Student becomes mentor in the age of discovery

Very early in the AIDS epidemic, my colleague Dr. Mark Stoler, a pathologist at Strong, made a discovery.

I knew Mark from years before because when I first started my career at the UR Medical Center, I worked in the University Health Service (UHS) and had a lot of medical students who were my patients and Mark was one of them.

He graduated, became an MD, and he did a pathology residency and then joined the faculty. Now we were colleagues. We were thrown together because he was the person who was able to tell me if a patient had pneumocystis pneumonia, which was the very common pneumonia of AIDS in those days.

Dr. Mark Stoler, circa 1988. Provided by Dr. Mark Stoler.

But the process took a long time. We had to do an invasive kind of procedure (a bronchoscopy), which involves a tube into the lung and snip out a piece of lung to get a biopsy. Then we had to wait two to three days for the specimen to be prepared so that you could look at it under the microscope and confirm the diagnosis.

In the meantime, we were treating patients, some of them unnecessarily with a pretty strong drug.  Usually around four o’clock every day, we’d sit in the dark in his office, going through slides under the microscope, talking about patients and also grousing about how all this process just takes so long. I kept prodding him and poking him. “Well, why don't you do something about it. Figure this out. You understand this. So you do it.”

Pathology Department, URMC, 1987. Dr. Mark Stoler is seated in the second row, fourth from the right. Provided by Dr. Mark Stoler.

About six months later he did. He showed me what he had discovered along with a couple other medical center people about how you could do the same thing with coughed sputum. You’d have the patient cough into a cup and can stain it and read it right there in hours.

What would have taken days now became possible in a matter of hours. What a brilliant guy he was. It was like my medical student became my mentor.

Last we talked, he was at the University of Virginia and working his magic and doing good work as well. I actually found him after recording the video for this blog.

He reminded me that when he was a pathology resident in 1983-84, he did the first autopsies of people with AIDS -- before there was a name for the disease.

The procedure he helped developed to expedite diagnosis of pneumocystis from bronchoscopy specimens faster than the old way.

Mark also was part of a group that described the first visualization of HIV in the brain through RNA.

Dr. Mark Stoler is professor emeritus of Pathology and Clinical Gynecology at the University of Virginia Health System. Provided by Dr. Mark Stoler.

“All of this in collaboration with Bill and other members of the infectious disease group during my late residency early faculty time at Rochester,” Mark recalled. “Very intense times that I, like Bill, will never forget.”

That discovery of using sputum for diagnosis came out of the necessity to do things better because we were constantly dealing with things that had never been dealt with. I was like building the car as we went down the road.

Mark accepted the challenge, collaborated with some people in the medical center and did it. And it made a huge difference in terms of how we were able to treat patients quickly, appropriately, faster, no delays.

Thank you, Dr. Stoler. Good job!