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.

Which series (silent witness etc) is the closest to real life?

None of them

Do you worry more about dying in an accident after seeing so much death?

Think I might have answered a similar question up the thread but I do understand what you mean. Certainly I'm very vigilant of my children in car parks and near roads because I've seen far too many deaths from road traffic collisions.

What do you think of Kay Scarpetta?

I think I read a Patricia Cornwell novel when I was a teenager but I can't remember it. I don't read crime novels now as I know it would just irritate me, plus its a bit of a busman's holiday.

Do you think you could carry out the perfect murder and get away with it? Not an elderly person with existing conditions, but a healthy, strong 30 year old man? (I know I sound dodgy, but I’m really not!!

Hmmmm, could do the old fine needle insulin injection between the toes but you'd have to incapacitate him first which is tricky as it would be picked up on toxicology. Most murderers are not that clever though and leave reams of evidence behind.

Are you allowed to examine someone you know? Even if it's just in passing, do you have to disclose this?

We would be allowed in a routine death but I would never do it, far too weird and upsetting. If it was a criminal case we would have to disclose it as well.

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

Not routinely; I might say "sorry dear" if I have to mess up someone's hair or something like that.

@Mrsmorton respect to you too and thanks.

Banana - Thanks for such an interesting thread. Even the mundane stuff like your working week is interesting. Your description of your on call arrangements made me wonder, is your job mostly “office hours” (ie 9-5) but including weekends, or do you sometimes get an urgent case which requires eg working through the night?

Is it true that the deceased can have a last gasp as it adjusts ie release of gases and if so, do you remember the first time it happened and if it scared the shit out of you? Follow up question, has anything in the lab scared the shit out if you or are you past that point?

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?

Not really, I think formalin is a carcinogen but we're not exposed to that in the same way that histopathologists are. As I got bigger I had to sit down between cases and it got harder to reach the organs to dissect them. I didn't really have to eviscerate (take the organs out of the body) as the mortuary technicians do that. I stopped doing post mortems at about 32 weeks so that I had time to write up the reports before going off on maternity leave. It can be manually quite hard work if you have heavy organs from a big person to deal with. Also trying to get into a scene suit with a bump is not an elegant process!

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.

I would just call and speak to a Coroner's officer to find out; they're used to getting lots of information requests. It could be that the case concluded without inquest after that period of time, or was delayed for some reason.

Can I ask do nurses assist you with the PM's ? Or healthcare assistants? Also is it routine to remove and examine the brain?

We have mortuary technicians (their official title is Anatomical Pathology Technicians or APTs) to assist us in eviscerating (taking out the organs) and they reflect the scalp, cut the skull cap off and remove the brain in every case. They are highly trained and have to learn a lot of anatomy for their exams.

i had to run out in the end and have tea and biscuits from a pathologist assistant who was lovely and says it happens a lot, does it op?

Yes, its usually the tallest broadest Police officer in the group who hits the deck first. I always say that I've forgotten all my clinical medicine so they had better not collapse on me and get out before that happens!

Right, I'm going to get a drink sorted before Line of Duty. Thank you all for your interest and questions, I'll answer the rest tomorrow

If a person has their throat cut, would they die from aspiration or blood loss or both?

Thank you! Been hoping you would come back.

This is so interesting, banana.

A personal one if that's ok.

A relative of mine died recently and suddenly at only 57. A post mortem was carried out but they still don't know the cause. Heart attack, stroke and aneurysm were all ruled out. We've been told it could take 14 weeks for further results to come back - do you know what kind of tests might be being done and why this takes so long?

Thanks so much for answering my question, OP - very interesting thread

So does every single person who dies have a post mortem done? I assumed it was just if there were suspicious circumstance. Why would you need to do a PM on a pedestrian hit by a car for example. Or if a 90 year old died in their sleep in a nursing home?

Excellent thread by the way.

Excellent thread, fascinating to read.

Fascinating thread OP, thanks. I have lots of questions, most of them perhaps too morbid to ask

Most interesting thread. I could simply not deal with death on a daily basis and have huge admiration for you. Thank goodness people as intelligent and strong as you exist 😬

If a person has their throat cut, would they die from aspiration or blood loss or both?

It could be either, depending on what structures in the neck are damaged. If the jugular veins and/or carotid arteries are cut then death would occur from blood loss. If the trachea (windpipe) was cut as well then blood may be aspirated into the lungs, which could potentially hasten the death.

A relative of mine died recently and suddenly at only 57. A post mortem was carried out but they still don't know the cause. Heart attack, stroke and aneurysm were all ruled out. We've been told it could take 14 weeks for further results to come back - do you know what kind of tests might be being done and why this takes so long?

Sorry for your loss @keepmehappy - if no definite cause of death is found by examining the organs we will take small tissue samples to look at down the microscopy (histology) and take blood and urine samples for toxicology. If it is indicated we may also take brain for specialist neuropathology. There are other tests as well (such as biochemistry, bacteriology, virology) which we use less often. The pathologist then has to wait for all the results from the tests to come back (apart from the histology which we examine ourselves) in order to see if a cause of death has been established and write the post mortem examination report. Toxicology waiting times vary around the country but 14 weeks is not unusual. Hopefully you will get some answers when the report becomes available.

So does every single person who dies have a post mortem done? I assumed it was just if there were suspicious circumstance. Why would you need to do a PM on a pedestrian hit by a car for example. Or if a 90 year old died in their sleep in a nursing home?

Gosh no, most people who die have a death certificate written by a doctor and the death does not even require referral to the Coroner/Procurator Fiscal service. Not all deaths referred end up having a PM, those that do are governed by laws denoting which deaths require investigation (see the list here www.gov.uk/after-a-death/when-a-death-is-reported-to-a-coroner ).

A pedestrian hit by a car would need a forensic post mortem examination because there may be a criminal prosecution of the driver and the information gathered at the PM is used in evidence. A 90 year old dying in a nursing home would most likely have sufficient known health problems for a death certificate to be written, but a PM may be required if there are issues of negligence or the family complain about the care.