Death’s Symphony

Pétur Guðmann Guðmannsson’s one-man-show in the autopsy room

“We have every kind of case here in Iceland — every chapter of the forensics book, everything besides train accidents,” Pétur Guðmann Guðmannsson, Iceland’s only forensic pathologist, says matter-of-factly as we meet at his office in the old blood bank of the National Hospital on Barónsstígur. Most of his work days start in an autopsy room with a tiny morgue attached. He shows me his tools — scissors, forceps, clamps, knives and even a saw lie in silent readiness. With two autopsies done for the day, there are four bodies waiting for him to unravel their mysteries tomorrow.

If there was an eye-opening moment in my career, it was probably when I decided to give up psychiatry. I started specialising in psychiatry because I was very interested in the theory behind it, but it wasn’t for me. You could say it was a burnout. I had always been interested in anatomy and disease and I knew that forensic pathology is all about that, like autopsy and working with your hands. It’s the complete opposite of psychiatry, where you never have anything solid; you can never put your finger on what is happening with a patient. That is my interest in forensic pathology. It’s in the process of the work and the method — not in crime or death, per se.

Morgue’s embrace

I mostly work alone, but for a week every month, my colleague flies in from Denmark to help. It’s a lot of work — too much for one person. There are no other similar specialists in Iceland. Only three Icelanders have specialised in this field and the other two are living abroad.

There are enough homicides, violence and crime for one forensic pathologist working with that and every other unexplained death. We do almost 300 autopsies a year for the police.

On a typical day, I come in and see what’s new — check if the police have sent requests for autopsies. Most mornings, there are one to five requests. I see if the bodies have arrived and we start working. [Pétur Guðmann has two assistants who take care of the autopsy room and handle the sewing.] We usually finish the autopsy work during the morning hours and try to do other things, like paperwork, after lunch.

A good number of unexplained deaths are disease-related, such as heart disease that no one knew about or a brain haemorrhage, for example. But not all the cases are suspicious; very few of them are genuinely suspicious. There are a few cases a year where we see there’s a good chance it’s a homicide, or it’s definitely a homicide. Then, it’s a much more complicated autopsy procedure.

Crime scene analysis

The police have experts in blood pattern analysis and fingerprints, among other things, but we, the forensic pathologists, are experts in the body. It’s important that forensic pathologists come to the scene and start the time of death investigation. You have to take measurements — body temperature, environmental temperature, tests from the eye fluid and so on. The sooner you do it, the better results you will get.

“If you’re working with whatever is complex or challenging in some way, either you quit and do something else, or you just get used to it.”

We do a rudimentary examination of the body to try to understand what’s happened and then plan a proper investigation of the body and order a CT scan as soon as possible. The autopsy would follow, with the police or the CSI technician with the police present.

My team and I also conduct many investigations of living people who have been assaulted. Probably the most common situation is domestic violence, where women have been subjected to an assault by their partner. They involve the police and the police would involve us to examine the outer aspect of the body. We probably handle about 30-50 of these cases each year.

Autopsy diaries

An autopsy can take as little as an hour to complete or up to days. We do a full examination of all the body cavities, the cranium and all the organs. The brain, the heart and the lungs are the key organs in death and the death process.

My favourite organ is probably the heart. It’s a vital and interesting organ. And it’s so simple – it’s just a pump. You can go to Bauhaus and buy a pump that’s as effective as the heart. But it’s nonetheless an irreplaceable and very disease-prone organ. It’s not the brain — you can’t see all the interesting brain conditions. If someone was crazy, or very creative, you wouldn’t see it.

Photo by Art Bicnick

In many cases, the cause of death lies just in the heart. It is marked after years of hypertension or eating Domino’s for every meal. You see it in the heart if people have not taken good care of themselves.

Functional diseases would be my least favourite to work with. These are diseases you can’t see because you have no function in the dead body. Some disease processes like epilepsy can occur without any visible pathology, the same with inborn cardiac arrhythmias and electrolyte disturbances.

A writer’s handbook

Through the years, writers have been reaching out with questions about different methods of death, murder or putrefaction, for example, “I’m writing a scene where someone is stabbed. How many times does he have to be stabbed?” They want to incorporate real forensic pathology and I’m glad to help. It’s always an interesting conversation.

I talked to Endurmenntun [Háskóli Íslands’ continuing education department] and said that I want to have a course for professionals in the judicial and healthcare system about forensic medicine — emergency doctors, nurses, ICU and police. There is a need for them to understand a little bit about death investigations. We did that course and then, the Endurmenntun said there are probably a lot of writers that would be interested, too, so we decided to do a special course for them. I have had this course now for probably three years, both fall and spring. It’s been full most of the time.

Photo by Art Bicnick

It’s clear that a student is writing a specific scene and this is why they’re there. They’re thinking if it is possible to stage a hanging, for instance. In the course, I’m trying to give a realistic picture of the job and of forensic pathology in general. I also talk about the death process and what happens to the body, like putrefaction, mummification and how that works and looks.

Outside the autopsy suite

I like music. I listen to Bach a lot. I think Bach is like doing an autopsy. It’s polyphonic, you have a lot of voices that are intertwined. If you have the nerd gene, like I do, you can just take a very, very short segment, dig into it, take the voices apart and think about each note. What are these two notes doing here together? What you can do with Bach’s music is you can put it back together and it becomes alive. But you can’t do that with dead bodies. This is what I think is fascinating in working both intelligently or artistically — this combination of things and analysing them down to the smallest detail.

“What you can do with Bach’s music is you can put it back together and it becomes alive. But you can’t do that with dead bodies.”

I read books, but I don’t read crime. I mostly read non-fiction — books about Bach, perhaps. I’m a bit of a nerd like that. But then I have the usual things in my life, of course — my kids and my wife. I try to take it easy on the evenings and on the weekends.

We have been having a hard time getting younger doctors into this specialty. So I used to tell them that it’s such a good job. We work office hours. You’re not in the hospital during the night and your clients are not booked weeks ahead. I’m always so surprised that younger doctors don’t tend to commit themselves to this specialty.

Navigating silence

There are two kinds of people I meet — those who are very interested [in forensic pathology] and those who try not to mention it. It’s more common that people don’t initiate that conversation and I don’t do it either.

My mother was very happy when I decided to become a doctor. She was very proud. But I don’t think she was hoping that I would be this kind of doctor. She doesn’t talk about it as much as she used to.

Of course, this kind of casework can be very overwhelming. It’s tragic and tends to be emotional. But if you have that type of mindset, then it’s not for you. Most forensic pathologists distance themselves from the emotional and tragic factors of the cases. It’s not burdening in that way. It’s like any other job; if you’re working with something complex or challenging, either you quit and do something else, or you just get used to it. It would be impossible to go home every day and think about all the poor families and so on.

This job is very rewarding as long as you don’t have the delusion that you are actually helping the people, because you are not helping them at all. What we are selling is neutrality. If it’s a homicide, we are not doing an autopsy for the victim, we are also doing it for the accused. We don’t take sides.

Death isn’t nice. I don’t make the connection between my work and my own death — I think about it the same amount as any other person.