"Forensic pathology is the last bastion of medical mediocrity," said Dr. Anderson, my mentor during general pathology residency.
A staff pathologist at the teaching hospital where I studied, he had attended a meeting of the National Association of Medical Examiners (partly because his pathology group did coroner autopsies but mostly as a paid vacation). He wasn't impressed with what he'd heard.
Because of a perceived doctor glut in the 1980s, good jobs were hard to come by.
I figured if I became proficient at something most pathologists didn't like, I could snare one of those rare good jobs.
Knowing most hospital pathologists hated coroner autopsies, I considered forensic pathology. Medical detective work sounded interesting, though I wasn't keen on being thought mediocre.
The idea congealed on a dreary winter weekend when one of the senior pathologists was on coroner call.
Two young men were hunting along the Illinois River. Spotting no game, they consoled themselves with beer and then started taking pot shots at floating objects.
A mass of floating debris far out in the channel caught their eyes. They pumped round after round into it as the current brought it closer. Eventually, they realized it was a body.
To their credit, they called police, who called the coroner, who called the pathologist, who spent several days sweating over the documentation and retrieval of dozens of bullets while his colleagues jeered his evil fortune.
Forensic pathology was clearly something most pathologists didn't like.
Despite some misgivings and little encouragement ("That's a nice field - for a woman," a staff doctor said), I took the plunge, winning board certification in forensic pathology in the spring of 1987. I've had a rewarding career and plenty of time to contemplate the label "mediocre."
There are a number of factors:
•Public funding of medical examiner offices often is not commensurate with the importance of the task.
•Poor pay for forensic pathologists leads to short supply and some bottom-of-the-barrel candidates.
•Forensic pathologists often become political and media scapegoats, a turn-off for potential recruits.
•Inadequate recruiting leads to overwhelming caseloads and little time for research projects or the pursuit of grants.
•Ethical constraints are a serious limitation to research.
Harm is the core of forensic pathology, and we can't study it ethically because research on humans must be done in a way that does no harm.
We can't shake babies to see if they die. We can't drop them from heights to compare length of fall and severity of injury. We can't administer combinations of drugs that could be toxic or lethal to observe their cumulative effects. We can't strangle people to see how long the hold must be maintained to cause death.
We can do almost none of the studies needed to answer our most challenging questions.
Lacking the meticulous, double-blinded studies that are the scientific standard, we are left with the personal experiences of generations of forensic pathologists.
We base some of our most important opinions on what amounts to tribal memories - the individual and collective case reports Dr. Anderson dismissed as "war stories."
firstname.lastname@example.org Dr. Carol J. Huser, a forensic pathologist, has served as La Plata County coroner
since January 2003.