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.

What’s the most interesting PM you’ve done and why?

Too many interesting ones to pick one out, but some of my complex murders I'll be dining out on for a good few years.

Do you often dream about your work?

No, hardly ever - thankfully.

Not to sound ridiculous but do you talk to the dead when you autopsy them? Like Ducky on NCIS?

Can you stay emotionally detached. Do you find having a child is emotionally harder.

We are a self selecting bunch of medics who choose to do this job, so I guess we must have some natural ability to withstand the emotional pressures. Having said that we are still human beings and susceptible to psychological distress. I think it may be time that the profession had a change from the "just get on with it" mentality and recognise that psychological support is needed, not just for the mass disasters but the day to day work of seeing people who have died in awful circumstances and may have suffered terribly. It is harder now that I have children for sure.

Does your job make it easier/harder to face your own mortality? Or of your loved ones?

I am hyperaware that life can be taken away in an instant and for no good reason, so I try to celebrate life and not sweat the small stuff. In terms of my own mortality I'm not scared to die but it makes me terribly sad that my children would have to grow up without a mother. I am terrified that my children could die but I think all parents are deep down. Its just unfortunate that as a medic and specifically a pathologist I know all the ways that could happen in great detail. It wasn't much fun being pregnant I'll tell you; hard to anticipate it would end happily. At 28 weeks with my first I was at a post mortem for a 30 week old fetus. Feeling my baby move inside me whilst watching a baby in front of me being cut up was surreal to say the least.

is there anything that drives you crazy every time you see it on TV and know it's false?

All of it! They give a cause of death before they've even put knife to skin! Its so bloody dark! Then they get involved in the investigation. I can't watch those programmes to be honest - it does my head in.

What's the biggest surprise (maybe finding something in a body, strange medical condition etc.) you've ever come across?

I found £160 in £20 pound notes in a plastic bag in a woman's vagina.

We might have crossed paths OP. I do dental IDs in a number of mortuaries in England. Always fascinated by the coroners preferences... some want dental, some don't... some want people frozen pending ID, some don't, some live a teaching case, some don't.
Anyway, huge respect sister.

What cause of death do you see most often?

Ischaemic heart disease

Did you have to have special measures put in place while you was pregnant as a risk factor or anything like that? Was there stuff you couldn’t do or had to avoid? Is it a very manual job?

what do you think about 'fast tracking' post mortems in case of certain religions? is it problematic time wise? i.e. do the tests get done in time?

I don't think its fair to be honest, it should be first come first served. But members of religious groups can put pressure on their MP and then we miraculously manage to fit them in

Until last year I worked at a university which ran a forensic science degree course. The students were expecting ng it to lead to a career in forensics. Were they misinformed? No medical training was involved. I am guessing the university wanted a popular course as it had a forensic scene house and sounded a very interesting course

The word forensic just means related to court, so you've got forensic pathologists like me, forensic scientists, forensic psychologists and psychiatrists etc etc. The course you refer to probably explored forensic science? There are forensic biologists and chemists who look at the crime scene but are not involved in examining the body. I meet them at the scene and then can never recognise them at court as they always have full white suits and face masks on when I've seen them before.

Do you receive backlash for your verdict if it is controversial? For example a death that looks like heart failure but was actually suicide?

I've had some hideous meetings with relatives in the past when they are in denial about how their loved one died. If you get sensible and understanding relatives it is great, because you can explain what you found and help give them closure and some peace. As we don't have living patients feedback on your skills is limited, but I had a mother of a man who had died from a drug overdose say to me "I'm glad its you who examined him because you're lovely", that really meant a lot.

I appreciate you’re a pathologist rather than coroner but you might have more insight on the process. When a case is referred to a coroner, is it possible to find out when the inquest is going to be held or what the outcome is if already held? I am curious about a local case which was referred to the coroner just over two years ago but I have never seen the outcome. I’ve checked the coroner’s website but it only seems to feature upcoming inquests.

What an amazing job.
Can I ask do nurses assist you with the PM's ? Or healthcare assistants?

Also is it routine to remove and examine the brain?

Thank you

this is quite morbid but after being too closely involved in hangings lately can I ask what happens? Do they die quickly? What is the cause of death?

It is thought that the mechanism of death in hangings is mostly pressure on the carotid bodies, which are part of the nervous system around the carotid arteries (which take oxygenated blood from the heart to the brain), causing reflex cardiac arrest. This means that pressure on a certain part of the neck causes the heart to stop. Loss of consciousness occurs in a matter of seconds with death following shortly afterwards. There have been studies of people who filmed their own hangings which is where this research comes from.

I was a student nurse and watched various post mortems in a morning. It has stayed with me and still does, i was shocked by the amount of activity in the room, i had to run out in the end and have tea and biscuits from a pathologist assistant who was lovely and says it happens alot, does it op?

Incredible thread OP. Thank you

What are some of the more unusual causes of death you've seen?

Such an interesting thread. Thanks.

Thank you so much for this thread

This is fascinating thanks OP.

I have 2 questions:

1. do people still have expressions on their faces after they die? If so, any notable examples?
2. is it really true that trapped wind makes bodies make noises and/or move?

I've just finished reading 'Unnatural Causes' and found it very interesting (though horrible in parts). Are there any cases you wish you'd worked on, and are there better support systems in place nowadays (mental health support I mean)?

I know Dr Dick Shepherd who wrote Unnatural Causes (its a very small profession) and I have also read his book. In terms of cases I wish I'd worked on, not really, as there is always an interesting case around the corner. And you rarely know at the time what will be really interesting in the long run, or cause you problems five years down the line...

There aren't better support systems in place at all, we're quite backward as a profession regarding looking after our mental health. But I hope the tide will turn soon, and Dick's book has become an interesting talking point about this. We shouldn't have to get PTSD before we acknowledge that help is needed.

Would you mind telling us what your typical day looks like? Or a typical week? And do you always work out of the same mortuary?

A typical week for me would be one or two mornings in the mortuary doing routine post mortems (up to 5 cases in a morning) with afternoons and other days for mainly report writing but also meetings, court etc. I might be on call (for suspicious deaths) for one or several days and/or a weekend. Other places you are on call for a whole week at a time, but each area organises it slightly differently. For the whole of the UK there will be a forensic pathologist on call in each geographical area on call 24/7 365 days a year for suspicious deaths. So my week is predictably unpredictable; if I'm on call I try to keep my time free but I get several hours notice so I don't have to drop everything immediately like in clinical medicine. I work out of one mortuary now and all the bodies are brought there, which is convenient as I know I can be home in 20 minutes. I trained in a different part of the UK and had to travel round to different mortuaries for cases which meant lengthy commutes at times.

Have you done an autopsy on anyone famous or anyone that has been in the news?

Not anyone famous but being in the news is par for the course. For one of my murders fairly recently I was filmed coming out of court and that was on the local news. You just keep your head down and try to look serious!

What does decomposition actually smell like?

I guess everyone has smelled rotten animals, its a bit like that. The natural disgust mechanism kicks in telling you to stay away.