A Matter of Life and Death. Sue Armstrong
12 and 10. I’d just come back from Iraq and had done a radio programme. I hadn’t heard the final piece, but my husband had recorded it for me, and I went to listen. Grace, my middle child, said, ‘Can I listen too, Mum?’ I did a quick think, and said, ‘That’s fine.’ I knew it was aiming for a middle-ground audience, so you’re careful about what you say. But I’d forgotten that the interviewer had asked me, ‘How do you reconcile the situations you can find yourself in and being a mum?’ And I’d said, ‘I believe I’m getting close to the point where I’m irresponsible, because my children need to know that their mother’s coming home.’ I looked at Grace, and her eyes were filling with tears, and she said, ‘What d’you mean you might not come home, Mum?’ I said, ‘Well, I might miss the plane …’ You could see what she was thinking: she wasn’t fooled.
When I did the second tour in Iraq, she was the one who suffered. I phoned every night, but she suffered, and I thought: I cannot put her through that. So I turn things down. I won’t go back to Iraq.
What about your husband? How supportive is he?
We’ve known each other since our teens, so we’ve been together a very long time. We went to university together, and he studied anatomy as well, but he learnt pretty quickly that if you want a decent income you don’t become an academic! So he went into business.
But he understands what I do, and he’s got a very good way of dealing with me. When I get home after being away he’ll not question me at all. Three or four days later I’ll start to tell him stories, and then he’ll wheedle bits of information out of me. He’s a very good listener, and we’ll sit and talk about it, but it’ll take a few days.
How would you say the extraordinary things you’ve experienced as a forensic anthropologist have affected your outlook on life?
The bottom line is that so many things don’t seem important any more. I don’t care if the floor doesn’t get hoovered. It doesn’t matter in the world if there’s a scratch on the car. I care that my children get a great big hug every night before they go to bed, because you’ve just dealt with 20 children who will never have that again. So you go home and you hold your children tighter, there’s no doubt. You value your family much, much more than you otherwise would, because you see the frailty of life. And that’s what’s important. The material side of things … it just doesn’t matter.
WITNESS TO THE RAVAGES OF AIDS
Sebastian Lucas
Professor of Clinical Histopathology, St Thomas’, King’s and Guy’s Hospitals, London
Sebastian Lucas grew up in a non-medical family in the south of England, and was persuaded to do medicine rather than animal physiology at Oxford University because it would give him more choices in life. The decision to specialise in pathology came soon after he began work as a medical student. ‘I realised that the patients I was looking at on the wards were chronically sick and I just thought: “Can one face working with chronically ill people day after day? Is there a bit of medicine which is problem-solving, and where you can solve one case and move on to the next?” That’s pathology.’
Lucas made his name in the early 1990s with his pioneering autopsy work on AIDS in Africa, where he investigated and underscored the powerful link between HIV and tuberculosis. The extent of TB surprised some doctors in the Western world, who believed TB was no longer a threat in the age of antibiotics, and had let down their guard. Having performed autopsies on more than 1,000 people who died of AIDS in Africa and England, Lucas knows as much as anyone about the multiple manifestations of the disease in different environments, and his findings have had a critical influence on the management and treatment of people with HIV. However, as he freely admits, much of the vital research he carried out in the 1990s would be impossible in today’s legislative climate. He got caught up in infectious diseases almost by accident, he says.
I’ll tell you about what got me into infectious diseases, and incidentally led me to where I am today. It was the drought summer of 1976 and I was at University College Hospital [UCH]. I was looking at a bowel biopsy late on a Friday afternoon when the rest of the department had gone home, and the case history said: 30 weeks pregnant, severe diarrhoea, query proctitis [inflammation of the rectum], query cause. It was a white woman, aged about 30. The usual diagnosis would be: nothing, or ulcerative colitis, or one of the standard diseases, but I looked at this biopsy and it wasn’t any of these. It was inflamed, but it actually had amoebae in it. I’d never seen amoebae before, but I knew what they should look like because I was vaguely interested in infectious diseases even then. So I looked at a book and there was a picture of amoebae; I looked down the microscope and there they were, and I said to myself, ‘This has to be amoebic colitis.’ So I rang the houseman and said, ‘This is amoebiasis.’ What she answered was unprintable! Because, she said, the woman was in theatre at that moment having her colon taken out because it was perforated. ‘She’s got peritonitis, and she’s probably not going to live.’ And she didn’t.
This was a Friday afternoon and the biopsy had probably been taken on Wednesday, because processing these things takes time. I was thinking, ‘If we’d had the answer yesterday, might her life have been saved?’ Well, you can conjecture till Kingdom come, I don’t know. But the point is they thought she had ulcerative colitis and put her on steroids. That’s what you do if it’s ulcerative colitis or Crohn’s disease, but if you’ve got amoebiasis it’s the worst thing you can do: the disease just lets rip, perforates the bowel and you die. This is perfectly well known, but you have to think of amoebiasis first. And what on earth is a pregnant 30-year-old who’s never left North London doing having amoebiasis, a tropical disease?
Not many people had ever seen a case of amoebiasis in this country. Certainly I never had. And certainly the main surgeon involved in this process never had. I remember presenting the case at the next gut meeting we had, and saying, ‘Actually, this is amoebiasis,’ and watching the physicians sink their heads in their hands and whisper, ‘Oh, God.’ Because this was a treatable disease …
So I did a bit of further investigation … As I say, this is what got me into infectious diseases: this actually changed my life. I found out, probably from the widower, that what had happened was that his wife hadn’t felt like cooking and so the neighbours cooked something for her and passed it over the fence. Very nice of them. This is in north-west London, and they had just come in from Bombay. So basically the infection was on their hands. A goodwill gesture, sadly carrying rather unfortunate consequences. Because there is no endemic amoebiasis in that part of London.
And it went further, the bizarreness of this story. In those days there was an amoebiasis research unit in the Hospital for Tropical Diseases, which was run by an extraordinary guy – he was an air vice-marshall, one of the older Air Force medics. I gave him a potted version of this story, and said, ‘There’s no question about the cause of death: it was amoebiasis. As far as I can see, the infection came from the neighbours who had recently arrived from India,’ where amoebiasis is endemic, and they were obviously symptomless carriers. I’ll never forget his retort: ‘This doesn’t happen in the United Kingdom!’ and he put the phone down. So the second message of this story – and I tell all the medical students – is: ‘Don’t always believe what old experts say!’
And infectious diseases are intellectually very teasing and exciting, are they?
Absolutely, yes. One of the things I do today, apart from looking at challenging autopsy cases, is a lot of infectious disease consultation work. People send me slides and say, ‘What is this? I think it might be this,’ or ‘I haven’t the faintest idea what it is.’ Every week will bring in one or two real gems.
Two days ago someone sent me a liver biopsy, saying, ‘What on earth is this?’ I looked at it and thought, ‘I can’t believe this! I’ve never seen it before, but I know what it is.’ It turned out to be someone who had had some abdominal