Taken . . . suddenly
THE loss of a loved one is a traumatic experience. But when it is unexplained, it can leave families grasping for answers.
An unknown heart condition or hidden industrial disease can only be exposed once a coroner's officer has gathered the initial information and passed it on to the Northamptonshire Coroner, who, if appropriate, will give instructions for a post mortem examination to take place.
Northamptonshire detective sergeant Nick Gray said police would attend the scene of an unexplained death after they were contacted by paramedics, a doctor or the person who found the body.
The police would gather information about the deceased's identity and how they were found, after a GP or paramedic had declared "life extinct."
The body would then be taken to the mortuary at Northampton General Hospital, which can hold around 70 bodies.
Det Sgt Gray added: "The coroner's officer receives the report and contacts the deceased's GP. They will find out if the death was expected, for example if the person was being treated for a potential life threatening illness, or if the deceased had seen their GP in the last 14 days and they were totally satisfied with the cause of death.
"If the GP doesn't know why the person has died and is unable to issue a death certificate stating the cause of death, the coroner will direct that a post mortem takes place."
A post mortem examination can be carried out even if the deceased has not been formally identified by a next-of-kin. Identification can be made through DNA, dental records or, at a later date, by a relative who has been traced.
Dr John Nottingham is a consultant histopathologist at Northampton General Hospital. He carries out post mortems (in non-criminal circumstances) with four other consultants at the hospital.
The team do about 700 post mortems a year, averaging about three a day.
Dr Nottingham said: "We do anything from drugs overdoses to road accidents to massive heart attacks. Most of the post mortems we do are on fairly elderly people.
"But we do see younger people over the age of 15. We do not do children, as they need to be seen by a paediatric pathologist and are sent to a specialist in Oxford.
"Most people die at home or in hospital, but we do get bodies which are unidentified or unidentifiable.
"Doing a post mortem is not really very pleasant. In fact, they can be thoroughly unpleasant. Some of them are quite upsetting, especially children. When you have got children of your own, it can be quite traumatic."
The pathologist will get a summary of the persons' medical history, surgery and medication from the coroner's officer before the post mortem takes place.
They try to carry out the examination as quickly as possible, so the body can be released to the family, via their elected undertakers, for the funeral.
During the post mortem, which takes on average from 30 minutes to two hours, the pathologist will remove all the internal organs from the body to examine them and, if necessary, will also look at the brain.
Once the examination is complete, all the organs are placed back in the body and a mortician will liaise with the family and funeral directors.
If the physical examination did not reveal the cause of death, tissue samples and blood will be taken for microscopic analysis and toxicology tests, which can take several weeks to return a result. The body will usually be released once samples have been taken, after agreement with the coroner.
Dr Nottingham said it was important to understand the cause of death, not only for peace of mind but so families could be screened for otherwise unknown genetic diseases.
He added: "Occasionally, we will see a young person who dies suddenly playing sport. They may not have any disease of the heart apparent, but some of the cells will have changes, which you can only see under the microscope.
"Some of these things run in families, so it is important for the person's children, parents, siblings or cousins to know the results, as they can be assessed by a cardiologist to prevent further premature deaths in the future."
But he admitted there was a certain amount of interpretation involved in establishing a cause of death, because people could have many diseases which led them to die. Blood tests are not carried out routinely and are only requested when there is a level of suspicion surrounding the death.
Dr Nottingham said: "It is essential to have the history from the last person who saw them alive. It is all a big jigsaw and the post mortem is just part of it. Some causes of death are apparent as soon as you start. You still examine the other organs, but not in such pressing detail."
But he added: "Sometimes we can be misled. A lot of Harold Shipman's patients were elderly people who must have had chronic disease of the heart or lung. Unless anyone had a high index of suspicion, you would not have thought their doctor was killing them.
"Again, a good history would have been essential in these cases.
"Many people over the age of 60 have some degree of heart diseases that could kill them at any point. Doing a post mortem, you would think they had died of the disease they had, not from a morphine injection. You would have to do blood tests on everyone, but that would be very time consuming and expensive.
"And sometimes you don't find anything at all when you do a post mortem. You can be left with a negative post mortem, which is very frustrating. This would mean the cause of death would be unascertained. This can be the case in sudden infant deaths, but may occur in adults as well."
But Dr Nottingham is keen to stress that carrying out post mortems is only a tiny part of a pathologist's work.
He said: "Ninety-five per cent of our work is related to people who are still alive. We only spend a few hours a week doing post mortems.
"But the department at Northampton handles over 20,000 tissue samples a year, plus 30,000 cervical smear tests."
Pathologists spend much of their time looking through microscopes, examining tissue and cell samples to help doctors with diagnoses.
Dr Nottingham added: "We are an essential part of the clinical teams who manage cancer patients, including people with breast cancer, lung cancer and bowel cancers."
But the most modern challenge to British pathologists is the identification of foreign diseases brought in by international travellers and immigrants.
Dr Nottingham said: "A patient who travelled extensively in Africa recently presented with skin lumps.
"It was only when a sample of one of these was put under the microscope that we recognised the disease as leprosy.
"Doing post mortems is an important part of our work, but living people are just as important."
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Saturday 26 May 2012
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