Terrible Beauty

We call these "signet ring" cells, because they look like rings viewed from the side.  Pretty description, pretty cells-  bad, bad cancer.

And it’s back to the Chinese Buffet for more Fortune Cookie fodder. Fortune cookies, I am learning, are a great source of inspiration for blog posts, when life seems too mundane to discuss, and when the brain seems to be lacking in wisdom to dispense.

Today's fortune:

“Everything has beauty, but not everyone sees it.”

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During the course of my workday, I frequently pop into my colleague’s office with a glass microscope slide in my hand.

“Look at this. It’s beautiful,” I’ll say.

It is invariably a cancer of some sort.

Cancer cells are basically cells that are growing on their own, who refuse to listen to the body’s signals and that invade into the normal tissue that surrounds them, get into the bloodstream like seeds carried by the wind, to land somewhere far away and grow more cancer. Mean, nasty cells.

Cancer shouldn’t be beautiful under the microscope. It should be ugly, and hurt your eyes to look at. It should be a great big blob of gray mush. But it’s not.

Under the microscope, cancer is pink and purple, because those are the colors that we use by convention to stain the cells so we can see them. Pink for the outside of the cell, the cytoplasm, and purple for the core, the nucleus. Pretty pastel colors, like Easter eggs.

Normal cells, cells that aren’t cancer cells, look like each other. They are orderly, and respect their neighbors’ space. Cancer cells, however, can be arranged in a marvelous array of patterns: swirls, whorls, bundles. They can march all over the microscope slide in straight little lines, and encircle nerves and blood vessels. They can make stars, bursting out into the tissue (cancer, of course, means “crab”- these crablike projections, these starbursts, are very characteristic of many cancers). The cells themselves can assume all kinds of fantastical shapes and sizes.


Pathologists, the ones that I know, acknowledge the fact that the things we find most attractive under the microscope are often the most deadly. The mass of long, spindly cells that have arranged themselves almost like the sky in Van Gogh’s “Starry Night” is a sarcoma, a tumor of muscle, nerve or fat, a tumor that has grown deep inside the patient’s tissue, sometimes reaching massive sizes before they’re found— discovered too late to stop the tumor cells from traveling into the lungs, or the brain.

I think that we pathologists also ask “why?” Why does “Starry Night” have to be such a horrible disease?

“Why” made me a pathologist. I wanted to know, needed to know why a person was damaged…why their lungs couldn’t take in air….why their heart ultimately stopped. I wanted to be able to trace it down to those cells down there, to the ones with the messed-up DNA. There. That’s why.

But some of the “Whys” still evade me. Why pretty cells make ugly diseases. Why wonderful people get ugly diseases.

Why don’t I know? Why can’t I know?

I must accept that all of my “why”s will not be answered.

I believe that it’s not meant for me to know.


Where were you when I laid the earth's foundation? Tell me, if you understand. Who marked off its dimensions? Surely you know! Who stretched a measuring line across it? On what were its footings set, or who laid its cornerstone- while the morning stars sang together and all the angels shouted for joy? (Job 38: 4-7 (NIV))