Master Sgt. Randy Knotts looks at a skin specimen through a microscope at the 48th Medical Support Squadron's anatomic pathology wing at RAF Lakenheath. (Ben Murray / S&S)
Master Sgt. Randy Knotts looks at a skin specimen through a microscope at the 48th Medical Support Squadron's anatomic pathology wing at RAF Lakenheath. (Ben Murray / S&S)
A tissue sample showing signs of thyroid cancer as seen in a "histology photomicrograph" or microscopic picture of a cell sample analyzed at the anatomic pathology wing of the Lakenheath Medical Center. (Courtesy of the U.S. Air Force)
The tools used in the RAF Lakenheath morgue aren't pretty, nor do they have pretty purposes. Most are for the removal and disection of large organs such as the brain, liver, lungs and heart. (Ben Murray / S&S)
Master Sgt. Randy Knotts, NCOIC of anatomic pathology for the 48th Medical Support Squadron, removes a bone saw from a cabinet in the RAF Lakenheath morgue. (Ben Murray / S&S)
UK weekly edition, Wednesday, June 6, 2007
RAF LAKENHEATH
Maj. Steven Davis rarely sees more than tiny pieces of the people he helps treat at the Lakenheath Medical Center — and many of those he does see in the flesh are dead.
As chief of anatomic pathology for the pathology flight of the 48th Medical Support Squadron, Davis has a unique, dual-layered job for one of the medical center’s lesser- known flights.
Located in a small outbuilding of the hospital, the anatomic pathology lab is the place where little pieces of patients go to be studied and analyzed for potential abnormalities when diseases are suspected.
Slices of irregular moles, samples of lung tissue, cervical biopsies, bits of gall bladders, lumps of known tumors — the pathology lab is where these things go to be scrutinized for diagnosis and treatment possibilities.
“They call us the doctors’ doctor,” Davis said recently. “A lot of what we do is behind the scenes.”
If a patient finds a breast lump, for instance, a doctor may take a sample of it and send it to Davis’ lab.
Before he can make a diagnosis, however, the sample has to be prepared for analysis in a detailed process overseen by Master Sgt. Randy Knotts, noncommissioned officer in charge for the flight.
First, the sample is taken to the “gross room,” where it is sliced into small, thin slices in a process called “breadloafing,” Knotts said. After that, it’s run through a series of chemical solutions, including formaldehyde, alcohol and citrus oil, over a 24-hour period, then embedded in wax. The wax makes it easy for technicians to cut the sample down to extremely thin slices — about 5 microns in width, or about half the thickness of a red blood cell, Knotts said.
Finally, the sample is run through a series of dyes that make the nuclei, membranes and interior of individual cells visible on a microscope slide.
Mostly, these slides — with little purple blotches on them — are what come to Davis, who said he looks for certain anomalies to make a diagnosis. Atypical cell growth, larger cell concentrations and dark patches in the tissue can all be signs of certain diseases, including various forms of cancer, Davis said.
That kind of analysis is the bread and butter of the anatomic pathology’s work — they process about 3,000 tissue samples a year — but the office does have the capability to do more cutting-edge work, Davis said. One capability includes a fast sample preparation process that allows Davis to analyze a tissue sample while a patient is actually in surgery.
In these “intraoperative consultations,” a doctor may open a patient’s lungs, for instance, take a tissue sample and have it run down to Davis, who can then quickly prepare it and diagnose whether it is benign or malignant — a determination that can radically change the course of the procedure, he said.
Within a short span, “We can get them an answer on whether or not it’s cancer,” he said.
But while the anatomic pathology department helps patients live, it also has a far different responsibility — taking care of the dead.
Davis and the technicians are also responsible for the base morgue, where bodies are occasionally held before burial and where, once in a great while, the staff performs an autopsy.
The latter activity is far less frequent since a new coroner took office in Suffolk, staff members said. The British coroner prefers that his staff conduct autopsies in most cases. But the Lakenheath staff members still do hold four to five bodies a year in the morgue between death and the funeral home.
In some ways the operation is a little like the popular crime scene and hospital-based TV shows where doctors and investigators use medical evidence to find out what killed someone, or what’s wrong with them, but much of what is on TV is hyped up for entertainment, Davis said.
“What’s most important to us is customer service, just like anywhere else in the hospital,” Davis said.
Ready if needed to care for dead
RAF LAKENHEATH — The back room in Building 926 at RAF Lakenheath is a little bit colder than the rest.
The walls are a nondescript gray and the light is mostly artificial because the shutters are pulled, but it’s that temperature, the hanging scale and the simplicity of the two cool, steel tables that give it its distinct identity. This is the Lakenheath base morgue.
Morgues often have a certain morbid fascination attached to them, and this one has many of the elements people associate with the temporary holding areas for the dead.
There is a tall, white refrigerator on one wall kept at 5 degrees Celsius (41 degrees Fahrenheit), with three stacked, sliding, human-sized plastic trays inside.
Banks of aged cupboards, equipment and cases of chemicals line the other walls around the two central steel tables. One is mobile, for moving bodies from one place to another, and the other is fixed, with higher sides and a drain in the center. That one is for autopsies.
It’s a pretty small room, actually, but it fits the demand of the medical center, said Master Sgt. Randy Knotts, noncommissioned officer in charge of the anatomic pathology flight for the 48th Medical Support Squadron, which runs the morgue.
The morgue only handles about four to five bodies a year these days, and an autopsy hasn’t been performed there for more than two years, he said. Because a local British coroner has jurisdiction in determining causes of death even for people who die on base, most autopsies are done by the British coroner’s staff, said Maj. Steven Davis, chief of anatomic pathology for the flight.
But if they do have to perform one, the morgue has on hand a set of tools that even Knotts said look specifically designed to scare children.
An electric bone-cutting saw; a set of thin, curved metal tongs; a square-headed hammer with a hook on the handle; tissue grips, and a long, straight knife for slicing organs. One T-shaped tool called the “key to the head,” is for tapping open a pre-cut skull, Knotts said.
It’s all part of an apparatus for handling a deceased person that can leave some people feeling squeamish, but Davis said he doesn’t get queasy over dealing with corpses.
Doctors are introduced to cadavers very early in their education, he said, and an autopsy is like an investigation.
“You’re focused on what your job is, and you’re focused not so much on the blood and guts as you are on how this person came to die,” he said.
— Ben Murray
