Derrick Pounder - Full Transcript

Derrick PounderProfessor of Forensic Medicine, University of Dundee

Interview location: Dundee University
Interview date
: 7th December 2002


Profile | Transcript Summary | Full Transcript



SA:  Where were you born and brought up?

DP:  I was brought up in Pontyprid in the south Wales mining valleys, and went to the local grammar school – it no longer exists of course.  Then off to university in Birmingham.  I graduated, and as soon as I graduated I jumped on a plane, left the country and went to Dublin in Ireland.  After Dublin I was in Australia for eight years, and then western Canada for two years, and then came back to the UK 15 years ago and I've been in Dundee ever since.

SA:  Do you come from a medical family?

DP:  Not at all.  I belong to that generation of the working class that was the first generation to go to university.  I got to university because of the socialist movement and the trade union movement and all their support for education.  In fact the government and the tax payer paid for my entire education.

SA:  In those days!  Tell me, how did you get into pathology – did you first study medicine and then choose pathology, or did you grow up wanting to be a pathologist?  How did you come into this field?

“Medical sleuthing”

Pathology is the foundation science of all of medicineDP:  Well I got into medicine because I was interested in science, and of course no one tends to ask you, "Do you really want to do medicine?"  Everyone encourages you.  So once I got my medical degree I still wanted to do science, and pathology is the foundation science of all of medicine.  So after a few years of hospital practice I decided I wanted to train as a pathologist.  I started that in Dublin, and it happened that, by pure chance, the hospital I was working in had, as one of the professors, the professor of forensic medicine for the College of Surgeons in Dublin. 

We did the coronial autopsies for that part of the city, and I did about 200 a year, coronial autopsies, and it was wonderful.  It was fascinating.  I was amazed by it.  I had the pleasure of being able to discuss the case with the professor in the morning and then attend his court and give evidence before him in the afternoon, so it was a very comfortable introduction to forensic practice, both the science and the courts, and I decided that that's what I wanted to do.

SA:  You say it was fascinating , what particularly?

The problem solving, was the fascinating part. It was ‘medical sleuthing’, a daily challenge -- and a pleasure DP:  The science was fascinating… The problem solving, I suppose, was the fascinating part.  And also the fact that you were using physical skills, your own personal physical skills, in terms of the dissection of the body, and using your own observation – not just using your eyes, but your sense of smell, your sense of touch as well -- and trying to put all the pieces together with the background information to draw the conclusions. 

It was ‘medical sleuthing’, if you like, on a day to day basis.  You never knew what you were going to get as a problem that day -- whether you'd be easily able to solve it, or you'd have to go to the books and the literature, or discuss it with colleagues and so on and so forth.  So it was really a daily challenge -- and a pleasure.

Occupational hazards

SA:  What were some of the most interesting and challenging things in your very early days as a forensic pathologist?

Problems of infection were challengingDP:  Well in the early days the most challenging thing was to spot a TB case, because there was an infection problem, and we had quite a few TB cases in Dublin.  I remember one case in which I'd missed the diagnosis and it wasn't until about six weeks later that I discovered that I'd done an autopsy on a TB case. 

Of course there are problems in terms of transmission – TB's a serious matter for the hospital.  I also recall that in that particular hospital, in the entrance hallway there was a plaque on the wall to a young doctor who'd died in the 1930s, a few years after graduating, and he'd died as a result of septicaemia from performing an autopsy. 

So health and safety and problems of infection were challenging.  And the forensic cases, because they're medico-legal, involved accidents, suicides… At that time I wasn't doing any homicide cases at all.  But some of the suicides -- unravelling what had happened there, when people were perhaps brought out of the river having been there a while -- could also be a challenge.

SA:  This is interesting…This is something nobody else has touched upon -- the risks involved in your job of dealing with diseases, and perhaps with something you just don't know about, like an Ebola virus, or HIV.  Do you always "gown-up" and dress as though whatever you're dealing with might be lethal?

Forensic practice has changed enormouslyDP:  Well forensic practice has changed enormously over the years. When I started out, the professor who was observing me doing the autopsy would wander in in his suit and stand alongside me while I, gowned-up of course, made the dissection, and he standing right at my shoulder leaning over.  And in later years I did the same thing.  These days that's totally unacceptable in terms of risk control. 

And of course there are risks with the autopsy -- we deal for instance with HIV-positive cases, we deal with hepatitis B and hepatitis C cases.  We even had a rabies case here recently in Dundee.  We have to perform these autopsies because   we need the information -- to help the living, essentially. 

But we have to control the There are risks with the autopsyrisks, so there are now a whole range of health and safety procedures, and we're gowned-up and gloved-up and double-gloved, with visors in front of our faces to protect us from splashes and so on.  I don't think you see it like that on television too often – it probably ruins the photography!

“Doctors of death”?

SA:  Tell me, what do you feel about the general public's perception of pathologists at the moment as ‘doctors of death’?  How important is your job and how important is it, say, that you did an autopsy on the man who recently died here of rabies?

Most pathologists are not performing autopsiesDP:  Public interest comes and goes depending on what happens to be in the media at any one moment in time.  Public perception of pathologists is that we do autopsies.  Well of course, I do.  I make a living out of autopsies.  But I'm in a very small minority amongst pathologists.  Most pathologists are not performing autopsies, they're in hospital practice and doing laboratory work to support the investigation of illness in the living, and then treatment.

We're in the business of investigating the dead in order to assist the livingThose of us who do autopsies mainly do them for medico-legal reasons.  These are deaths in which there's a community interest in the investigation -- community interest because, first of all, we want to investigate any possible crimes, but secondly because we want to prevent further deaths as well. 

All of the public health measures in terms of carbon monoxide poisoning, seat belts, drink driving and so on -- all that derives from the investigation of fatalities.  And it takes place over a long period of time.  We forget where [the momentum for safety laws] started sometimes -- it started in the autopsy room.  So, we're in the business of investigating the dead in order to assist the living – there's no other reason for doing it.

SA:  Looking at something like seat belts – they're compulsory now in this country, but where would the pathologist have had an input into the discussion about the wearing of seat belts?

DP:  Well some years ago we had many more fatalities on the road than we currently have, and at that time the documentation of the injuries which killed people was made by the pathologists in the autopsy room.  All of that information was gathered together, and it was analysed according to whether the person was a pedestrian, a driver, a front-seat passenger, rear-seat passenger, motorcyclist, and so on. 

And out of those studies came legislation concerning seat-belts, crash helmets for all motor-cyclist, drink-driving of course, and a whole variety of other rules.  So it was the analysis of aggregated data from a large number of fatalities over a period of time.  First of all it was recommendations, and only later did it become legislation.


Champion of human rights

SA:  I understand you're also involved in human rights work -- how did you get involved in that?

I've always been sympathetic to the underdogDP:  Well I was always interested in human rights.  I've always been sympathetic to the underdog, it comes from my cultural and social background.  And it happened that, in the mid 80s, a few forensic practitioners who were interested in human rights found that we could use our professional skills in support of human rights -- we could bring together our professional interest and our social interest, and we began to form an informal international network.  We liaised with the various human rights organisations, and we started to consult for them in the same way that we would consult for lawyers nationally. 

And really that's logical, because human rights law internationally is fundamentally no different from national law in terms of protection of people from crimes against the person – torture and extra-judicial killings in a human rights context.  We support the legal system nationally by providing expertise, and we support the legal system internationally by providing expertise.  Of course in the mid 80s it wasn't a very popular thing to do, it was very much criticised.  These days human rights are on the international agenda, and it's much more the thing to do, and so we have many more colleagues now who are able to join us because it's not so damaging to your career.

SA:  So you really stuck your neck out at the beginning?

DP:  At the beginning yes, it was difficult, because it was seen as highly political, highly contentious.  Even if you were based in a country which was relatively sympathetic to the concept of human rights, there was still a feeling that it was a little beyond the pale for a professional person, who was after all mainly serving the criminal justice system, to be involved in something potentially so sensitive as these human rights issues.

SA:  Tell me about some of the cases you've been involved in, and what your task as a forensic pathologist is.

These are cases of tortureDP:  Well I consult for human rights organisations in the same way as I would consult for lawyers within the country.  These are cases in which there's an alleged crime against the person. These are cases of torture, extra-judicial killing, or something of that kind.  And the information I might get might only be a photograph of a dead body taken by relatives, or an injured person taken by relatives.  It might be a medical report, or an autopsy report performed in another country.  And I would evaluate that and give a written or a verbal opinion to the human rights organisation and advise them whether there was solid medical evidence to support the allegation, and whether it was a case which they could pursue.

For example, I remember a case I did for Amnesty International – it was a Tunisian death and the man had been arrested, turned up dead on the roadside, and the police and pathologist said he'd been knocked down by a car, when clearly the autopsy results showed he'd been tortured to death.  So I wrote an opinion to that effect; Amnesty International was able to pursue it.  It was pursued through a whole variety of international agencies, and basically the Tunisian government was pressed and pressed again to explain themselves and found themselves in a very difficult position.  So that's one aspect.

We went to investigate the killingAnother aspect is to actually go to the country and have a look.  I've been to a whole variety of countries with a whole variety of agencies.  Some of them are human rights organisations like Amnesty or Physicians for Human Rights, and we would go, perhaps visit a scene of death, make interpretation of the findings in the building -- gunshot wounds in the walls for example.  I went to Turkey with two human rights organisations and some lawyers -- we went to investigate the killing of some members of DEVSOL, a leftist armed group, and we found evidence in the building that people were probably executed there, just from the location of the gunshot marks.  They were all on the floor in one room.  The shooter had clearly been in the room, and yet three people had died in that building allegedly as a result of a gunfight, but there was no evidence of a gunfight.  So that's a practical example of using forensic skills to derive evidence.

I've been to other countries and performed autopsies, either with a professional colleague in that country, observing as an outside observer, or sometimes performed the autopsies myself.  I've been to Israel to do that on several occasions, looking at deaths of people in the custody of the Shin Beit [Israel security service] I was involved in one notorious case where the Shin Beit shook a man to death in the same way that you sometimes hear that adults have shaken a baby to death.

That case, although a terrible one, was a fascinating one from a scientific and legal and human rights perspective.  The man was arrested and was brain dead in hospital within 24 hours of his arrest.  The authorities gave no information about how he came to die, other than that he collapsed during interrogation.  They wouldn't even tell their own pathologists what the circumstances were.  We performed the autopsy and the physical evidence was clearly that he'd suffered a brain injury, and I went further and said that I believed that was due to shaking.  We had good evidence that they did shake people. 

Methods of interrogation could actually kill peopleInterestingly enough, the lawyer for the family said that he would phone the police and ask them whether they had shaken this man.  I told him, "No don't do that.  Phone the police and ask them how many times they'd shaken him".  So he did and he told me -- of course the conversation was in Hebrew, I couldn't understand it, but he told me afterwards that there was this stunned silence at the end of the phone and then the man asked, "How did you know?"!  So that became a notorious case because it showed that the methods of interrogation could actually kill people.  And ultimately, some years later, it led to a ruling by the Supreme Court in Israel that this method of interrogation by shaking was unlawful.

Genocide: identification of the dead

SA:  Have you ever had to go to places where perhaps there's a mass grave and some conjecture about whether or not this was a genocidal act and had to tease out what's happened?

DP:  I've been involved in the Balkans -- as of course have large numbers of my colleagues.  One of the, I think, very commendable things concerning forensic pathologists in the UK is the amount of time they've given freely to support the investigations in places like Bosnia and Kosovo.  Any of those cases are extremely difficult. There are individual graves and multiple graves and mass graves, and my experience of those has been largely in terms of assisting with the identification of the dead for humanitarian purposes. 

It may be of value in a humanitarian senseBecause of course performing the autopsy is not just about finding the cause of death, it's also about getting any other information of value.  The information may be valuable for a prosecution in terms of physical evidence, but it may be of value in a humanitarian sense, in terms of identifying the person and returning the body to the loved ones so that they can bury it decently and complete their grieving process.  In that sense I've been involved in showing clothing of the deceased to families, discussing with families autopsy findings, and trying to reconcile the information they have about the deceased with the information we've discovered from the body in order to make the identification. 

There is in Sarajevo a very important organisation called the International Commission for Missing Persons, and I'm a member of the advisory scientific board of that.  This is an organisation founded by the Americans, by President Clinton, some years ago to identify the missing dead in the Balkans.  It's a massive programme involving obtaining blood for DNA stands for deoxyribonucleic acid.  This is the material inside the nucleus of the cells of living organisms that carries genetic information (see also RNA). testing from hundreds of thousands of Testing bone samples from 20-30,000 bodiesrelatives of the dead and testing bone samples from 20-30,000 bodies using a computer programme to match them and identify the bodies.  This is the forensic pathology equivalent of a moon shot – it's the cutting edge of science.  And the wonderful thing is it's beginning to work.  We're beginning to get identifications at about the rate of 100 a month, due to the application of this technology.

SA:  How important is it to families that they do know something of what's happened – even if you can't actually bring a body back for them? 

DP:  Of course every family wants to know whether a loved one died.  Very often the circumstances are such that an objective observer would say, "They must be dead."  But families naturally cling to hope.  No one really wants to believe that a loved one is dead unless they are faced with the objective proof.  And so very often there is a long period of denial in terms of the circumstances. 

For some families it's impossible to come to terms with the individual being missing, and they have to have the body to convince themselves that the person is dead.  Indeed in some cultures not having the body can make life extremely difficult in terms of the grieving process.  Cultures vary of course, but the Americans for example make a huge effort to discover and return the bodies of their war dead from the Vietnam War, and they spend large amounts of money to do that.  That's part of their culture.  Historically, we have had a slightly different culture in Britain, we tended to leave our war dead on the battlefield and bury them there overseas.  We haven’t repatriated them, at least until very recently.

They want proof that those are the bodies of their loved onesSo there are cultural differences and we have to recognise those differences and serve the people in a way which is appropriate to them.  In the Balkans they want the bodies back; they want proof that those are the bodies of their loved ones, and if we're able to do that then we should do it.

SA:  There's a very moving story in one of the newspaper interviews I read about clothing – can you tell that story…?

DP:  One of the methods of identifying the dead is by the clothing they're wearing.  In the poorer communities the clothing may be handmade, or hand repaired, which makes it unique, and so long as you can be assured that the clothing hasn't been transferred from one body to another it's good evidence of identity.  So in the Balkans we've recovered the clothing of the dead and washed it.  (Of course the bodies are so badly decomposed that even if you wash it the clothing still stinks terribly.)  But having done that it's then laid out – the clothing of many people, perhaps hundreds of people – in an old building, an old warehouse with broken windows and so on, anywhere which is covered and has some reasonable ventilation.  And then the local people are invited to come and view it to see if they can recognise the clothing of a loved one.

I recall a man identifying clothing which he said were the trousers of his father.  But they were mass-produced so I said to him, "How d'you know?"  And he said, "Well they used to be my trousers."  And I said, "But they're mass produced, how d'you know?"  He said, "Look here," and he showed me a hand-made pocket in the trousers.  He said his mother had made it from this flowery fabric because there were no pockets in the trousers and he had to carry his identification documents with him everywhere.  And he recognised that unique item of the clothing.

To see families identify clothing in that way is very sad In another instance I had a young woman come around and identify the hand-kitted socks and hand-knitted sweater of her brother, [his voice breaks]… Of course to see families identify clothing in that way is very sad.

Coping with evidence of inhumanity

SA:  It's terrible…  I mean, what you're witnessing is the evidence of mass human cruelty – how do you cope?

We're trained to develop some detachment without losing our compassionDP:  It's relatively straightforward to deal with the dead in an objective manner, firstly because in medicine we're trained to develop some detachment without losing our compassion.  Secondly, of course, forensic pathologists like myself have been doing this work for many years and it's, if you like, instinctive to us, it's part of our professional mode of operation.  So in a different environment, even though it's a very tragic one with large numbers of people dead, it is possible to operate in that way. 

What becomes very difficult – and it's the same for everybody – is when you're faced with the emotion of survivors.  And that's the same in hospital practice, of course -- the most difficult thing is not to deal with a dead patient but to deal with the grieving relatives of that patient.  That's always disturbing. So my most vivid memories of these events are always to do with the living, not to do with the dead.

SA:  Are you taught how to deal with that side of thing when you're trained?  Or have you just learnt that over the years?

DP:  Well traditionally we never taught doctors how to deal with these emotional problems.  We made the assumption that doctors would acquire it by osmosis and would have strength of character – which is of course a nonsensical approach.  Nowadays we teach the medical students, the young doctors, how to deal with these things, and our education is much improved in that respect.  But of course I was brought up in the old school of: throw him into the pool and he'll learn to swim!  I deal with it reasonably well and I've coped well over the years, but I still feel the effects sometimes.

Every Christmas, for example, I remember an elderly Palestinian man who was watching the exhumation of the body of his son. It was at night in a small village in Palestine, in the hills, and he said nothing, he just knelt down at the railings round the graveyard, and he clung to them so that no one could remove him.  Of course he was dressed in traditional Arab dress, so whenever I see a nativity scene just before Christmas I remember this old guy…

The memories linger with you One of the difficulties is that the memories linger with you and you accumulate large numbers of them.  A useful way of dealing with them in a professional sense, I find, is to talk about the cases professionally and to add the human anecdote as part of the lecture, and by sharing it with large numbers of people therefore to unburden myself of it.

SA:  Is there a professional recognition of the burdens you carry, and are you cared for?

DP:  Well, forensic pathologists traditionally have never had counselling, and I don't think we'd ever look to it.  I think by and large we support each other in our own way.  We have our own means within our community of discussing these things.  We can, when things are hard, share our feelings with colleagues.  We have the opportunity to talk about cases to a wider group in an academic sense, which is very helpful.  And of course we have families and friends. 

And the things which are emotional are the things which are non-secretive usually – we don't have to keep it within our scientific community.  Things which are most stressful, most emotional, are things which would touch any other human being, and are not confidential and we can share those.  As I say, I share them in lectures and in stories… And by talking to you!


Science with a social purpose

SA:  How have your experiences influenced your work and influenced how you actually do your science?
We have a lot more contact with the wider community
DP:  Well, I suppose you can look at improvements in doing the work from two points of view. The one is the purely scientific, but of course we don't do the science for scientific reasons, we do it for social reasons, so the more important aspect is how you improve the social effect of work.

That ultimately means how you deal with the community beyond your immediate professional relationships.  And here I mean for example relatives of people who have been killed, victims of violence, people who may have been tortured, victims of miscarriages of justice, families who want information about what happened to a loved one -- how that loved one came to die, what evidence is there about the circumstances and from the autopsy that will give them an insight? 

Sometimes a loved one may have committed suicide and the family is trying to come to terms with that fact, or is denying that fact and wants to explore the issues surrounding it. These days we have a lot more contact with the wider community than we did when I started doing this kind of work. Then it tended to be more isolated, more bureaucratic, and far less compassionate and concerned with the living.

SA:  This is very interesting because some of the older pathologists I've talked to say they went into pathology because they'd had distressing incidents with families of people who had died and they thought it would be much easier to go into the sort of cold lab.  But what you're saying is that nowadays you're very much part of the social scene around illness and death too.

DP:  Well absolutely.  These days forensic pathologists -- autopsy pathologists generally -- are talking to the families of the deceased.  We're talking to a wide range of people, and far from being isolated in the mortuary we seem to spend most of our time talking to people about what we've done in the mortuary!  The days where you could do an autopsy, file your report, and put it away are long since gone.  There'll be telephone calls and someone will ask to meet me.  Maybe it's a clinician who's going to phone for the results of the autopsy, perhaps it's the procurator fiscal to say he'd like me to meet with a family.

The other day I phoned a father of a young man who'd died – the father was in New Zealand, and I was telling him the results of the autopsy and the significance of them.  So serving the community in a very direct sense is very much part of what we do.

SA:  Why is the general public so deeply unaware of the role of pathologists? Because you've outlined a whole lot of roles – the one that underpins clinical practice, but also the one which gives ordinary people some handle on this whole area of dying, and we'll all experience it in our families at some point.  Why are they so unaware of that?

We tend not to talk openly about deathDP:  People are unaware of forensic pathology in a direct sense -- they're aware of it on television in an entertainment sense, but are unaware of it in a direct sense because of the way we deal with death these days in our community.  There were times when most people died at home, their bodies were kept at home until they were buried, and everybody had seen a corpse.  These days most people die in hospital -- 60-70% of the population. 

The body doesn't come to the home, it goes to a funeral director's.  We have less contact with death, we tend to insulate younger members of the community from death, as if it were something to avoid in the sense of not recognising it.  And because of that we tend not to talk openly about death and matters related to it, to avoid these kind of discussions, which of course the forensic pathologist is central to in terms of work.

SA:  What was your own first experience of death?

DP:  My first experience of death probably would be family death, and the burial of a great uncle whose funeral I went to.  I must have been quite young – maybe 11 or 12 years old I think.  I remember the singing at the funeral -- of course it was a Welsh funeral, and that was very lovely indeed.  I can still remember standing near the grave, so it must have made a very big impression on me.  But my first sight of a dead body wasn't until I went to university and went to medical school -- I would have been about 18, 19 years old -- and we dissected a body. 

You become very used to seeing a bodyIn those days we used to have half a dozen people and you'd be allocated a whole body, and you'd spend a year or perhaps longer dissecting the body. It was really a sort of social event of the group.  We'd six of us be sitting around the body (which was donated of course by someone during life so that we could dissect it in death) and we would dissect it and have all sorts of social and political and academic discussions, on a wide variety of things totally unrelated to anatomy, over the body.  You developed quite a nonchalant, in one sense, and intimate in another sense, relationship with a specific corpse.  So you become very used to seeing a body.

Respect for the dead

SA:  It's interesting this, because now people are super-sensitive to the whole idea of the respect shown to bodies.  Yet people involved in attending accidents and things talk of the black humour they often use at such times, and medical students tell the same sort of stories as you've just told.  Is this how you deal with distressing activities, and does it matter?

DP:  My recollection from my university days in terms of dissecting the body was that there was never any disrespect towards the body.  In fact the corpse was almost a part of the group, if you like, albeit one that didn't participate in our arguments about the politics and social life of the university and all these academic things we talked about.  But it was very important to us and very precious to us, because we were learning anatomy -- we were fascinated by the science and without that body we couldn't learn. 

Of course we told jokes, lots of jokes, but they weren't against the body.  They were very often totally unrelated to medicine.  It wouldn't be uncommon for someone who was walking past to see us standing around a dead body dissecting and laughing away. Of course, you might misinterpret that as disrespect, but there was no disrespect there.  And I'm sure that anyone who had the insight and courage to donate their body for anatomical dissection would be the first to appreciate that.

Respect has no direct relationship with being grim! Respect has no direct relationship with being grim!  We show respect in our everyday lives to people and can laugh and joke and engage in all the other interactions that are part of being human, and no one would say that that was disrespectful.  Sometimes glum silence itself is disrespectful socially.  So of course, if you were to see an autopsy today, you would see the pathologist and the technician who were performing the autopsy dissecting the body and at the same time perhaps engaging in a conversation about a football match, or about some political problem with the administration, or complaining about the weather, or telling a joke they'd heard in the pub last night, or discussing the soap they might be missing because of running late at work – all of these things which are a normal part of human dynamics.  And if we didn't do that, how much more difficult would it be for us to actually perform this task on a body?  It would become unbearable for us.

SA:  I suppose in a way it's a bit like an Irish 'wake' – they're anything but grim!  People have a real good party and that's not seen in the least as disrespect, is it?

DP:  Well exactly, the Irish wake is a very good example of putting a positive slant on something which is very difficult to deal with.  Of course we don't have wakes in mortuaries, and I think we travel a middle ground between, on the one hand not being disrespectful and disregarding of the body, and on the other hand not being glum-faced and silent in our examination of the body.

Balancing science and politics

SA:  We've talked about your relationship with the survivors of somebody you're looking at, but what about the politics of it?  When you see something like a massacre, how do you cope with your political feelings at the same time as the science? 

DP:  I've learnt over the years that if you want to be an advocate, you must be an advocate, but you can't pretend that you are, at the same time, an objective scientific expert.  You have to be one or the other.  So I play different roles at different times. I was a founder member and past chairman of Physicians for Human Rights in the UK.  There I was an advocate.

Leaving out the emotional language is a very important part of being the expertBut if I go as an expert with a professional group – whether it be to examine bodies or to advise on results of an investigation, or to advise on organisational structure of an investigation -- then there I'm objective, I'm a scientist.  Advocates have to inject a bit of passion into what they do, it's part of the way you must present things.  As a scientist you have to leave out a lot of that passion in order to ensure that people look to the facts of what you're saying, and appreciate that your application of the logic to those facts justifies your conclusion, and that it's not clouded by emotion.  So leaving out the emotional language is a very important part of being the expert.

No mind is blank

SA:  When you go to something like a mass grave do you go with a lot of questions or with a completely open mind?

Everybody comes with some preconceived notionDP:  No one approaches any investigation with a blank mind.  Everybody comes with some preconceived notion.  The important thing is to recognise what your preconceived notions are and to handle them in an appropriate way and not to be blinded by them.  Sometimes the preconceived notions are very reasonable notions to have.  If you were to go to a grave site in Bosnia and you were to find 40 bodies, your immediate suspicion must be that this was a mass killing as part of a genocide – that would be entirely reasonable.  And on the basis of that you would then plan your investigation.  It may be that you would discover otherwise in the course of your investigation.  It may be that these were natural deaths in a hospital that happened to have been buried in a mass grave because of the circumstances of the war.  But you would have planned on the basis of your initial impression, and kept an open mind in relationship to the facts that you discover, changing your plan as new facts are discovered.

SA:  So have you sometimes found that your initial conjecture was completely confounded when you investigated a body? 

We wrote the case off as a suicideDP:  Yes, absolutely.  I can remember vividly one mistake I made when I looked at a death which appeared to be a suicide.  I concurred with the police that all the evidence seemed to point to suicide, and we wrote the case off as a suicide only to be confronted six months later by the confession of the person who had committed the homicide!  So of course sometimes you get it wrong – it's just the same as any other aspect of human endeavour.

SA:  Tell me about your work in South Africa.

DP:  I've worked in South Africa in a variety of ways.  During the apartheid era I was out in South Africa supporting various human rights organisations, and in more recent years, since we've had the new government and the end of apartheid, I'm working with a group there to improve the forensic evidence in cases of rape and child abuse.  So I've moved from providing forensic support to human rights organisations opposing the government, to supporting the forensic services of the new government, which is perhaps a reflection of the objectivity of forensic pathology as a science.

SA:  Why do you do this?  What are your motivations for getting involved in this side of forensics?

I can't repay a previous generationDP:  I suppose my motivation is a general motivation.  I feel very much that I wouldn't be a doctor had it not been for the efforts of previous generations.  And I can't repay a previous generation; I can only repay this generation.


SA:  A final question about the science.  How easy is it to be conclusive about a cause of death if a body has been, say, a long time underground?

Sometimes it's not possible to establish anythingDP: The more a body deteriorates, of course, the more evidence is destroyed and the more difficult it becomes to determine not only the cause of death, but the circumstances of death, identity and all the other things we're interested in.  So bodies which are recovered from mass graves, or bodies that are discovered after many years present real challenges.  Sometimes it's not possible to establish with absolute clarity what happened.  Sometimes it's not possible to establish anything at all, not even the identity. 

But even the circumstances of discovery of the body can themselves be powerful evidence.  After all, if you find 200 bodies in a grave hidden in the woods it speaks rather eloquently of the circumstances by which they came to be there.  Very often it's circumstantial evidence in those cases that's more powerful than the scientific evidence.  The science is only part of the investigation, it's not the investigation.  It's supportive.  And although we can do some very wonderful things with the science, we're only part of a bigger team with the same goal.

On the track of new diseases

SA:  One last thing…Can you tell me a bit about the importance of pathology in discovering new diseases?

New infectious diseases come up all the timeDP:  We tend to think that we have all the diseases that we're ever going to have and that all that changes is the extent to which we have them.  But of course new infectious diseases come up all the time.  We're all familiar now with HIV but 20-odd years ago there wasn't any.  Similarly more recently in Britain we've had a death from rabies contracted from a bat – a new virus for us to deal with.  And it's only through autopsies that we can gain information as to how these new infections kill, and use that information to then treat and assist the living, who have those infections.

We need autopsies to improve our treatmentsSo autopsy pathology is a way in which we explore new diseases -- and indeed we also explore complications of medical treatment when the medical treatment is new, such as a new drug or a new operative procedure.  So we need autopsies to explore the new in order to improve our treatments.

SA: Could we have got anywhere with new variant CJD if there hadn't been autopsies.

DP:  New variant CJD is a good example of the need to do an autopsy.  But not only that – the need, for example, to retain the brain and examine it very thoroughly over a long period of time, and therefore, regrettably, not to bury the brain with the body.  The public benefit from that type of investigation is enormous, because we couldn't, without that, correctly make the diagnosis of nvCJD.  We would not be able without that to establish the number of cases, whether there was, in the epidemiology a pattern to those cases, and track the spread of this disease in the community now and in the future.  So we need the autopsies, we need the tissue from the autopsies, we need the time to work on that tissue and we need to archive much of it, because without that we can't go back and use new techniques to explore the previous deaths.

SA:  What does it require to get the general public to cooperate in this?

DP:  I think the general public is very understanding of this in the wider sense.  And I think that if we have a general discussion everyone can agree on what's best.  The problem comes of course when we're not having a general discussion but we're talking to a member of the public about the death of their loved one.  No one can be unemotional about that; no one can be detached about that.  Much of the debate that we've seen – and of course it's very attractive to the media because it's emotional and grabs the public attention – has been in relationship to individuals who are speaking of the loss of a loved one.  I have enormous sympathy for the grief that they've suffered, and the additional grief they've suffered as a result of a whole variety of revelations about organ retention.  At the same time, we shouldn't let that deprive us of a broader objective discussion as to what is in the interests of the community in the long term. 

We need to step back a bit from the emotionIf we look at the discussion internationally, we see, for example in Australia – the Australians have a slightly different view on life than we do, and I speak as someone who's lived in Australia – they have a different approach and a much more accepting one.  So these are cultural issues, and I think at this moment in time we need to step back a bit from the emotion, draw a line under the difficult period we've been through, and now try to reach a community consensus on the way forward, with a view to helping the living by investigating deaths.


Copyright © 2022 | Conversations with Pathologists. All Rights Reserved. Design by MK Digital

Please publish modules in offcanvas position.