Pathologist Curing Cancer, Performing Autopsies

Brent Staggs, MD, answers his cell phone and says he can meet any time the next morning. During the hour-long interview, he seems unhurried answering questions about everything from his profession to his children to his love of golf.

That kind of easy availability is rare for a medical professional, most of whom are booked with patients weeks in advance.

But Staggs’ job isn’t like most medical professionals.  A pathologist with a specialty in hematopathology and a fellowship in gastrointestinal pathology, Staggs comes to work each day at Pathology Labs of Arkansas in Little Rock with stacks of cases to review at his pace. With little patient interaction, he can help treat up to 60-70 cases per day, all while sipping a cup of coffee if he wants one.

“It takes a specialized personality to be sure, similar to a radiologist, kind of, because you don’t see many patients,” he said. “We do occasionally see some, and so you have to realize that your patient interaction is based on the tissue, and obviously you have to feel a sense of responsibility there. And it takes a different skill set to be able to enjoy looking through a microscope all day, (which) is not something a lot of people would do. I like it. It’s sort of like figuring out a puzzle each time I do it.”

Those are, of course, high-stakes puzzles. Many of his patients have cancer, and it’s up to Staggs, 35, to determine where the cancer is originating and what kind of chemotherapy it will respond to. It’s an enormous responsibility that he doesn’t take lightly knowing lives hang in the balance.

“I still think about something that I’ve (worked with) nearly every night,” he said, “and that’s part of what’s so mentally taxing is so many of those situations come up every day. ... I’ve occasionally had one where I said, ‘Man, I could have done something more,’ but for the most part, usually I say, ‘I did everything I think I could have done there, and it just turned out differently.’ And so that’s not so bad.”

Staggs predicts his profession is on the verge of undergoing some big changes. He can see the professions of pathology, which focuses on the cellular level, and radiology, which focuses on gross organs, merging into a position he called a radiopathologist that is able to interpret future MRIs that will image cells. “So they’re going to need our training,” he said. “We’ll need their training. And there will be some sort of merger. Then that may be within the next 20 years or so.”

The process of diagnosing and treating tumors is moving toward gene-specific treatments and therapies where the genomes of cancer cells will be analyzed so that specific chemotherapies can be developed for each tumor. He cites progress made in the fight against chronic myelogenous leukemia, a disease caused by a specific gene translocation that activates an abnormal receptor. A new drug targets and blocks the mutation.

“Twenty years ago, we had just very rudimentary old-timey treatments for that, and then overnight, basically, when that medication came out, (the disease) just melts away, and the tumor goes,” he said.

That kind of treatment may be a long way off. While the human genome has been mapped, cancers have not been. A tumor might have 48 abnormal genes requiring 48 drugs. “I think the genetic profile is kind of the final frontier,” he said.

While most of Staggs’ time is spent saving lives, he also has plenty of experience dealing with death. The first autopsy he ever saw was one he performed on his first day of residency. Since then he has performed thousands, including many for a private business he once owned, and has worked with the state crime lab. He said he long ago became accustomed to the procedure, except when it involves children the same ages as his three – 8, 6 and 2.

“The hardest ones are kids, especially when you have kids that age,” he said. “I don’t have a problem at all with an adult anymore. I mean, it’s not that I’m callused. It’s just a routine thing. I’m looking for the disease. I feel like I’m helping there. But when I see kids my kids’ age, it’s kind of tough thinking, ‘This could be my kid here.’”

Staggs does many private autopsies, including many for cases involving asbestos. He wonders what the next unexpected killer will be. One possibility: the gadolinium contrast used in MRIs that has proved harmful to patients with kidney problems. His experiences have left him with mixed emotions: sympathy for companies that are hit by an unexpected side effect they couldn’t have foreseen, but also an appreciation for patients who suffer because of a company’s mistake.

He has caught a few bits and pieces of the popular “CSI” television franchise, which depicts pathologists like him as glamorous crime fighters. Real life, of course, isn’t like that. The big differences: the speed on television at which crimes are solved and the details that lead to those solutions. Staggs said the idea that a single hair could lead to a suspect after the body has been transported and handled by dozens of people is more than a little far-fetched. “Details matter, but it’s been my experience in 99 percent of forensic cases that it’s usually pretty obvious what happened,” he said.

Spending all day every day dealing with cancer and death can make a person think about things. He and his wife, Josie, make sure they plan a healthy menu and check for potential signs of trouble, such as swollen lymph nodes.

“I think definitely I’m a little paranoid about it and try to eat healthy and do anything I know to do to keep from getting some of these (diseases), but I also realize some of it’s just inevitable,” he said.

Staggs, who now lives in North Little Rock, grew up in Sherwood and majored in pre-med at Ouachita Baptist University. No one in his family had been a doctor, but he had always been a good student and knew the medical field would be stable. He didn’t settle on pathology until late in the process.

“I like it a lot more than I ever thought I would,” he said. “I thought I would just get out and get a job that I like to do and that it would be much more important to do all the other things in my life. But I really enjoy coming to work and feel like I do a really good job for all the patients. I have a lot of good pathologists here, but I feel like my being here helps the patients that I see. I’ve had a lot of training and worked very hard to be really good at it. So that’s what I tell a lot of the clinicians, a lot of people coming out, is you’re not here to kind of do it halfway. And that’s what helps you sleep at night, too.”

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