Forensic doctor talks about his work and presents several advice not to end up on his desk

The job of a forensic doctor has traditionally been on the list of the scariest activities in the world and the general opinion about this job is based on short stories and movie stereotypes. We know little about this profession because we don’t even want to think about death. However, everyone knows that dying is an inexorable part of existence.

O awesome.club interviewed a forensic doctor with 30 years of experience. Alexey Kupryushin was head of an IML (Forensic Medical Institute) for 20 years. He currently combines the work of a forensic doctor and a pathologist, also being responsible for private forensic medical examinations. Recently, Alexey created a blog in which he assures that his work is “lively and interesting”. And we cannot agree more with him.

The main reason I became a forensic doctor is my interest in research. It’s like a drug. Without it, life seems boring. And what is my interest? Nobody knows how a particular person’s body works. What’s behind an appearance, skin and bones? Only a forensic doctor knows. Often, only he knows how to find the cause of a person’s death. Sometimes professionals who cannot work as doctors in other specialties become forensic doctors. For example, I could never work as a surgeon myself. Interfering with a living body is unacceptable to me. The most I can do for a living person is give an injection. Forensic doctors and pathologists are often confused, but they are not the same thing. Pathological anatomy and forensic examination are different specialties, but they have a lot in common. The general object of study is a corpse and both use similar autopsy techniques. The differences are only in certain details. They have many tasks in common, but the goals are different. Pathologists contribute to the therapeutic and diagnostic process. Forensics contribute to justice. It is very difficult to find stretcher bearers who want to work at the IML. Many people can’t last more than a month, despite the fact that the activity offers a stable and quite high salary. Once, we couldn’t find a stretcher bearer for a whole month. My wife (a medical pathologist) was in the taxi talking to the driver. Apparently, everything she told him about her work was so interesting that the taxi driver wanted to try it. Working as a stretcher-bearer at the IML did not require medical training, as these professionals are trained in the workplace. The taxi driver came and stayed. And he keeps working…

From 300 to 400 bodies a year are evaluated, on average, by a forensic doctor in a city of more than one million people. Sometimes there are 500 autopsies. That’s a lot: the recommended fee is only 100. There aren’t enough forensic doctors and medical students aren’t interested in working at the IML. The forensic specialist spends more time in the office than in the autopsy room. The study of a corpse is not the only or the most complete way to obtain information about its death. In my practice, there have been cases where the study lasted several hours and its analysis and conclusions reached a few days. A good sense of smell gives the forensic doctor some advantages when it is necessary to reveal what a person was poisoned with. During work, I am able to identify different smells. In case of ammonia poisoning, there is an odor of carbolic acid (phenol). With dichloroethane, it is possible to notice the smell of dried mushrooms. In the case of hydrocyanic acid or nitrobenzene, the aroma is of bitter almond. With alcohol, it smells like fusel oil. The smell of butyl alcohol (butanol) is reminiscent of fruit. There are also substances with very particular smells, such as those reminiscent of the aroma of garlic.

In the first IML where I worked, for many years, a woman named Anna worked as an assistant, who was already a certain age when I started. She used to wear a scarf and wool boots, had a hooked nose, huge hands, and reminded me of a fairy tale witch. We young experts would often call on her to sniff the corpse. She would bring her nose close to her body and, in a low, hoarse voice, solemnly pronounce: “acetone” or “technical liquid”. We often receive visits from superstitious or religious people who come to ask for water with which a corpse has been washed. I believe they need it for some ritual. Assistants usually give the tap water, even. They also request ropes taken from the necks of hanged people, bedding and personal effects of the deceased. Sometimes our work can be deadly. You never know what might be found during a study. There have been cases where forensics, stretcher workers and assistants have become infected with tuberculosis. There is also the risk of other diseases such as cholera and even anthrax contamination.

I believe that starting from high school, some basic concepts of human health should be taught. People between the ages of 15 and 20 should be able to detect when they are healthy and when they are not. If you have symptoms that have never occurred before, or if something hurts and the pain doesn’t go away, you should see a doctor. In no case should we bear it and wait for it to pass alone. Unless you want them to say, “Wow, you held up a lot, but you couldn’t resist just because you tried to be strong.” On most occasions, the “mild” invisible killer is high blood pressure. Many young people believe that only idiots measure their own pressure when they are young, that this is an old man thing. I would say the following: “idiot is precisely who does not measure pressure.” If your head hurts, you just take medicine, or don’t take it at all, as the pain is mild. And so you last a few years. But, over time, the elasticity of the arterial wall decreases and this even occurs in the brain. And the next increase in voltage leads to rupture. The result is intracerebral hemorrhage and death. I once studied the corpse of a student. She died suddenly, standing by the window. Two weeks before the sad event, the girl suffered a viral respiratory infection without getting to bed. She recovered, but still had some “negligible” symptoms, a slight shortness of breath and tingling in her chest. These symptoms bothered her, but she didn’t see a doctor, which might have saved her life. Myocarditis (inflammation of the heart muscle) was a complication of her infection.

When working with a major source of danger, for example with an electrical current, you should always observe safety precautions. People tend to approach this subject with little seriousness. In case of fire, do not search for money or valuable belongings; you will have the opportunity to recover material possessions afterwards. Save yourself and save those who need help. To have a serious burn, it only takes a few moments. Also, a fire quickly releases a huge amount of carbon monoxide. It becomes so abundant that, just by breathing it for a moment, a person loses consciousness, dies and ends up charred. The beach and alcohol are a dangerous combination. A number of drownings occur because of drunkenness. Hypothermia can be lethal; dilated skin vessels are considerably reduced. The heart needs to pump more blood and is unable to perform this task; then the patient loses consciousness. Once removed, it can quickly regain consciousness, but if it remains in the water, the lungs quickly fill with fluid and the person eventually dies. Several times I had to study the bodies of drivers who died in a collision with an obstacle because of heart damage. At the time of impact, the organ was filled with blood. This phase of the heart is called diastole; due to the hydrodynamic impact, the blood simply burst the heart. If the seat belt was buckled, the impact wouldn’t be as strong. A few ribs would be fractured and nothing else. At high speeds, the feeling of being protected by the metallic parts of cars is imaginary. When impact occurs, the cabin deforms like a cardboard box when stepped on. So when you’re driving at extreme speeds, it can be smart to imagine that the bodywork is made of cardboard and take the necessary precautions. During an argument, people often direct their punches at the rival’s head. In general, the consequences are not very serious, with the exception of bruises on the face. But I work at an IML and all I see is deaths… anyone who has punched someone in the head might not have thought that their attitude could cause hemorrhage and brain swelling. Most likely, neither of the two people involved in the fight imagined that this imbalance would end in death. There are several educational medical programs on TV and lots of first aid instructions. All information on this topic is available on the Internet and YouTube. But who would really know how to properly perform cardiac massage or cardiopulmonary resuscitation (CPR) that would be effective?

At first, when I started working as a forensic doctor, I couldn’t stop wondering what was inside people’s bodies. Seeing a pretty girl on the bus, I imagined what her internal organs would look like. After some time, this passed. My wife and I met at the IML. That day there was a terrible accident on a city road and I worked in emergency mode. She was a doctor and had to attend her patient’s autopsy. And that’s how we met. Our first Christmas was celebrated at the IML, both being in service. Soon, my wife became a pathologist and, of course, we often talked at home about our work. Once, I was lying in the garden looking at the clouds in the sky. Suddenly, I realized that they remembered something. Then I remembered: if you cut the heart wall parallel to the front or back surface, the mark after the myocardial infarction will look like that image I saw in the clouds. In place of the blue sky, a red-brown heart muscle is seen on the margins of the gill area. It’s called post-infarction cardiosclerosis.

In the IML, there are many tales about the resuscitation of the dead, but I have only witnessed two such cases. On both occasions, it was just an alcoholic coma. The alcoholics were placed in a refrigerator, where later…