“I love classical music. I love the opera. For me, it’s the back door into heaven – so passionate and beautiful, life and death,” says Dr. Fergall Magee, Unified Department Head of Pathology and Laboratory Medicine at Saskatoon Health Region and the University of Saskatchewan.
Life and death is a concept Dr. Magee is all too familiar with, having worked for over two decades as a pathologist.
“If you ask the public, ‘What’s a pathologist?’ many will think of CSI Miami,” says Dr. Magee, a pediatric pathologist who studies organs and tissues in the lab to diagnose various diseases – unlike forensic pathologists on CSI who examine corpses to determine cause of death.
For physicians, “pathology is the science behind the cure.”
“It’s claimed that up to 80 per cent of medical decisions are based on some type of result from a lab,” he says, adding that before he became the department head last year, most of his time was spent in the lab.
“I tell our residents that we’re the doctors’ doctor, because we’re consulted all the time, and it’s not just to explain what a test means,” he says. “We repeatedly have doctors coming to the lab to review cases. If it’s about cancer, the three questions they want answered are: ‘Is it cancer? What type of cancer is it? How extensive it?’ because that’s what determines the treatment. They’ll say, ‘I’m doing this. Is there anything extra I should do?’ We communicate a lot with our physician colleagues.
“However, in pediatrics, there’s a lot more contact with patients and parents than in the adult world. A lot of parents ask for a one-on-one with you to explain the diagnosis,” says the man who started his medical career in pediatric oncology.
While completing his training in pediatric oncology, Dr. Magee says he ran into gaps in diagnostic information, causing him to change gears.
“There are few people anywhere who do pathology with a pediatric specialty,” he says. “There’s tremendous potential in pathology to have a significant impact on patients by making sure they have the right test done, in the right way, with the right result, and that they get it in a timely fashion.”
Dr. Magee went on to complete an anatomical pathology residency in British Columbia (BC), followed by a fellowship in pediatric pathology and a Masters degree in clinical epidemiology – the study and analysis of the causes and effects of health and disease in the population.
“Epidemiology allows us to review what we do,” says Dr. Magee of his decision to pursue this field of study. “It allows us to ask, ‘Are we doing the right thing? Are we doing it the right way? Is there a better way to do it? Is it having the effect we think it’s having?’ Epidemiology gives you the answers to those questions. My Masters made me think more about health systems, about what we’re really doing and how we can do it better.”
After completing his Masters degree, Dr. Magee worked at the British Columbia Children’s Hospital until he was offered a job at the Izaak Walton Killam Hospital for Children in Halifax, Nova Scotia, where he spent seven years.
As an anatomical pediatric pathologist, Dr. Magee’s focus throughout his career has been on diagnosing cancer in children to guide treatment options, providing him with the opportunity to join the Children’s Oncology Group, the biggest pediatric cancer group in the world, and experience first-hand the remarkable work it is doing to improve the outcome for children with cancer.
“There has been a tremendous improvement in the diagnosis of cancer since the 1960s,” says Dr. Magee. “We’re not only diagnosing more cases correctly, we’re doing things differently. For example, the Children’s Oncology Group has introduced what’s called risk stratification, which allows us to both diagnose a tumor and predict how it will behave. In the past, we’ve only been able to diagnose tumor type, meaning that all patients were treated the same way. Now, if your tumor has a bad DNA profile, you get more aggressive therapy at the start, and you have a much better chance of doing well. If a tumor has a good DNA profile, you get milder treatment, which means fewer complications and a higher survival rate.”
As a pediatric pathologist, Dr. Magee also deals with prenatal and newborn screening, as well as consulting on the post-mortem autopsy results in the death of children. He recalls one instance when he was called on a Wednesday morning, after a long weekend, to talk to a mother, six months pregnant, and her husband about their young son, who had died shortly after a camping trip.
“They brought him to the children’s hospital in Halifax at 9 a.m. Tuesday morning, and by 9 a.m. the next morning, he had died. The case was reported to the coroner because the death happened within a short period of time,” Dr. Magee explains. “I was called to talk to mom and dad, and explain why we needed to do an examination. I said, ‘We’re doing this for two reasons. First, did your son get exposed to an infection that might affect other children – is there something where you were that we don’t know about? Second, did he have a predisposition – was he unable to respond to what he got that would not have been a challenge for another child?’
“The mom asked me, ‘What would you do?’” continues Dr. Magee.
“I said, ‘A skin biopsy for genetic testing and a bone marrow test to make sure his marrow is okay. I would also make a small incision and take a piece of bowel because he had gastrointestinal symptoms, lymph node to make sure he has the correct defensive mechanisms and liver as a precautionary measure.’”
The mother agreed, so Dr. Magee and his team did the tests and diagnosed chronic granulomatous disease, a hereditary disease in which certain cells of the immune system have difficulty forming reactive oxygen compounds used to kill certain ingested pathogens (e.g., virus, bacteria).
“The direct implications were that this happens only in boys,” explains Dr. Magee, “and her current pregnancy was a boy. Testing immediately after birth confirmed that the second child had the same condition, so he was placed in a screening program.
“We couldn’t bring back the child who died,” adds Dr. Magee, “but if they had said no to an examination, or if we hadn’t gone to the effort of explaining how important it was, they might have lost their second child too. It’s a question of knowing and protecting – making the best of a bad situation.”
Diagnosing disease can be an emotionally taxing vocation, but Dr. Magee says that getting answers for people is helpful.
“People want answers. They want to know why their child died or if their baby had ‘x,’” he says, recalling another difficult case where a couple, who were pregnant for the third time after having lost two babies in utero at 22 weeks, were experiencing the same problems with the third pregnancy. Samples confirmed the same anomaly and high recurrence risk, providing this couple with the extremely difficult, but valuable knowledge, that adoption was their only option.
“It can be tough. It’s not always happy,” says Dr. Magee. “We’re often not able to say to people, ‘We’ve cured it or fixed it,’ but on good days, by making meaningful decisions, we can try to change things for the better. Being able to give people their best option because you’ve given them the most sophisticated diagnosis possible – that’s what attracts me to pathology.”
Four years ago, Dr. Magee accepted a position as division head of anatomic pathology (cancer diagnosis) at Royal University Hospital and moved with his wife, an operating room nurse, from Nova Scotia to Saskatchewan. Last year, he moved into the position of unified department head.
“Saskatchewan has a young population; it’s changing – that’s why we moved here,” he says, adding that his son, a videographer, lives in Vancouver making documentaries about subjects ranging from rock bands to politics.
Dr. Magee says he has fond memories of coaching his son’s soccer teams, and that this experience has made him a better leader.
“The two most useful things I’ve done for this job is my Masters degree and my exams for coaching, which taught me about visioning, deconstructing, motivation and communication,” he says. “Coaching is all about trying to get people to function as a team – together everyone achieves more. It’s not about winning; it’s about getting better.”
He also loves art galleries, cross country skiing and kayaking.
“I absolutely love cross country skiing,” he says enthusiastically. “You’re out in the countryside, the sun is shining, you’re on a beautiful trail in the forest, and if you’re with someone, you get to talk to them. I love that.”
One of Dr. Magee’s favourite trails is in Vernon, BC – at an altitude of 6,000 feet and 120 kilometres long.
“It’s an amazing place!”