your country, your language, your traditions, your friends, no?  It's always traumatic.”  Despite the sadness, it’s “an invaluable experience.  You see two aspects of life; two ways of looking at life; two universes, which are completely different...It gives you a broader perspective.”
  • Talks about how, while performing autopsies, he is conscious of the story behind the medical facts.  His sensitivity to the bigger picture is one of the motivations for his writing.  “If you really were going to write a full report about the cause of death, it would be like the novels of the seventeenth century.”



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