The lifeblood of medical care

By Amy Reiswig, June 2012

When we get very sick, Dr. Brian Berry and his hematopathologist colleagues provide the behind-the-scene search for the cause.

Lifeblood. It’s a term used as a metaphor for importance: trust is the lifeblood of a relationship; free speech is the lifeblood of democracy; cooperation is the lifeblood of community. Someone for whom such a designation is truly apt in terms of our local community is hematopathologist Dr. Brian Berry, MD.

Hematopathology is a branch of diagnostic medicine in which blood is analyzed for disease. Those vials that get slapped with a bar code and sent who knows where when you’re having tests done at the Royal Jubilee Hospital or, in about half the cases, at LifeLabs—end up in Dr Berry’s lab.

From Rosemere, Quebec, Berry came to the Jubilee originally interested in studying cardiology. His studies took him to New Zealand and Calgary before bringing him back to Victoria—with a changed interest—where he has been working since 1992. Of his two specializations—anatomical pathology and hematopathology—Berry says, “The diagnostic part always interested me. I always enjoyed seeing patients, and I still do. But I love the technology. For instance, molecular technology often starts off in hematopathology, so we’re at the forefront.” And despite the quite astounding array of complex, costly and, to the layman, mysterious devices there on the fifth floor of the Royal Jubilee, the serious-science-lover Berry is keen to emphasize that “The lab is a medical practice. It’s not just machines spitting out numbers.”

As Director of Hematopathology, Berry is responsible, along with his colleagues, for most of the routine and all of the specialized lab testing of blood for all of Vancouver Island. In fact, there are only three hematopathologists on Vancouver Island. But that doesn’t mean they slavishly spend their entire workdays, from 7:30 am to 6 pm, hunched over microscopes peering at slides. If you get a complete blood count (CBC) done, for instance, the vial siphoned off from your arm is processed with spectacular speed and accuracy by an amazing small-room-sized robotic system, with parameters set by Berry.

In terms of the more specialized blood testing, the unflappable Berry says: “We see everything. We see nothing that’s normal—nothing that’s even mildly abnormal.” Which means: what passes under his eyes is the very abnormal, the most serious, and therefore from very nervous and scared patients waiting for results.

While Berry sometimes sees weird tropical diseases—“the occasional malaria to get people excited and wishing they were somewhere sunnier,” he quips—the lab’s main focus in terms of specialized testing is lymphoma and leukemia, which they see daily, as well as bleeding disorders, of which there are many besides hemophilia (which he says is actually fairly uncommon). Berry also performs about 600 bone marrow biopsies a year, something which he says makes his wife, an ICU nurse, feel sick just hearing about.

“I think telling people their diagnosis would be far harder,” he reflects of front-line physician duties. “Some days I do go home and say ‘You know, guys, life’s not bad. Today I diagnosed a 12-year-old with acute leukemia.’” With three kids of his own, all in university, he is aware of how precious health is.

And he acknowledges the incredible responsibility his job carries. “You don’t want to, you can’t, make an error on a patient’s diagnosis because that can be tragic,” he said, noting the scandals of misdiagnosis in Newfoundland, Ontario and other provinces due to errors in pathology reports. “I’d say 80 percent of physician decisions—that doctor trying to diagnose your elderly aunt or your young daughter—are based on lab data in one form or another. The expectation from physicians is that there are no mistakes coming out of the lab, because the next step—like chemo—is something that could kill you.” 

 When I am not at my best on the job, through not enough sleep or not enough coffee, the kinds of mistakes I might make—spelling blunders, lost notes or a bad misquote—can be embarrassing and breed misinformation, but are not life-and-death. That kind of fatigue- or distraction-based human lapse, however, is not something someone like Berry can afford to allow. “Do we think about that every time we make a diagnosis? No. It’s there. It’s just part of the operating system.”

Aside from his role in making diagnoses, Berry also oversees the blood bank and is heavily involved in transfusion medicine. “There are 26 different blood components,” he explains. “Mostly they transfuse blood and not the 25 other things,” but transfusions can be way more complex than the routine use of blood or plasma. And it’s not only complex; it’s expensive, as BC spends over $150 million a year on blood services. “That’s huge money,” Berry admits, “so it has to be used wisely.” 

Berry, a blood donor himself, is therefore also working in transfusion safety—what products to use, when, in what way—so as to prevent over-transfusing, under-transfusing, transfusing with the wrong thing. He is involved with provincial and national committees and projects, such as a database for transfusion-error surveillance, which he says is “the cutting edge of injury and adverse event surveillance” and can help blood products be used in what he calls “a more rational way.” 

So the next time you roll up your sleeve, whether to give blood willingly or through doctor’s orders, rest assured there are professionals like Dr Berry to oversee where that precious substance goes and what it might tell you. As he asserts, his job of “diagnostic lab medicine is the infrastructure”—he might have said the lifeblood—“for medical care.”

Writer Amy Reiswig notes that June 11-17 is National Bood Donor Week in Canada. Don't be shy—you might save a life.