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Dr. Yolanda Oertel ...

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Dr. Oertel

Profiles in Cytopathology

Andrea Abati, M.D. Bethesda, Maryland

The first time I was fortunate enough to meet Dr. Yolanda Oertel was in September of 1989. She was invited to speak at the First Annual Kathryn Hinnant Memorial Lecture at New York University Medical Center. The Pathology department was completely buzzing with the excitement of having an FNA legend in our midst – we were young and enthusiastic and could not wait to hear what she had to say. She spoke to us about Thyroid FNAs. I remember her talk as though it was yesterday – her conversational tone, logical approach, tremendous sense of humor and ability to laugh at herself made the talk unforgettable.

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After the talk there was a dinner in her honor with all of the faculty members. Yolanda insisted on sitting with the residents and young faculty members and laughed with us when we discovered that “veau” was sweetbreads and not veal!!! We were completely mesmerized with her “True Stories in Cytology” and her “Lessons for the Girls” (“….. money is power….I hate to cook ….”). None of us who were there will ever forget the talk or the dinner. Yolanda had absolutely charmed New York.

After a hiatus of about 15 years, it was once again my good fortune to spend time with Yolanda. My initial impressions had not changed one bit, and she looked exactly the same! She is a dynamo - bright, driven, enthusiastic, and incredibly focused as well as funny and self effacing. Her career is going gangbusters at the Washington Hospital Center where she has her own FNA clinic (something she has always dreamed of), and she shows no hint of slowing down. Her private life is as busy and as fulfilling as her professional life. Only one word describes her – WOW. What a person. What an inspiration.

We are truly lucky to have Yolanda as a member of the PSC. Her dedication to the field and her interest in the propagation of FNA has led her to create and fund a new and unique annual prize – “The Interventional Cytopathologist Award“. Although the details are still in the planning stages, this annual award will go to cytopathologists that are in the trenches aspirating lumps and bumps, with the hopes that others in our field will be inspired to incorporate more of this into their practices.

The following are excerpts from my delightful conversation with Dr. Oertel:

What was your early career like?
I went to medical school in Peru and originally trained there in Pathology under Dr. Javier Arias-Stella. I came to the USA in 1966 to do an NIH fellowship at the AFIP. I met my husband James at the AFIP in the cafeteria! James was born in Baton Rouge, LA., graduated from LSU, did his Pathology training at the University of Rochester, NY, and spent his professional life at the AFIP where he became Chairman of Endocrine Pathology.

Favorite cooking story:
Whenever we eat at home, it is a “home assembled meal” cooked somewhere else . When I retire, I will write a book about my misadventures in the kitchen. A friend told me that if you know how to read you know how to cook. That is not true. James loves muffins, so I bought a box of Hickory Farms’ wild rice muffins. I read the instructions at least twice and followed them closely. The muffins smelled and looked great, but we could not eat them. We were afraid to break our teeth, because it was like chewing lead pellets. Trying to figure out what I had done wrong, James asked me if I had followed the recipe, which I had. He asked me if I had cooked the rice. I had not, because nowhere did the recipe mention to cook the rice. He said everybody would know that. I guess I am not everybody.

Hobbies and non-medical interests:
I am an avid reader. I go through stages: re-reading the classics, fiction, biographies, mystery stories, poetry; you name it... A book I could re-read anytime is Man’s Search for Meaning by Viktor Frankl.

Spanish is my native tongue and I enjoy the work of Latin American and Spanish authors. I have read almost the entire works of the Peruvian contemporary writer Mario Vargas Llosa. Believe it or not, through his writings I became acquainted with the work of Isaiah Berlin, who has become one of my favorites.

Both James and I are very fond of music and opera in particular. We have attended performances of The Washington Opera for over 30 years and have become more involved in the last ten. We have met some of the singers and Placido Domingo and his wife. We were early supporters of Washington Concert Opera and also of Opera International. Since we moved to Virginia, we have attended performances of the Opera Theater of NorthernVirginia. We are founding members of the Vocal Arts Society (James is in the board of directors) and have met budding artists who later became stars like Renée Fleming and David Daniels. Among our other interests: The World Future Society; we helped revive the local chapter many years ago.

Why you love FNA:
You can solve so many problems, you can help so many patients, and you can help your colleagues practice cost effective medicine. In 1993 we published an article regarding this in the Southern Medical Journal (Vol 86, 282-284). Like many other pathologists, I chose the specialty because I did not want to see patients, but enjoyed the intellectual challenge of medical practice. For the last 51/2 years all I do is see patients and perform FNAs, and I have never been happier. I feel so useful, needed, and appreciated. I have a wonderful time with my patients. At WHC the medical director has received many letters from my grateful patients, and I have received several BRAVO awards. I have been given a plaque for “consistently delivering outstanding patient care,” which hangs on the wall of my FNA waiting room. It is one of my prized possessions. Having lived in the Washington DC area for 36 years and aspirating for close to 30 years, I meet former patients on the subway, at concerts and the Opera at the Kennedy Center, and at the movies. Sometimes it seems really incredible to me that I have aspirated so many patients, over 6,000 at the WHC, since I “retired” from GW and I don’t remember how many thousands I did at GW.

Best FNA story:
Over a year ago, an elderly Chinese man was referred to Dr. Leonard Wartofsky (chairman of Medicine at Washington Hospital Center), for a second opinion. He was already scheduled for surgery at a prestigious academic institution with a presumptive diagnosis of anaplastic carcinoma of the thyroid because of a firm mass in the right neck and supraclavicular area. As usual, he called me and asked if I could aspirate a “walk-in.” I performed 5 aspirates and could see no evidence of carcinoma on the wet smears. Cytologically, it was an organizing hematoma. I proceeded to ask for more details about the presence of the mass. The daughter of the patient (a pharmacist from NY City) was the interpreter. The patient had noticed the mass “after a car accident.” His wife had been driving and he was the passenger. I signed out the report as “Organizing hematoma” with a comment that it was secondary to seat belt injury. The surgery was canceled. Four months later, the patient and his daughter brought bottles of cognac as presents for Dr. Wartofsky and for me. When I touched his right neck, the mass was gone. They were surprised that I could remember which side the lesion had been on. How could I forget?

FNA horror story:
During my early days at GW I had a patient with a thyroid lesion. After the first needle stick the patient told me “I am dying,” and I believed her. I asked the cytotechnologist helping me to call the “RT” (Resuscitation Team). She left the room and later I learned that she had told the secretary: Dr. Oertel has asked me to call Artie and I don’t know who he is. After this experience, I made sure that everybody in the FNA service knew how to contact the RT (at the WHC we refer to Medical Response or to Code Blue). Every telephone has a red sticker with the appropriate number; every employee helping with patients has received CPR training, etc. I have been scared or startled a few times. For example, when aspirating a thyroid nodule on a patient whose beautiful, long hair (a wig) fell off, and all of a sudden I saw a bare head on the aspiration table. A couple of years ago, we had to move a patient off the examining table and place her husband on the table because he was fainting!

Most important professional accomplishments:
I worked in an academic institution for 25 years, so I have taught Surgical Pathology and Cytopathology to many young people. I do consider myself first a teacher and then a diagnostician. I believe that I have helped establish in the Washington, DC, area the diagnostic value of FNA. I retired from GW (Professor Emerita) and was hired by Dr. Mary Kass at the Washington Hospital Center to concentrate on the performance of FNAs. She is now president of the College of American Pathologists and has asked me to lecture on “How to Create a Successful FNA Clinic in the Pathology Department,” at the CAP annual meeting in September, 2004. I feel very fortunate that I have earned the respect and professional recognition of my colleagues; they make me feel needed and valued, and that keeps me going. As a foreign medical graduate, one of the highest honors I have received is to be appointed by the American Board of Pathology to the Cytopathology Test Committee.

Hopes for the future of the profession:
I do hope that before my time to “check-out” comes I will see many more “interventional pathologists.” There is such a tremendous need for our services. Patients are waiting 4 to 6 weeks for an appointment and I am aspirating 100 to 140 patients per month. What else can I tell pathologists to convince them to join the ranks of “aspirators?” We are not utilizing FNA to its full potential.

Advice to those pathologists who would like to get more involved in doing FNA for the community.
Approach those surgeons with whom you deal most frequently. Also, find out who are the busiest surgeons in your hospital and explain to them how you can help them. Make yourself available. Provide prompt and concise reports. Needless to say, you have to have training on how to perform the procedure. Make sure your patients leave the aspiration room feeling better than when they came to you. Word of mouth from satisfied patients is the best advertisement or marketing tool.

Advice to those of us who would like to convince endocrinologists to stop sending us 30 slides of blood
Encourage the endocrinologists to come to your laboratory and look at the smears from the aspirates they have performed. Then show them smears that are cell-rich; it will not take them long to see the difference. Keep nagging them, at every opportunity that you have, that they should not apply too much suction.

Anything else you would like to say in a public forum…
If you think your clinical colleagues are not going to let you perform aspirates, then it will not happen. If you choose to believe otherwise, you will be able to do it. I am living proof of it. Work hard, do the best you can, go gradually, be persistent, and keep learning. Remember that having an MD is not enough. If you are going to succeed at FNAs you have to get a PhD in humility. Be aware that you are going to make mistakes. I tell my residents that the only people who never make mistakes are those who never do anything. Your mistakes in surgical pathology might take a long time to catch up with you. But, if you make a mistake in FNAs, everybody will know right away. Hence, you have to work at building a strong team or becoming a member of a strong team. When everybody looks after everybody, the inevitable mistakes will be few and far between. If you are truly committed to helping patients, this will come across; the patients and referring physicians will know that you want to solve the clinical puzzles. I hope my errors will be forgotten or at least forgiven. My top priority has been uncompromising and outstanding patient care. I have demonstrated this over many years of practice (my actions speak louder than my words).

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