Being a pathologist is an important specialty in the medical field that is critical to understanding how diseases affect the human body. It is a specialty that is particularly applicable as the healthcare industry grapples with treating those affected by the novel coronavirus (COVID-19), according to Nicholas Boire, MD ’19, a pathology resident at the Mayo Clinic in Rochester, MN.
“Infectious disease pathology has never been more relevant than now, when we’re actually in a situation where we have a new disease and we, as a science community, are not yet sure how this disease functions,” Dr. Boire said. “We’re still uncovering how COVID-19 affects each body system and its pathophysiology. There are a lot of unknowns with the disease and that’s where my specialty comes into play.”
As an anatomical and clinical pathology resident in the Department of Laboratory Medicine and Pathology at the Mayo Clinic, the top hospital in the United States according to the U.S. News 2020-21 Best Hospitals Honor Roll and Medical Specialties Rankings, Dr. Boire is already making strides within the specialized field. The Long Island, NY, native was part of a team of the institution’s pathologists who performed some of the early autopsies on COVID-19 patients. The group recently published a case report citing its findings.
“COVID-19 (as a pathogen) has been fascinating with regards to my specialty,” he said. “What we saw [in the findings] was a spectrum of neuropathology, including white matter hemorrhages, acute axonal injury, and some lesions that resemble acute disseminated encephalomyelitis. All of this has not been documented before. As our research and understanding of COVID-19 continues to evolve rapidly, it’s helping to highlight what could happen over a clinical course in patients who are hospitalized, which will ultimately help to identify and manage the disease.”
At the Forefront of COVID-19 Research
The Mayo Clinic has been doing its part to provide critical COVID-19 information and education to the public, to physicians, and to laboratory scientists. In February, the institution developed its own test and had it validated within three weeks—an “incredible and daunting task to those that know how the process works,” Dr. Boire said. In the following days, the institution brought in other commercial tests, and now has those at its disposal as well.
By the end of August, the institution expects to be able to perform up to 30,000 tests a day on the COVID-19 virus, with results within 48 hours if not sooner, according to Dr. Bobbi Pritt, MD, MSc, DTM&H, chairperson of the Division of Clinical Microbiology at the Mayo Clinic and director of the clinical parasitology laboratory at the institution. As an international reference lab, the institution has been asked by the state of Minnesota and nationwide to help out with testing patients.
In terms of research, the Mayo Clinic has concentrated on four main areas, according to Dr. Pritt: finding new ways to detect the virus itself; finding new ways for detecting antibodies to the virus; looking at ways to detect protective immunity from the virus from those who are infected so that their plasma could be given to other sick patients; and also looking at innovative ways for those who are possibly infected to collect a specimen for testing from the comfort and safety of their own home.
COVID-19 has “really brought pathology to the forefront,” Dr. Pritt said. “It’s a powerful opportunity for us as pathologists to be at the table as part of the team making decisions about testing and treating people.”
Working under Dr. Pritt, his mentor, Dr. Boire has thrived in his residency.
“He is a very enthusiastic, innovative, and an intelligent resident. He is very passionate about microbiology and pathology in general. I can see he has a very promising career ahead of him,” she said of Dr. Boire.
A Dream Come True
Obtaining a residency at the Mayo Clinic was a dream come true for Dr. Boire, given the institution’s extensive facilities and strong commitment to patient care and research impressed him.
“The size and scope of their microbiology department is incredible. Each individual pathology subspecialty here is larger than most hospital’s entire pathology department,” he said. “But it’s not only the facility; it’s about the individuals I work with. No matter how difficult a case, there’s always someone to help and one case can be shared with five or six pathologists—each one an expert in a different specialty.”
Dr. Boire spends his days reviewing cases alongside attending physicians involved in his specialty.
“The guiding principle of the Mayo Clinic is that ‘the needs of the patient come first.’ If they believe something will help a patient, they will invest,” he said. “When people around the world don’t know what they have, they come to us. It has been an incredible educational opportunity.”
A Scientist from an Early Age
Growing up, Dr. Boire was always interested in science and wanted to be a research scientist. With a natural curiosity to learn more, he gravitated toward biology and chemistry. Dr. Boire received his undergraduate degree in biochemistry/molecular biology at Gettysburg College.
Following undergrad, he decided to tackle one of his bucket-list items—by spending time in Africa to serve in the United States Peace Corps. It was while in Africa, volunteering in various clinical settings and shadowing physicians who were providing care to local populations, that Dr. Boire became fascinated with pathology, specifically that of infectious diseases, which were prevalent in the area.
“Pathology interested me because, in medicine, it’s the closest thing to basic science research—uncovering the how and the why of diseases,” he said. “Pathologists are considered the doctor’s doctor.”
Upon returning to the states, he obtained his master’s degree in molecular biology and immunology from the Johns Hopkins Bloomberg School of Public Health. Soon after, Dr. Boire decided to take the next step in his career path by entering St. George’s University School of Medicine MD program.
“SGU got me to where I am and made sure I had the foundational knowledge to be considered competitive during residency interviews,” Dr. Boire said. “The school gave me a foot in the door by helping me get a residency position in one of the best, if not the best, hospitals on the planet, doing exactly what I want to do.”
— Laurie Chartorynsky