This week sees the publication of Sue Armstrong’s A Matter of Life and Death: inside the hidden world of the pathologist with Canongate. It is a collection of conversations with pathologists, exploring their hidden worlds and it’s a book I look forward to reading as soon as a certain reading challenge has been completed. I invited Sue to write a guest blog post to uncover the story behind the book and to give a taster. With many thanks, and over to Sue…
In summer 2001, I received an agitated call from a friend of mine, a pathologist attending a medical conference nearby. “Have you seen the newspapers today?” he said. “They’re calling us ‘doctors of death’. But that’s completely wrong,” he protested. “We’re doctors of life. Physicians would be feeling in the dark in treating their patients if it wasn’t for us.”
This was shortly after the crisis at Liverpool’s Alder Hey Hospital, when parents of children who had died there became aware for the first time that the small bodies they had received for burial after post-mortem were not always complete – that their children’s brains and other organs were sometimes retained for further investigation or research. This was not a secret, but neither was it always made explicit to parents, and the revelation caused a storm of outrage directed at pathologists. Paediatric pathologists, in particular, came in for abuse. Some received threatening phone calls at home; others found their children being bullied at school because of their parent’s profession.
How to defuse this ugly mood and bring some understanding of the critical, but hidden, role pathologists play in all our lives? I put the idea to the BBC of a radio feature looking at what kind of people go into pathology and what they actually do. It was readily accepted and I was asked for a two-part series for Radio 4 that was broadcast at prime-time in the evening science slot. The first programme allowed pathologists simply to talk about themselves and their work. The second focussed on a patient with breast cancer, examining the role played by pathologists in the management of her case, and following them into the lab where they were studying breast tissue from surgery. Making the programmes was fascinating: this is a profession that demands engagement with some of the most profound issues of living and dying – issues that fascinate us all, even if most of us choose not to dwell on them – and I came away from interviews thoroughly stimulated and inspired. Here was a story worth telling.
A Matter of Life and Death: inside the hidden world of the pathologist* is a continuation of that story, and it takes a similar approach to the radio broadcasts – conversations with pathologists that explore the homes they grew up in, when and how their interest in pathology was kindled, who have been their mentors, heroes, role models, and what their working lives entail.
Dame Julia Polak, one of the longest-known survivors of a heart-lung transplant, told me of her shock at discovering that she was suffering from rare pulmonary hypertension – the very disease that was the focus of her research at the time. The transplant, performed by her friend and research colleague Sir Magdi Yacoub, saved her life and changed her career path. Today Dame Julia is director of the Tissue Engineering and Regenerative Medicine Centre at Imperial College, London.
Irene Scheimberg, who grew up like Julia Polak in Argentina, spoke of having to flee that country in the late 1970s when the military junta began abducting and killing her friends. Now, as a consultant paediatric and perinatal pathologist at the London Hospital, Scheimberg's own experience of loss remains a central reference point in her work with families. She and Waney Squier, consultant paediatric neuropathologist at the John Radcliffe Hospital, Oxford, both had fascinating things to say about challenging the dogma of 'shaken baby syndrome'.
Forensic pathologist and human rights activist Derrick Pounder of Dundee University told me harrowing tales of excavating mass graves in the Balkans. And from forensic anthropologist Bill Bass – founder of the Body Farm made famous in the Scarpetta novel, The Body Farm, by Patricia Cornwell – I learnt a bit about how corpses decompose. Dr Bass took me on a conducted tour of the strangely peaceful and un-ghoulish “Forensic Research Facility” on the wooded banks of the Tennessee River.
Jeffery Taubenberger, senior investigator in the Laboratory of Infectious Diseases at the National Institutes of Health, USA — and a serious musical composer in his spare time – told of the search for samples of the Spanish flu virus that caused the devastating pandemic of 1918. And Juan Rosai of Centro Diagnostico Italiano, talked about the history of surgical pathology from its origins among physicians in Renaissance Italy who, curious to see what lay behind the signs and symptoms they had been treating, performed post-mortems on their patients.
These are just some of the characters and themes from a rich collection of conversations that explore not only the individuals' paths through life and the diseases that have most interested them as pathologists, but how their work on the front line of disease and death has affected their philosophy of life and how they view the prospect of their own demise. For it is these questions, as much as any, that intrigue those of us who prefer not to deal with the reality of death until we have to.
* A Matter of Life and Death: inside the hidden world of the pathologist, by Sue Armstrong. Canongate. £12.99