The Pathologist

Home office forensic pathologist Dr Ashley Fegan-Earl

All forms of death come across my table. Road traffic accidents, shootings, stabbings, heart attacks and suicides are staple fare, but there are more unusual and exotic cases, too. I have examined an individual killed by a crocodile and repatriated here, which was unusual.

You certainly have to prepare yourself for anything – one time I was performing a postmortem on a man who had been found dead in the Thames and when I opened his chest a crayfish scuttled out. I’ve seen bodies where the victim has been eaten by their pet, be it cat or dog. If a starving animal is left alone with a dead body for long enough that will happen – that is nature. Of course, when bodies are badly decomposed my job is very challenging, although we can often establish a cause of death in the end, or at least some valid conclusions.

No postmortem is ever inconclusive. For example, we can tell a lot from entomology – after death, if unattended, a human body is no different to any other animal and it decomposes.

Insects

Different insects are attracted to different stages of decomposition and study of the types and maturity of those insects may assist our entomology colleagues in estimating the time of death. People sometimes tend to see a postmortem as a pointless exercise – a way to establish the cause of death and nothing else – but it is so much more than that.

Even when the way a person has died seems obvious, it’s useful to know the context. Information from the dead can often provide feedback that helps the living, whether it is establishing a previously unknown history of genetic disease in a family who can then be treated, or helping car manufacturers to design safety features to minimise injuries in road traffic accidents, having analysed the patterns of injury in fatal accidents. The natural history of many diseases, among them Aids-related conditions, has been worked out through postmortem examination.

For me the variety is part of the attraction of the job – unlike conventional hospital medicine where you tend to specialise, I’m dealing with different parts of the body all the time.

Types

All postmortems can be separated into two categories: routine, which are unexplained  deaths but not deemed to be suspicious; and specials, which are deemed to be suspicious and have to be conducted by a Home Office pathologist.

I undertake 700 to 800 routine postmortems and 80 to 100 specials each year. You can see the tragedy in each of the cases but you have to retain a professional detachment, not least because at the back of your mind you’re aware that based on your opinion and conclusions, someone may be arrested for a crime. But I try not to dwell. That said, I always found performing postmortems on children difficult and since becoming a father, I rarely do them any more. Even so, sometimes the bodies of children come into the mortuary with books and toys among their possessions, which are similar to those of your own children.

That’s not easy.

I’m aware of the great appetite for forensic science shown by the public, although I do find some television shows rather wearying. They lend a rather misplaced glamour to proceedings, not to mention giving us skills we don’t have. The number of times people think we can identify the killer or give a precise time of death when we quite simply can’t is astonishing. In a way, our job is far more mundane than people realise.

The Coroner

HM Coroner Alison Thompson

I conduct around  12 inquests a week, which can each last anything from half an hour to several weeks – the latter usually if a jury is involved, which will happen with cases like a death in custody or a police shooting. Overall I record the same proportion of verdicts most years, although there are occasional spikes in suicide rates, which range from 12 to 20 per cent.

A substantial part of my work is bringing matters that have arisen from an inquest to a wider audience once the inquest is closed. As we see in the series, I dealt with the death of a young woman who had taken her own life ingesting cyanide she had bought on the internet from a chemical company. It was a highly unusual case, but if lessons can be learnt, it’s part of my role to flag it up.

To work as a coroner you need at least five years’ qualification in either law or medicine. I’m a qualified barrister, so came through the legal route, and have now been West London’s Coroner for 12 years. In that time I’ve dealt with thousands of suspicious, unnatural or sudden deaths in the six London boroughs under my jurisdiction, which includes Wormwood Scrubs and Heathrow Airport, and I’ve seen it all, from bizarre sexual fetish deaths to more unusual and poignant cases. Recently we held an inquest into the death of a baby who had been asphyxiated and left in a hotel room.

Extremes

People can get confused about why an inquest is needed if a postmortem has established cause of death, but sometimes knowing the medical cause is only part of establishing how someone died. Every death is sad in its own way, although you have to learn to leave it behind you at the end of the day. The extremes are the most upsetting, the very young and the very old.

It’s gruelling when you are confronted by a grieving couple trying to come to terms with the death of their child. At the other end of the spectrum the deaths of the elderly often touch me, particularly if they were on their own. In those instances, you do feel you need to speak for them.

The Coroner’s Officer

Shirley Stewart

My role is essentially that of a civilian investigator – my primary function is to investigate sudden, unexplained or violent deaths on behalf of the coroner. In those instances I’m the first contact point for the police and ambulance service who attend the scene, and my first job is to establish whether the death is suspicious, and the circumstances in which the victim died. I build up a picture, which I then report to the coroner so she can decide whether a postmortem is needed.

I don’t routinely have to attend postmortems, but over the years I have seen a lot of dead bodies.  If a body needs to be formally identified, I will accompany the families to the mortuary and I always dread it. Until that moment a part of them always hopes there’s been a mistake and you know that their world is going to fall apart the moment the cover is pulled back. It’s very hard to witness that grief – sometimes I have to bite very hard on my bottom lip. But I see it as my job to make their transition through the difficult legal process as smooth and painless as possible.

You need a strong stomach to do this job; it’s not a spectator sport. As a nurse I’d dealt with death but in this job you see it all – shootings, stabbings, road accidents, bodies that are in advanced stages of decomposition – in fact there’s more and more of these recently.

I sometimes ask myself whether this is a sad reflection of society: so many people dying on their own and not being missed. The smell is something you can never forget. That said, the most difficult part of the job undoubtedly is witnessing the grief of families. On bad days I’m glad to get home.

Death Unexplained is on Tuesdays at 10:35pm on BBC1

This is an edited version of an article in the issue of Radio Times published 7 February 2012