النص الكامل لحلقة Demystifying Forensic Medicine: Tales from the Morgue

there are big offices in places like New York, Los Angeles, Dallas, San Antonio, St Louis and so on. 00:06:23.692 --> 00:06:28.415 So, essentially, medical examiners are forensic pathologists. 00:06:28.415 --> 00:06:45.649 Not all, very few coroners are I put it in those in that way, but in all of the systems forensic pathology is the academic discipline at the center of the death investigation, and we're the people that conduct post-mortem examinations. 00:06:48.581 --> 00:06:53.612 How do you handle the emotional challenges of working with death and trauma on a daily basis? 00:06:55.540 --> 00:07:02.173 I think that people may be surprised that it really doesn't really affect us too much. 00:07:02.173 --> 00:07:04.766 Obviously, we're trained as doctors. 00:07:04.766 --> 00:07:08.641 Really affect us too much? 00:07:08.641 --> 00:07:14.259 Obviously, we're trained as doctors and in medicine one of the things we have to deal with is people who are dying or having curable diseases and they will die. 00:07:14.259 --> 00:07:35.538 We also have our personal experiences and the role that we have in conducting a post-mortem examination of somebody is to do the best we can for that person in establishing why they died. 00:07:35.538 --> 00:07:46.874 And you know, a lot of forensic pathologists will tell you oh, I would like so-and-so to do my autopsy, because they will do a good job. 00:07:46.874 --> 00:07:51.031 And I mean, there's nothing new about this. 00:07:51.091 --> 00:08:07.072 The philosopher jeremy bentham had himself autopsied in the 1830s, um, and I think that therefore, we separate the emotion of the death from our physical work. 00:08:07.072 --> 00:08:09.869 And people say to me well, what about children? 00:08:09.869 --> 00:08:26.103 And the irony is that the more injured and hurt a child is, in one sense, the easier our job is, because we don't face the controversies of not being able to find a cause of death, which is one of the things that we have to deal with. 00:08:26.103 --> 00:08:36.956 And I found it more difficult to come to terms with the fact that many of the post-mortem examinations in what are often called cot or crib deaths. 00:08:36.956 --> 00:08:45.500 We didn't have an answer and that was almost more distressing than the actual process of autopsying the child. 00:08:45.500 --> 00:08:52.234 And of course, it's absolutely devastating for the parents to have this. 00:08:52.960 --> 00:09:17.346 Some of the cases a minority die of inflicted injury from the parents and, as I say, those are often the easier ones to deal with because if the cause of death is obvious and there's a lot of injuries, then our evidence cannot be challenged and we have the knowledge that we've been able to find a cause of death. 00:09:17.386 --> 00:09:27.826 But if we don't have a cause of death, that took some getting used to and in a proportion of the cases we do, both in adults and children, we won't find a cause of death. 00:09:27.826 --> 00:09:30.807 Now, some of those are because the body's decomposed. 00:09:30.807 --> 00:09:31.428 That's fine. 00:09:31.428 --> 00:09:43.479 We fully understand that If you find someone that's been missing over a winter and their body's completely decomposed, that's, you know, no one's going to find the cause of death, no one's going to find the cause of death. 00:09:43.479 --> 00:09:46.022 But in others, you know the marathon runner that drops dead and we just don't find anything. 00:09:46.022 --> 00:09:50.311 I mean, we now understand a lot more about why these people die. 00:09:50.311 --> 00:09:58.591 They often have genetic abnormalities of their heart conduction and we're able to test for that now in a way we weren't 30 years ago. 00:09:58.591 --> 00:10:07.153 So we do make progress in all of these and that's quite satisfying to be able to develop our science. 00:10:08.899 --> 00:10:13.111 Can you walk us through the steps of undertaking a forensic autopsy? 00:10:15.340 --> 00:10:20.928 Yeah, well, it's funny because we're often asked this when we give evidence in court. 00:10:20.928 --> 00:10:34.552 When we give evidence in court, or even if we aren't, we explain that we have a five-step process and the first step is to obtain a history, like you would if you go to the doctor. 00:10:34.552 --> 00:10:36.495 You know, I've got chest pain. 00:10:36.495 --> 00:10:45.672 Well, ours are obviously maybe from the patient, in the sense that they may complain to their relatives or people around them. 00:10:45.672 --> 00:10:49.274 I've got chest pain, I've got a headache and then collapse and die. 00:10:49.274 --> 00:10:53.190 We obtain the scene information. 00:10:53.190 --> 00:10:56.668 We do so. 00:10:56.668 --> 00:10:59.380 How were they found, you know? 00:10:59.380 --> 00:11:00.907 Was there bloodstaining at the scene? 00:11:00.907 --> 00:11:04.269 Are they involved in a road traffic crash? 00:11:04.269 --> 00:11:07.347 If a traffic crash, what does the car look like? 00:11:07.347 --> 00:11:16.809 I mean, is it badly damaged or is there no damage to the car which might point to it being not a traumatic death but a natural death with someone collapsing from a heart attack at the wheel? 00:11:17.941 --> 00:11:26.426 We conduct an external examination, just the same as you would if you went to the doctor your own family doctor. 00:11:26.426 --> 00:11:33.131 The only difference is we examine everything and a family doctor typically will direct his examination to what you're complaining of. 00:11:33.131 --> 00:11:44.682 And then the different stage that we do is we do an internal dissection, looking at the organs, which is not available in the same way to other people. 00:11:44.682 --> 00:11:49.692 Now you may say well, what about doing CT scans or something like that? 00:11:49.692 --> 00:11:55.913 Well, we can do that these days, but they still are not as accurate as conducting the full dissection. 00:11:55.913 --> 00:12:01.110 And then, of those

stages, the fifth stage. 00:12:01.110 --> 00:12:05.302 So we've had history scene, external internal examination. 00:12:05.302 --> 00:12:13.306 We then do ancillary testing, which is most commonly looking at tissue down the microscope and doing toxicology. 00:12:13.306 --> 00:12:23.191 So toxicology and I'm aware you're a toxicologist is one of our most vital ancillary tests and we work very closely with, uh, with toxicologists. 00:12:24.413 --> 00:12:39.803 Because at the end of the day, you're going to die of one of three things in general terms you're going to die of natural diseases, you're going to die of trauma or you're going to die of drugs and poisons. 00:12:41.206 --> 00:12:46.304 Now there can be an interaction and you may have two of those three or you may have all three. 00:12:46.304 --> 00:12:58.214 A good example of all three is in some police-involved deaths, where you have somebody who is intoxicated with drugs, say on cocaine, they have a bad heart and they get into a struggle with the police and then they die. 00:12:58.214 --> 00:13:00.825 So they have all three of our triangle. 00:13:00.825 --> 00:13:08.028 And when we've got all of that information we then put it together to render our opinion. 00:13:08.028 --> 00:13:26.681 So, if you like, the first five steps are gathering evidence and then we do our analytical stage to come up with an opinion on cause of death and, if I'm a medical examiner, on what in North America we refer to as the manner of death. 00:13:26.681 --> 00:13:33.924 In other words, is it a suicide, a homicide, an accident, natural diseases, or we can't determine what it is. 00:13:33.924 --> 00:13:36.611 So that's the processes we go through. 00:13:38.542 --> 00:13:41.750 How do you handle situations where your findings are challenged? 00:13:43.139 --> 00:13:45.966 Well, there's two points to this, I think. 00:13:45.966 --> 00:13:50.333 One is that we should be doing evidence-based medicine. 00:13:50.333 --> 00:14:19.756 So evidence-based medicine should come from our experience, but also knowledge from the literature that this pattern causes that result, and so if you're on solid scientific grounds, you should be able to point that out if you come under cross-examination to say you've got it wrong, which we do. 00:14:19.756 --> 00:14:45.410 The other point, though, is that we are an opinion-based science, have an opinion element to it in that if, say, you go to the hospital, and whether it's having a blood alcohol measured or a blood glucose measured, there is actually a range of results. 00:14:45.410 --> 00:14:51.066 We give one result, but it it actually could be plus or minus. 00:14:52.067 --> 00:15:11.666 That's just the nature of the way laboratory medicine works, and in forensic pathology, you may be asked well, the injury you said was caused by a blow with a piece of wood, could it be caused by a fall against an object? 00:15:11.666 --> 00:15:20.323 And you either have to concede that based upon your

knowledge, or you say no. 00:15:20.323 --> 00:15:23.591 I don't believe so, for the following reasons. 00:15:23.591 --> 00:15:45.631 And in court cases, your duty is to answer the questions, be calm, don't argue with counsel, just answer their questions, and if you're right, that will normally come through. 00:15:47.821 --> 00:15:53.332 Chris, have you worked on any high profile or notable cases and how have they impacted you? 00:15:53.679 --> 00:15:55.484 multiple cases and how have they impacted you? 00:15:55.484 --> 00:16:00.873 What I would say is a high profile case rarely starts as a high profile case. 00:16:00.873 --> 00:16:07.679 It sometimes does. 00:16:07.679 --> 00:16:12.145 You know, if you have the shooting of a police officer on duty, that's going to be big news and I've dealt with those cases. 00:16:12.145 --> 00:16:21.533 I've also done reviews of TV stars who've died or been connected to a death. 00:16:21.533 --> 00:16:29.942 By and large they're straightforward, and you don't. 00:16:29.942 --> 00:16:33.072 They're not always the most tricky cases we deal with. 00:16:33.072 --> 00:16:38.860 They're not always the most tricky cases we deal with. 00:16:38.860 --> 00:16:45.450 There are some that can be contested and there may be potentially different causes of death. 00:16:45.450 --> 00:17:00.410 But in the others I mean the last police shooting death I did they brought someone back for trial after many years of not being able to arrest him because he had fled the jurisdiction and I presented my evidence and had no questions in cross-examination. 00:17:01.320 --> 00:17:09.111 So you know, a high-profile case, yes, but not one that was difficult from a forensic pathology point of view. 00:17:09.111 --> 00:17:25.433 But there are cases that I've had colleagues who've had threats for the evidence, almost not before the evidence given, because people form perceptions without realizing what's going on. 00:17:25.433 --> 00:17:26.625 That's very rare. 00:17:26.625 --> 00:17:38.276 The one case where I did receive some threats I didn't take seriously but they were made by email. 00:17:38.276 --> 00:17:49.092 I received unsolicited emails saying that I was a despicable human being and so on, because they didn't like what I was, but I hadn't even said anything at that stage. 00:17:49.092 --> 00:17:50.204 This was the bizarre thing. 00:17:50.204 --> 00:18:00.126 So, yeah, it happens in high-profile cases, but I mean, to me it's been exceptional and I didn't feel threatened. 00:18:00.126 --> 00:18:06.946 But I have had colleagues who genuinely have been and I guess it partly comes with the territory, but none of us. 00:18:06.946 --> 00:18:18.134 We're all trying to do our best and give straightforward and honest evidence, and just that in this contentious world world, some people don't understand our role. 00:18:19.599 --> 00:18:26.973 Chris, how do you think forensic medicine, specifically forensic pathology, might evolve in the next decade?

00:18:30.441 --> 00:18:31.082 It's interesting. 00:18:31.082 --> 00:18:32.964 People ask me about AI. 00:18:32.964 --> 00:18:38.432 Do I see AI, artificial intelligence, coming into forensic pathology? 00:18:38.432 --> 00:18:58.228 And the answer is not much pathology. 00:18:58.228 --> 00:19:07.682 We're developing techniques and patterns of injury, patterns of disease, and that's what we had to learn the 21st century. 00:19:07.682 --> 00:19:18.763 We started to develop techniques such as CT scanning for post-mortem and genetic testing for diseases, which are by no means they're useful. 00:19:18.763 --> 00:19:52.020 But the central tool in the next 10 years will be the autopsy, and it will be the autopsy as we conducted it 100 years ago, and there are interesting differences in the way the autopsy is used, in that some jurisdictions you know more commonly in continental Europe than in the English-speaking world tend to focus on crime, so they don't do as many autopsies in medical legal death investigation. 00:19:53.323 --> 00:20:08.364 I still believe the autopsy has a vital role to play in non-criminal cases and for public health, and I think that will also is a focus that people are beginning to look at a bit more. 00:20:08.364 --> 00:20:11.089 We can use the autopsy. 00:20:11.089 --> 00:20:23.074 The autopsy still has a role in research, in clinical medicine, as well as in looking at trauma and drug-related deaths. 00:20:23.074 --> 00:20:33.101 So we still, for example, are trying to work out exactly when someone has died of a drug toxin versus another drug toxin. 00:20:33.101 --> 00:20:34.742 And why do I say that? 00:20:34.742 --> 00:20:43.759 Well, because many of our deaths in the fentanyl crisis that's occurred in North America also have cocaine on board. 00:20:43.759 --> 00:20:47.388 Well, did the cocaine actually contribute to the death or not? 00:20:47.388 --> 00:20:48.712 We don't actually really know. 00:20:48.712 --> 00:20:55.512 But is there any way we can try and tease that apart and say well, what does it matter? 00:20:55.512 --> 00:20:56.121 Well, it does. 00:20:56.121 --> 00:21:07.067 If you want to prosecute someone for supplying fentanyl causing the death, which you can do in North America, you can't do in England because of case law. 00:21:07.067 --> 00:21:26.359 So there's still a lot we have to learn and I believe that the autopsy will continue in the next 10 years to be the standard tool, possibly directed slightly in the next 10 years, to be the standard tool, possibly directed slightly, with a focus more on research and public health than sometimes we have done. 00:21:27.520 --> 00:21:28.826 There are two types of autopsy. 00:21:28.826 --> 00:21:38.009 There are autopsies of documentation and there are autopsies of discovery, and the most interesting ones to do are the autopsies of discovery. 00:21:38.009 --> 00:21:40.006 And what do I mean by that? 00:21:40.006 --> 00:21:47.703 Well, the police come to me and say we've

had a shooting, we've had a stabbing, they know what's happened, I just have to be there to document it. 00:21:47.703 --> 00:21:52.664 Maybe they don't know exactly the number of gunshot wounds, Maybe they don't know exactly the number of stab wounds. 00:21:52.664 --> 00:21:54.450 Were there defence wounds? 00:21:54.450 --> 00:21:57.241 Did they have any underlying disease that may have affected them? 00:21:57.241 --> 00:22:01.848 And then we'll do the toxicology that may have affected them and then we'll do the toxicology which may have affected behaviour. 00:22:01.848 --> 00:22:04.313 But more interesting are our sudden deaths. 00:22:04.313 --> 00:22:14.469 Often as you get older you realise where I don't actually know what the cause of death is until I've completed all my tests, and those are more interesting, I think. 00:22:15.632 --> 00:22:22.131 Chris, are there any unusual or surprising aspects of forensic pathology that people would not expect? 00:22:24.601 --> 00:22:41.887 I think that people get a false impression of forensic pathology based on TV shows, but upon Silent Witness and upon similar shows that we Can Walk it or Midsummer Murders, you know, they give the time of death instantly. 00:22:41.887 --> 00:22:44.623 That's all baloney, it's not. 00:22:44.623 --> 00:22:48.790 We just can't do that, and they give far too much detail. 00:22:48.790 --> 00:22:53.548 Um, at the scene, it takes time to work these things out. 00:22:53.548 --> 00:23:00.412 So that's something I think that we often have to correct, and anyone who's in forensic science knows this. 00:23:00.412 --> 00:23:01.842 It's known as the csi effect. 00:23:01.842 --> 00:23:20.791 You have to tell the juries that a lot of what is in tv drama is exactly that it's drama, it's not reality, and so sometimes our tools are more powerful than people think, but more often than not they're not, as it's not as straightforward as is portrayed. 00:23:20.791 --> 00:23:36.685 So that's one thing, and it may well be that the public don't fully appreciate that the autopsy can be a significant tool for closure, to provide the family with knowledge of what happened to their loved ones. 00:23:36.685 --> 00:23:40.690 That could not be done without the autopsy. 00:23:42.980 --> 00:23:48.492 Chris, how do you determine the time of death and what factors influence this estimate? 00:23:49.339 --> 00:23:55.241 Well, the easiest way is to find out when they were last seen alive, when they were found dead, and say they died sometime in between the two. 00:23:55.241 --> 00:24:00.046 And that old joke is true. 00:24:00.046 --> 00:24:17.119 What you can do is sometimes you can narrow it down by well, if someone was found dead and it's a criminally suspicious death and the person who found them says, well, I came across them and they collapsed in my presence, I immediately called 999-911. 00:24:17.119 --> 00:24:20.292 And the ambulance arrives within 15 minutes. 00:24:20.292 --> 00:24:20.934 And they are. 00:24:20.934 --> 00:24:22.560 They have complete rigor mortis. 00:24:22.560 --> 00:24:24.306 You couldn't be going. 00:24:24.306 --> 00:24:25.749 That can't be correct. 00:24:27.713 --> 00:24:32.584 There are people have looked at temperature, um cooling of the body. 00:24:32.584 --> 00:24:38.291 People have looked at biochemistry to see the changes in potassium in eye fluid. 00:24:38.291 --> 00:24:49.849 All of these are interesting but really don't get used much in casework because there are so many variables. 00:24:49.849 --> 00:24:55.807 Later we have things like forensic entomology, which can also be helpful. 00:24:55.807 --> 00:25:05.315 So that's insects get laid on bodies and maggots come, and then other beetles come and eat maggots and so on. 00:25:05.315 --> 00:25:17.852 It's known as the faunal succession, and we have specialists in entomology who do forensic entomology and that can be helpful to give a timescale of how long the body is there. 00:25:18.599 --> 00:25:25.948 But in truth most cases don't need time of death and if they do. 00:25:25.948 --> 00:25:34.759 The limits to how accurate we can be often fall outside or within, depending on which way you look at it. 00:25:34.759 --> 00:25:36.522 What is known, so I mean it. 00:25:36.522 --> 00:25:46.442 You, if you do temperatures, typically they talk about you know the best is a five-hour window, and the police may say well, we already know that there's a four-hour window. 00:25:46.442 --> 00:25:52.232 So we can't do any better than that, than just ordinary observations. 00:25:52.232 --> 00:25:55.944 So textbooks have chapters on time of death. 00:25:55.944 --> 00:26:01.320 There's a whole textbook dedicated to time of death, of death. 00:26:01.320 --> 00:26:06.813 There's a whole textbook dedicated to time of death, and a lot of forensic pathologists will say it just isn't simple to use the various techniques. 00:26:08.842 --> 00:26:16.851 Chris, what are the differences you note in practicing in Canada versus United Kingdom and what advice would you have for somebody considering that career? 00:26:18.259 --> 00:26:22.989 Well, my advice to someone who's thinking about becoming a forensic pathologist is do so. 00:26:22.989 --> 00:26:26.904 It's been the most fascinating career as far as the. 00:26:26.904 --> 00:26:36.048 There are, in many respects, no differences between what I did in England and what I do in Canada. 00:26:36.048 --> 00:26:39.949 The autopsy practices are the same. 00:26:39.949 --> 00:26:45.442 Time has evolved to allow us to do one or two more tests. 00:26:45.442 --> 00:26:49.010 We do a different proportion of deaths in Canada to England. 00:26:49.010 --> 00:26:57.084 When I was in England I mean they have reduced, apparently, but we were doing nearly a quarter of all deaths as a medical, legal autopsy. 00:26:57.084 --> 00:27:02.179 It's about 8.5% in canada, but all the patterns are similar. 00:27:02.179 --> 00:27:14.528 I mean you, you may, you know I I

get more um suicidal shootings in canada than I saw in england because we have more hunting guns, but not it's not. 00:27:14.528 --> 00:27:18.102 We don't see the firearms deaths that the united states does. 00:27:18.102 --> 00:27:22.153 We obviously have a have different patterns of drug use. 00:27:22.153 --> 00:27:25.525 It was all heroin when I was there and ecstasy. 00:27:25.525 --> 00:27:31.443 I wrote a bit on ecstasy in the 90s and we saw ecstasy and heroin. 00:27:31.785 --> 00:27:34.292 Don't see much ecstasy, occasional case. 00:27:34.292 --> 00:27:36.981 Don't see a huge amount of heroin. 00:27:36.981 --> 00:27:42.744 We just see fentanyll but another drug called the nitazines or nitazines depending on which way you pronounce it. 00:27:42.744 --> 00:27:45.430 I've not seen a case in ottawa. 00:27:45.430 --> 00:27:47.861 They occur in england now. 00:27:47.861 --> 00:27:58.561 So some of those um differences, and then you may have one difference that we do deal with. 00:27:58.561 --> 00:28:02.345 You have to be cognizant of religious, cultural differences. 00:28:02.345 --> 00:28:10.670 So we have important indigenous populations in Canada that we didn and we have the same here. 00:28:10.670 --> 00:28:15.251 So some religions are not so keen on the autopsy as others. 00:28:15.251 --> 00:28:59.936 But here we also have important interactions with indigenous First Nations people, the Inuit and the Métis, who have been disadvantaged over the generations by colonialism and there is an antipathy towards authority, or there can be, so we have to be cognizant of that and respectful of their traditions as much as we're respectful of people who are of different faiths. 00:29:00.460 --> 00:29:02.147 Chris is there. 00:29:02.167 --> 00:29:03.894 Anything else you'd like to share with our listeners? 00:29:03.894 --> 00:29:09.464 Well, what I would say is that forensic pathology has remained. 00:29:09.464 --> 00:29:10.406 It's a different career for a doctor. 00:29:10.406 --> 00:29:10.988 There's no question. 00:29:10.988 --> 00:29:17.462 I don't treat people, although I arguably treat the community, and we have a public health role. 00:29:17.462 --> 00:29:26.346 We, I believe, are an integral part of society, assisting the criminal justice system but also public health. 00:29:28.050 --> 00:29:31.423 I've been doing this now full time for nearly 35. 00:29:31.423 --> 00:29:33.067 I mean, since I started. 00:29:33.067 --> 00:29:36.762 I did my first autopsy over 40 years ago, so I've been doing it a long time. 00:29:36.762 --> 00:29:37.989 I've had the fortune to travel around the world. 00:29:37.989 --> 00:29:38.632 I've been doing it a long time. 00:29:38.632 --> 00:29:40.440 I've had the fortune to travel around the world. 00:29:40.440 --> 00:29:44.420 I've given evidence in Ireland, for example. 00:29:44.420 --> 00:29:46.559 I've been over in Northern Ireland. 00:29:46.559 --> 00:29:50.039 I've been in the Netherlands, south Africa, australia. 00:29:50.039 --> 00:29:53.480 It's taken me to do cases all around the world. 00:29:55.611 --> 00:30:03.874 But what's interesting is, in all of those places, the central thing about murder trials still is the post-mortem examination, which is why we can do it. 00:30:03.874 --> 00:30:15.688 And I think that if you are, what I would say is, if you are interested in doing it, then you need to explore it, but you do need to go to medical school, you do need to train in pathology. 00:30:15.688 --> 00:30:20.105 But if you do, and there are people who come and talk to me about this. 00:30:20.105 --> 00:30:25.413 You'll have a fascinating career and you'll meet wonderful people like you. 00:30:25.413 --> 00:30:31.496 Because one of the things I do want to say in all of this and we met um, we have mutual friends. 00:30:31.496 --> 00:30:34.382 Forensic pathology doesn't exist in a vacuum on its own. 00:30:34.382 --> 00:30:34.702 We are. 00:30:34.702 --> 00:30:39.269 We have team members, forensic biologists, forensic members, forensic biologists, forensic toxicologists. 00:30:39.269 --> 00:30:56.156 We have police investigators, we deal with lawyers, we deal with families, we deal with doctors because of patients. 00:30:56.176 --> 00:31:12.994 So we're one cog in a big mechanism and it affords fantastic opportunities to meet other professionals who have a fascinating perspective on forensic science and medicine. 00:31:12.994 --> 00:31:14.539 Can I just say thank you, you are an absolute pleasure to be here. 00:31:14.539 --> 00:31:22.230 Thank you, and to our listeners, thank you for tuning in to another episode of the Analytical Zen Podcast. 00:31:22.230 --> 00:31:24.575 Be sure to join us next time. 00:31:24.575 --> 00:31:27.342 Stay curious.