I'm a forensic pathologist - AMA

[slightlybrownbanana]

I do autopsies every week on a range of different type of deaths, not just homicides. People are often fascinated when I tell them what I do and it is very interesting but not like on the telly.

How often do you retain samples of organs to aid research into causes of death? I know there have been some issues with samples being retained and families not being notified that this had been done. If so, how does this come about and who is responsible for getting consent?

My DF died of a massive heart attack almost 30 years ago. Clearly back then we weren't asked for consent although we would have gladly given it. I have absolutely no problem with samples being taken and retained if the research helps to stop other families going through the same thing and it doesn't bother me that we weren't asked. I know that times have changed though.

I think my DF would find it quite amusing that there might be a bit of his heart in a wax block somewhere still being looked at and hopefully still contributing to life saving research. And if that is the case then I'm very glad he is helping.

And a question from me. What happens to all the 'fluids' released when you are doing a PM? Particularly those due to decomposition you mentioned earlier. Do they get sluiced down the general drain or are they isolated and subject to specialist treatment? I should probably ask a funeral director the same question. What happens to all the stuff expelled through the embalming process?

Fascinating thread OP. Thank you.

How often do you retain samples of organs to aid research into causes of death? I know there have been some issues with samples being retained and families not being notified that this had been done. If so, how does this come about and who is responsible for getting consent?

Small tissue samples which are made into slides are taken in pretty much all post mortem cases and kept indefinitely as part of the medical record under the laws in Scotland. Similar samples are kept in England and Wales under the jurisdiction of the Coroner for many post mortem cases. In terms of what happens to these samples after the Coroner has finished his/her investigations this is governed under the Human Tissue Act and Coroner's officers should ask relatives if they would like the tissue returned to them, destroyed or kept.

What happens to all the 'fluids' released when you are doing a PM?

They all get washed down the drains from the mortuary. I don't know about embalming but I imagine it would be the same in the funeral homes.

Sorry to jump into your interesting thread op but after snottty mentioned her DF wanting to contribute to life saving research I wondered if I might possibly mention the idea of donating your whole body to science.

Find out more here.

www.rcseng.ac.uk/about-the-rcs/support-our-work/donate/donate-your-body-to-medical-science/

Although if it has not been a natural death and you need a PM then understandably the medical school cannot accept your body as a donation.

I cannot recommend this book enough. My lovely colleague's DM left her body to Sue Black's team in Dundee to inform anatomical science and to inform the next generation of anatomists and doctors. I work with her son. He is incredibly proud of her and so am I. What an amazing gift to give.

www.amazon.co.uk/All-That-Remains-Life-Death/dp/0857524925?tag=mumsnetforu03-21

Thanks Innernutshell

Had no idea it was possible until speaking to colleagues in the last week. But it really is. They can chop up every bit of me if it will help someone else to live. So long as I'm dead.....

@SnotttyNosedSheila that’s so lovely to hear; I studied medicine at Dundee almost 20 years ago and was so grateful to those who left their bodies for me to learn anatomy on. Sue Black taught us and did a lot of the anatomy lectures back then too, she wasn’t so famous then though! I liked her but I remember her as super grumpy when anyone was late

OP do you miss clinical medicine? One of my good friends is a histopathogist and she does miss the general hospital banter etc. Also, how would you say your technical training was/is in comparison to surgeons working on the living? Do you spend time in operative specialties as a trainee or has all your practice been on the dead?

Thanks for the thread, it’s fascinating!

slightlybrownbanana thank you, and your colleague, so much for helping. Your 'best guess' is exactly what I thought it was, so very helpful to me. My newborn had all his organs removed in 'blocks' and stored without my knowledge and their reasons/excuses/lies have haunted me; all they needed to do was explain and ask. I would have willingly donated his body to research but they never asked. Legislation was implemented because of this; many families were badly damaged.

SnotttyNosedSheila - How often do you retain samples of organs to aid research into causes of death? I know there have been some issues with samples being retained and families not being notified that this had been done. If so, how does this come about and who is responsible for getting consent?

This was the reason I asked the OP my question earlier. It wasn't just samples; in my sons case the only organ not removed was his skin. My newborn was involved in the retained baby organs class action case and despite lengthy protracted legal proceedings many of us were left more confused than before the inquiry began. I was led to believe my sons remains would be returned for burial after the case closed. This never happened as I couldn't afford the legal fees needed to go through the next part of the process, and that is still painful. Thankfully legislation was implemented so this shouldn't happen again. The sad thing was that almost all the parents would have given their child's/baby's organs etc for medical research if it would save other families suffering... By we were never asked.

Sorry, I had to get that out of my mind, thank you slightlybrownbanana and sorry to use your post.

Wee so sorry this happened to you at a time that was horrendous in itself.

OP do you miss clinical medicine? One of my good friends is a histopathogist and she does miss the general hospital banter etc. Also, how would you say your technical training was/is in comparison to surgeons working on the living? Do you spend time in operative specialties as a trainee or has all your practice been on the dead?

I don't miss clinical medicine at all; I only did a year and that was enough. I was no good at crash calls and hated the stress of someone dying. But I love to know and learn how the body works and goes wrong - in my profession I get more time to consider this. My training was all with the dead. Unlike in surgery I can make as big an incision as I like and it doesn't matter and I don't have to worry about infection (apart from the risk to myself).

Wee so sorry to hear about your experience. Autopsy pathology has a dark past regarding organ retention and I'm glad that there are now laws to stop unacceptable practices. In my training, and now I'm qualified, consent from relatives for tissue and/organ retention has always been emphasised as essential and we wouldn't dream of doing anything without it.

Please don't take this the wrong way OP, but how do you do it? As in do you not get scared/creeped out/upset at some of the bodies?

I would imagine you have to be a sort of calm, matter of fact person. I would run out screaming on my first day, that makes me sound dramatic but even pictures in documentaries give me the heebie jeebies, thankfully not everyones like me and can do your amazing job.

Wee I'm so sorry for your loss and what happened to your DS. That is a whole different and truly awful thing from them keeping bits of my DF's heart.

Jeezypeepers Wow, how interesting! She comes across as a bit grumpy in the book but in a good, taking no nonsense way.

Thank you slightlybrownbanana for answering my questions. Absolutely fascinating!

Slight tangent but how does being an organ donor affect leaving your body to science? Presumably if I am old when I die my organs wouldn't be much use but my body could be?!

I've considered leaving my body to science off & on but not got anywhere with doing anything about it.

There are some stipulations where they won't accept your body for donation Nquartz. Organ donation being one. Another is if your body isn't in any good shape when you die or if you have a very invasive cancer. The link above will give more info.

Old organs are still very much needed by all the people waiting on donation lists though.

The most important thing is to let your family know your wishes as currently they can veto anything you wish to happen.

Thanks @Innernutshell

DH & my family definitely know I'm an organ donor, we've all had the conversation.

The notion, often said on mumsnet, that someone is “heavy boned” or has a larger frame than someone else - hence that person will always weigh more or look bigger than someone not heavy boned or of a slimmer “frame” - does this ring true to you?

Not sure if already asked but how many do you carry out in a normal day? What is the timeframe for getting the body / how long do you store people for before / after the PM? Really interesting thread, thank you!

I always wanted to be a forensic pathologist after watching Quincey MD and as a very young teen, or possibly even while I was still at primary school reading Forty Years of Murder by Prof Keith Simpson. I was gutted to find out at a careers day aged 15 that I had to spend so many years at uni to do it, so changed plans after that but have always regretted not pursuing this career. It also didn't help that I was scared of the dark and in the era of the Yorkshire Ripper I used to worry about being called out to a murder on the moors in the dark and him still hanging around!

This thread is fascinating. Thanks OP

This thread is fascinating! Thanks op. Couple of questions: do the faces often have expressions? If so are they upsetting? Also, do you shave the head to remove the brain? Or how do you do it so it's not very obvious to family who view after?

The notion, often said on mumsnet, that someone is “heavy boned” or has a larger frame than someone else - hence that person will always weigh more or look bigger than someone not heavy boned or of a slimmer “frame” - does this ring true to you?

No it doesn't to be honest. I have to document every body's height and weight but I don't tend to notice it unless someone is emaciated or massively obese. Plus technically it is difficult to remove the organs of a morbidly obese person; we have to make sure we protect our backs.

Couple of questions: do the faces often have expressions? If so are they upsetting? Also, do you shave the head to remove the brain? Or how do you do it so it's not very obvious to family who view after?

They don't tend to have expressions and I don't think I would find it upsetting if they did as I'm just so accustomed to dealing with dead bodies. There is no need to shave the head to remove the brain. A cut is made by technical staff across the top of the head to reflect the scalp then the skull is cut with a bone saw. Having head hair helps disguise the incision once it is sewn back up and family members often can't tell what has been done.

OP I was reading something in diversity training about orthodox Jews and death and certain requirements they may ask pathologists to adhere to, such as a non Jew wearing gloves when touching the body, the body never being in a dark place and even a Rabbi attending the postmortem to make sure that certain things are done properly. Do you come across things like this regularly (specific religious/cultural requirements)?

Also do you have background music on during the PM?

@Freudianslip1 I have never changed my practise according to someone's religious beliefs and I've never had a Rabbi or any other religious person present at the post mortem examination.

I always have music playing when I'm doing routine post mortem examinations but not when it's a suspicious death.