I Don't Like Mondays
Mondays are usually bad because I'm the lead for Gynaecology pathology in Gloucestershire and Mondays are when we hold the weekly gynaecology multidisciplinary team meeting (MDTM); this is the meeting at which all new cases of gynae malignancy are discussed - the history is given, the X-rays are reviewed, the histology (pathology) is reviewed (by me) and then decisions are made about treatment, follow up, diagnosis and prognosis. The meeting lasts at least an hour and a half and the preparation beforehand at least another hour, which is a big chunk out of the working day. Today, though I was on for autopsies as well.
There are approximately 1100-1200 autopsies performed in Gloucestershire every year, and there are 8 of us to do them; on any given day two us are on (one in Cheltenham, the other in Gloucester). Today, in Cheltenham, there were 3, all Coroner's cases.
The first was straightforward - an elderly gentleman with a history of heart disease who suddenly collapsed whilst out with his dogs. His heart weight was twice the normal size and the muscle surrounding the scar of the old infarct (dead tissue) was scarred, liable to go into an arrhythmia at any time.
The second, though, was more problematic. Another elderly gentleman who had come into hospital for resection of a rectal cancer. Following the operation he had developed an acute abdomen and imaging showed free gas and fluid in it. The assumption was that the anastomosis (the join) had leaked. He died from this despite everyone's best efforts. When he was opened up, there was, indeed, established and generalised peritonitis (which stank). Interestingly, though, the anastomosis looked good; even more interestingly, he had a small but deep ulcer in his duodenum, one which had burrowed down into the pancreas. It is entirely possible that this was the source of his peritonitis, but until I look at samples under the microscope, I won't know.
The third was the most troublesome of all. A middle aged woman who 'enjoyed a drink.' Her husband went out; when he came back she was on the floor with her head in a pool of blood. Murder? Well, the police didn't think so. Nothing was missing, there was no sign of a struggle and the blood seemed to be coming from a cut on the side of her head (which was by the corner of a cabinet unit). When I first encountered her, the most obvious thing was the overwhelming smell of alcohol (you can actually get to feel quite light-headed sometimes - a sort of 'passive drinking' effect). There was indeed a cut on the lefthand side of her head and beneath it there was some bruising in the temporalis muscle...but that was it. No skull fracture, no obvious trauma to the brain, no intracranial bleed.
The rest of the post mortem was equally uninformative. No obvious heart disease, no pneumonia, no abdominal catastrophe.
Which is a problem.
All you can do then is take samples to examine under the microscope, take blood and urine for toxicological analysis and, in this case, suspend the brain in formalin for fixation and later expert neurpathological opinion - just in case she was an epileptic or suffering from alcohol-related brain disease. Then I ring the Coroner's office and give them the news that they hate to hear - cause of death is as yet 'unascertained.'
And when I know what she died from, I'll let you know.
If you would like to discuss any of this, please contact me through my website - www.keithmccarthy.co.uk.
Keith McCarthy on Monday, November 14th 2005 @ 08:09 PM GMT [link]
Sunday, November 13th 2005
**First Blog - Bizarrely Yours**
I'll kick off my first blog entry by telling you about a recent bizarre experience of mine.
I was asked to take part in a writing event. No, that wasn't the bizarre experience (well, not as such); it was more where this event was held and what courage I gained from it. It was in a basement cafe (sorry, but I don't seem able to do accents in this system) in Jarrold's in Norwich, as part of their store-y-line event. This was in conjunction with East Anglia's New Writing Partnership. My part in this event happened on 24 October 2005 and required me to read aloud from Love Lies Bleeding, my eleventh novel and the eighth in my humorous Rafferty & Llewellyn crime series.
Jarrold's had writers reading their books all over their store. As I said, I was in the basement cafe (this was my suggestion (!) because we were adjacent to the sharp knives, one sharp knife having featured in my latest crime novel.). I had to stand and read from my latest book, surrounded on all sides by these weary souls who had only come in for a bap, a cup of coffee, a bit of peace, and a rest for their weary shoppers' legs. As a plus (or a minus, I suppose, depending on how weary a shopper you were) they also got me: reading aloud from said latest book amidst the clatter of dishes and the screams of fretful toddlers.
Pretty bizarre. My husband came along; as bag-carrier, general factotum and to offer moral support. He said he was proud of me. That he couldn't have done it. That he'd rather have had all his teeth extracted. Without anaesthetic. (Doesn't actually count. 'Cos he already has had all his teeth extracted). But I knew what he meant. Usually, I would have felt the same. Only this experience was so surrreal, that, even more bizarrely, I didn't feel a bit nervous. A first for me.
At this point, I would like to offer a big 'Thank You', to the ladies who were seated at the table to my immediate right. You were so kind with all your encouraging smiles. Even better: you didn't lob a bun (stale or otherwise) at me once, for which I'm very thankful. So thankful, that I've taken encouragement from your restraint to do the whole thing again on 14 November at Cafe Writers in Norwich (sorry - no accent again). Hopefully, they will also lack buns, particularly those of the hard and stale variety...
An even bigger 'Thank You' to Jarrold's and all at the New Writing Partnership in East Anglia for organising such a novel, non-nerve-wracking experience. Perhaps next I should try drinking immoderately, taking off all my clothes and doing a streak at Lords?! Might get on the telly...! Maybe not.
Next blog, I'll perhaps tell you how I'm getting on at the Speakers' Club I've recently joined. And - who polishes the cups I've won (it 'aint me, ladies!). If you want to read anything more about me, try my website: www.geraldineevans.com.
Geraldine Evans on Sunday, November 13th 2005 @ 04:58 PM GMT [link]
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