Showing posts with label pathologists. Show all posts
Showing posts with label pathologists. Show all posts

11 October 2020

Dr. Obenson: Doctor and Detective


Dr. Ken Obenson is one of only two certified forensic pathologists practicing in New Brunswick, Canada. He holds the distinction of being  first black pathologist certified by the Royal College of Physicians and Surgeons of Canada in forensic pathology. 

Although he investigates deaths in deceased of all age groups from babies to adults, it is with the death of babies where, “I often need to apply all the detective skills that I acquired through training and experience. Infants don’t have the usual stigmata of disease or injury unlike adults who tend to have well documented disease histories - and infants can sustain injuries that may not be as obvious at autopsy as adults.”

“My role, in the case of a natural death, is to make sure that I make the best effort to find the explanation for the death so I can allay some of the fears of the family,” Dr. Obenson explains. “When an infant dies, the parents almost always blame themselves. It can be heartbreaking for the parents when we are not  able to  provide a definitive cause of death. Unlike some other practice groups, we don’t use the term SIDS because it is a diagnosis of exclusion. SIDS or not, the cause death is undetermined and this is what they (the parents) worry about. Not just for this baby, but for others they may have in the future.” 

One case he investigated was particularly illuminating. It was the death of an infant who was only a few days old. The CT, X-ray, autopsy, toxicology, microbiology and other examinations found no cause of death. Information gathered by the police, revealed that the baby was visited by its’ large extended family who had all held the baby. On a preliminary examination of slides of the markedly autolyzed tissue that he had sampled at the autopsy Dr. Obenson found evidence of viral infection (suspected to be parvovirus) in one section of liver. Knowing exactly what to look for, he reexamined the slides more closely  and found  further evidence of the infection in several other organs. 

Because he was able to determine that death was the result of a viral infection, Dr. Obenson was able to allay the parents’ fears that something congenital was responsible for their baby’s death and reassure them that their next baby would not be at risk of dying. It also allows them to make different decisions about how many people their next baby comes into contact with while vulnerable and perhaps they may even insist on hand washing and other infection precautions in the future. Very importantly, it saves them from unspoken accusations that they might have done something directly to cause their baby’s death, like smothering, etc. 

Dr. Obenson was quite satisfied with the outcome in this case, knowing that the finding of a lethal viral infection probably helped  the parents in dealing with  their loss.  This is why he insists that as per international guidelines, a  thorough post mortem examination be performed in infants, after a comprehensive death scene investigation with review of  radiologic, toxicological, histologic and microbiological findings. 

“My role, when there is a homicide of an infant, is collect evidence such that the law is able to hold whoever is responsible to account,” he explained. “I have been qualified as an expert witness in court which means that because of my training, certification and experience, I am able to  give opinion evidence as to the cause and manner of death, unlike 'eye' witnesses who can only speak to what they have seen or heard.” 

Although for most of us, the murder of an infant is unthinkable, it does happen. Dr. Obenson explains that if there is an adult unrelated to the infant living in the house, like a new boyfriend, they are statistically more likely to kill that child. However, biological parents also do kill their babies, with fathers being more likely to do so violently than mothers. Unfortunately the less violent the trauma the more difficult it can be to detect physical evidence of foul play. For example, Dr. Obenson points out, if a baby is smothered, petechial hemorrhages in the eye  that are often seen in, but not exclusive to an asphyxial death are less likely to occur in infants- which is why these death investigations can be so complex. 

Dr Obenson takes his role as an impartial witness seriously and derives no personal satisfaction from a conviction. His only responsibility is use all available evidence from death scene, to social circumstances to post mortem examination and ancillary tests to arrive at a reasonable opinion on the cause of death. 
Dr. Obenson has practiced forensic pathology in the United States, in Jamaica and for nearly 20 years in Canada. He says, “We don’t have as many suspicious child deaths in Canada, particularly homicides. My theory is that the social safety nets in Canada alleviate some of the social stresses families feel.” 

This is the best argument I have ever heard for supporting families: protecting children.

13 October 2019

Dr. Frank Warsh: Coroner to Crime Writer


Dr. Frank Warsh is a coroner and the author of The Flame Broiled Doctor from Boyhood to Burnout in Medicine and Hippocrates:The Art and The Oath

Death is his job - literally - so how does his job inform his new foray into crime fiction? Many doctors will grumble at the unrealistic depictions of doctors in film and books. Doctors will grumble even more loudly at the depictions of patients and families - because that is the important part of medicine. So, does a coroner write crime fiction differently than a lay person?

• What is the actual job of a coroner?

“The core of the job is determination of cause and certifying the death.

“The cause of death is what killed you. The manner is part of the set of conventions we use to describe a death. The manner is what’s being referred to when a character on a cop show says, “the death was ruled a homicide”. That statement is screenplay silliness for two reasons. First, rulings come from judges, not Coroners or Forensic Pathologists. Second, the manner of death follows from the cause, rather than being determined independently.

“Unlike the myriad causes, there are only four manners by which a person can die: natural, accident, suicide, or homicide.

“Again, the manner follows from the cause. If somebody dies from a heart attack, that’s a natural death. If it’s a hanging, barring some very, very compelling evidence of foul play it’s a death by suicide. The old Coroner’s joke is calling a gunshot wound to the chest a natural death, because if you’re shot through the heart and lungs, naturally it will kill you.”

• Why would people want to read Coroners’ stories?

“Clearly there’s overlap between Coroner work and crime investigation. My job is quite literally the intersection between police procedural and medical procedural work.

“It’s hard to overstate how important the job of Coroner is and can be, speaking for the dead as the motto goes. Most untimely deaths are not the result of a crime, but rather workplace accidents, substance abuse, an individual’s traumatic upbringing, systemic problems in institutions, or failures by society as a whole. Obviously these stories matter to people in positions of authority and policymakers. But fictionalized, they can teach us a lot of truths about human nature and how far we still have to go. It’s a job that allows for genuine sober reflection, rather than just reacting to the daily noise of the news cycle.

“A former patient, who’s become a cherished friend since I left practice, had a daughter that died from an overdose after a long struggle with drug use. Happens every day, no question. But the young woman had been a repeat victim of sexual violence from a very early age. Worse still, she suffered years of trauma at the hands of a broken mental health care system the family desperately needed to work. We take it for granted that our institutions are the “good guys”, working only in the best interests of the sick and the vulnerable. That’s far from a guarantee, no matter what we’d like to think. Fiction is a perhaps a safer way to face these truths, because there are no real-life stakes to the story being told.

“Now that covers the interesting and important reasons to read Coroner stories, but I’d be remiss if I left out how entertaining, even funny, Coroner work can be.

“Setting aside gratuitous cartoon deaths you might find in a Quentin Tarantino film, death in and of itself isn’t entertaining. It’s death *investigation* I find entertaining. Some of the fun comes from the characters you meet – police, undertakers – that have personality quirks or morbid senses of humor you don’t find in health care settings. Sometimes it’s the loved ones of the dead who can throw you for a loop.

“And sometimes the investigation itself is full of absurdities, completely at odds with what we expect from all the highbrow detective stories we might read or see on TV. Closets full of Costco-size jars of weed. Bongs on display like sports trophies. Porn playing on a loop while you scour an apartment for medical records. You can’t make this stuff up.

“Earlier this year, I happened to attend six deaths in a row where the person had died on the toilet. To the individual families, those are tragedies. To the poor schlub Coroner – me – it’s a Saturday Night Live sketch, the absolute antithesis of the glamorous, high-tech investigations portrayed on CSI.

“Real life – or real death, I suppose – is stranger than fiction, and quite often funny as hell. These are the kinds of stories I’m now looking to tell, in short story form for the time being.”

• Thoughts on commercial success?

“You need your finger on the pulse of the audience to find fortune as a writer, and the only pulses I feel these days have stopped.”