Pathology chose her when she was just a little girl with broken bones and a broken family. She wouldn't know it though until decades later.
It's her first week on the job as the only pathologist in the town of Guntersville. When she moved her family to rural northeast Alabama, she knew she'd have to make a few adjustments.
"I'm known for speaking my mind, but I have to be careful now, be more diplomatic," Nicole D. Riddle, MD, FCAP, says with an easy laugh.
Cunningham Pathology hired Dr. Riddle to cover Marshall Medical Centers. They wanted a young pathologist who would be on the forefront of molecular medicine. When she delivers diagnoses in this town of 8,000 people, she's bound to meet her patients at the fish and tackle shop or the antique store.
"A lot of people know each other," Dr. Riddle says. I meet somebody; and then I see a store or a street with the same name, and I realize they're related."
Her smile fades for a brief moment as she leans back in her chair, wincing slightly from an actively healing fracture in her back. A pair of crutches lean on the wall behind her, close enough to reach when she needs it.
The younger patients are the ones who tug at her heart the most.
"When I see the young ones, I think about what they've done in their lives, where they're from and how they'll deal with the diagnosis," she says.
Her own diagnosis came at the age of five.
From the time she was born, Nicole spent a lot of time with doctors and in hospitals. At ten months old, she began bleeding vaginally from a cyst on one of her ovaries that eventually had to be removed.
When she turned four, she fell and broke her hip, but she says her biological father wouldn't take her to the doctor—medicine was the work of the devil, he said—so her leg healed crookedly. Her mother was too afraid to defy Nicole's father. Then, Nicole fell again and suffered a lesion on her head that didn't heal for a year.
By the time she was five, one of her father's church members realized something was wrong and called Child Protective Services to the family's home in Smithfield, Rhode Island.
"I was hiding in the closet, cowering, wondering what was going on," she says.
A SWAT team broke down the door of her house. They found her in a tiny crawl space and carried her outside.
"I remember sitting in the police station with all these nice people in uniform who were being nice to me, trying to keep me calm."
Nicole didn't see her family for a month, but she saw plenty of doctors. They diagnosed her with McCune-Albright syndrome, a condition that's predominantly defined by polyostotic fibrous dysplasia of the bone. It's caused by a random genetic mutation that affects the bones, skin, and hormone-producing tissue.
Her mother divorced her father, but there wasn't enough money to care for the family and pay for Nicole's treatment. That's when Shriners Hospitals for Children stepped in and provided free experimental medicine. Between the ages of eight and 14, Nicole underwent a surgery every year.
"Getting the right diagnosis was extremely important for me," she says. "If I had not been diagnosed, I would have continued to break bones and be crippled and confined to the bed. I would have had a much different life."
She's walked with the help of crutches since she was eight. After graduating from medical school, Nicole chose to focus her career on bone and soft tissue pathology. She's worked as an attending pathologist for three years.
"Healing begins with the patient's diagnosis," Dr. Riddle says, "and without the pathologist, you don't get the proper diagnosis. Once a patient comes through that door, it all begins with us."
Driving through rural Alabama, she often passes two or three nice houses and then a row of battered trailers. When she talks with neighbors, they say money's tight and mention driving for miles to save 10 cents on gas.
As a member of the College of American Pathologists, she hopes to launch See, Test & Treat® in Marshall County. The program offers pathologist-led, free cervical and breast cancer screening as well as same-day results to women in need.
"Coming from a family where I didn't always get the health care I needed, I know some women don't have access," she says. "Either they can't get to a doctor or they don't have the money."
The start of her journey as a child, battling poverty and illness, is never far from her mind when she's examining tissue on a glass slide.
"I come from a humble background, and I'm always reminded not to get too big for my britches," Dr. Riddle says. "I'm reminded of where I come from. I haven't forgotten."
Nicole D. Riddle, MD, FCAP, serves on the College of American Pathologists', New-In-Practice Committee and is a former chair of the Residents Forum Executive Committee.