Forensic Pathology and Investigating Coroner with Dr. Kona Williams

We have the absolute honour to have Dr. Kona Williams on our podcast this Month. Dr. Williams is the first Indigenous Forensic Pathologist in Canada and has a passion for solving mysteries. She enjoys teaching and is a current Assistant Professor at NOSM University. Dr. Williams is also a strong advocate for the Missing and Murdered Indigenous Women and Girls and has dedicated her career to justice for her patients and community. 

Transcript

SPEAKER_01 0:16

Hello everyone and welcome back to the Pathways Podcast produced by Nawsam U Student Council. In this series, we sit down with physicians in Northern Ontario and learn about their journey to medicine, their careers, and their lifestyle. My name is Mackenzie, a third-year medical student at Nawsum University.

SPEAKER_00 0:31

And I'm Cameron, also a third-year medical student at Nossam University.

SPEAKER_01 0:36

And today we're thrilled to welcome Dr. Kona Williams to today's episode. Dr. Williams is a forensic pathologist and investigating coroner based in Sudbury, as well as assistant professor at Naussam University. So without further ado, thank you, Dr. Williams, for being here today.

SPEAKER_02 0:53

Thank you both very much for having me.

SPEAKER_01 0:55

Alrighty. So let's start from the very beginning. When did you realize you wanted to be a doctor?

SPEAKER_02 1:01

Um, you know, it was it was fairly late uh in university. I I wanted to be um a research scientist, a PhD research scientist. And I was really interested in genetics and viruses, and you know, I kind of thought that was my career goal. Uh and my honor supervisor said, you know, your grades are really good. Did you ever think about medical school? And, you know, there's no doctors in my family. I was the only one doing, you know, doing science. Uh, so it hadn't even really occurred to me. Um, but you know, I thought, well, I'll give it a shot and see what happens. Um, so I did all my MCATs and, you know, studied hard and kept up the good grades uh and applied. And to my absolute surprise, I got in. Um, and so I that completely changed the course of my life. Uh, and I remember, you know, thinking, oh my goodness, I guess, I guess I'm gonna be a doctor. And yeah, that was like it was one of those like pivotal shifts in your life when you just realize that, you know, this is what you're gonna do.

SPEAKER_01 2:06

That's awesome. I'm sure a lot of our listeners can appreciate a similar type of uh, you know, realization uh to wanting to be a doctor. Can you take us through uh kind of realizing and discovering you wanted to be a doctor to the steps that you had took to get there, like where you went to medical school, things like that.

SPEAKER_02 2:23

Absolutely. So I decided uh to attend um the University of Ottawa for medical school. And I, you know, I had no idea what what to expect. Um, like again, I said I have no doctors in my family. And so, you know, the first few months of medical school was a real eye-opener. I kind of got a better idea of this thing called residency. My whole family told me, they're like, oh, seven years and you're a doctor. I'm like, I don't think that's exactly how it's supposed to go, but uh, you know what, I'll find out more when I get there. Um and you know, my well, he's my husband now, but uh at the time my my my boyfriend, I guess, he was like, okay, so you're gonna do moose more school. And um it it's it's just four years, right? I'm like, uh, yeah, just just four years. It's four more years of school. That's fine. Uh, and then very quickly found out that, you know, residencies obviously many more years after that. And was like, okay, it'll just be, it's only, you know, two years for family medicine, I'll be a family doctor and and we'll be good. Um, but very quickly found out that um pathology was sort of my game. Uh, it's not to say that I didn't explore things. I went and looked at everything. Um, you know, everything was open to me as far as I was concerned. As some of my, some of my classmates had been very focused from the beginning. You know, if you want to be an ophthalmologist, for example, you kind of have to do that. Uh, but I was completely undifferentiated. I had no idea. Um, but in first year of medical school, there was a really good teacher. And of course, you guys know, you know, just as well as I do the fire hose of information you get every day. And we had a pathologist, and she came and explained, you know, three very simple, at least to us, concepts. Um, and you know, the way that she presented the information, the way that she talked, the way that she taught was so, I mean, it was a relief, and it was, it made sense and it was so engaging that I had to ask, you know, like what's a pathologist? Uh, and she invited me to the pathology department. And unfortunately, you know, many, um, not many medical students even consider pathology as sort of a career. So I was, of course, the oddball of the entire group of 150 students. And I spent a good amount of time in pathology and learning all the cool things and seeing all the really weird and wonderful stuff that we only read about in textbooks. And it's it's not to say that I didn't flirt with other specialties. I mean, radiology is fairly similar. I like the diagnostic aspect. I like thinking about things, and I liked, you know, it's it's almost like a puzzle. Uh, and that was something that really appealed to me. And again, going back to the PhD research scientist, like figuring something out, having a question and getting an answer. That was really, really interesting to me. But, you know, I hung out with the anesthesiologist, I really enjoyed surgery. Um, my goodness, like there were so many different uh areas of medicine that I just explored. And for all of you listening, do that. You know, don't, don't, you know, discount something or think, ah, I'd never be interested in that. Just go and and do your best and learn as best as you can. Because you just never know when your when your path would change uh, you know, like minded. So I applied for, um, I couldn't really decide between radiology and pathology. So we did the whole CARMS tour and it was like back and forth across the country and, you know, Karms interviews and all that. And at the very, you know, the very last day coming home finally uh on the plane, I had to sit down and write out my rank list. And I thought, you know, am I gonna do path or am I gonna do radiology? Like what am I gonna do? And so I wrote down all the pros and cons for each of them. And, you know, the final decision really revolved around, do I want the answer? And that was my deciding factor. Now, my best friend uh in medical school, she went on for uh to a very lucrative career in radiology. Um and, you know, I I don't have quite that um lucrative of a uh, I guess, a career choice. Um, but pathology has given me many more interesting uh sort of avenues. And I've never met an unhappy pathologist. We're all, you know, the lifestyle is great, there are no, you know, real pathological emergencies in the middle of the night. Uh and I think as I told both of you, I I do like being, you know, sort of in bed. I'm boring. I like being in bed at like nine o'clock with a book. Uh, and I can maintain that. Um, so I did my five years, I stayed in Ottawa, I did my five years of pathology residency there. And at the time, you know, that I started, there was something called the Gouge Inquiry. And that changed forensic pathology in this province completely. So it was a complete overhaul of the death investigation system in Ontario. And so I'd only heard kind of inklings of that. Um, but during my time as a resident in Ottawa, they created a whole new system, the Ontario Forensic Pathology Service, and they created a regional forensic pathology unit in Ottawa and brought in, you know, proper forensic pathologists. And so I got to learn from them. Um, and it was fascinating. Um it was just, you know, it was something that I really thought this is, you know, to me, this is like, I get to be on my feet, I get to be doing things, I'm not sitting, you know, at a microscope all day long, uh, which is actually a good, a good bulk of of pathology residency, uh is lots of reading, lots of looking at slides. Um, I did that, but I also liked looking at the whole picture. So looking at, you know, an entire person from, you know, it could be, you know, from a societal viewpoint, all the way down to uh, you know, their their genes and what might have gone wrong. And I thought that is really something. Um so I was, again, super lucky. I met some good forensic pathologists. They encouraged me to go check it out. I ended up going to Toronto for an elective and met um some amazing forensic pathologists. And I knew from the day I walked in that door that this is what I was meant to do. And so I got a forensic pathology fellowship. And I was uh with me and another fellow, we were the two first fellows to be training in the brand new giant facility that they have uh in North York. And it at the time, and I think it still is, the most advanced facility on earth right now for uh, you know, forensics and forensic pathology and forensic science. Um so I was like a kid in a candy store, and I got to um, you know, train at the best facility on earth who was some of the best in the world at what I do. Uh and so, so that was sort of the path that I took. It was very um, you know, it was very surprising. There are lots of twists and turns, uh, but I am really happy with where I am right now.

SPEAKER_01 9:43

Wow, that's uh an excellent response. I really appreciate how you kind of dove into, you know, the radiology versus pathology kind of pipeline coming through um medical school. And I guess the difference might be like if you want to work in a bright room or a dark room. But uh I also enjoy the fact that it kind of seemed like you got involved in pathology kind of at the right time and uh the right place as well. Um so it seems like you've thoroughly enjoyed your residency. Uh would you say that's that's true?

SPEAKER_02 10:14

Yeah, residency was was actually was actually a lot of fun. It's I will say for pathology, it's a very different way of seeing a patient. Because you you just spent the last five years um, you know, dealing with clinical medicine, like like, you know, patients in in on the wards, in, you know, in um, you know, the community hospitals and you know, in clinic. And then, you know, you start your pathology residency and you still do the first year as sort of like like almost like a, you know, what was known as a rotating internship, your PGY one year, your PGY two year, everything, you know, that you've learned, you have to take that and then apply it to the tissue you see on a slide. And I I remember the first day that I had to do sign out, I had a slide and I, you know, there's 20 slides per tray. I had like 20 trays, so it was it was nuts. Um, but I remember looking at a tonsil and thinking, oh my God, okay, what do I know about tonsils? Thinking back to all my clinical years and then, okay, what can go wrong in a tonsil? And looking at the textbook and sitting there for two hours trying to figure out what could possibly be wrong. Is this cancer? Is this something? Uh, basically to eventually call it, okay, well, it I think it's normal. So you kind of hit that wall because, you know, everything that you've learned, yes, you still need it, but you have to apply it in a very different way. And that is, you know, sort of how pathology is. Like you are the diagnostic, uh, the diagnostician. You're the one that has to have the answer. Uh you know, in clinical medicine, you know, place like the emergency room, for example, like your error rate might be as high as, you know, 15, 20%. Um, you know, because you just, you know, somebody can leave or, you know, okay, well, I didn't want really sure what happened with this person. So there's there's lots of room for sort of, you know, errors. Um, but in pathology, the error rate is well below 1%. And it has to be that way because you're like the kind of the end of the line. So when clinicians are sending you, you know, their questions and their patients, you're the one that has to make the diagnosis, knowing full well that everything that happens to that patient as a result of your diagnosis, like everything that happens, for example, if somebody has, you know, cancer. Well, that's huge. That's like a whole life-altering diagnosis. And you'd better be right. So that's, you know, that's that's kind of the thing behind path is that there's so much to learn, there's so much to understand, there's so much to, you know, to read and to know about. You have to know about all the diseases and all the genetics, and, you know, then you have to know about the treatment, and you have to know what is going to happen to that person as a result of your diagnosis. Uh, and that's, you know, both uh terrifying and a huge responsibility, but also an enormous privilege to be able to give that information to clinicians, to give them that that one bit of information that they really depend on so that they can help their patient. Like it's it's an amazing, it's an awesome responsibility.

SPEAKER_01 13:28

That's fantastic. It's uh it's gotta be daunting for pathology residents, you know, day one to try and take from what you learned in medical school and and like you said, kind of adapt it to make sense for pathology. Um, and what we learned in medical school uh with Cameron and I is that uh you really learned that like biopsy is usually the gold standard for a lot of diagnoses. So we definitely uh appreciate all the hard work that you guys do. I wondered if you could just dive into some of the different career streams and fellowship options that's uh available to uh people who uh go into pathology.

SPEAKER_02 14:06

Yeah, so pathology is, you know, it's literally the study of disease. So you can take any organ, um, and there will likely be a pathologist who's a specialist in all of the diseases of that particular organ. Uh so the majority of pathologists they work in hospitals and you know, usually tertiary care hospitals, and they are, again, they're diagnosing diseases. So everything that comes out of a human body has to go to the lab. And, you know, if there's tissue, that will get looked at under the microscope by a pathologist. So, you know, you have um, you know, cardiovascular pathologists. So they look at hearts and valves and, you know, vessels like aorta. They're they're looking at all sorts of pathologies of the heart and the vessels. You have neuropathologists, so they're they specialize in the brain. Um, I was never really good at that. I was trained by a PhD. Well, the chief forensic pathologist for Ontario, who also has a PhD in neuropathology, he loves the brain. And I did not, uh, but huge respect to neuropathologists because they can answer questions that, you know, I just throw my hands up in the air and go, yeah, you know what? I have no idea. Um, so any organ system, the heart, uh, the lungs, the brain, the liver, the kidneys, uh, the blood, uh, the bone. There's basically a pathologist for for like every organ system. Then you have, you know, you might have a pediatric pathologist. So they specifically look at, you know, infants and and uh, you know, genetic anomalies and all the, again, the weird and the wonderful things that that we only look in textbooks and understand. Um, and then there's there's, you know, sort of like the oddball, there's the forensic pathology. Um, so you know, pathologists are generally considered a bit odd, uh, I guess by clinicians. But, you know, forensic pathology is weird to pathologists. So that goes further into sort of the more medical-legal um sphere, where, you know, yes, we do autopsies, but we're also testifying in court and, you know, doing autopsies on like people who've who've you know died under criminally suspicious or, you know, if they've been, they've been actually killed by somebody else. Uh, you know, so that that aspect of it is a bit, it's unusual even for pathology, but it's I I mean, of course, I'm biased. I think it's like the best area of pathology ever. Uh, and then you also have what kind of more general pathologists, they kind of do everything. There is, I'm not sure if there still is uh a general pathology resonancy. So a lot of it used to be when I was going through was anatomical pathology, and you had general pathology. So they not only do sort of the surgical, the anatomical pathology part, but they also, you know, deal with all the lab stuff. So microbiology and chemistry and hematology and transfusion. So they also deal with all of that. The field of pathology has gotten so big and uh it's, you know, you almost can't know it all. So, you know, those pathologists who trained like that are very few and far between. Uh, and I have huge, like mad respect for those, those pathologists because they they literally know and do it all.

SPEAKER_01 17:30

Wow, that's really interesting. And would you say that uh if a physician who goes down the path of forensic pathology, is it common that they completely focus on forensic pathology or can they also work in general pathology as well?

SPEAKER_02 17:44

Uh you can do both. Um, there's a number of my colleagues who actually do do both. So, you know, they might do forensics on the weekend and then do uh, you know, surgical pathology during the week. Generally, more the hardcore forensic pathologists, they they just love it. Uh and I'm I'm sort of one of those. Although uh it didn't stop me from being the medical director, the laboratory medical director for health sciences north. So that incorporated sort of the forensic unit, but also the entire lab. And so um, you know, having that leadership role was amazing. It was phenomenal. And, you know, I had to step out of my forensic comfort zone a little bit and and start making decisions about, you know, transfusion and making decisions about chemistry and and you know, genomics. Um, but I was really lucky that I had an excellent, you know, uh the lab staff are phenomenal. Um, it's too bad that they're kind of like in the background for the most part, yeah. But the hospital couldn't run without them. And the team that's at Health Sciences North is they're incredible. Uh, if you ever get a chance to meet them, by all means, uh they'd be delighted to show you the lab and show you all the cool stuff.

SPEAKER_01 18:57

That's great. Definitely the uh unsung heroes of the hospital. And through all your training with uh residency fellowship and med school and all that, is there anything that your specialty has surprised you, like something that you weren't aware of before getting involved in it? And then at the end it kind of surprised you?

SPEAKER_02 19:26

Yeah, absolutely. Um, so near the end of my fellowship, I started to get wind of the Missing and Murdered Indigenous Women and Girls Inquiry that looked like it was gonna start. And so my background, like my dad uh was an elder, he was a Cree elder, and he was uh part of the TRC. So, I mean, that has always been um sort of part of my, you know, sort of teaching growing up. Like I knew all this. But, you know, I wasn't gonna be a family doctor, I wasn't going to be uh, you know, an emergency room physician or in public health. So the whole thinking about how that aspect of my life, um, you know, with missing and murdered women, indigenous girl, uh, indigenous women, girls, with the TRC, with the the unmarked burials in residential schools, none of that had really kind of come to focus yet. I did not see how at that point, how forensic pathology and what I was doing had anything to do with that. Uh you'd think I would have had a little bit better foresight. Um, but you know, I mean, you're you're so focused on what you're doing that, you know, it's almost like those two parts of my life were completely separate. And so when I finished my fellowship, the Missing and Murdered Indigenous Women Girls Inquiry started getting going. And that was when uh it became very apparent. At that point, I was the only First Nations forensic pathologist that anybody knew of, that my role in this arena, so the intersection between the issues affecting uh Indigenous people, that sort of historical trauma, that all of that was going to collide with my role as a forensic pathologist. And that kind of pulled me in a completely different uh direction where I could basically meld the two of them together. So that was not something I was expecting. The other part that I wasn't expecting was the media attention. Um, I you know, pathologists, you know, there's always that thing where pathologists are introverted and we don't like people. It's not entirely true. We do actually like people, we're always communicating with people. But, you know, we're not out there, it's not like we have usually have like TV shows about us or anything like that. So having all that media attention and media focus, especially being, you know, a First Nations person, was a little bit scary. Uh, I tried to use it as best as I could to kind of advocate. For indigenous people and for forensic pathology, because nobody really knew what that was. But with that comes the consequences too. So the bad stuff, you know, the stereotypes, the racism. You know, I kind of live with that all through my life. So I kind of knew how to handle it. But on that scale, uh it kind of came as a shock. Um, but at this point in my life, like I'm 10 years out of fellowship. Like that just doesn't seem like that could have possibly happened. Um, but here I am.

SPEAKER_00 22:29

And, you know, this is the path that that's that's where it's taken me. That's really amazing to hear. And I think, you know, you had some things that surprised you along the way, but you sort of took them and embraced them. And I think that's really inspiring for us to hear as medical learners. And I also just have to say, you have already taught me so much more about pathology than I had ever known before meeting with you today. And I'm sure our listeners can relate as well, because we really don't hear a lot about pathology as an option in medical school, kind of compared to other career paths. Um, and so with that, I'm just curious to know if you've had any other jobs or roles in medicine in addition to your role as a forensic pathologist.

SPEAKER_02 23:09

Yeah, I seem to be collecting them. Um so, so like I said, I was the lab med director for Health Sciences North for quite some time. And then that gave me leadership skills. So that's one of the things in medicine where, you know, it's always like you guys are going to be leaders. You are going to be, you know, teaching the next generation. You're going to be, you know, having to run your own business and all that. Um, but they don't really actually tell you how to do that. So, you know, jumping into that leadership role, um, really, especially because that's when the pandemic started. So you can imagine what that must have been like, uh, you know, sort of being in charge of the lab and all of a sudden we have this, you know, global pandemic. Um, so that teaches you a lot. Um I'm also the section chair for pathology, uh, so you know, at Nossum. So that's that's a new role. Um I do lots of teaching and and not just not just medical students. So I I used to teach a uh a course on uh intro to forensic pathology for the uh forensic science students in uh Toronto when I was there. Uh I stayed there for uh you know a few years after I finished fellowship. And I brought that that course up here to the Laurentian Forensic Uh Science Program. So teaching is is really uh you know kind of a big part of what I do. Um, you know, so we we do tend to wear to wear multiple hats. I mean, a lot of it's kind of allied with pathology and and and forensic pathology. The other thing that I decided to do uh is I'm gonna be doing my MBA at Rotman starting in uh January. So yeah, like we just we have we have lots of things. Pathologists like to keep busy, at least I do. Uh so there's lots of hats that I like to wear. I bought and live on a farm in sort of the outskirts of Sudbury. So we have a hundred-acre farm, and you know, you know, chickens and bees and ducks and geese and dogs, and it's been, you know, that's a whole other part of my life that's, you know, not exactly forensic related, but um, it keeps me sane and it keeps me, it does keep me busy. It's it's certainly not quiet around here, but it's the kind of life that, you know, if things are are tough at work or, you know, really busy, I can always come back here and I look out and I'm, you know, I've got a hundred acres of land and it's it's amazing. Um so so again, like that, that's another important part, I think, especially for learners, is to get that balance. Uh, it's not easy. Medicine doesn't make it easy, um, but it's important that if you can find it, uh, hang on to that and make sure that you incorporate that in your life no matter how busy it gets.

SPEAKER_00 26:01

That's really good advice. And you're right, it definitely does sound like you wear many hats. I had no idea that you owned a farm, but that is so cool. And I think that's great advice for anyone listening as well. Just throughout our careers in medicine, it's so important to have other things to kind of fill our cups as well. So thank you so much for that advice. And I just wanted to clarify as well, I know before we started recording today and we were meeting you, you had told us that you work as a coroner as well. Would you mind just diving into that a little bit more?

SPEAKER_02 26:32

Yeah, of course. I'll give you guys a little bit of a snapshot as to how death investigation works. So in Canada, we have two types of death investigation systems. Some provinces have a medical examiner system, and some provinces have a coroner system. And in Ontario, we have a coroner system. And Ontario is fairly unique because the coroners in this province, you need to be a medical doctor. Uh, so all coroners have um their MDs. And and just as an aside, for any of you who may be considering this kind of work, you as soon as you get your MD, you can apply to be an investigating coroner. Uh, and you know, for for those of you who have uh the substantial medical student debt uh that you know that I am I still have and I'm still paying off, um, it can be a way to, you know, to make a little bit of extra money, you know, when you need it. So an investigating coroner is sort of the first, one of the first contacts when somebody, you know, has died suddenly, unexpectedly, under you know, criminally suspicious circumstances, the coroner will be called. And so we have a number of investigating coroners in northern Ontario. Uh, they're kind of all over, all over Ontario, but we have you know our own sort of Northeastern regional coroners unit um or regional coroner's office. And then we have a Northeastern Regional Forensic Pathology unit, which I run. But investigating coroners are sort of the first contact that the family will have with the death investigation system. So if their loved one again dies unnaturally, or we're not really sure, it could be, it might not be, the coroner will call and the coroner can decide whether or not uh, you know, they investigate um that that particular death. So to give you an idea, about 100,000 people a year die uh in Ontario every year. And I'd have to say about 20,000 of those uh cases will, the coroner will get involved. Um and so what they do is they have to answer a number of questions, like who died? So identification is like really important. When did they die? Where did they die? Uh, you know, how and then by what means. So they have to answer these questions. And if they can't answer, you know, one or more of them, uh, then that person likely needs an autopsy. But all through that, the coroner, we work together. Uh, so, you know, we work with the forensic pathologist and the coroners, they work together. The coroners are the liaison uh with the families. So they'll be talking to the family, relaying information about the investigation, including any autopsy findings or any autopsy results uh back with that family. And um, you know, hopefully come to some sort of resolution as about at least the closest approximation to the truth about how their family member died. Uh, a lot of coroners, you know, they kind of do this sort of, it's like kind of on the side. Um, so you get a lot of investigating coroners who do this sort of additionally. So they'll be on call, you know, one or two nights a week. And, you know, everybody kind of shares, shares the call schedule. Um, but it's good for for people who are interested and for people who want to try that. We've got some amazing investigative coroners in Sudbury and in Northern Ontario, and they're always open to having medical students, you know, come along for the ride and and see what they do. It can be, it's a it can be a challenging job. I have to say it's not for everybody, but you can be there for the family when the absolute worst thing has happened to them. And that's rewarding in its own way, uh, as kind of a different way of you know being a physician and and and supporting a family through a very difficult and challenging time. Um and, you know, everybody, we always need coroners. So for anybody who's interested, I I definitely uh encourage uh anybody to consider it uh and to look into it further and you know, reach out to the the local coroners you have. You can always, you know, reach out to your friendly neighborhood forensic pathologist as well. We'll be happy to happy to help you out.

SPEAKER_00 30:55

Amazing. Yeah, that definitely sounds like really rewarding work. And I know there's actually a few people in our class who are considering maybe including some coroner work in their future practice. So I think that was a really helpful overview, and it sounds like it's quite the unique role. So thank you for that. My next thing I'm curious about is I know you mentioned that you had no doctors in your family. So did you have any mentors throughout your education or your career who have helped to guide and motivate you along the way?

SPEAKER_02 31:23

Absolutely. Um so the first one, I mean, the one that that really she's the one that changed my life. Her name is Dr. Mary Senterman. She's retired now, but she was a pathologist at the University of Ottawa, and she was the one who taught so well that first lecture. Um yeah, so like when you guys become teachers, when you guys are giving lectures, be mindful that you may actually be changing someone's entire life by the information and how you convey the information that you have to give. So she did. Uh, and she was so good. Like she, you know, brought me into the department and she showed me things and, you know, really kind of sparked that curiosity. I think she saw that. Um, and but at the same time, uh, encouraged me, like, go see everything. Don't just focus on this because, you know, this is kind of fun. It is fun and it is great, and we'd love to keep you, but go check everything out because you just never know. Uh so I did. And and emergency medicine was awesome. And I knew from the very beginning that I did not want to be a geriatric psychiatrist, but I had a blast giving, you know, mini mental status exams to all the lovely, you know, little old people. So I made the most out of every single rotation that I had, uh, but I kept gravitating back. And, you know, they were glad to have me. And so, you know, her kind of patience and gentle uh encouragement helped, you know, sort of solidify that, you know what? Yeah, I think this is what I want to do. Now, things changed in like residency and especially in fellowship. So, you know, when I got introduced to real forensic pathologists, they came, they had to come bring them in from the UK because they didn't really have too many of them here uh to start with. But in residency, I met uh the man who changed the entire face of forensic pathology in Ontario. And that was um, well, the current chief forensic pathologist, Dr. Michael Polanin. So he was, you know, the second mentor who really changed everything. And it I remember I went to, I went down to do my elective as a resident in at the Toronto Forensic Unit. And at that point it was in this old building downtown. They hadn't quite yet moved over to the new building. And, you know, I I like I said, like I recognized that these were my people, like the first day. Um, but Dr. Polanin wasn't there. He does a lot of international work. Um, he's currently actually in Iraq right now, uh, doing autopsies and training people um in Baghdad. So he does this kind of stuff often. And so he was away. So I got to work with all the other forensic pathologists, and I thought it was, you know, I was just having the time in my life. And the very last day I was on the schedule, and everybody kind of wrote down their initials on the board for who was going to be it, you know, doing what case and with who. And, you know, I saw initials and I'm like, I don't know who that is. Um, and so I was working with this guy, and by that time, you know, I was totally comfortable doing autopsies at uh at that forensic unit. And he was asking me questions, I'm answering them. I was completely unaware as to who I was really working with. And, you know, at that point, I was like, okay, well, now it's, you know, my time to go. And, you know, it was driving home and I was driving one of the residents uh who was also going to go visit his family uh in Ottawa from Toronto. And we were literally parked in traffic uh on the highway. And the phone starts ringing, and I'm like, I don't answer my phone. It doesn't matter if I'm in a car and I'm driving, I do not answer my phone. And I remember him saying, Oh, for goodness sake, just answer it. I'm like, it's a 416 number. I'm not answering that. I don't know who that is. He's like, just answer it. We're parked. So I answered it. Uh, and the person on the other end of the line was Dr. Polanin. And I almost dropped the phone. And he said, you know, you did really well this morning. I heard really good things about you. I'd like to offer you a fellowship. So I think I squeaked my way through that and said, Oh, okay, thanks. And, you know, he got all the the uh paperwork. And my resident friend said, uh, yeah, you did a really good job with him this morning. And I was like, what do you mean? And he goes, We that's who you were working with. I had no idea because I still like he introduced himself. And I certainly, you know, I didn't know what he looked like. Nobody said anything. So I was both feeling like an idiot, but also really relieved that I didn't know because I probably would have cut my finger off or something. Uh and so he is a mentor that I needed at that stage. So somebody who could push me and challenge me and challenge my thinking. And, you know, you need to get this right. And, you know, really uh that sort of intense training was what I needed to become, you know, a good forensic pathologist. Uh you know, and he's again one of the best in the world. Uh and, you know, to have that uh right from the beginning, I think I've probably been a little bit too intimidated. But near the end of my training, uh, that was the kind of mentor that I needed. Uh and you know, that's that's kind of how it goes. Like through your medical training, you will have mentors uh that you need uh at the right times and they will show up uh when you need them. Um and to remember that you are also mentors and you know, to pass that on and and to, you know, pay that forward so that when you get students who, you know, might seem a little bit hesitant or might seem a little bit too cocky, your job is to guide them and to make sure that they have the tools that they need to carry that forward. Uh and that's I figure that's what I'm doing, that's what I'm doing right now. I'm kind of in this weird sort of middle zone where I I I realize that I'm influencing students and I realize that I'm, you know, encouraging them and mentoring them. But I'm still learning. I'm still learning from my my senior colleagues. So it's a it's an interesting place to be. Uh, but when you find somebody who who lights that that little spark, follow it. And and don't, you know, don't be afraid. I I would say just, you know, follow that that little spark. Follow that little, you know, that sort of like like little tickle in the back of your mind. You're like, oh, maybe this is something that I should consider. Uh, because you never you never know where it'll take you.

SPEAKER_01 38:03

Wow, that's such a fantastic story. And it's a good thing that you answered the that 416 phone call. Um it's true even for us in third year. Um, we really appreciate the role that mentors have and helping form our education because sometimes it feels like we have our head downs and the head down in the books so much that uh you kind of lose focus on you know the future and planning for that and what you want to do, and there's so many options. So definitely uh we'll have to keep it in mind to pay it forward in the future for sure. So thank you for sharing that. Knowing that a uh typical day in medicine can vary greatly, and especially as a forensic pathologist, would you be able to try and take us through maybe a typical week instead of what that what that looks like for you in your current roles?

SPEAKER_02 38:51

Of course. So for me, so for a week where I'm cutting in the morgue, um, I have a fantastic team. Uh I have pathology assistants that I work with. Um, and so they get everything organized and you know, they help me with, you know, the dissection. You know, for those of you who have been to an autopsy, you know what I mean. Uh and so usually for the most part, I do a lot of my dissection work, my autopsies, so to speak, the the actual physical dissection in the mornings. And that can vary depending on the nature of the case. I've spent, you know, sometimes it can be 15 minutes uh for say an external examination, if if that's required. And I've spent three days uh with one particular case. So if you're thinking of like a, you know, dismember decomposed homicide, um, that can take a long time. And you never know what's coming. So, but typically uh I do my my sort of my dissection in the morning. The afternoons are for paperwork. So, you know, of course, we generate a lot of data and I have to order tests after, you know, every autopsy. It's usually things like toxicology, uh, histology, so looking at tissues under the microscope. So yes, I still do that. Uh, but that I can do, you know, in my office and I can blast my now vintage 90s dance music uh while I'm looking at my slides and writing my reports. Uh I typically have, you know, any number of meetings because of the leadership roles that I that I hold. And at the end of the day, I can go home and I get a good night's sleep and I do the same thing the next day. My typically my my evenings and my weekends are mine, although I'm usually busy with something or another. But the other thing that I do is I testify in court. So forensic pathologists are probably the, you know, the one, one of the few physicians who are very close to the legal system. So we do testify in court quite a bit. And, you know, getting a subpoena as a clinician uh to potentially go testify, it always seems to be some terrifying thing. So if that's the case, if you guys ever get a subpoena and you don't know what to do, um, you know, one of the things you can do is reach out to your forensic pathologist because we will teach you all the ins and outs of how to how to deal with court. So often court, uh, you know, homicide trials, uh and you know, giving my evidence as an expert witness. Usually court doesn't happen in the summer. They tend to shut down. But, you know, I've got a number of court dates coming up. And so that can take, you know, sometimes it can take half a day, sometimes it can take two days. So it's kind of unpredictable. I often, so I'm usually the the forensic pathologist on call for the region. And, you know, my calls are not too onerous. So most of the time I'll just get, you know, a quick message from a coroner saying, hey, heads up, I've got this case coming in. Or, oh, can I run something by you? Uh, I I don't really know if I should send this in for an autopsy or what do you think? Uh so I get, you know, calls like that. There are no like forensic pathology emergencies where you have to like run into the hospital and do an autopsy stat at midnight, like no. Like I said, I like to be in bed by nine. Um, but you know, my days are are pretty, pretty straightforward uh for the most part. Pathologists are known to have an excellent lifestyle. Uh, and that that is true in forensic pathology as well. You know, not to say that there aren't hair-raising days or weeks when things get really crazy, but for the most part, you know, I get to come home and spend time with, you know, the farm and my family. And and, you know, it's not like I'm, you know, doing cases on call overnight or anything like that. So, you know, day-to-day is is pretty at this stage where I love what I do, I'm good at it, and they pay me for it. Uh, this is kind of kind of this golden triangle where you guys, yeah, I hope every one of you gets this uh gets to that stage where you're just like, I'm the top of my game and I love what I'm doing. And, you know, yes, I can, you know, hopefully pay off that monster student debt. That's those are those are sort of like kind of the uh the essence of of sort of what I do. Uh pathologists, um, we have a long work life, I suppose. Many pathologists, you know, they can work into their 60s and 70s, and and not because they have to, uh, but because one, physically they can. Uh mentally, the work is interesting, and and we just love what we do. And it doesn't mean that we have to work full-time into our 70s or, you know, some cases I know some pathologists who are in their 80s. But the work is just interesting, it keeps the mind sharp, and uh we we generally tend to really, really enjoy what we do.

SPEAKER_01 43:46

Sounds like it's quite a varied day, but also that you get to kind of do a few different interesting things throughout the day and find time for you know all the extracurriculars that you're that you're doing. Um We'll have to add pathology to the you know lifestyle specialties. Um a question that we like to ask our guests is uh regarding like their favorite patient presentations to treat or their favorite pathologies to treat. So I wonder if maybe we could ask you what cases you find the most interesting as a forensic pathologist.

SPEAKER_02 44:21

You know, it's interesting that you asked that because, you know, at the very beginning of of my career, um, you know, I I would never have said this because, you know, you're still very new and it's still a bit, a bit scary and overwhelming. But for me, it is the the concealed homicides. So the cases where everybody's missed it. And, you know, you get this person on your table and everybody thinks it's it's a nothing burger. And, you know, you look at that person and it's um you get that sort of heart skip for a second where you're like, oh my God. Right at this moment in time, it is just me and the person who did this who knows that this person died at the hands of somebody else. Uh, and so it's it's almost like this, this like 20-second, uh, like almost time shift. And then, you know, that's when you have to start telling people. Uh, so you have to tell the, you know, the police that, you know, there's a homicide and that you have to call the homicide team. It always comes as a surprise. It's never a good day for the police. And luckily, it's very rare when this happens. Most, you know, homicides are obviously homicides, uh, but every now and then you get those ones where everybody's missed it. And that's the reason why you have forensic pathologists, because we are, again, like the last diagnostician. And so, you know, if you think about the consequences of missing it, you know, what happens if you are not a very good forensic pathologist and you miss something like that? Well, that whoever did this, they could do that to somebody else, right? Or what if you're not a very good forensic pathologist and you overcall something that isn't a homicide? Well, somebody's going to jail for what you say. So, you know, so the real world consequences are huge. And, you know, that that's the other the flip side of forensic pathology. Like it does sound, you know, like most of my days sound like, you know, they're a lot of fun. And, you know, I like what I do. And my patients are the easiest in the hospital to manage. Like they're very quiet, they don't talk back, there's no follow-up. But the flip side of it is are those scenarios where the, you know, risk to the public, where, you know, something that you say is going to be on the six o'clock news and they're going to be looking for somebody. And that's a hundred thousand dollar police investigation that evening. Somebody's going to jail for what you say. I know this doesn't sound like, woo, this is like the thing that I live for, but um, you know, that is both almost a thrill and the enormous weight of the responsibility of, you know, what you say. And and, you know, based on all the training and experience that you have, the ability to do that and to hold that responsibility, not just to the person in front of you, not just to the family of that person, but to the whole public. Um, that to me is not only challenging, but it's also the whole reason why I'm here. Uh that those are the kinds of cases that stick with you. You learn so much from, you know, from those types of cases. And you become a better forensic pathologist when you have them. Uh, so again, luckily they're they're few and far between, but when they happen, uh, you know the system is working and you know that you did the right thing. You made the right call.

SPEAKER_01 47:55

Wow, that's really interesting to hear how how you kind of process um that responsibility and how it can be incredibly challenging, but also incredibly rewarding at the same time. And I can just imagine how the euphoric feeling you must feel when you kind of make the realization of that homicide and uh just knowing that you'll be able to hopefully get that patient the justice that they deserve. So um I really appreciate you sharing that because it really goes to show how meaningful your work is. One question uh for medical students that are interested potentially in forensic pathology, do you have any advice on how to get involved in that field?

SPEAKER_02 48:38

Yeah, come talk to us. Um, you know, go hang out with a pathologist. You know, each one of you has to come and see an autopsy, uh, either here at the uh the Thunder Bay site, but talk to us. Um, ask us questions. When I get the student, when I get you students in um to have your autopsy observation, you guys can ask me any questions you want. Uh there's no optimist questions. Often, you know, good students will stay, you know, even after the autopsy, they just have so many questions about it. So don't be afraid to ask. And for those of you who are interested, you know, who go through the autopsy experience and go, huh, you know what? Like maybe that's something I might want to do. Just send us an email. Say, can I come back? You guys, it's an open door policy. You guys can come back whenever you want. Uh, so after your first one, if you're like, yeah, yeah, I kind of want to do this, come back. Uh, we'd be happy to have you. Um, I've had a number of students who've come back, and some of them are, you know, want to be investigating corners. Some of the are in pathology residency, some of them have gone on to forensic pathology fellowship. So, yeah, talk to us, check it out. And uh, we're always happy, like it's to talk your ear off about it. Uh, and and don't be afraid to uh to follow up and come back if you want to.

SPEAKER_01 49:55

Oh, that's wonderful. And having had gone through the autopsy um experience and having that privilege of of joining for one, I would say that it's uh always a good opportunity and that the pathologists are always so willing to answer our questions and also quiz us on some anatomy. So it's always such a privilege to do that. A question that we like to try and tease out during these interviews is if there's any differences in practicing uh your specialty in a more northern context versus what uh your colleagues might be doing in a larger center such as Ottawa or Toronto?

SPEAKER_02 50:32

Yeah. Um so so, like I said before, the the the Toronto Forensic Unit, uh, I call it the mothership, they have technologies that I kind of miss. So at that facility, for example, they have a CT scanner. And so post-mortem CT scanning is a big thing, and it's sort of catching on at the bigger centers around the world. I do miss that because you know, having access to regular postmortem CT, you know, is really useful. It's another tool that I can use. Um but I mean, obviously in Northern Ontario, the CT scanner at the hospital is for living people. Very, very occasionally will I ask for one. Uh, and I don't, I don't do it, I don't do it lightly. So it's I think I've maybe asked for a post-mortem CT maybe three or four times uh in the six years that I've been here. Um so very respectful of you know the hospital facilities and the CT scanner, but it would be nice to have, you know, I I keep saying if they if their CT scanner ever gets too old, can I just, you know, bring it up here and I'll use it, you know, in the morgue. I don't know where I'd put it. The other thing I think is is a geographical distance. And I mean that that's true for all areas of medicine when you're when you're you know working and living in Northern Ontario, is just the huge geographical distance that we have when patients have to travel. And that also includes the dead. So, you know, sometimes it can take two, three, four days um for a a deceased person to get to the forensic unit for their autopsy. And obviously that that can limit, you know, if there's there's changes that happen after death that can, you know, kind of interfere with sometimes my diagnoses. Bodies come in frozen and we have to, you know, defrost them. Sometimes, you know, if somebody dies out in the woods, um, you know, it's not like in Toronto where it's a big city. There are bears and there are wolves and there are all sorts of other predators out there uh that will, you know, change uh uh a dead body uh pretty quickly. That you we certainly wouldn't see that down in uh in Toronto, uh, for example. Uh the opioid crisis has hit Northern Ontario really hard, much harder than any other place, I think, in an in an in the province. Uh so we do see the effects of that. There's unfortunately lots of overdoses. I don't have the answer to how to, you know, fix that. All I can give is information. But at the same time, uh living and working in Northern Ontario is such a privilege. Um, you know, Toronto was amazing for the facilities. Uh I do miss the restaurants. Uh there's lots of lots of cool places to eat down there. But there's a peace up here that I didn't get in a big city. There's, you know, sort of, you know, the clean air, the, you know, the forests and and the the quiet and the wild places that just kind of pull you if if you're that kind of person. Um and that gives you sort of that that peace after a crazy or busy week or a busy day that again, I didn't really, I didn't really find in Toronto because it was always busy. Whereas up here, there is that ability to kind of put the pause uh button on, you know, a hectic life and just kind of take it all in and realize that, you know, there's more, there's more to life than than work. Um, you know, you got to make some time for living too. So there's pros and cons. And I think there's probably some overlap with my clinical colleagues. They're also dealing with some of the same things. Uh, but but people in smaller centers, small communities, the things that that people can come up with as solutions to problems, that kind of challenge somehow creates uh solutions in a way that that I don't really see anywhere else. So and that that was very evident in the pandemic. I mean, people in in small places, you know, they had to to look out for themselves. They had to make decisions that might never have occurred in in in big city centers. So, like I said, there's pros and cons. Um, but I am here. I am not going back. You're gonna have to pull me by my legs and and and whatever and drag me out of this place to get me out of uh out of Northern Ontario.

SPEAKER_00 54:55

I I'm here to stay. That's so great. And it's really interesting to hear your perspective about the unique challenges, but also the benefits and joys of living and working in the North. So thank you so much for sharing that insight with us. And now, while forensic pathology sounds like a really interesting career, I'm sure it can also be quite difficult and sometimes stressful at times. So I would imagine that working as a forensic pathologist requires incredible resilience. In your opinion, what makes a good forensic pathologist?

SPEAKER_02 55:28

Uh, curiosity. I I think I think most of my forensic pathology colleagues are are just naturally curious. We want to know things. You know, we see some interesting finding, and um, you know, we'll of course we we document it because we love documenting things and taking pictures and stuff. And we'll share that with our colleagues. It goes both ways. Like we're always sharing interesting findings with each other. And um, oh, have you seen this or have you heard of this? Uh so having a network of really, you know, kind of curious people is, you know, I guess you kind of gravitate towards that. Uh, it does take a really kind of, I guess, a special person to work with the dead. That's the other thing. Like it's not, it's not for everybody. And and I recognize that most medical students, me included, didn't go to medical school thinking, ooh, I want to work with dead people. So, you know, you do have to have that, one, the curiosity to be able to, you know, even consider it. But two, there's a strength there that we see the very worst that people can do to each other. We see horrible things all the time. But I think what makes a really good forensic pathologist is to be able to take that and say, okay, this is a terrible thing. But there's a family that's waiting for the information that I have, that I can tease out, that I can figure out, and I can give them. And uh, you know, give it's it's uh the search for the truth is sort of the heart of it. And and getting that getting to that truth and and doing as best as you can uh while still learning, but getting to that truth and being able to open that up in a way that's both accurate but compassionate to families and to the public, I think that makes an an excellent forensic pathologist.

SPEAKER_01 57:23

That's some really good advice. And uh current medical students, I'm sure, are appreciative to know what it kind of takes to become a forensic pathologist in ways that they can work on themselves to go towards the uh the the specialty they're interested in. And shifting to the future, where do you see the practice of forensic pathology? Are there any changes that are likely to occur or any changes you'd like to see?

SPEAKER_02 57:48

Yeah, we we're just so we have uh a new organization in Canada called the Canadian Association of Forensic Medicine. So this is something that that me and my colleagues started up. It's it's only a couple of years old. So we just had our meeting in Halifax uh a couple of weeks ago. And we were discussing sort of technologies. Um so AI wa was a big one. Uh and of course, there's always that that that concern that, oh, could AI take over? I still see it as a tool. And and I think, you know, in some ways, it could certainly in its own way revolutionize forensic pathology and and medicine as well, but kind of almost at the same level as the CT scanner when when we started having access to that. The other area that I see, and we're we're making inroads into this, is post-mortem uh genetics. So, for example, when somebody, say a young person is, you know, drops dead on a football field, you know, 20 years ago, we might have just said, well, it's probably something with the heart, you know, but in a young, healthy person, we're not entirely sure what it is, but it's probably something. Nowadays we can figure that out. So, you know, we can do postmortem genetics where we can test for genetic mutations uh of the cardiovascular system, for example. And, you know, maybe it's just a one-off on that young person, or maybe it's passed on in families. And that would be really important for other first-degree family uh members to have that information, particularly if they're also young or they have kids, to go get checked and to go uh, if they do carry the mutation, then they can go to a heritable heart disease clinic and hopefully prevent sudden cardiac death in the future. So, you know, there's there's different different technologies, I think, that are going to become incorporated into forensic pathology that we're just starting, we're just at the edge of it and we're just we're just starting to get into it. So we don't don't exactly know how far we can take it. Um what else could there be? Taking taking our knowledge to other parts of the world. So, like I said, the chief forensic pathologist, he does a lot of international work. So developing capacity in other countries is huge. In Canada, our our training in forensic pathology is internationally known. And so when big disasters happen in other areas of the world, uh often our expertise is asked for. So there's opportunities there to go and travel the world and go, you know, do interesting cases. Um, yeah, and this is far in the future. I was literally just before, uh, just before we we started talking, there was a documentary that was playing on the TV that my husband was watching about people going to Mars. And I'm thinking, well, wouldn't that be amazing to have a forensic pathologist going to Mars? Because people are gonna die and we need to know how. And to have, you know, a forensic pathologist on Mars figuring out how people are dying and hopefully preventing that would be uh would be something else. Uh I always like, I'll put my hand up and I'll go. But yeah, hubby told me, uh, don't you dare. Uh, but there's there's lots of things to do, I think, in forensic pathology that uh, you know, there's a just that's just a flavor.

SPEAKER_01 1:01:04

Wow, sounds like the future of uh forensic pathology is pretty bright. And I love the idea that the expertise um of the field is going to be maybe called upon to kind of resolve any type of international, you know, disaster or anything like that. That's uh it's a really cool idea. And uh if it brings you to Mars too, I think that's that's another great reason to get into forensic pathology. And now we're moving on to our last couple questions here. If you could go back and see yourself, you know, in the med school days, uh, what's one piece of advice that you'd give yourself to help you get through that hard time?

SPEAKER_02 1:01:44

I see med school and residency and training as this mountain, and you guys are on it. Um, and so often we're so bogged down and we have so much to learn, and you're just going day by day, and each day is a step up that mountain. That is a slog, and there are days where you're you're gonna question, why on earth did you decide to go to medical school? Why did you think that this is a good idea? You know, especially when my high school classmates, they all had families and houses and cars, and I'm still in school. But we often forget to kind of, you know, as we're going up that mountain, we all often forget to look back. And so one day, all of a sudden you're at the top of that mountain. And I think, you know it is important to kind of look back and to see how far you've come. Because, you know, 20-year-old me would never have thought uh that I would be, you know, like over 20 years later, um, doing what I'm doing and doing amazing things and fascinating things, and I'm, you know, loving what I do. So once you get to the top of the mountain, take the time to look around because you never know. You may be one of those people that's like, I am totally happy with what I'm doing. I don't need to do anything more. You might be one of those people like me who's like, oh wow, okay, I'm enjoying the view right now, but there's another mountain and there's another one and there's another one. I'm gonna go see if I can get to the top of those and what that looks like. Uh but take the time to enjoy the view.

SPEAKER_01 1:03:19

I really love that advice. Just to uh make sure to uh, like you said, climb that mountain and and take time to look back and uh you know appreciate when you reach those milestones or uh those goalposts that we keep moving forward every time we get close to something, you know, as you approach graduating medical school, you're already thinking of July when you start residency and things like that. So I really appreciate that uh that perspective and that advice. And as a bonus question for nawesome students that are listening, do you have any advice for students attending their first autopsy?

SPEAKER_02 1:03:56

Yes. Um, don't panic. I I also think we should have that like as a sign on the front door. Like, don't panic. There's things that you should bring. So, one, bring comfortable clothes. Um, scrubs are fine. Bring comfortable shoes and bring your curiosity. That's that's it. We will take care of you. We will make sure that we make the experience uh and tailored it to however, you know, the comfort or the interest of any student that comes in. Uh, we've got an excellent team here in Sudbury. So um the biggest thing would just bring your curiosity, bring your questions. Uh it's a it's a place to ask uh as many questions as you wish. I know as medical students, often you don't get a whole lot of, you know, sort of almost one-on-one time with with staff or attending physicians. Uh, this is your chance. And like I said, just bring your curiosity and bring your questions, and we'll take it from there.

SPEAKER_01 1:04:53

That's awesome advice. And uh that wraps up our episode. So thank you, uh, Dr. Williams, for being a guest on our podcast. Thanks for sharing your stories, you know, your whole journey throughout your career, um, advice to medical students. That's all been so wonderful. And uh, we really appreciate uh you taking the time out of your vacation for us. So thank you.

SPEAKER_02 1:05:15

Thank you so much for having me. Appreciate it. And uh any medical students who are interested, um, you can reach out to me.