Do you think that popular entertainment has significantly distorted the public’s perception of the work that pathologists do?

Yes, definitely. The prevailing image of the pathologist, fostered by TV and books, is of someone working with a body pulled from a canal or shallow grave to try to find out what happened. In fact the great majority of pathologists’ work is to do with living patients: they are key members of the clinical team in the health services, involved in making or refining diagnoses and advising on treatment options.

Are there any particular qualities than unite the pathologists that you interviewed for the book?

The quality that most united my interviewees was fascination with the science of medicine rather than the ‘art’– a burning curiosity to understand the mechanisms of disease. I was also struck by their compassion – these were not men and women hardened by familiarity with death and dying, but people made wiser and somehow more caring.

What would we as a society do without pathologists?

Quite simply, we couldn’t do without pathologists. The cornerstone of modern medicine would be missing. We would cease to make progress in understanding diseases, and would be handicapped in making diagnoses and in investigating new scourges (such as SARS, swine flu, AIDS). And we would lose a vital tool for quality control in the health services: studies show that the cause of death as stated by clinicians has to be revised in at least 10% of cases in the light of post-mortem findings. Errors of clinical judgement and even malpractice are often brought to light in the pathology lab. Harold Shipman would have been caught earlier if post-mortems had been more of a routine procedure in unexpected deaths.

You must have heard some shocking stories when interviewing people for the book – were there any that were too distressing to go in to the book?

Most of the stories I heard were poignant rather than shocking, though my interview with Helen Wainwright in South Africa certainly had shocking elements. But I didn’t feel it was my responsibility to protect my readers from the realities of the pathologist’s world, and I didn’t drop anything because it seemed too distressing.

What was the most impressive piece of pathological detective work that you heard about during the course of your research?

There were so many ‘wow’ moments in the course of my research. But the piece of detective work that most readily springs to mind for sheer brilliance is the story Jeff Taubenberger told of his efforts to extract, from ancient tissue slides, bits of the DNA of the Spanish flu virus that killed up to 80 million people at the end of World War I. Searching the archives of the Armed Forces Institute of Pathology in Washington, Jeff discovered the slides of lung tissue from a soldier who had died in the pandemic in 1918. He subsequently obtained fresher tissue from another victim of the pandemic who had been buried in the permafrost in Alaska, and from these decades-old specimens he not only managed to tease out and sequence the viral DNA, but to ‘reconstitute’ the virus, using the wizzardry of ‘reverse genetics’. This has enabled him to ask vital questions about what made the 1918 flu virus so exceptionally virulent.

Did you have an audience in mind when writing A Matter of Life and Death?

Yes, I had in mind people like myself, who may or may not have specialist knowledge of medicine, but who are fascinated by the topic and willing to grapple with some fairly tough science in the interests of understanding, if it is explained clearly.

What’s your next project? Would you like to continue with the medical theme?

I have several ideas that I’m mulling over for other books, and may well run with another medical theme. Watch this space!

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