Browse By

Provocations on Infrastructure: Flow

Where is that mysterious place that we send all our “labs” to? Everyday, we round and round on the wards, wake up patients, and poke and prod them to get an idea of what they have and get a sample of their tissue. As the day goes on, we send a constant stream of patient samples to the “lab.” We do this so that we get the data through which we can diagnose their disease. In our medical school classes and exam questions, we are provided with lists of numbers that in magical combinations spell out certain disorders, but rarely do we question from where these numbers originate. The lab values just materialize on our charts. Who measures them? What happens to the samples? Even more mystifying – as few are privileged to set foot in the “lab” upon which our medical enterprise depends – is where this special place is. Like the flight data recorder or “black box” for the airliner, in hospitals we have this “black box” of the pathology lab.

I would encourage you to pay a visit. If you are familiar with a research lab, or indeed have any experience in a high school science lab, you already know what to expect. There are benches where scientists work, with various containers and liquids that are poured back and forth, combined, plated, and grown. Different colors have different meaning, and sometimes drops of bodily fluids are put on little rectangular pieces of glass and viewed under the microscope. Somehow, the mysteries of the human body are gradually elucidated through chemistry. The patient samples we take are thus transmuted into numbers. This familiarity, however, should not preclude you from visiting the “lab.” It is more than a factory that just spits out lab values.

Pathology, after all, is the study of diseases. It’s the basis of the entire medical enterprise, the scientific foundation of the craft of healing. The “lab”, then, is like a fount of knowledge from which we imbibe; it’s a perpetual spring from which medical knowledge flows. This is the reason for our pilgrimage.

From the drawing of the pathology lab, we can see “modules” in this black box that is dedicated to particular studies, from hematology and urinology to histology and bacteriology. Just as there are doctors for the lung and for the heart, there are pathologists who specialize in looking at blood, culturing bacteria, and examining slices of human tissue under the microscope. In any one of these modules, the entire patient population of the hospital is condensed into 100 square feet. Tubes and tubes of blood line the shelves, and petri dish towers cover the benches, growing entire ecosystems of bacteria ranging from antibiotic resistant staphylococci to the Strep bacteria that causes sore throat. These “modules” are like different filters through which we look at patients. In one mode, we see patients as the various blood cells that run through their veins. In another mode, we might see all patients as solutions of electrolytes at varying concentrations, much like gigantic – and walking / talking – bottles of Gatorade.

Imagine the lab space, then, as an alternative kind of social space. Instead of a giant party of patients, the lab is a giant party of human cells and microorganisms. It’s a massive library or archive of diseases, where books are constantly acquired, read and transmitted, and then stored. We can also look at it as a museum, where instead of artworks, we get parts of “life,” condensed as cells, on display. Through microscopes and other imaging techniques, we peer into the depth of the body in the pathology lab. Forget about the beautiful pictures in “Humans of New York.” Come see the beautiful slides in “Human Pieces of the Hospital of the University of Pennsylvania.” Diversity finds an alternative form in this “black box” hidden in the depth of the clinic. The box tracks the flows of human movement through the hospital, and in turn a stream of knowledge and data bursts forth.

Consider for a moment, then, all the flowing elements that make this museum of disease, “The Pathological,” possible. Life continuously flows through the space:  one, there is the life of the patient. Water and air, the elements that sustain life, flow through this space and keep it afloat. Electricity powers the microscopes and instruments that process and read the specimen that stream into the laboratory. Supplies like test tubes and petri dishes are constantly used and disposed of. The Pathological is a microcosm of the hospital, processing the constant ins and outs of life, and recording – like the “black box,”  the flow of life itself.