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.

@farmergilesnomore no such thing as a too morbid question in my line of work!

Does the way that someone died affect how their corpse smells? I was with a close relative during end of life care as their organs failed and their skin started to have a musty, sweet smell which became progressively more persistent and unsettling. I am interested in how much information you get from each of your 5 senses during a PM. Does your sense of smell ever tip you off about things to look for?

I realise that this is a slightly specific question, but I wonder if you could shed light on it, OP?

My DGF had heart failure and was discharged from the cardiologist around 92 or 93 as there was nothing further he could do. He went to his GP after a "funny turn" and was advised to pack a bag and go to hospital. He - presumably - had a massive heart attack whilst packing: the person with him called an ambulance, but he was pronounced dead at the hospital. He was 96.

My parents arrived at the hospital to find the police waiting for them, and the police subsequently asked for access to his home. My DGF was also sent for PM.

They were told that this was routine, but it was my impression that when a very elderly person with an extensive medical history has seen the GP on the day of their death, there's usually no PM. Although DGF died suddenly, his death wasn't unexpected, based on what the cardiologist had told him about his prognosis several years earlier, and of course, because of his age.

Is it normal that police would be in attendance in A and E in this type of case? And normal to check the home and order a PM?

DF was asked to be present by the police whilst they looked at DGF's body. It all just seemed a bit odd. DM (his daughter) was devastated, of course, so I didn't mention that it seemed unusual - but in your experience, do you do a lot of PMs on the very elderly who die in similar circumstances?

@JesusInTheCabbageVan I have just seen that Unnatural Causes is on my shopping list. I think I heard him on the radio and then noted his book details. Would you recommend I do buy it now you've read it?

Do you ever sense the presence of the dead person? I mean as though their spirit might be watching (I am not mad, I promise).

@slightlybrownbanana - thank you for answering my question. Especially as I realise now it was probably a ridiculous one.

Best day of my career so far was assisting a home office pathologist with an autopsy after a suspicious sudden death. I was sooo late off my shift but I was so glad I stayed

I'd gone with the body to mortuary for continuity and they asked if I'd like to stay and watch. It was fascinating.

And they got me gowned and wellies on and had me there right next to the pathologist- who was absolutely lovely and showed me everything he was doing including when he found cause of death.

It was a whole new world to me !

I'm a bobby. Thought I'd be squeamish but so wasn't!

hellen my Dad was a bobby too and loved going to PMs as he found it fascinating , yet he couldn't stand hospitals and would do anything to avoid visiting anyone who was a (living!) patient in one!

Fascinating thread BTW

I've thoroughly enjoyed reading this thread, was meant to be hoovering up but this is far more interesting. I think I'd be permanently excited if I lived your life op 👍.

A couple of questions OP:

1. When a body is really decomposed is it slimy? In that case how do you 'contain' it to do any postmortem (or even just contain it to get it in a body bag) I saw one of those house cleaning programmes once and they cleaned up after a woman had died on her sofa but not been discovered until late stages of decomposition. There were massive stains all over the carpet so I assume she had literally just broken down into liquid?

1. You said you discovered something in the vagina? Someone I know died very suddenly and during the PM it was discovered he had undiagnosed high rectal cancer. Do you use a camera to check orifices routinely or what?

Hello!

I work in a histology lab and we sometimes receive PM specimens.

Thank you for doing this, I find I cannot ask my pathologists many questions as they are always in a hurry!

Does the way that someone died affect how their corpse smells? I was with a close relative during end of life care as their organs failed and their skin started to have a musty, sweet smell which became progressively more persistent and unsettling. I am interested in how much information you get from each of your 5 senses during a PM. Does your sense of smell ever tip you off about things to look for?

Yes people who have been dying for several days often on ITU do smell different to those who have died suddenly, and I think you have described that odour very accurately. When people have died suddenly and have not yet started to decompose they smell of very little to me because I'm used to it. I can smell alcohol on people, sometimes very strongly. And body odour is just as bad on dead people as in the living! A lot of my clientele smell much better after the wash and shampoo that they receive after the post mortem examination.

My DGF had heart failure and was discharged from the cardiologist around 92 or 93 as there was nothing further he could do. He went to his GP after a "funny turn" and was advised to pack a bag and go to hospital. He - presumably - had a massive heart attack whilst packing: the person with him called an ambulance, but he was pronounced dead at the hospital. He was 96.

My parents arrived at the hospital to find the police waiting for them, and the police subsequently asked for access to his home. My DGF was also sent for PM.

They were told that this was routine, but it was my impression that when a very elderly person with an extensive medical history has seen the GP on the day of their death, there's usually no PM. Although DGF died suddenly, his death wasn't unexpected, based on what the cardiologist had told him about his prognosis several years earlier, and of course, because of his age.

Is it normal that police would be in attendance in A and E in this type of case? And normal to check the home and order a PM?

DF was asked to be present by the police whilst they looked at DGF's body. It all just seemed a bit odd. DM (his daughter) was devastated, of course, so I didn't mention that it seemed unusual - but in your experience, do you do a lot of PMs on the very elderly who die in similar circumstances?

I agree with you that it seems unusual for your grandfather to need a post mortem in these circumstances (given his past medical history), but is up to the individual GP as to whether they are willing to issue a death certificate. If a death is referred to the Coroner then the information required will be gathered by police officers, that is the reason why they were in attendance. They hopefully act sensitively in that situation and would explain that they were acting for the Coroner and that there was no criminality involved. Sorry you've had an upsetting experience.

In Scotland your grandfather would be a good candidate for a 'view and grant', where the pathologist reads the history, examines the body externally to look for injuries and if satisfied can issue a death certificate, but this is not included in the laws of England and Wales and all cases proceed to full post mortem examination.

Hi,

Thanks for this thread it is really interesting!

Two questions for you!

Question 1)
Have you ever worked on a case where a baby died from (SIDS) cot death and if yes did the baby/s tend to have underlying health conditions that could of attributed to their death?

2. What book/s do you recommend to read that gives a much deeper insight into your industry?

I saw post mortems as a student nurse and found them fascinating. What got me though, was when the brain had been dissected it was put back in the abdomen and the skull stuffed with green cloth. Did I remember that correctly? Does that happen?

Do you ever sense the presence of the dead person? I mean as though their spirit might be watching (I am not mad, I promise).

No, I've never felt or thought that.

I think I'd be permanently excited if I lived your life op @userxx trust me its not that exciting!

But I do always have an interesting tale to tell and you get to be nosey about people's lives. So much goes on behind closed doors and truth is often stranger than fiction.

When a body is really decomposed is it slimy? In that case how do you 'contain' it to do any postmortem (or even just contain it to get it in a body bag) I saw one of those house cleaning programmes once and they cleaned up after a woman had died on her sofa but not been discovered until late stages of decomposition. There were massive stains all over the carpet so I assume she had literally just broken down into liquid?

Yes that's right - putrefaction or wet decomposition involves the tissue breaking down to liquid and liquefied fat is very slimy. It can cause technical difficulties because your hand slips when you're holding the knife, plus its highly unpleasant. Containing it is tricky. If you can take the surface that the body is lying on and put it all in the body bag that helps. There are other types of decomposition, namely mummification where the tissue goes all hard and leathery in a dry environment, and adipocere where the fat becomes sort of chalky and soap like - but putrefaction is the most common type of decomposition I encounter.

You said you discovered something in the vagina? Someone I know died very suddenly and during the PM it was discovered he had undiagnosed high rectal cancer. Do you use a camera to check orifices routinely or what?

In my case I was taking a swab of the vagina for evidence (these swabs are analysed for semen and DNA by forensic scientists) as it was a suspicious death and felt the swab touch something artificial, then pulled out a bag with money in it. We wouldn't probe the orifices in a routine post mortem examination unless it was indicated for whatever reason. A high rectal tumour would be found when the bowel is removed internally as it is cut off through the rectum within in the pelvis.

Have you ever worked on a case where a baby died from (SIDS) cot death and if yes did the baby/s tend to have underlying health conditions that could of attributed to their death?

SIDS (sudden infant death syndrome) is a diagnosis of exclusion and it is used in a child under the age of 1 when no cause of death has been found following post mortem and extensive investigations and there are no suspicious circumstances. Because of that if there was an underlying health problem this would be stated in the death certificate and using SIDS would be inappropriate. There are lots of theories as to why cot death occurs but no definite evidence of a mechanism of death currently. As a forensic pathologist I only get involved in cot death cases if there is an element of suspicion but I have worked with paediatric pathologists on cases which have subsequently been attributed to SIDS.

What book/s do you recommend to read that gives a much deeper insight into your industry?

As previously mentioned in the thread I would recommend Unnatural Causes by Dr Shepherd which I recently read and enjoyed.

I saw post mortems as a student nurse and found them fascinating. What got me though, was when the brain had been dissected it was put back in the abdomen and the skull stuffed with green cloth. Did I remember that correctly? Does that happen?

Yes, that's correct. The reason why the brain is not returned to the skull at the end of the post mortem examination is that blood and tissue fluid would seep out of the stitches in the scalp which would be awful for relatives. Instead all the organs go into a bag in the torso and the skull is packed with wadding.

Fantastic thread and wonderful answers. And I think you do a job so important, and skilful, that you deserve massive praise. Thank you.

Have you ever appeared in documentaries?

Do you rinse a suspected murder victim’s nose for pollen?

Hi, you may not be able to answer this for me (hopefully you can)!

I'm currently a mature student studying criminology with Forensic Science. I love the nitty gritty side to it and feel I am swaying more to forensics. What sort of jobs could I look to be going for when I graduate? I'd be so happy with lab work but would love crime scene work too. Do you think my degree could help get a foot in the door?

Thank you 😊