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Working alone can leave one blind to possibilities

I did La Plata County’s forensic autopsies as a solo practitioner for 12 years, a risk many forensic pathologists would be loath to take.

Most forensic pathologists view solo practice as undesirable for a variety of personal, financial and professional reasons.

Only a small jurisdiction with a limited population and number of deaths would need only one forensic pathologist. Smaller communities are far from major airports and have fewer shops, cultural attractions and sports venues. Most lack higher educational opportunities and are perceived by some to have inferior primary and secondary schools.

Small jurisdictions pay less. Newly trained pathologists, many of whom have young families and most of whom are saddled with educational debt, can’t afford to accept less than their expertise would command elsewhere.

Experienced pathologists are accustomed to even higher salaries. They’re unlikely to take big pay cuts even if they appreciate small-town life.

For many, the professional downside of solo practice is a huge deterrent.

People die in almost unlimited ways under almost unlimited circumstances. The variety of questions that arise concerning those deaths is also nearly limitless.

No forensic pathologist has seen or thought about everything. No forensic textbook or literature report covers everything. No forensic pathologist can read and remember all the literature that’s available. At times, only the cumulative knowledge of peers can prevent serious errors.

It’s easy to access accumulated knowledge in a big office. In many, all cases are reviewed by everybody at a daily conference. Even without such a conference, it’s simple to pick a co-worker’s brain.

Isolated practitioners can communicate electronically or by phone, but they aren’t likely to have the sorts of close collegial relationships that develop between those who sit in the next office and do autopsies at the next table. I’m sure I consulted colleagues less frequently in Durango than I had in Florida.

I recently heard about an illustrative case: An infant brought to the emergency room had no heartbeat, but an EKG detected electrical activity in the heart muscle.

Investigators needed to know how long after death residual electrical activity could be detected in the heart. They probably thought that time interval would confirm or refute the caregiver’s story.

Emergency room personnel thought an hour or two was the maximum. The medical examiner didn’t know. He consulted colleagues.

One had investigated the death of a person whose heart monitor recorded electrical activity for 13 minutes before the tracing ended. By the time medics arrived, all activity had stopped.Two pathologists described cases in which the heart was still “twitching” – therefore electrical activity was present – when the body was autopsied hours after the death declaration. In one of those cases, a pathologist who specialized in hearts was in the building. Summoned urgently to the morgue, he glanced at the twitching heart, shrugged and announced, “They do that sometimes.”An experienced medic said EKGs were always done on death calls, even on bodies that had lividity and rigor mortis. More than once, he’d seen traces of heart activity in such bodies – a surprise to many of the pathologists involved in the discussion.In my 30 years as a forensic pathologist, I saw a twitching heart at autopsy only once. A pathologist who hasn’t seen this might think electrical activity long after death was impossible, might be swayed by the opinions of emergency room personnel and might not ask anyone else.

When dealing with the unusual, reliance on only your own limited experience can be dangerous.

Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland. Reacher her at chuser@durangoherald.com.