A Matter of Life and Death. Sue Armstrong
have cytoplasm that is the body of the octopus and they have all these ‘tentacles’ that carry the melanin and transfer it to surrounding cells.
I never stopped thinking about that case. When I moved to Chicago I told Dr González-Crussí about it and he said, in his classic reflective way, ‘Very interesting … I have never seen a case like that.’ Then a couple of months later he called me up for a frozen section analysis. They were operating on a patient with a melon-sized tumour in the perineal area that was surrounded by a patch of hyper-pigmentation, like a naevus, and I remember his voice on the phone: ‘Miguel, you remember the case you told me about from Mexico a few years ago? I think we have something very similar.’ Sure enough, it was identical under the microscope. So we decided to publish those two patient cases together, in the oldest pathology journal, Virchow’s Archive. From that point on I was hooked into the biology of melanocytic development.
Dr González-Crussí was telling me that paediatric pathology, as a specialism, is relatively new. Were you aware of that when you came into this field?
Yes, I was aware. I remember that when I went to Yale, some of my colleagues were wondering, ‘Why do we need this guy? We can do the paediatric cases.’ It was a fantastic department at the time, and people were very well trained and experienced in many fields – but paediatric pathology is completely different from adult pathology. Under a microscope, tissue from a child that is one day old is different from the tissue of a child that is one month old, and that’s different from tissue of a one-year-old, and that’s different from the tissue of an 18-year-old. In paediatrics the key is development. When you take a case to an adult pathologist, the questions he or she will ask when looking at a slide, of a tumour, for example, are essentially, ‘Where is the lesion? How fast did it grow? How big is it?’ The first question a paediatric pathologist will ask is, ‘How old is the patient?’
So yes, when I came to paediatric pathology, I think people had started to recognise the need. There had been paediatric pathologists, pioneers, but as a speciality it became more recognised around 25 years ago.
Tell me, how important is your profession to you on a personal level?
Well, pathology is a very important part of my life, but it’s not the only one – and it’s probably not the most important one. A friend of mine, another doctor who was with me in Chicago, said something that has remained with me. He said, ‘You know, before I see you as a doctor, as a pathologist, I see you as a parent.’ And I think that is what defines me: I am a father. Three of my four children live close by, my youngest lives with me, and we all get together every other week. We drink a bottle of wine; we cook and have fun. We speak about matters, we travel together.
That brings me to one final question: you didn’t go back to Mexico?
I couldn’t. The rupture with my ex-wife was so difficult that when my children were kept against the law for a few days in Mexico, I realised I had to keep a distance, for their health and for their education. So even though my original plan was to be a pathologist in Mexico after some speciality training here, I couldn’t. I remained here and tried to make the best of it, but I have tried to give something back to Mexico, and to Latin America.
Sue Black
Professor of Anatomy and Forensic Anthropology, University of Dundee
Sue Black grew up in idyllic surroundings on the west coast of Scotland, where her parents managed a hotel. An incident during a dustmen’s strike when she was a child had a critical influence on her life and career. She watched her father beat a rat to death with a stick as it rummaged in the overflowing garbage bags behind the hotel. ‘I could see its tail lashing, I could see its eyes, and I could hear it growling. And from that point onwards I’ve had an absolute and utter morbid fear of rodents,’ she says. It even determined the choices she made in studying anatomy at university. Today Sue Black is one of a tiny community of forensic anthropologists in the UK. An expert at Disaster Victim Identification, she has worked for the International War Crimes Tribunal in Kosovo, the United Nations in Sierra Leone and the UK government in Iraq, and following the 2004 tsunami in Thailand.
Sue Black lives with her family in Stonehaven, Aberdeenshire, and admits it is sometimes hard to balance what is often a dangerous, though compulsively fascinating, job with the responsibilities of motherhood.
When I went to university I had no idea what I wanted to do eventually, except that it had to be something vaguely biological. At the end of second year the only two subjects I was any real good at were anatomy and botany. I went to see both tutors, and the botanist – bless his heart – was the most boring person on earth. I thought, ‘I can’t name and draw plants for the rest of my life. I can’t! I’ll do anatomy.’ So I went into anatomy.
The third year was dissection and I absolutely loved dissection. But in fourth year you had to do a research project, and they all involved things like ‘lead level in the rat brain’, ‘carcinomas in the hamster pituitary’… and nothing could persuade me to lift a dead rodent out of a bucket. It’s a complete and utter, illogical fear because of my father. So I told the tutor, ‘Look, I can’t do mice, rats, hamsters – can’t do them alive or dead.’ And she said, ‘Well, we can put a project together on human bone; how about that?’ Perfect! As long as it didn’t involve a rodent, I was happy.
So I did my honours project in the identification of human bone. Then my head of department, John Clegg, said, ‘We’ve got some money if you want to do your PhD here.’ So I’ve fallen into it the whole way along – which is a nightmare for any school that’s trying to use you as a career model!
I did my PhD, and then a very dear friend of mine, Louise Scheuer, contacted me to say there was a vacancy in the department she worked in at St Thomas’ Hospital in London. It was a fairly aggressive interview panel, but there were two people who wanted somebody in the post who could teach anatomy. At that time there were so many people in anatomy departments who couldn’t teach anatomy: they were cell biologists, biochemists, etc. The head of department then was Michael Day and his final question to me was, ‘If I needed you to go into my dissecting room this afternoon to teach, could you do it?’ I said, ‘Yes, of course I could,’ and that sealed it.
So I started lecturing at St Thomas’. One day Iain West, the forensic pathologist, phoned the anatomy department and said, ‘I’ve got some bones; does anybody up there know anything about bones?’ I was sent down, and the most miserable policeman was standing there. He looked me up and down and you could see him thinking: ‘Slip of a girl, what’s she gonna know?’ But we took the bones and put them in a plastic bag. They’d been found in a rubbish tip and were suspected to be a missing person. We put the plastic bag on the radiator and left the bones there for about 10 minutes, then I opened the bag and stuck it under his nose and said, ‘What can you smell?’ He said, ‘That smells like roast lamb,’ and I said, ‘Exactly. They’re sheep bones.’ And he was so impressed, this policeman, that he’d got it right that next time there were some bones he said, ‘Oh, I’ll have that woman from anatomy.’ So I just started doing more and more of the bones work around London, and then ended up doing work for the Foreign Office. It just sort of spiralled from there.
And what did you learn about bones? What can you tell from bones?
When you’re given a pile of bones – it might be something to do with the World Trade Center; it might be the London bombings – the first thing is: are they human or not? It’s easy to tell if you’ve got a skull. But if it’s a tiny bit of bone from a finger or something …
You’ve got to bear in mind that with things like the World Trade Center, there were restaurants, so there was beef, pork, lamb in the remains. When the London bombs went off there were people carrying shopping – you know, they had Sainsbury’s